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Multisystem 1st Half > environmental pathology > Flashcards

environmental pathology Flashcards

1
Q

the definition of “a poison” is a _____ concept dependent on ______

A

quantitative concept

dependent on dosage

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2
Q

most solvents and drugs are lipophilic, why?

A

to promote transport in and around body

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3
Q

phase 1 vs phase 2 drug metabolism

A

phase 1 = hydrolysis, reduction or oxidation using cytp450 = rns that convert parent drug to water soluble active metabolites by adding or unmasking a polar group

phase 2 = glucuronidation, sulfation, methylation, and conjugation w glutathione –> conjugation rxns that increase water solubility with a polar group to INACTIVATE it for renal excretion

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4
Q

nicotine and its mechanism

A

alkaloid
not direct cause of tobacco-related dz, but very addictive
a stimulant, agonist at nicotinic choliergic receptors
Quickly reaches brain via blood and activates nicotinic Ach receptors inducing release of many chemical messengers
= serotonin, Ach, norepi, epi, vasopressin, dopamine, B-endorphin

–> increased BP, vasoconstriction, and tachycardia

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5
Q

physical signs of tobacco use

A

teeth and finger staining
anthracosis of lungs
smokers cough
increased phlegm

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6
Q

disease caused by smoking

A 
peptic ulcer
CV disease
antherosclerosis
COPD (emphysema and chronic bronchitis)
lung cancer
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7
Q

lead poisoning

sources and mechanism

A

sources: paint, batteries, ceramics

absorbed and binds to sulfhydryl groups in proteins to interfere with Ca metabolism

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8
Q

signs and symptoms of lead poisoning

A

o Most deposits into bone and interferes with cartilage remodeling –> radiopaque xray lines at epiphyses

o Leads to: demyelination and CNS defects –> developmental issues in kids, encephalopathy (edematos brain with compressed ventricles and flat gyri), peripheral neuropathy

  • blue lines at gingival margins
  • GI issues

*Anemia
 Causes anemia by interfering with heme synthesis –> accumulation of protoporphyrins and basophilic stippling
 Treat anemia with chelation

o Kidneys show proximal tubular damage with intranuclear inclusions

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9
Q

basophilic stippling, radiopaque lines, blue gingival line, anemia and CNS issues/neuropathy

A

lead poisoning

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10
Q

mercury poisoning
source
mech
and effect

A

source is fish
mechanims: binds to sulfhydryl groups in proteins
damages CNS and kidneys

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11
Q

fetal exposure to mercury causes what?

A

minamata disease
=cerebral palsy(weak/weird motions), deafness, and blindness

*developing brain is very sensitive to methyl mercury

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12
Q

minamata disease

A

fetal exposure to mercury that causes cerebral palsy, deafness and blindness

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13
Q

polycyclic hydrocarbons

source and effect

A

combustion of C containing fuels

potent carcinogen

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14
Q

vinyl chloride

source and effect

A

PVC and polyvinyl resins

hepatotoxicity, liver angiosarcoma

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15
Q

benzene

source and effect

A

rubber

causes leukemia

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16
Q

organochlorines

source and effect

A

pesticides (DDT)

endocrine dysfunction (antiestrogen and antiandrogen)

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17
Q

organophosphate pesticides

mechanism and effect

A

irreversible inhibitors of acetylcholinesterase by phosphorylating active site
–> results in abnormal nerve transmission, NTs aren’t broken down (neurotoxicity)

o Signs due to excessive cholinergic stimulation: pupil constriction, blurred vision, muscular paralysis, diarrhea, abdominal cramps, salivation, bronchoconstriction
 In kids: lethargy, weakness, salivation, and seizures common (not common in adults)

o Histology –> demyelinated nerves, atrophic muscle fibers, and pale foci of demyelination/necrosis

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18
Q

dioxin, PCB

A

food contamination (rice oil)

causes chloracne and folliculitis

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19
Q

arsenic poisoning

sources, mech, and effects

A

wood preservatives, smelting industry and mines, groundwater in china

interferes with cellular oxidative phosphorylation

effects on SKIN, Gi, nervous system and heart

  • -skin lesions + n/v/d
  • -sensorimotor neuropathy in 2-8 weeks (demyelination)
  • -chronic –> hair, nails and skin
  • ——-mees lines in nails (white striae)
  • ——-skin hyperpigmentation and hyperkeratosis (thick and scaly)
  • ——bowens disease (early SCC Insitu; red scaly skin)
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20
Q

what is there an increased risk of with arsenic poisoning

A

cancer (squamous cell carcinoma)

bowens disease = early SCC in situ (red scaly skin)

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21
Q

mees lines and hyperkeratosis?

A

arsenic poisoning

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22
Q

cadmium poisoning

A

mining, electroplating, paint, and batteries

toxic to lungs and kidneys due to ROS
obstructive lung dz and renal tubular damage

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23
Q

sources of carbon monoxide poisoning?

A

autofumes, cigarettes, natural gas, unvented heaters = CO is made by incomplete combustion

classic case = dead guy with dead pet with unvented space heater

24
Q

mechanism of CO poisoning

A

o 200x greater affinity for Hgb than O2;

Binds to Hgb, decreasing available sites for oxygen –> less oxygen and CO2 carried

25
Q

effect and signs of CO poisoning

A

o Hypoxia leads to ischemic change in the CNS and basal ganglia
—-necrosis of globus pallidus
o cherry red color = livor mortis

headaches, dizzy, nausea, confusion

26
Q

what two toxins cause livor mortis?

A

cherry red coloration

cyanide and CO

27
Q

acetaminophen overdose

A

o 95% is Detoxed in liver by phase 2 enzymes and excreted as glucoronate
 BAD PATH: 5% is processed by cyp2E1 which converts it to NAPQ –> protein adducts and lipid peroxidation –> liver injury
o High doses Can cause hepatocellular injury, centrilobular necrosis, and acute liver failure
o Treatment for overdose: N-acetylcysteine

28
Q

treatment for acetominophen overdose?

A

n-acetylcysteine

29
Q

aspirin overdose

A

Overdose causes alkalosis (stimulates resp. Centers) followed by metabolic acidosis

o Chronic toxicity = h/a, dizzy, tinnitus, confusion, n/v/d
o Commonly causes acute erosive gastritis and GI bleeding

30
Q

cocaine

A

o Leaves of coca plant; snorted, injected or crystallized to crack (more potent)
o Very addictive; metabolite is benzoylecgonine (BE)
o CV effects =sympathomimetic, blocks uptake of dopamine –> tachycardia, HTN, vasoconstriction, platelet aggregation and lethal arrythmias

31
Q

heroin

A

o Opioid from poppy plant; synthetic drug injected
o Causes euphoria, pulmonary edema, infections (skin popping)
–can cause sudden death
o Methadone used to treat addicts

32
Q

thermal injuries

  • 1st degree
  • 2nd degree
  • 3rd degree
  • 4th degree

can cause?

A
  • 1st degree = confined to epidermis
  • 2nd degree = dermis/partial thickness
  • Full thickness = 3rd degree to subcutaneous; 4th degree to muscle
  • Internal injuries from inhalation
  • Shock sepsis and respiratory effects
33
Q

hyperthermia

cause of heat cramps?
of heat exhaustion?
of heat stroke?

2 serious conditions?

A

• Heat cramps – loss of electrolytes
• Heat exhaustion – sudden collapse, CV failure to compensate for hypovolemia
• Heat stroke – high temp, humidity, exertion
o rhabdomyolysis or inherited malignant hyperthermia

34
Q

hypothermia

A
  • body temp falls below 90 degrees
  • directly causes high salt in cells due to crystallization of water
  • indirectly causes circulatory changes –> vasoconstriction, increased blood viscosity, ischemic injury
35
Q

electrical injury causes

A

burns and ventricular fibrillation

36
Q

ionizing radiation

effects

A

energy traveling in waves or high speed particles and causes DNA damage

embryonic destruction of neurons/glial cells
adult brain is resistant

effects on skin, lungs, lymph nodes, GI, gonads, and blood/bone marrow

37
Q

what doesnt count for cause of death?

A 
o	cardiac arrest
o	respiratory arrest
o	Cardiorespiratory arrest
o	Renal failure
o	Asystole
38
Q

cause of death

A

the disease/injury that initiated the chain of events that brought about death
• initiating disease or condition; may precede death by seconds or years; Usually determined by autopsy
• may not be obvious if occurred in remote past
• many intermediate illnesses or conditions may connect the COD to fatal condition
–a proximate –> intermediate –> immediate

39
Q

mechanism of death

A

the nonspecific final common pathway by which the cause of death exerts its lethal effect
• Cardiorespiratory arrest, exsanguination, hypoxia, etc

40
Q

COD vs mechanism of death

A
  • Cause of death = etiologically specific; can stand alone on death certificate
  • Mechanism of death = broad differential; cannot stand alone on a certificate
41
Q

manner of death

A

– how the cause of death came about or the circumstances under which the person died; determined by death investigation
• Natural
• Accident – neither he/she nor someone else brought it on and it was not reasonably foreseeable
• Suicide – “self murder”; victim knowingly engaged in an act that could reasonably end life
• Homicide – victim killed by another person
*undetermined

1 yr + 1 day rule does NOT apply  gunshot to head 10 yrs prior that results in a lethal seizure 10 yrs later is a HOMICIDE!

42
Q

smoke inhalation can cause..

A

.pulmonary edema

43
Q

metabolizing a toxin MOST often is the enzyme

A

cytp450

44
Q

ceramics, basophilic stippling, radiopaque lines –>

A

lead poisoning

45
Q

necrosis of pallidus globus

A

kerosene heated, dead dog, dead man –>you see

CO poisoning

46
Q

cherry red livor mortis….what kind of poisoning?

A

CO poisoning

red color from pooling of blood

47
Q

WHAT Poisoning inhibits heme synthesis?

A

lead poisoning causes microcytic hypochromic anemia

48
Q

treatment for lead poisoing?

A

chelating agent

49
Q

dont eat what in preganncy?

A

fish - mercury can affect fetuses!!!

50
Q

what substances are inhibitors of acetylcholinesteras?

A

organophsophates (insecticides)

51
Q

antidote for organophosphate poisoning?

A

atropine for symptoms (

and treat w pralidoxime

52
Q

neuromuscular weakness (flacidity) with salivation…what kind of poisoning

A

caused by organophosphate poisoning (pesticides like malathion/parathion)

53
Q

what poisoning interferes with mitochondrial ATP formation/cell metabolism?

A

arsenic

54
Q

hepatic lesions associated with arsenic

A

liver angiosarcoma
hepatic necrosis
cirrhotic portal htn
hepatitis

55
Q

ingested arsenic causes…

A

mees lines on nails

56
Q

neutrophil elastases breakdown lung tissue

effect on nicotine on this process?

A

inactivates the inhibitors of the elastases –> enhanced tissue destruction in lungs

57
Q

mutations in progression to squamous cell carcinoma?

A

p16, p53, then cyclin D

Multisystem 1st Half (23 decks)

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