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ENVIRONMENTAL & NUTRITIONAL PATHOLOGY Flashcards

1
Q

How does benzene cause marrow aplasia and increase risk of acute myeloid leukemia?

A

Benzene is oxidized by hepatic CYP2E1 to toxic metabolites that disrupt differentiation of hematopoietic cells in the bone marrow

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2
Q

Bitot’s spots that develop in Vitamin A deficiency are associated with which type of metaplasia

A

Squamous metalpasia

(goblet/columnar epithelium undergoes metaplasia to keratinizing squamous epithelium)

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3
Q

List sources of arsenic

A

ground water

wood preservers and herbicides

mines and smelting industries

Herbal medicine

Vineyard workers

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4
Q

Identify the deficient micronutrient

  • Rash around eyes, mouth, nose, and anus called acrodermatitis enteropathica
  • Anorexia and diarrhea
  • Depressed wound healing and immune response
  • Impaired night vision
  • Infertility
A

Zinc

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5
Q

List the common causes of death due to electrical injuries

A

burns

ventricular fibrillation or cardiac and respiratory center failure

asphyxia due to chest wall spasms

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6
Q

Is this Kwashiorkor/Marasmus?

Hypoalbuminemia

Edema - generalized or dependent

Flaky paint dermatoses

alternating bands of pale and darker hair.

A

Kwashirokor

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7
Q

List the acute effects of alcohol

A

CNS- depressant effect, respiratory arrest

GI- acute gastritis, ulceration, fatty change

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8
Q

Clinical features of Vitamin C deficiency

A
  1. Scorbutic gums
  2. Poor wound healing
  3. Corkscrew hairs
  4. Bone changes- faliure to form osteoid, classic subperiosteal hemorrhages at ends of long bones
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9
Q

Sources of environmental exposure to mercury

A

a. contaminated fish (methyl mercury)- swordfish, shark, and bluefish, tuna fish
b. dental amalgams
c. contaminated rivers and streams

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10
Q

What is the mechanism of injury in Acetaminophen toxicity?

A
  1. covalent binding to hepatic protein- forming proetin adducts
  2. depletion of GSH
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11
Q

Which form of Vitamin A is a constituent of visual pigments?

A

Retinal

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12
Q

Clinical manifestations of acute aspirin toxicity

A

Increased anion gap metabolic acidosis

Hyperthermia

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13
Q

Which agent used to treat constipation may also cause fat-soluble vitamin deficiencies?

A

Mineral oil

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14
Q

List the clinical features of Rickets

A

Craniotabes

Frontal bossing

Rachitic rosary

Harrison’s sulcus

Bowing of the legs

Lumbar lordosis

Genu valgum, genu varum

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15
Q

Why is a millet based diet pellagrogenic?

A

Although this grain contains adequate tryptophan, it also contains high levels of leucine, another amino acid that interferes with the enzymatic conversion of tryptophan to niacin.

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16
Q

List the adverse effects of anabolic steroids

A

Stunted growth in adolescents

Acne

Gynecomastia

Testicular atrophy in males

Growth of facial hair

Menstrual changes in women.

Psychiatric problems

Premature heart attacks

Hepatic cholestasis - orally administered anabolic steroids

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17
Q

Type of hypothermic injury characterized by:

Direct damage to tissue caused by ice crystallization in cells

occurs when tissue is exposed to temperatures less than 0° C

A

Frostbite

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18
Q
  1. List the sources of radon exposure
  2. What’s the health risk assoc with radon exposure?
A
  1. Sources:
    a. radioactive gas derived from uranium
    b. present in soil and in homes
  2. Lung Cancer
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19
Q

List 3 effects of chronic alcohol abuse

A

fatty change

alcoholic hepatitis

cirrhosis- portal hypertension , hepatocellular carcinoma

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20
Q

The formulation of Viamin A that is used to treat Acute promyelocytic leukemia

A

All-trans-retinoic acid (vitamin A)

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21
Q

Clinical consequences of Chronic aspirin toxicity (salicylism)

A

Dizziness

tinnitus

Bleeding tendencies

Analgesic nephropathy - tubulointerstitial nephritis with renal papillary necrosis

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22
Q

Why must alcohol not be mixed with narcotic, sedative, and psychoactive CNS drugs?

A

When alcohol is present in the blood at high concentrations, it competes with other CYP2E1 substrates and delays drug catabolism, potentiating the depressant effects of narcotic, sedative, and psychoactive drugs in the CNS

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23
Q

Least radiosensitive tissues

A

bone (least sensitive), brain, muscle, and skin

24
Q

List 5 complications of burns

A
  1. Hypovolemic shock
  2. Pseudomonas aeruginosa -infection of burn wounds
  3. Curling ulcers - proximal duodenum
  4. Hypermetabolic syndrome- increased basal metabolic rate
  5. Smoke inhalation- carbon monoxide/cyanide poisoning
25
What condition is the attached imaging finding associated with?
Wernicke's encephalopathy (triad of ataxia, ophthalmoplegia/nystagmus and confusion) The image shown is bilateral symmetrical hyperintensity involving the mammillary bodies
26
List 3 food items assoc with carcinomas
Aflatoxin - hepatocellular carcinoma (causes mutation in codon 249 of the p53 gene ) Nitrosamines & nitrosamides - gastric carcinoma Artifical sweeteners - bladder cancers
27
List 3 conditions assoc with OCP use
Thromboembolism Cardiovascular disease Hepatic adenoma
28
**Is this heat cramps/ heat exhaustion/heat stroke?** \>40° C (\>104° F) Hot and dry (anhidrosis) Impaired consciousness CNS dysfunction athletes and military recruits, Lactic acidosis, Rhabdomyolysis (↑CK), myoglobinuria, ↑serum BUN, creatinine, Hypocalcemia
Heat Stroke
29
Why are diets based on corn pellagrogenic?
Diets based on unfortified maize (corn) are pellagrogenic for the following two reasons: a. low in tryptophan, the amino acid precursor of niacin, which can be used to offset a diet low in niacin b. any endogenous niacin in untreated corn is bound in a nonbioavailable form
30
Which vitamin is employed in the treatment of cystic acne?
Oral isotretinoin (vitamin A)
31
**Is this heat cramps/ heat exhaustion/heat stroke?** 37° C (98.6° F) Skin - Moist and cool Mental status- Normal Painful, involuntary spasmodic contractions of muscle that occur after exercise
Heat cramps
32
**Is this heat cramps/ heat exhaustion/heat stroke?** \<40° C (\<104° F) Skin- Profuse sweating Mental status - Normal Hypotension, nausea, vomiting
Heat Exhaustion
33
List 4 causes for Vitamin K deficiency
Parenchymal liver diseases Biliary disease Fat malabsorption syndromes Dietary deficiency Drugs – cholestyramine, coumadin
34
List 2 biochemical effects of arsenic
1. interferes with mitochondrial oxidative phosphorylation 2. inhibits pyruvate dehydrogenase which requires lipoic acid as a cofactor. Arsenite forms a stable complex with the thiol (SH-) groups of lipoic acid
35
What best accounts for the changes in the brain following acute exposure to CO poisoning?
Hypoxic neuronal change
36
large, solitary, and well-encapsulated mass Benign Susceptible to hemorrhage assoc with OCP use
Hepatic adenoma
37
List 3 Cancers associated with ionizing radiation
AML, CML Papillary thyroid carcinoma Lung, breast and bone cancers(Osteosarcoma)
38
Causes for acute CO poisoning
Running car in a closed garage Improper use of gasoline-powered generators (e.g., during power outages) Mine fires
39
List the clinical features of pyridoxine deficiency
**Oral:** Glossitis Cheilosis **Neurologic :** Distal limb numbness and weakness Impaired vibration and proprioception Preserved pain and temperature Sensory ataxia Generalized seizures
40
Identify the deficient micronutrient Dental caries
Fluoride
41
What are the bone changes assoc with scurvy?
1. Osteoblasts fail to form osteoid (bone matrix) 2. classic subperiosteal hemorrhage at the ends of the long bones
42
Consequences of homozygosity for the ALDH2\*2 allele
unable to oxidize acetaldehyde nausea, flushing, tachycardia, and hyperventilation after its ingestion. Intolerance to alcohol
43
List 2 biochemical consequences of alcohol consumption
1. Deficiency of NAD - main cause of the accumulation of fat in the liver of alcoholics 2. increase in the NADH/NAD ratio in alcoholics - lactic acidosis
44
List one important cancer caused by arsenic exposure
liver angiosarcoma
45
List the hormonal derangements assoc with anorexia nervosa
Decreased GnRH Decreased LH, FSH Decreased estrogen Decreased thyroid hormone release
46
Clinical features of Vitamin B3 deficiency
Pellagra- diarrhea, dermatitis(Cassal's necklace) and dementia
47
Mechanism of damage by UV radiation (UV-B)
Produces pyrimidine dimers that distort DNA structure Inactivate p53 Activate RAS proto oncogene
48
List 2 morphologic changes assoc with Kwashiorkor
Liver- enlarged, fatty change Small bowel - loss of villi and microvilli
49
Clinical signs of arsenic poisoning
Severe headaches abdominal pain Diarrhea Delirium Convulsions
50
Morphologic finding in the liver in acetaminophen toxicity
Marked hepatocellular necrosis is present in a zonal, centrilobular pattern
51
Identify the deficient micronutrient
Thyroxine
52
List the features of thiamine deficiency
Dry beriberi - Nervous system involvement Wet beriberi – CVS involvement Infantile beriberi Wernicke encephalopathy Korsakoff syndrome
53
Clinical features of chronic CO poisoning
CNS- widespread ischemic change- basal ganglia; lenticular nuclei Permanent neurologic sequelae - impairment of memory, vision, hearing, and speech.
54
Signs of acute vitamin A toxicity
1. Headache, dizziness 2. Vomiting 3. Stupor 4. Blurred vision
55
Clinical features of mercury exposure
a. developing brain is extremely sensitive to methyl mercury b. Diarrhea constricted visual fields nephrotoxicity in proximal tubule, tachycardia hyperhidrosis (↑sweating) peripheral neuropathy hypertension

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