Environmental Pathology Flashcards
Environmental disorders make up ___% of neoplasms.
65
T/F. Environmental disorders refers to injuries or disorders that are caused by chemical not physical agents.
False, Environmental disorders refers to injuries or disorders that are caused by chemical AND physical agents.
What related field focuses on injuries that occur in the workplace from chemical and physical agents.
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.
Name the US agencies involved in regulating environmental hazards.
a. Environmental Protection Agency
b. Food and Drug Administration
c. Occupational and Safety Health Administration
d. Consumer Products Safety Commission
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
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
What four ways do injuries caused by chemical agents occur?
- inhalation
- ingestion
- injection
- absorption thru the skin
T/F. Estimated 2 million potentially hazardous exposures each year in the U.S. most (90%) are unintentional.
True.
Oral intake accounts for ___% of chemical agent exposures. Children less than 6yrs account for ___% of exposures. Adverse drug events account for about ___%.
73; 61; 2
What are the most frequent chemical agents?
The most frequent agents are common household items: cleaning agents, analgesics, cosmetics, plants or cold preparations.
“CLADME” are factors that affect chemical injuries. What does it stand for?
- Concentration
- Liberation
- Absorption
- Distribution
- Metabolism
- Excretion
T/F. Adverse drug reactions (ADR’s) are common affecting an estimated 70% of hospitalized persons and about 10% of these are fatal.
FALSE, Adverse drug reactions (ADR’s) are common affecting an estimated 7-8% of hospitalized persons and about 10% of these are fatal.
What are the major and minor adverse drug reactions?
minor - rashes, GI upset
major - anaphylaxis (penicillin), blood clots, arrhythmias, hematologic (anemia, thrombocytopenia, leukopenia)
T/F. Blood clots can can occur with any medication, but is most often associated with antibiotics.
False, Anaphylaxis can occur with any medication, but is most often associated with antibiotics (penicillin is the classic).
T/F. The more potent the drug – the more likely it is to cause an adverse reaction – anti-cancer drugs are the best examples.
True
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.
accidental; intentional; 2-4; 10-30
What happens to patients suffering from an aspirin overdose?
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.
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.
Acetaminophen (Tylenol)
Until 2002, what were exogenous estrogens widely used for?
postmenopausal syndrome (hormone replacement therapy) and to prevent or slow progression of osteoporosis
What did recent Women’s Health Initiative data indicate?
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.
What are the risk and benefits of OCP’s?
risks (blood clots, hypertension, hepatic adenoma, cholecystitis, slightly increased risk in breast cancer)
benefits (contraception, protective effect for endometrial and ovarian cancers)
Why do patients with lead poisoning develop microcytic hypochromic anemia?
Lead has a high affinity for enzymes involved in the synthesis of hemoglobin which blocks or hinders the incorporation of iron into the molecule.
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.
bones; teeth; calcium; lead lines
What happens when lead deposits in the gums?
gingival hyperpigmentation - “lead line” of soft tissue
How does lead poisoning affect the CNS in kids?
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.
In adults lead toxicity may lead to peripheral neuropathies (___ and ___).
wristdrop; footdrop
Does lead poisoning affect the GU tract?
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.
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?
5 ug/dL
chelation therapy
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
All are correct
List some club drugs popular in dance clubs, bars, raves or trances.
methamphetamines (such as MDMA, ecstasy), hallucinogens (LSD, ketamine and, CNS depressants (GHB) and benzodiazepines (Rohypnol).
What is a side effect of methamphetamines (MDMA, ecstasy)?
bruxism - clenching of teeth. One way of dealing with this is by using a pacifier, reportedly used to store another “hit”.
___ 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.
Abrasion; Contusion; Laceration
What is the temperature range that the body operates in?
31° to 41°C (89-106°F)
What physical agent causes > 5000 deaths per yr in the US?
hyperthermia (burns)
___ is due to prolonged exposure to low temps.
hypothermia
What is the percent body surface area or the rule of 9’s?
- head and neck 9%
- trunk front, trunk back - 18%
- arms 9% each (1% for each hand)
- legs (18% each)
- perineum 1%)
What factors affect the clinical significance of burns?
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?