Environmental Diseases Flashcards by Jenna Garvin

“Environmental diseases” refers to injuries or disorders that are caused by ________ or _______ agents.

chemical

physical

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It’s estimated that U.S. work-related injuries occur _ times more frequently than home injuries.

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List the U.S. agencies involved in regulating environmental hazards.

EPA
FDA
OSHA
Consumer Products Safety Commission

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These agents typically cause injuries via inhalation, ingestion, injection, or absorption through the skin

Chemical agents

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There are an estimated _______ (how many?) potentially hazardous exposures each year in the U.S.?

2 million

Note: Most (90%) are unintentional

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Name some common household items that are the most frequent chemical agents to cause harm.

cleaning agents
analgesics
cosmetics
plants
cold medications

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Children (<6 years) account for over __% of exposures.

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There are several factors that affect chemical injuries. What does CLADME stand for?

Concentration
Liberation
Absorption
Distribution
Metabolism
Excretion

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___________ can occur with any medication, but is most often associated with antibiotics (penicillin is a classic example)

Anaphylaxis

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The more ______ the drug, the more likely it is to cause an adverse reaction.

potent

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Some other notable adverse drug reactions include:

Aspirin - acute metabolic injury (respiratory alkalosis followed by metabolic acidosis)
Acetaminophen - liver damage
Exogenous estrogens & oral contraceptives - increased risk for breast cancer, strokes, and blood clots

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Lead has a ____ affinity for enzymes involved in the synthesis of _________ which blocks or hinders the incorporation of ____ into the molecule.

high
hemoglobin
iron

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Patients with lead toxicity will develop what condition?

microcytic hypochromic anemia

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The majority of absorbed lead is taken up by the…

bones and teeth

80-85%

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Lead competes with _______ and interferes with the normal __________ process.

calcium

remodeling

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T/F

In lead toxicity, bone becomes hyperdense with visible changes on x-rays (lead lines).

True

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T/F
In children, lead toxicity in the CNS may result in reduced IQ’s and learning disabilities, while adults may develop peripheral neuropathies (wrist/foot drop)

True

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Lead deposits in the gingiva causes…

hyperpigmentation (lead lines of soft tissue)

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T/F

Lead toxicity in the GI tract is characterized by mild, localized, “colicky” pain.

False

severe, poorly localized

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T/F

Lead toxicity can also affect the kidneys.

True

Lead damages renal tubules which may lead to interstitial fibrosis and possibly even failure.

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The maximum allowable blood lead level is _ ug/dL

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Treatment for lead toxicity consists of ________ therapy and _________ measures.

chelation (starting at 45 ug/dL)

supportive

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Name the general classes of drugs of abuse

sedative-hypnotics
CNS stimulants
opioids
cannabinoids
hallucinogens
inhalants
non-prescription drugs

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This is a collective term for substances that have become popular in dance clubs, bars, raves, or trances.

club drugs

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____ is a methamphetamine and is the pure crystalline form of ________.

MDMA | ecstasy

One of the side effects of MDMA is _______ which users deal with by using a ________.

bruxism | pacifier

Mechanical injuries include, but are not limited to... (3 types)

abrasion contusion laceration

A wound produced by scraping or rubbing leading to removal of a superficial layer of skin.

abrasion

A wound caused by a blunt object - doesn't break the skin but may lead to damage to blood vessels and extravasation of blood in tissues (AKA bruise)

contusion

A tear in tissue - usually irregular, jagged edges

laceration

About how many deaths per year in the U.S. are caused by thermal burns?

>5000

The body operates in a temperature range of...

31-41 degrees Celsius (89-106 degrees Fahrenheit)

What are the factors affecting the clinical significance of burns?

- percentage of total body surface involved - depth of the burn (full vs particle thickness) - possible internal injuries - age of the patient - how fast and how well is it treated

> __% total body surface involvement is grave.

With >30-40% total body surface involvement, ______ is frequent.

shock

T/F | Internal thermal injury is a possible clinical consequence of burns.

True | noxious fumes, any part of respiratory tract may be damaged, delayed ARDS

Heat cramps, heat exhaustion, and heat stroke are all consequences of what condition?

Hyperthermia

Abnormal elevation of the body temperature above 40 degrees Celsius causing vasodilation, pooling, decreased circulating blood volume, ischemia of tissues, muscle and heart necrosis. - May lead to DIC

heat stroke

Abnormally low body temperature - Mild range: - Moderate range: - Severe range:

Hypothermia 32-35 degrees C (89-95 F) 28-32 degrees C (82-89 F) < 28 degrees C (<82 F)

Name some sources of radiation.

``` cosmic rays UV light elements in Earth's crust (radon) medical diagnostic/therapeutic equipment industrial products nuclear power plants nuclear weapons ```

Electromagnetic waves include:

x-rays and gamma rays

This is a unit that expresses the amount of energy absorbed by target tissue.

Gray (Gy)

_______ is roughly equal to Gy but dose also factors in relative biologic effect (RBE).

Sievert (Sv)

What are the two forms of radiation that cause injury?

electromagnetic waves | high-energy neutrons and charged particles (alpha and beta particles, protons)

A single intraoral dental image emits how many mSv?

0.002

Cone beam CT (CBCT) emits how many mSV?

0.02-0.08 mSV

Occupational exposures should be less than __ mSV per year.

In general, describe the mechanism of radiation injury.

Radiation interacts with atoms and molecules by excitation and ionization

Damage to DNA, causing mutations is which type of radiation mechanism of injury?

target effect (direct)

The production of free radicals that interact with membranes, nucleic acids, and enzymes is which type of radiation mechanism of injury?

indirect effect

Radiation injuries may be/could lead to...

``` reversible apoptosis/mitotic rest nuclear abnormalities DNA strand breaks (latency -> long term effects) cytoplasm swelling membrane/mitochondria/ER changes ```

Name 6 organ systems affected by radiation.

``` skin hematopoietic/lymphoid gonads lungs GI tract circulatory ```

What is the clinical significance of when lymph nodes and spleen are shrunken and granulocytes/lymphocytes are decreased in a patient following excessive radiation exposure?

The patient would be susceptible to infections at this time.

T/F | With regard to radiation injury, the gonads in both sexes are sensitive, while the uterus and cervix are resistant.

True

The lethal range for humans begins at about _ Sv, and at _ Sv death is certain without medical treatment.

2 | 7

This fatal acute radiation syndrome occurs during 2-10 Sv, GI symptoms, decreased WBCs/platelets, anemia, sepsis, bleeding problems, and death in 2-6 weeks.

Hematopoietic

This fatal acute radiation syndrome occurs from 10-20 Sv and causes severe GI symptoms, bloody diarrhea, dehydration, shock, sepsis, and death n 5-14 days.

Gastrointestinal

This fatal acute radiation syndrome occurs at >50 Sv and causes listlessness, drowsiness, seizures, coma, and death in 1-4 hours

Cerebral

An adequate diet should provide:

sufficient carbs, protein, and fats essential amino acids and fatty acids vitamins and minerals

If the diet is deficient in 1 or more components it is termed...

primary malnutrition

If supply is adequate, but there may be a problem with absorption, storage, utilization, excessive losses, or drug effects is termed...

secondary malnutrition

What are the 2 protein compartments in the body?

Somatic (skeletal muscles) | Visceral (mainly liver)

This disease is characterized by: - deficiency of caloric intake (growth retardation and loss of muscle mass) - somatic protein compartment is depleted - emaciated extremities - anemia and immune deficiency (esp. T cells) - body temp. and pulse decreased

Marasmus

______ is a common finding in individuals with marasmus and an indicator of immune system deficits.

Thrush

This disease is characterized by: - greater deficiency of protein than total calories - severe loss of the visceral protein compartment - decreased albumin leads to generalized fluid retention and edema - skin changes ("flaky paint" appearance) - fatty liver (pot bellies)

Kwashiorkor

How do you assess loss of the somatic protein compartment?

measuring skinfold thickness

How do you assess loss of the visceral protein compartment?

measuring serum proteins (albumin, transferrin)

When the weight falls below __% of the normal, the child has marasmus.

A form of wasting that is associated with cancer patients, probably results from decreased intake and increased catabolism.

cachexia

Name the fat-soluble vitamins.

A, D, E, K

This vitamin prevents night blindness and is made up of 3 biologically active forms. Also, name the active forms.

Vitamin A | retinol, retinal, retinoic acid

Over __% of vitamin A is stored in the _____ where there are reserves for __-__ months. When retinol is released from the liver, it must be bound to _______-_______ protein.

90 liver 6-12 retinol-binding

Name the 3 functions of vitamin A.

- maintain normal vision in reduced light - augment differentiation of specialized epithelial cells (mucus-secreting) - enhance immunity to infections (especially in children)

An early sign of vitamin A deficiency is... | If the deficiency persists, then there will be...

impaired vision at night | dryness of the conjunctiva (xerosis)

T/F In vitamin A deficiency, the epithelium of the respiratory and urinary tracts may undergo metaplasia (predisposing patients to infection).

True

T/F Vitamin A deficiency affects the immune system and may result in infections such as measles, pneumonia, and infectious diarrhea.

True

Vitamin A toxicity refers to excessive ingestion of ______ IU or more daily.

25,000

_____ are especially susceptible to vitamin A toxicity.

Infants

Name 3 conditions that result in decreased absorption of fat-soluble vitamins.

Crohn's disease (inflammatory bowel disease) cystic fibrosis alcoholic liver disease

What are the symptoms of acute vitamin A toxicity?

- nausea - vomiting - irritability - headache - blurred vision (papilledema)

What are the symptoms of chronic vitamin A toxicity?

- anorexia - hair loss - dry skin - pruritis - dry mucous membranes - fissured lips - fatigue - weight loss - bone and joint pain

Vitamin C is _____-soluble and is _________ (we cannot synthesize it)

water | essential

Deficiency of vitamin C leads to _______.

scurvy

What are the 3 functions of vitamin C?

- formation and stabilization of collagen (hydroxylation of proline and lysine) - conversion of tyrosine to catecholamines - role as an antioxidant

Scurvy is a disease of impaired _______ synthesis.

collagen

What are 3 common oral conditions resulting from scurvy?

gingival bleeding gingival swelling periodontal infections

T/F | Vitamin C toxicity may result from excessive ingestion of >2g/day.

True