Exam 1; Environmental Pathology Flashcards by Courtney Kast

What are the factors that affect chemical injuries

CLADME
Concentration
Liberation
absorption
distribution
metabolism
excretion

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True or False

Adverse drug reactions are common

True (2%)

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An overdose of this may be accidental in kids or even intentional in adults

aspirin

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An overdose of this may cause liver damage

acetaminophen

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85% of this compound found in the air, soil, water, etc. is taken up by bones and developing teeth; it competes with Ca and interferes with the remodeling process

lead

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What can be seen on the x-ray on something exposed to lead

lead lines (hyperdensity/hyperpigmentation)

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Lead blocks or hinder the incorporation of this into hemoglobin

iron

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Since lead blocks iron incorporation into hemoglobin, what can develop

anemia
neurologic disturbances
“wrist drop and foot drop” - peripheral neuropathies

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What kind of problems can lead cause with the GI tract

colicky pain - severe, not localized

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What kind of problems can lead cause wit the kidneys

damages tubules, fibrosis, even renal failure

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What are the CDC guidelines of the lead threshold in blood

level of concern ≥5µg/dL

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Chelation therapy of lead is initiated when

blood levels of lead are ≥45µg/dL

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What is the range of temperature the body operates at

89-106℉ (31-41℃)

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What is the rule regarding burns

rule of 9’s; % body surface area

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What is the rule of 9’s

head and neck - 9%
trunk front and back each - 18%
arms - 9% (hands 1%)
legs each - 18%
perineum - 1%

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What are four important factors regarding burns on a patient

depth of the burn (full or partial thickness)
potential for internal injuries from inhalation of fumes or hot gasses
age of the patient
speed and quality of treatment

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What percentage of BSA burned leads to a grave prognosis

> 50%

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Shock is common when what percentage of BSA is burned

> 30-40%

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When BSA burned reaches shock levels, what three things can occur

massive fluid shift causing hypovolemic shock
sepsis/infections
other problems like electrolyte and nutritional imbalance

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Internal thermal injuries like inhalation can cause what two things to occur

damages to the URT and LRT

acute respiratory distress syndrome (ARDS)

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What are three variances of hyperthermia

heat cramps
heat exhaustion
heat stroke

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What occurs during a heat stroke

elevation of body temperature above 40℃ causes regulatory mechanisms to fail; perisperhal vasodilation results in pooling and decrease blood volume leading to ischemic and necrosing tissues - DIC

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What occurs during hypothermia

bradycardia
atrial fibrillation
loss of consciousness
cell damage due to crystallization of water

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What are the two forms of radiation injuries

electromagnetic waves; x and gamma rays

high energy neutrons and charged particles; alpha and beta particles and protons

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Radiation interacts with atoms and molecules by what

excitation and ionization

In which ways does radiation interact with biological systems

directly on DNA; causing mutations | indirectly causing the production of free radicals

What can be the result of radiation injury to the cell

may be reversible, induce apoptosis or mitotic arrest nuclear abnormalities or DNA strand breaks cytoplasm is affected via swelling, membrane changes, and mito/ER changes

What is the level of radiation that occupational exposures should not exceed

20mSv/year | a single oral find has 0.005mSv

What happens over time to the skin exposed to radiation damage

erythema at 2-3 days edema at 2-3 weeks blistering/desquamification at 4-6 weeks atrophy/fibrosis/neoplasia at months/years/decades

How does radiation affect the lymphocytes

decreases levels over hours, but they rebound in weeks/months

How does radiation affect the lymph nodes and spleen

shrinks in size

How does radiation affect the PMNs

decrease in levels over 1-2 weeks, but levels rebound in 2-3 months patients are susceptible to infection at this time!

These cellular components also decrease due to radiation, and take a longer time to rebound

erythrocytes and platelets

How does radiation affect the gonads

both sexes are sensitive to radiation - sterility

How does radiation affect the lungs

sensitive due to the rich vascularity; pulmonary congestion and edema; ARDS

How does radiation affect the GI tract

very sensitive; ulcers, strictures (narrowing) and later possible carcinomas

How does radiation affect the blood vessels

endothelial cell injury then fibrosis and narrowing

What is the lethal range of radiation

2Sv, at 7Sv, death is certain without medical care

What are the fatal acute radiation syndromes and level os Svs

hematopoietic; 2-10Sv gastrointestional; 10-20 Sv cerebral; >50Sv

What occurs during the hematopoietic radiation syndrome

``` decrease WBCs hair loss infections sepsis and bleeding death 2-6 weeks ```

What occurs during the gastrointestinal radiation syndrome

``` vomiting bloody diarrhea shock sepsis death 5-14 days ```

What occurs during the cerebral radiation syndrome

``` listlessness drowsiness seizures coma death 1-4 hours ```

What is the difference between primary and secondary malnutrition

primary - diet is deficient | secondary - diet is fine, there is a problem with absorption, etc.

This protein compartment is found in the skeletal muscle and you can assess the loss of this compartment by measuring skin fold thickness

somatic protein compartment

This protein compartment is mainly found in the liver and you can assess this compartment by measuring serum proteins

visceral protein compartment

In this disorder, there is a deficiency of caloric intake

marasmus

What does marasmus cause in the body

``` growth retardation loss of muscle mass the body catabolized proteins as a source of energy, depleting the somatic compartment extremities appear emaciated head looks too large ```

What are some manifestations of marasmus in the body

``` anemia vitamin deficiencies immune deficiency, especially T cells - infections are coming (thrush) bradycardia low body temperature ```

In this disorder, there is a greater deficiency of protein that total calories; common form of PEM found in africa

kwashiorkor

What does kwashiorkor cause in the body

depletion of the visceral protein compartment leading to a loss of vascular oncotic pressure (and low serum proteins) leading to fluid retention and edema

What are some manifestations of kwashiorkor

skin changes; hyper pigmentation, desquamation, hypo pigmentation hair changes fatty liver vitamine and immune deficiencies

Which is worse, marasmus or kwashiorkor

kwashiorkor

Why may it be difficult to diagnose kwashiorkor

the weight is between 60-80% of normal, but is misleading due to the edema

This is a form of PEM found in cancer patients, most likely due to loss of appetite and increase catabolism (cytokine mediated)

cachexia

What are the three biologically active forms in vitamin A

retinol retinal retinoic acid

Where is over 90% of vitamin A stored

in the liver

What are the three functions of vitamin A

maintain normal vision in reduced light augments differentiation of specialized epithelial cells (mucus secreting) enhance immunity to infections

True or False | Vitamin A deficiency is common worldwide

True

What are the ocular changes of a vitamin A deficiency

impaired night vision (early) dry eyes leading to corneal damage total blindness

What are the non-ocular changes associated with a vitamin A deficiency

squamous metaplasia of the respiratory and urinary tracts; increase infections and stones impaired immunity - measles, pneumonia, infectious diarrhea

What are some symptoms of vitamin toxicity

nausea and vomitting blurred vision hair loss dry skin

What results from a vitamin C deficiency

scurvy; found in the elderly, alcoholics, pirates, dialysis patients

What is the function of vitamin C

formation and stabilization of collagen conversion of tyrosine to catecholamines role as an antioxidant

Scurvy is a disease of what

impaired collagen synthesis; the weakened collagen cannot support capillaries or venues therefore causing hemorrhage (especially in the skin and gingival mucosa) poor wound healing

What symptoms are common with scurvy

gingival bleeding swelling periodontal infections

What are some symptoms of vitamin C toxicity

enhancement of iron absorption acidic urine - stone formation rebound scurvy if suddenly stop taking large amounts