Environmental Disorders 02 - Metals and Air pollutants

Question 1

What is the treatment for CO poisoning?

Answer 1

O2 via tight fitting mask or endotracheal tube (100% O2), hyperbaric oxygen chamber

Question 2

How would you diagnose someone of chronic CO poisoning?

Answer 2

measure carboxyhemoglobin levels in the blood

Question 3

Radon exposure can lead to what cancer?

Answer 3

lung cancer in uranium miners

Question 4

How can one expose themselves to radon?

Answer 4

indoor air: produced when naturally occurring uranium in soil and water decays, is odorless, tasteless and invisible. It is present indoors and#out, in all types of buildings, and radon levels vary geographically from location to location

Question 5

What is formaldehyde used for?

Answer 5

manufacture of building materials (cabinetry, furniture, adhesives)

Question 6

Is formaldehyde a carcinogen for only humans?

Answer 6

classified as a carcinogen for humans and animals

Question 7

What is sick building syndrome?

Answer 7

Exposure to one or more indoor pollutants, possibly poor ventilation

Question 8

CDC measures lead poisoning to what amount?

Answer 8

> 5ug/dL

Question 9

When is treatment for lead poisoning in children mandated?

Answer 9

≥ 45 ug/dL

Question 10

What are some clinical findings evidenced upon examination of children with led poisoning?

Answer 10

encephalopathy

growth retardation: lead is deposited in the ephiphysis of growing bone

Lead “colic in GI

Kidneys: Chronic renal damage leads to interstitial fibrosis/renal failure, decrease in uric acid excretion leads to gout (“saturnine gout”)

Question 11

How is a child prone to developing encephalopathy when they have lead poisoning?

Answer 11

There is higher intestinal absorption and the more permeable blood-brain barrier of children creates a high susceptibility to brain damage

Question 12

What are the clinical findings evidenced in adults who have lead poisoning?

Answer 12

Peripheral neuropathy : foot drop (peroneal nerve palsy), wrist drop (radial nerve palsy), and claw hand (ulnar nerve palsy)

lead line in gums - usu. in adults with preexisting gingivitis

Lead “colic in GI

Kidneys: Chronic renal damage leads to interstitial fibrosis/renal failure, decrease in uric acid excretion leads to gout (“saturnine gout”)

Question 13

What may you find in a blood smear of those with lead poisoning?

Answer 13

Sideroblastic anemia - microcytic, hypochromic RBCs with punctate basophilia on peripheral smear, ring sideroblasts on bone marrow

Question 14

What is the pathogenesis of sideroblastic anemia?

Answer 14

• inhibition of Ferrochelatase (Iron cannot bind with protoporphyrin to form heme, FEP proximal to the enzyme block is increased) - iron accumulates in the erythroblasts (sideroblasts)
• inhibition of Ribonuclease: Ribosomes cannot be degraded and persist in the RBC, results in coarse basophilic stippling

Question 15

What are tests that can be performed to determine if one has lead poisoning?

Answer 15

• Increased whole blood and urine lead levels
• Increase in free or zinc-bound red cell protoporphyrin

Question 16

Treatment for lead poisoning?

Answer 16

Chelation therapy
* Succimer
* Dimercaprol
* Ethylene Diamine Tetra Acetic acid (EDTA)

Question 17

Minamata disease?

Answer 17

Disease caused by mercury poisoining through consumed fish containing methyl mercury

Question 18

How does Mercury poisoning occur in general?

Answer 18

mercury binds to sulfhydryl groups in certain proteins with high affinity, leading to damage in the CNS and kidney

Question 19

Where is arsenic typically found?

Answer 19

– Naturally found in soil and water
– Used in wood preservers, herbicides

Question 20

What is the best treatment for acute promyelocytic leukemia?

Answer 20

A-ll Trans Retinoic Acid + Arsenic Trioxide is used in treatment for acute promyelocytic leukemia

Question 21

What is this condition and what can it be seen in?

Answer 21

Mees lines can be seen in thallium and arsenic poisoning

Question 22

Chronic exposure to arsenic can present as what? (What are the clinical features?)

Answer 22

– Skin changes: hyperpigmentation, hyperkeratosis
– Mees lines: transverse bands in nails
– ↑ risk for cancers of lungs, bladder and skin
– Arsenic induced skin tumors - multiple, usually on palms and soles (differ from the sunlight
induced skin cancers)
– Non-malignant respiratory disease

Question 23

What is the best treatment for arsenic toxicity?

Answer 23

chelating agents: Succimer or dimercaprol

Question 24

What is cadmium toxic to in the body the most?

Answer 24

kidneys and lungs mostly

Question 25

What are some clinical features of Cadmium toxicity?

Answer 25

* Obstructive lung disease , ↑risk of lung cancer * Renal tubular damage progressing to end-stage renal disease * Skeletal abnormalities associated with calcium loss * Itai-Itai (ouch-ouch): Cadmium-containing water used to irrigate rice fields in Japan lead to osteoporosis and osteomalacia in post-menopausal women, associated with renal disease

Question 26

Where is benzene found and what can this toxicity in the body lead to? (Explain pathogenesis as well.)

Answer 26

occupational exposure of rubber worker, oxidized by hepatic CYP2E1 to toxic metabolites, leading to dose-dependent marrow aplasia and inc. risk of AML

Question 27

Where can one get polycyclic hydrocarbon toxicity and what complications can result from it?

Answer 27

combustion of fossil fuels (in steel foundries), present in tar and soot. Lung and Bladder cancer

Question 28

Where can one get vinyl chloride toxicity and what complications can result from it?

Answer 28

(synthesis of polyvinyl resins) angiosarcoma of the liver

Question 29

Where can one get bisphenol A toxicity and what complications can it lead to?

Answer 29

(polycarbonate food and water containers, epoxy resins that line food bottles and cans) potential endocrine disruptor in children heart disease in adult populations

Question 30

Where can one get organochlorine toxicity?

Answer 30

pesticides: DDT, lindane, aldrin Non-pesticides: PCBs and Dioxin

Question 31

What are some complications of organochlorine toxicity? (MOA needs to be explained as well)

Answer 31

* Dioxins and PCBs : Skin disorders (folliculitis, chloracne), Liver and CNS toxicity – PCBs induce CYPs leading to abnormal drug metabolism

Question 32

What is the treatment for organophosphate poisoning?

Answer 32

atropine; pralidoxime

Question 33

What are some important lab findings to consider when you suspect organophosphate poisoining?

Answer 33

dec. serum and RBC cholinesterase levels

Question 34

What are some sources that can predispose one to pneumoconioses?

Answer 34

coal dust (mining of hard coal) Silica (sandblasting, stonecutting) Asbestos (mining, fabrication, insulation work)

Question 35

What are sources of cyanide poisoining?

Answer 35

house fires odor of bitter almonds

Question 36

What are treatment modalities for cyanide poisoining?

Answer 36

amyl nitrite followed by thiosulfate

Question 37

What is the treatment of choice in concurrent cyanide and CO poisoining (as in house fire)

Answer 37

infusion of hydroxycobalamin

Question 38

What is the best way to check lab values of those with cyanide poisoining?

Answer 38

Quick bedside or laboratory confirmatory test, and it remains a clinical diagnosis. Fire victims with soot in their mouth, altered mental status, and metabolic acidosis with extremely high lactate levels suggest cyanide poisoning

Question 39

Smoke inhalation is a unique challenge because of what substances that the victim is exposed to?

Answer 39

CO and cyanide

Question 40

What are the drugs that are not recommended for CO poisoining because of adverse effects associated with them? What are the complications?

Answer 40

* Amyl and sodium nitrites can cause methemoglobinemia and hypotension and therefore are not recommended if carbon monoxide poisoning is also suspected

Question 41

What is an advantage of using hydroxycobalamin in cases of cyanide and CO poisoining?

Answer 41

faster onset of action

Question 42

What is the formula for pack years?

Answer 42

(avg cigarette packs per day x number of years of smoking)

Question 43

What are some acute effects of smoking linked to nicotine use?

Answer 43

(↑HR, BP, cardiac contractility and output)

Question 44

What is the most important metabolite of nicotine? What is the best screening for nicotine users to test it?

Answer 44

Cotinine Cotinine screening test for blood or urine is used to detect if a person is a nonsmoker

Question 45

What is a major noxious chemical in cigarette smoking?

Answer 45

Tar contains most of the carcinogenic agents in cig smoke

Question 46

What is an effective treatment for UC?

Answer 46

nicotine patch

Question 47

What can Ecigs cause?

Answer 47

EVALI e-cigaratte, or vaping, product use associated lung injury

Question 48

What are complications of using smokeless tobacco/chewing tobacco?

Answer 48

* Can cause nicotine addiction * ↑ risk of oral cancer

Question 49

What are the complication of passive (second-hand) smoke inhalation in adults and children?

Answer 49

* In children – ↑risk of respiratory/middle ear infections in children – Exacerbates asthma * In adults – ↑risk for lung cancer and coronary artery disease

Question 50

How can smoking cause bronchitis?

Answer 50

Direct irritant effect on tracheobronchial mucosa, produces inflammation and↑ mucus production

Question 51

How can smoking cause emphysema?

Answer 51

Recruitment of leukocytes to the lung, with ↑ local elastase production and subsequent injury to lung tissue, leads to emphysema

Question 52

T/F. Polycyclic hydrocarbons and nitrosamines are potent carcinogens in smoking?

Answer 52

True

Question 53

The risk of developing complications of smoking is related to what?

Answer 53

number of pack years

Question 54

What is the laryngeal cancer of greatest concern with smokers?

Answer 54

squamous cell ca

Question 55

What are the lung cancers that are associated with smoking?

Answer 55

squamous cell carcinoma, small cell carcinoma, some types of adenocarcinoma

Question 56

T/F. There is a decreased risk of carcinogenic influence from asbestos in smokers?

Answer 56

F

Question 57

What are some CVS effects related to smoking?

Answer 57

– Acute myocardial infarction (atherosclerosis of coronary arteries) - Sudden cardiac death - peripheral vascular disease (atherosclerosis of femoral and popliteal arteries)

Question 58

What are some complications found in the GIT of smokers?

Answer 58

– ↑ risk for oropharyngeal cancer: squamous cell carcinoma – ↑ risk for upper and mid-esophageal cancer: squamous cell carcinoma – ↑ risk for stomach cancer: adenocarcinoma – ↑ incidence of GERD : ↓ tone of lower esophageal sphincter – ↑ risk for peptic ulcers and delayed healing of peptic ulcers – ↑ risk for pancreatic cancer: adenocarcinoma

Question 59

What are major genitourinary complications of smoking?

Answer 59

– ↑ risk for cervical cancer: squamous cell carcinoma – ↑ risk for urinary bladder cancer: transitional cell carcinoma

Question 60

What are some effect on fetus linked to maternal smoking?

Answer 60

– Low birth weight in newborns – Intrauterine growth retardation

Question 61

What condition that affects the CNS is smoke related to?

Answer 61

stroke

Question 62

What are some MSK findings in those who smoke?

Answer 62

Osteoporosis, ↓ estrogen in females and ↓ free testosterone in males

Question 63

What hematopoietic condition is smoking linked to?

Answer 63

inc. risk for AML