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cdc yellowbook > Environmental Hazards & Risks > Flashcards

Environmental Hazards & Risks Flashcards

1
Q

which one is more carcinogenic? UVA or UVB?

A

UVB

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2
Q

what does UVA cause?

A

acute photosensitivity reactions;
premature aging

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3
Q

who is at increased risk for adverse effects of UV exposure?

A

solid-organ transplant recipients;
autoimmune connective tissue diseases (e.g. systemic lupus erythematosus)

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4
Q

what are Photosensitizing Medications - antibiotics?

A

doxycycline (and other tetracyclines to a lesser degree), fluoroquinolones, sulfonamides.

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5
Q

what are Photosensitizing Medications - cancer therapies?

A

chemotherapeutic agents, radiation therapy, some immunomodulators

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6
Q

what are Photosensitizing Medications - NSAIDS?

A

especially ibuprofen, ketoprofen, naproxen, piroxicam

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7
Q

what are Photosensitizing Medications - other common medications?

A

furosemide, methotrexate, sulfonylureas, thiazide diuretics, retinoids

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8
Q

what is the most common malignancies in the US?

A

skin cancers

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9
Q

which cancer is closely linked to UV exposure?

A

BCC - basal cell carcinomas (rarely metastasize and are generally cured with excision or other local treatments);

SCC - squamous cell carcinomas

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10
Q

who is at increased risk for squamous cell carcinomas?

A

Solid-organ transplant patients who are on immunosuppressive therapy and patients with chronic lymphocytic leukemia

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11
Q

which is the least common but most serious of the UV-associated skin cancer?

A

melanoma

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12
Q

what are the risk factors for melanoma?

A

fair skin, genetic susceptibility, hx of blistering sunburns before the age of 18

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13
Q

what are the symptoms of melanomas?

A

an irregularly bordered, darkly pigmented flat or raised spot on the skin that changes in size, shape, or both over time.

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14
Q

Increased exposure to sunlight, particularly UVA, can exacerbate existing skin conditions and can unmask photosensitivity disorders, such as …

A

autoimmune connective tissue diseases (e.g., dermatomyositis or systemic lupus erythematosus),
phototoxic medication reactions,
polymorphous light eruption,
porphyrias,
solar urticaria.

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15
Q

what is photo-onycholysis?

A

a separation or lifting of the nail plate from the nail bed in people taking an oral photosensitizing agent, usually a medication, in association with intense sun exposure.

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16
Q

what is Phytophotodermatitis?

A

a noninfectious condition that results from action of UVA radiation on naturally occurring photosensitizing compounds, furocoumarins, that occur in several plant families.

In the tropics, the most common source is the photosensitizing juice of certain types of limes, often called Persian, wild, or key limes; in northern temperate regions, the most common source is giant hogweed (Heracleum mentagazzium).

The interaction of UV light and the furocoumarins causes an exaggerated sunburn that creates a painful line of blisters where the juice was on the skin, followed by linear, brown, hyperpigmented patches that take weeks or months to resolve.

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17
Q

sunscreens may be labeled “water resistant” for up to .. minutes.

A

40-80 minutes

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18
Q

what does SPF measure?

A

protection from UVB only

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19
Q

what dose SPF of 30 means?

A

1/30th UVB reaches the skin

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20
Q

how often do you need to apply sun screen?

A

every 2 hours

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21
Q

from a mathematic perspective, sunscreens rated as SPF 30 block … % of UVB, SPF 50 block .. %, and SPF 100 block ..%.

A

97, 98, 99%

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22
Q

what is broad spectrum?

A

cover both UVA and UVB

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23
Q

what is chemical UV filters do?

A

absorbed into the skin and work like a sponge to absorb the sun’s rays

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24
Q

what are the FDA approved chemical UV filters? (organic filters)

A

avobenzone
cinoxate
ecamsule
homosalate
octinoxate
octisalate
octocrylene
oxybenzone

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25
Q

what is physical (inorganic) UV filters do? and what are they?

A

reflect both UVA and UVB;
zinc oxide, titanium dioxide

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26
Q

what is good of using physical UV filters?

A

little risk of allergic or irriant contact dermatitis

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27
Q

which areas/locations require physical UV filters?

A

Aruba, Bonaire, parts of Mexico, Palau, US Virgin Islands

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28
Q

which sunscreens are banned from Hawaii?

A

octinoxate and oxybenzone

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29
Q

what are the risks associated with physical UV filters?

A

don’t use as sprays - metallic nanoparticles can be harmful to the lungs

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30
Q

what are the risks associated with chemical UV filters?

A

contact dermatitis, both allergic and irritant;
sun sensitivity (associated with avobenzone, cinoxate, octocrylene);
possible endocrine disruptors?

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31
Q

When selecting sunscreens that contain chemical UV filters, travelers should choose products that contain less than …

A

3% avobenzone, cinoxate, ecamsule, ;

10% homosalate,

5% octinoxate, octisalate, octocrylene, or oxybenzone.

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32
Q

what is the age for sunscreen use for babies?

A

> 6 months - only physicial UV filters

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33
Q

what is the timing of applying sunscreen? before exposure, during exposure?

A

15 min prior; every 2-4 hours

34
Q

what are the risk of UVA and UVB for eye?

A

UVA - harm central vision by damaging the macula

UVB - damange the anterior eye (cornea and lens) ; corneal sunburn called photokeratitis or snow blindness; other symptoms include copious tearing (watery eyes), injected sclerae (noninfectious pink eye), or a gritty foreign-body sensation of the eye

35
Q

actue exposure of UVR on eyes can lead to ?

chronic exposure?

A

corneal burns

cataracts, age-related macular degeneration, benign conjunctival growths (pterygium and pinguecula) and cancers

36
Q

which sunglasses should you choose?

A

UV 400 - 100% block of damaging UVR;
uniform tint throughout;
gray tints offer the best color fidelity;

37
Q

does sunless tanning provide photoprotection?

A

no

38
Q

what are the major means of heat dissipation?

A

radiation while at rest;
evaporation of sweat during exercise

39
Q

which two major organ systems are most critical in temperature regulation?

A

cardiovascular system;
the skin

40
Q

what are the chronic illnesses that limit tolerance to heat and predispose people to heat-related illness?

A

cardiovascular disease, diabetes, renal disease, certain medications, and extensive skin disorders or scarring that limit sweating.

41
Q

Apart from environmental conditions and intensity of exercise, what is the most important predisposing factor in heat-related illness?

A

dehydration

42
Q

what is Heat cramps?

A

painful muscle contractions that begin ≥1 hours after stopping exercise and most often involve heavily used muscles in the calves, thighs, and abdomen.

43
Q

how to treat heat cramps?

A

Rest and passive stretching of the muscle, rehydration solutions or water and salt

44
Q

what is heat edema? how to treat?

A

occurs more frequently in women than in men.

mild swelling of the hands and feet during the first few days of heat exposure,

resolves spontaneously - do not treat with diuretics, which can delay heat acclimatization and cause dehydration.

45
Q

what are the mild heat-realted illnesses?

A

heat cramps;
heat edema;
prickly heat (miliaria or heat rash)

46
Q

what is prickly heat (miliaria or heat rash)?

A

small, red, raised itchy bumps on the skin and is caused by obstruction of the sweat ducts.

47
Q

what are the moderate heat-related illnesses?

A

heat syncope;
heat exhaustion;

48
Q

how is heat syncope caused?
how to treat?

A

by vasodilation - occurs in unacclimatd people standing in the heat or after 15-20 minutes of exercise;

supine position, rest, relief from heat, oral rehydration

49
Q

what is heat exhaustion?

A

Transient mental changes (e.g., irritability, confusion, irrational behavior) might be present in heat exhaustion, but major neurologic signs (e.g., seizures, coma) indicate heat stroke or profound hyponatremia.

50
Q

how to make simple oral salt solution for dehydration?

A

1/4-1/2 teaspoon + 1L water (can add sugar to improve taste)

51
Q

what is severe heat-related illness?

A

heat stroke;
exercise-induced hyponatremia;

52
Q

what is heat stroke?

A

the only form of heat-related illness in which the mechanisms for thermal homeostasis have failed, and the body does not spontaneously restore the temperature to normal

Uncontrolled fever and circulatory collapse cause organ damage to the brain, kidneys, liver, and heart.

53
Q

what is acute heat stroke called? characterized by?

A

exertional heat stroke - by collapse while exercising in the heat, usually with profuse sweating

54
Q

what is gradual heat stroke called?
when does it occur?

A

nonexertional or classic or epidemic heat stroke;

occurs in chronically ill people experiencing passive exposure to heat over several days.

55
Q

how is a presumptive diagnosis of heat stroke made in the field?

A

body temp 41 and over;
marked alteration of mental status

56
Q

how to manage heat stroke?

A

use evaporative cooling - tepid water on the skin and maintain air movement over the body by fanning; cool or cold wet towels & fan

apply ice or cold packs to the neck, axilla, groin, and as much of the body as possible; vigorously massage the skin to limit constriction of blood vessels and to prevent shivering

immerse in cool or cold water, ice bath

rehydration

57
Q

how does hyponatremia occur?

A

failure of the kidneys to correct salt and fluid imbalances properly;
antidiuretic hormone influencing the kidneys to both retain water and excrete sodium;
sodium losses through sweat

58
Q

how to diagnose hyponatremia in the field setting?

A

altered mental status;
normal body temperature;
hx of taking in large volumes of water

59
Q

during prolonged exercise over 12 hours or heat exposure, people should take supplemental …?

A

sodium

60
Q

does sports-electrolyte drinks contain sufficient sodium to prevent hyponatremia?

A

no

61
Q

how to prevent heat-related illness?

A

clothing;
fluid & electrolyte replacement;
heat acclimatization;
physical conditioning

62
Q

what is the result of heat acclimatization ?

A

increased sweating that contains less salt;
decreased energy expenditure with lower rise in body temperature

63
Q

how do you define hypothermia?
what can produce hypothermia?

A

core body less than 35 celsius;
humidity, rain, wind

64
Q

what are nonfreezing cold-related injuries?

A

trench foot (immersion foot), pernio (chilblains), cold urticaria

65
Q

what is trench foot caused by?

A

prolonged immersion of the feet in cold water (0-15 celsius)

66
Q

what is the damage of trench foot?

A

nerves and blood vessels;
pain aggravated by heat and a dependent position of the limb

67
Q

how to first aid trench foot?

A

avoid rapid rewarming of trench foot –> make the damage much worse

68
Q

what is pernio?

A

localized, inflammatory lesions occurring mainly on the hands after exposure to only moderately cold weather.
The bluish-red lesions are thought to be caused by prolonged, cold-induced vasoconstriction.

69
Q

how to treat pernio?

A

Rapid rewarming makes the pain worse; slow rewarming is preferred. Nifedipine can be an effective treatment.

70
Q

what is cold urticaria? how to prevent?

A

localized or general wheals with itching;

If cold urticaria occur regularly in a traveler, they can be prevented or ameliorated by prior treatment with antihistamines.

71
Q

what is freezing cold injury ?

A

frostbite - tissue damage caused by direct freezing of the skin

72
Q

what is the treatment of frozen digit or limb?

A

rapid rewarming in water heated to 40-42 degrees;
severe pain - analgesic needed;
once rewarmed, examine for blisters;
avoid further mechanical trauma and prevent infection - wash area thoroughly with a disinfectant, put dressings between the toes or fingers to prevent maceration, use fluffs for padding, cover with a roller gauze bandage

73
Q

what is proximal blisters mean in terms of frostbite blister?

A

tissue distal to the blister has suffered full-thickness damage

74
Q

what are the thrombolytic agents for forstbite?
when should they be used?

A

prostacyclin, recombinant tissue plasminogen activator;

within 24-72 hours of frostbite

75
Q

what is a primary contributor to indoor air pollution?

A

secondhand smoke

76
Q

Major sources of indoor carbon monoxide is?

A

methane gas ranges and ovens, unvented gas or kerosene space heaters, and coal- or wood-burning stoves.

77
Q

what is air quality index level ‘good’ and what does that mean?

A

0-50 - satisfactory air quality; air pollution poses little or no risk

78
Q

what is the highest air quality index that indicate ‘hazardous’? what does ‘hazardous’ mean?

A

301-500

health warnings of emergency conditions; entire population is more likely to be affected

79
Q

what level is ‘unhealthy for sensitive groups’ for air quality index?

A

101-150

80
Q
A

cdc yellowbook (26 decks)

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