Environmental Pathology Flashcards

1
Q

Environmental disorders make up ___% of neoplasms.

A

65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F. Environmental disorders refers to injuries or disorders that are caused by chemical not physical agents.

A

False, Environmental disorders refers to injuries or disorders that are caused by chemical AND physical agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What related field focuses on injuries that occur in the workplace from chemical and physical agents.

A

Occupational medicine

It has been estimated that in the US work-related injuries occur 2x more frequently than home injuries at an annual cost that exceeds $25 billion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the US agencies involved in regulating environmental hazards.

A

a. Environmental Protection Agency
b. Food and Drug Administration
c. Occupational and Safety Health Administration
d. Consumer Products Safety Commission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which of the following are categories of environmental diseases?

a. Air Pollution
b. Industrial Exposures
c. Tobacco Smoke
d. Chemical agents
e. Physical agents
f. Electrical injury
g. Radiation injury
h. Nutritional diseases

A

All are categories of environmental diseases

a. Air Pollution – outdoor/indoor pollution
b. Industrial Exposures – coal, asbestos, other metals
c. Tobacco Smoke – major public health problem
d. Chemical agents – therapeutic & nontherapeutic drugs
e. Physical agents – mechanical trauma, thermal injury
f. Electrical injury
g. Radiation injury
h. Nutritional diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What four ways do injuries caused by chemical agents occur?

A
  1. inhalation
  2. ingestion
  3. injection
  4. absorption thru the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T/F. Estimated 2 million potentially hazardous exposures each year in the U.S. most (90%) are unintentional.

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oral intake accounts for ___% of chemical agent exposures. Children less than 6yrs account for ___% of exposures. Adverse drug events account for about ___%.

A

73; 61; 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most frequent chemical agents?

A

The most frequent agents are common household items: cleaning agents, analgesics, cosmetics, plants or cold preparations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

“CLADME” are factors that affect chemical injuries. What does it stand for?

A
  1. Concentration
  2. Liberation
  3. Absorption
  4. Distribution
  5. Metabolism
  6. Excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F. Adverse drug reactions (ADR’s) are common affecting an estimated 70% of hospitalized persons and about 10% of these are fatal.

A

FALSE, Adverse drug reactions (ADR’s) are common affecting an estimated 7-8% of hospitalized persons and about 10% of these are fatal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the major and minor adverse drug reactions?

A

minor - rashes, GI upset

major - anaphylaxis (penicillin), blood clots, arrhythmias, hematologic (anemia, thrombocytopenia, leukopenia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F. Blood clots can can occur with any medication, but is most often associated with antibiotics.

A

False, Anaphylaxis can occur with any medication, but is most often associated with antibiotics (penicillin is the classic).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F. The more potent the drug – the more likely it is to cause an adverse reaction – anti-cancer drugs are the best examples.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aspirin (Acetylsalicylic acid or ASA) overdose may be ___ (young kids) ___ or (adolescents/adults). Ingestion of as little as ___ gms (kids) or ___ gms (adults) may be fatal.

A

accidental; intentional; 2-4; 10-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens to patients suffering from an aspirin overdose?

A

The major acute injury is a metabolic one – first there is respiratory alkalosis followed by metabolic acidosis. Chronic ingestion (3 gm or more per day) is associated with headaches, dizziness, ringing in the ears (tinnitus), drowsiness, mental status changes, gastritis, GI bleeding, nausea and vomiting. It may progress to seizures and coma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What medication has an overdose that occurs in large ingestions (15-20 g), liver damage within hours to days followed by non-specific symptoms (nausea, vomiting, diarrhea) then jaundice and shock as the liver failure progresses? There may also be heart and kidney damage as well.

A

Acetaminophen (Tylenol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Until 2002, what were exogenous estrogens widely used for?

A

postmenopausal syndrome (hormone replacement therapy) and to prevent or slow progression of osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What did recent Women’s Health Initiative data indicate?

A

patients receiving long term HRT are at increased risk for breast cancer, strokes and blood clots. The benefits of SHORT term therapy (alleviation of severe peri-menopausal symptoms or prevention of osteoporosis if no other modality is effective) may outweigh these risks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk and benefits of OCP’s?

A

risks (blood clots, hypertension, hepatic adenoma, cholecystitis, slightly increased risk in breast cancer)

benefits (contraception, protective effect for endometrial and ovarian cancers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do patients with lead poisoning develop microcytic hypochromic anemia?

A

Lead has a high affinity for enzymes involved in the synthesis of hemoglobin which blocks or hinders the incorporation of iron into the molecule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A majority (80-85%) of absorbed lead is taken up by the ___ and ___. Lead competes with ___ and interferes with the normal remodeling process. Bone becomes hyperdense with changes (___ ___) visible on x-rays.

A

bones; teeth; calcium; lead lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens when lead deposits in the gums?

A

gingival hyperpigmentation - “lead line” of soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does lead poisoning affect the CNS in kids?

A

Lead toxicity in the CNS is most likely to occur in kids. A number of neurologic disorders may be seen – ranging from mild deficits to sensory, motor, cognitive and psychologic. Reduced IQ’s and learning disabilities may result.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In adults lead toxicity may lead to peripheral neuropathies (___ and ___).

A

wristdrop; footdrop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Does lead poisoning affect the GU tract?

A

Yes, it is characterized by severe, poorly localized, “colicky” pain. Lead is also toxic to the renal tubules, which may lead to interstitial fibrosis and renal failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the CDC guidelines on lead (Pb) threshold blood level for concern? What is therapy is done if it is greater than or equal to 45ug/dL?

A

5 ug/dL

chelation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which of the following general classes of drugs of abuse are matched correctly?

a. Sedative-hypnotics – alcohol, barbiturates, benzodiazepines
b. CNS stimulants – cocaine, amphetamines, weight loss products
c. Opioids – heroin, morphine, methadone, codeine
d. Cannabinoids – marijuana
e. Hallucinogens – LSD, mescaline, phencyclidine (PCP), ketamine
f. Inhalants – glues, toluene, paint thinner, gasoline, amyl nitrate, nitrous oxide
g. Nonprescription drugs – atropine, scopolamine, antihistamines, weak analgesics

A

All are correct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

List some club drugs popular in dance clubs, bars, raves or trances.

A

methamphetamines (such as MDMA, ecstasy), hallucinogens (LSD, ketamine and, CNS depressants (GHB) and benzodiazepines (Rohypnol).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a side effect of methamphetamines (MDMA, ecstasy)?

A

bruxism - clenching of teeth. One way of dealing with this is by using a pacifier, reportedly used to store another “hit”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

___ is a wound produced by scraping or rubbing leading to removal of a superficial layer of skin. ___ (bruise) a wound caused by a blunt object, doesn’t break the skin but may lead to damage to blood vessels and extravasation of blood in tissues. ___ is a tear in tissue, usually with irregular, jagged edges.

A

Abrasion; Contusion; Laceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the temperature range that the body operates in?

A

31° to 41°C (89-106°F)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What physical agent causes > 5000 deaths per yr in the US?

A

hyperthermia (burns)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

___ is due to prolonged exposure to low temps.

A

hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the percent body surface area or the rule of 9’s?

A
  • head and neck 9%
  • trunk front, trunk back - 18%
  • arms 9% each (1% for each hand)
  • legs (18% each)
  • perineum 1%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What factors affect the clinical significance of burns?

A

1) percentage of total body surface involved (Rule of 9’s)
2) depth of the burn (full or partial thickness)
3) possible internal injuries from inhalation of hot gases and fumes
4) the age of the patient
5) how fast & how well is it treated?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If greater than ___% total body surface involvement prognosis is grave. ___ is frequent with greater than 30-40% (20% in notes) total body surface involvement.

A

50; Shock

Shock causes the following to occur:

a) massive fluid shifts causing hypovolemic shock
b) sepsis/infections – Pseudomonas spp., candida
c) other problems - electrolyte, and nutritional imbalances

38
Q

What do internal injuries from fumes (CO, HCN) do to the body?

A

damages both the upper and lower respiratory tract and causes acute respiratory distress syndrome (ARDS).

39
Q

Explain the difference between heat cramps, heat exhaustion and heat stroke.

A

Heat cramps – vigorous exercise with loss of fluid & electrolytes (sweat)

Heat exhaustion – most common, failure of the CV system to adjust to hypovolemia. Sudden onset, collapse, usually recover

Heat stroke - abnormal elevation of the body temperature above 40°C, regulatory mechanisms fail and the body core temperature rises. Peripheral vasodilatation causes “pooling” and decreased circulating blood volume. Tissues become ischemic, necrosis of the muscles and heart may lead to disseminated intravascular coagulation (DIC). High mortality rate especially in elderly and persons under severe physical stresses (athletes).

40
Q

T/F. Hypothermia is due to abnormally low core temperatures due to high humidity, wet clothes, vasodilation (EtOH).

A

True.

41
Q

What are the temperature ranges for mild, moderate and severe hypothermia?

A

Mild (core temp =) 32-35oC (89-95oF)
Moderate 28-32oC (82-89oF)
Severe less than 28oC (less than 82oF)

42
Q

T/F. Hyperthermia leads to bradycardia, atrial fibrillation, loss of consciousness.

A

False, HYPOthermia leads to bradycardia, atrial fibrillation, loss of consciousness.

43
Q

At a cellular level, local chilling or freezing of cells and tissues is ___ dependent. Direct effects due to ___ of water and ___ effects are due to circulatory changes, trench foot gangrene.

A

rate; crystallization; indirect

44
Q

___ ___ occurs when the temperature of the extremities falls below freezing.

A

Frost bite

45
Q

What are some sources AND forms of radiation injury?

A

Sources: Cosmic rays, Ultraviolet light, Elements in earth’s crust, e.g. radon, medical (diagnostic and therapeutic), industrial products, nuclear power plants, nuclear weapons
Forms:
a. Electromagnetic waves – x-rays and gamma rays
b. High-energy neutrons and charged particles (alpha and beta particles, protons)

46
Q

Radiation interacts with atoms and molecules by ___ and ___.

A

excitation; ionization

47
Q

Cellular mechanism of radiation damage either directly damages the ___ or indirect produces ___ ___ that interact with membranes, nucleic acids and enzymes.

A

DNA; free radicals

Result may be reversible, cell death (apoptosis) or mitotic arrest, nuclear abnormalities, DNA strand breaks which could lead to latent long term effects. Cytoplasm is also affected – swelling, changes in membranes, mitochondria and endoplasmic reticulum

48
Q

___ is a unit that expresses the amount of energy absorbed by target tissue.

A

Gray (Gy)

49
Q

What is roughly equal to Gy, but does also factor in relative biologic effect (RBE)?

A
Sievert (Sv) roughly equal to Gy, but dose also factors in relative biologic effect (RBE)
Single chest x-ray – 0.01 mSv
Chest CT imaging – 10 mSv
Single dental intraoral film – 0.005 mSv
Cone beam CT (CBCT) – 0.02 - 0.08 mSv
Occupational exposures to be
50
Q

What are the skin changes that occur over time following radiation injury?

A

erythema (redness) at 2-3 days
edema (2-3 wks)
blistering and desquamation (4-6 wks)
atrophy & cancers (months to yrs)

labile cells are the most sensitive to radiation

51
Q

T/F. Hematopoietic and lymphoid tissues are extremely susceptible to radiation injury.

A

True.

52
Q

What changes occur in hematopoietic and lymphoid tissues following radiation injury? When are patients most susceptible to infections at this time?

A

lymphocytes decrease in hours and rebound (hopefully) in weeks to months.
Lymph nodes and spleen shrink in size.
Granulocytes (PMNs) decrease over 1-2 wks and rebound in 2-3 months, pts are susceptible to infections at this time!
Platelets and erythrocytes fall still later and have even more delayed recovery periods - take longer to rebound (erythrocytes resistant, but precursors are vulnerable)

53
Q

T/F. Gonads in both both sexes are resistant but the uterus and cervix are sensitive to radiation injury.

A

False, Gonads in both sexes are sensitive (possible sterility), but the uterus and cervix are resistant.

54
Q

Why are the lungs sensitive to radiation injury?

A

because of the rich vascularity

endothelial changes, pulmonary congestion and edema, ARDS, and alveolar capillary block

55
Q

T/F. The gastrointestinal tract is very sensitive to radiation injury causing ulcers, strictures and later possible carcinomas.

A

True.

56
Q

Blood vessels exposed to radiation first have ___ injury then later may become ___ and narrow.

A

endothelial; fibrotic

57
Q

Total body radiation effects – even small amount of radiation to the whole body can be ___. The lethal range for humans begins about ___ Sv; at ___ Sv death is certain without medical care (even then mortality is quite high).

A

devastating; 2; 7

58
Q

Explain the following fatal acute radiation syndromes.

a) Hematopoietic
b) Gastrointestinal
c) Cerebral

A

a) Hematopoietic – 2-10 Sv, GI symptoms, decreased white blood cells, platelets, and anemia; resultant sepsis and bleeding problems, death in 2 to 6 weeks
b) Gastrointestinal – 10- 20 Sv, severe GI symptoms, bloody diarrhea, producing dehydration, shock, sepsis and death in 5-14 days
c) Cerebral - > 50 Sv – listlessness, drowsiness, followed by seizures, coma and death in 1-4 hrs.

59
Q

___ is a branch of science that studies the qualitative and quantitative aspects of the diet and utilization of the components required to sustain health.

A

Nutrition

60
Q

What should be included in an adequate diet?

A
  1. sufficient CHO’s, protein & fats for the daily metabolic needs
  2. essential amino acids and fatty acids for synthesis of structural and functional proteins and lipids
  3. vitamins & minerals – coenzymes or hormones
61
Q

T/F. C. Primary malnutrition occurs when the supply is adequate, but there may be a problem with absorption, storage, utilization, excessive losses, or drug effects.

A

False, Primary malnutrition – diet is deficient in 1 or more components. Secondary malnutrition – supply is adequate, but there may be a problem with absorption, storage, utilization, excessive losses, or drug effects.

62
Q

What are some common causes of poor diets?

A

SES (poverty), ignorance of dietary needs, fad diets, acute illness which raises the basal metabolic rate (burns), self imposed diet restriction/habits (anorexia nervosa, bulimia), malabsorption syndromes, genetic diseases (impair ability to use properly)

63
Q

What are the two protein compartments in the body?

A
  1. Somatic protein compartment – skeletal muscles – can assess loss of this compartment by measuring skinfold thickness
  2. Visceral protein compartment – mainly the liver - can assess this compartment by measuring serum proteins (albumin, transferrin)
64
Q

Protein-Energy Malnutrition (Protein-Calorie Malnutrition) is common in ___ countries. Up to ___% of children are affected. It is a major cause of morbidity in kids less than ___ years.

A

developing; 25; 5

65
Q

How is PEM assessed? What are the two major disorders of PEM?

A

body weight (compared to age, sex, and height norms) and rate of growth (charts)

The 2 major disorders in which the intake of protein and/or calories is inadequate: marasmus and kwashiorkor.

66
Q

In which disease is there a deficiency in caloric intake which results in growth retardation and loss of muscle mass as the body catabolizes protein (amino acids) as a source of energy?

A

Marasmus

67
Q

In Marasmus, the ___ protein compartment is depleted. ___ fat is also broken down. The ___ are emaciated. Other manifestations include anemia and immune deficiency, especially the _-___-mediated immune system. The ___ looks out of proportion (too large).

A

somatic; Subcutaneous; extremities; T-cell; head

There is also growth retardation, anemia, multiple vitamin deficiencies, bradycardia, decreased body temps, and normal serum albumin

68
Q

___ is a common finding and an indicator of immune system deficits in Marasmus patients.

A

Thrush

69
Q

In what disease is there is a greater deficiency of protein than total calories? It is the most common form of PEM found in Africa, it is also found in SE Asia. It is more severe than marasmus.

A

kwashiorkor

70
Q

In Kwashiorkor, there is severe loss of the ___ protein compartment. The decreased ___ causes a loss of vascular ___ pressure and generalized fluid retention and visible edema may result (which can mask the true extent of the weight loss).

A

visceral; albumin; oncotic

71
Q

Kids with kwashiorkor will classically have skin changes – (alternating zones of hyperpigmentation, desquamation and hypopigmentation) called a “___ ___” appearance, hair changes, fatty liver, vitamin and immune deficiencies also occur.

A

flaky paint

72
Q

How far does the weight of a child have to fall to be considered marasmus? malnourished?

A

marasmus - 60%

malnourished - 80%

73
Q

Where can secondary forms of PEM be found?

A

in chronic illness or hospitalized patients

74
Q

What is a form of PEM seen in cancer patients?

A

Cachexia - partly due to decreased appetite and increased catabolism (cytokine mediated)

75
Q

T/F. Vitamin deficiencies are found in people living in higher socioeconomic groups.

A

False, lower SES groups

76
Q

What are the fat soluble vitamins? What is needed for fat soluble vitamins?

A

ADEK
healthy intestinal mucosa and bile and pancreatic secretions for absorption. In chronic malabsorption states (inflammatory bowel diseases – for example Crohn’s disease or cystic fibrosis) and in alcoholic liver disease the absorption of the fat-soluble vitamins will be poor.

77
Q

Why are fat soluble vitamins easily stored and deficiencies usually develop slowly?

A

because of lipid solubility

78
Q

What vitamin has been found to prevent night blindness? What are the 3 biologically active forms? Where is it found? Where is it stored?

A

vitamin A

retinol; retinal; and retinoic acid

yellow and leafy green vegetables and in some animal products (liver, fish, eggs, milk & butter)

Over 90% of vitamin A is stored in the liver, where there are reserves for 6-12 months.

79
Q

T/F. Vitamin A does not require a carrier after being released from the liver.

A

False, it is bound to a carrier protein (retinol-binding protein)

80
Q

What are the functions of vitamin A?

A
  1. maintain normal vision in reduced light
  2. augments differentiation of specialized epithelial cells (mucus-secreting)
  3. enhance immunity to infections, esp in children
81
Q

Vitamin A deficiency is found worldwide (Africa, Central & S. America, SE Asia, & the Middle East). Early sign is impaired vision at night. If the deficiency persists, then there will be dryness of the conjunctiva (xerosis). How does this occur?

A

The mucosa of the lacrimal glands will be replaced by keratinized epithelium and keratin debris may accumulate. Further drying may lead to damage to the cornea and total blindness is possible.

82
Q

In vitamin A deficiency, the epithelium of the respiratory and urinary tracts may be undergo ___ ___. This will predispose to infections. The immune system is affected by vitamin A deficiency – common infections such as ___, ___ and infectious ___ may result.

A

squamous metaplasia; measles; pneumonia; diarrhea

83
Q

What vitamin is water soluble, essential (cannot be synthesized) and found abundantly in citrus fruits, vegetables (tomatoes, g. peppers, cabbage, leafy greens, potatoes), milk and some animal products?

A

Vitamin C (ascorbic acid)

84
Q

Deficiency of vitamin C leads to ___. What type of patients will have this disease?

A
scurvy
elderly
alcoholics 
erratic eating habits 
peritoneal dialysis 
hemodialysis patients 
infants fed evaporated milk formula that isn’t fortified with vitamin C
85
Q

What are the functions of vitamin C?

A
  1. formation and stabilization of collagen (hydroxylation of proline & lysine)
  2. conversion of tyrosine to catecholamines
  3. role as an antioxidant
86
Q

Scurvy is a disease of impaired ___ synthesis. How does this lead to hemorrhages?

A

collagen

Weakened collagen doesn’t support the walls of capillaries & venules – thus hemorrhages are a common finding in the skin and gingival mucosa. Other sites for bleeding include the joints (hemarthrosis), behind the eye, subarachnoid space and within the brain (can be fatal).

87
Q

Skeletal changes are found in infants and kids with vitamin ___ deficiency because there is insufficient production of ___ matrix resulting in cartilaginous ___, ___of the long bones (esp the legs), ___ of the sternum.

A

C; osteoid; overgrowth; bowing; depression

88
Q

T/F. In vitamin C deficiency, wound healing (needs collagen) is impaired, ability to localize infections is impaired, anemia (due to bleeding and iron deficiency) is common.

A

True.

89
Q

What dental conditions are common in patients with Vitamin C deficiency?

A

Gingival bleeding, swelling and periodontal infections are common.

90
Q

Discuss some of the toxicity issues associated with Vit C ingestion.

A

excessive ingestion possible (> 2 g/d). The idea that high doses of vitamin C prevents colds has not been conclusively established. Some protection from gastric and esophageal cancers has been reported. Large daily ingestions can enhance iron absorption which could create iron overload in susceptible persons. Vitamin C is excreted in the urine, ingesting large doses will acidify the urine which may increase risk for stone formation (data is controversial). Finally if a person abruptly ceases taking megadoses they may precipitate “rebound scurvy” because of enhanced clearance mechanisms.