environmental pathology Flashcards
Children account for over 60% of injuries from _________
chemicals
what does CLADME stand for? (in relation to chemical injury)
Concentration Liberation Absorption Distribution Metabolism Excretion
what are “major” adverse drug reactions?
anaphylaxis (penicillin), blood clots, arrhythmias, hematologic (anemia, thrombocytopenia, leukopenia)
Adverse drug reactions are also related to _______
potency
which is why ARD’s are common with anti-cancer meds
what happens if someone overdoses on acetaminophen?
OD of 15 to 20 grams– causes liver damage, may result in liver failure/death
long term use of _________ is associated with elevated risk of breast ca, strokes & blood clots
exogenous estrogen
85% of Lead is taken up by ________ and ___________
bones & developing teeth
what is Gingival hyperpigmentation ?
“lead line” of soft tissue
how does lead effect red blood cells?
Pb blocks or hinders incorporation of Fe++ into hemoglobin
what types of anemia are caused by lead poisoning
microcytic
hypochromic
what is the CDC threshold for lead exposure?
Pb threshold blood level for concern > 5 micro-grams/dL
when is chelation therapy used for lead poisoning?
initiated when lead concentration > 45 micro-grams/dL
what dental-related side effect is seen during the use of ecstasy?
bruxism- grinding teeth
what are the 4 types of physical agents that cause injury?
1) mechanical injury
2) thermal injuries
3) hypothermia
4) hyperthermia
____________ causes over 5,000 deaths per year in the US
hyperthermia (burns)
what is the “rule of 9’s” in relation to burn severity?
% body surface area involved:
Head & neck 9% Trunk front 18%, trunk back 18% Arms 9% each (hands: 1% each) Legs 18% each Perineum 1 %
what factors are important in determining burn severity?
1) % of body surface involved
2) depth of burn
3) potential for inhalation damage of smoke/heat
4) age of patient
5) speed & quality of treatment
If more than ____% of the body surface is burned, the patient has a grave prognosis
50%
when is shock common in burn victims?
when > 20% of the body is burned
Acute respiratory distress syndrome (ARDS) is a result of what?
inhalation of smoke or hot gases during a fire
at what temperature do most heat strokes occur?
- happen above 40 degrees Celsius
what are the symptoms of heat stroke?
peripheral vasodilation, confusion, coma, ischemia, muscle necrosis, DIC: high mortality rate
what body temperature is mild hypothermia? moderate? severe?
Mild (core temp =) 32-35 C (89-95 F)
Moderate= 28-32 C (82-89 F)
Severe= < 28 C (< 82 F)
the symptoms of severe hypothermia include what?
Bradycardia, atrial fibrillation, loss of consciousness
how can radiation damage cells?
1) Direct damage to DNA
2) Indirect – production of free radicals that can damage membranes, nucleic acids and enzymes
Occupational exposures to radiation should not exceed ______ mSv/yr
20
what types of tissues are most sensitive to radiation?
1) Hematopoietic/lymphoid tissues
2) gonads
3) lungs- due to vascularity
4) GI tract- VERY sensitive
5) blood vessels
when are patients susceptible to infection following radiation exposure?
PMN’s decrease over 1-2 weeks, rebound in 2-3 months
patients are weakened WEEKS after exposure- not immediately
what is the range for lethal doses of radiation?
- Lethal range begins about 2 Sv
- at 7 Sv death is certain w/o treatment
what are the effects of acute Hematopoietic radiation syndrome?
- 2-10 Sv
- drop in WBC’s, hair loss, infections, sepsis & bleeding
- death 2-6 weeks
what are the characteristics of acute GI radiation syndrome?
- 10-20 Sv
- vomiting, bloody diarrhea, shock, sepsis
- death 5-14 days
cerebral acute radiation syndrome is characterized by what?
- more than 50 Sv
- listlessness, drowsiness, seizures, coma
- death 1-4 hrs
what is the difference between primary and secondary malnutrition
Primary – diet deficient in 1 or more components
Secondary – supply is OK, problem w absorption, storage, utilization, excessive losses or drug effects
during what form of protein-energy malnutrition is somatic muscle most severely effected?
marasmus
during what form of protein-energy malnutrition is the liver most severely effected?
kwashiorkor
When weight falls to < 60% of normal, the child has _______
marasmus
what are the physical characteristics of children suffering from marasmus?
Extremities appear emaciated, head looks out-of-proportion (too large)
children with marasmus are especially prone to infections. what part of their immune system is most effected? what common infection is seen in them?
- T cell defects are common
- thrush is commonly seen
Serum _______ concentrations are relatively normal during marasmus
albumin
how does Kwashiorkor syndrome differ from marasmus?
Greater deficiency of protein than total calories, more severe than marasmus
what are the characteristics of Kwashiorkor syndrome?
- Low albumin
- generalized edema
**Weight is between 60-80% of normal but this is misleading because of the edema
_________ is a form of protein-energy malnutrition seen in cancer patients
Cachexia
why is cachexia seen in cancer patients?
Partly due to decreased appetite
Increased catabolism – cytokine-mediated (IL-1, IL-6 and TNF)
what conditions will decrease the bodies ability to absorb fat-soluble vitamins?
Inflammatory bowel disease (Crohn)
Cystic fibrosis
Alcoholic liver disease
what are the 3 forms of Vitamin A?
retinol, retinal, and retinoic acid
what is the physiological roll of vitamin A?
Maintain vision in reduced light
Augments differentiation of specialized epithelial cells (mucus secreting epithelium)
Enhances immunity to infections
what are the severe effects of vitamin A deficiencies?
Squamous metaplasia of respiratory & urinary tracts
- increases risk for infections and stones
Squamous metaplasia of respiratory & urinary tracts is the RESULT of what condition?
vitamin A deficiency
a deficiency of Vitamin A can predispose people to what types of infections?
measles, pneumonia and infectious diarrhea
all caused by weakened immune system
