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Environmental Medicine > Final > Flashcards

Final Flashcards

1
Q

A xenobiotic is:
a.Any substance that mimics the body’s endogenous biochemistry
b.Any substance that is foreign to the body, or an entire biological system
c.Any substance that is naturally found in the body, or an entire biological system
d.Any substance that causes an organism to lose all function and perish

A

Any substance that is foreign to the body, or an entire biological system

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2
Q

Primary routes of absorption of toxins are
a.Inhalation, ingestion, dermal absorption
b.Inhalation, injection, dermal absorption
c.Ingestion, injection, dermal absorption
d.Ingestion, gestation, dermal absorption

A

a.Inhalation, ingestion, dermal absorption

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3
Q

Primary routes of excretion of toxins are:
a.Sweat, urine, feces
b.Vomit, urine, feces
c.Urine, bile, breath
d.Urine, bile, vomit

A

Sweat, urine, feces

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4
Q

What is the predominant CYP in the liver?
a.2E1
b.1A1
c.1B2
d.3A4

A

d.3A4

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5
Q

As discussed in class, what effect does fasting have on biotransformation?
a.Fasting is likely a good idea for biotransformation because it helps reset the metabolism, thus making biotransformation more efficient
B. Fasting is likely a good idea for biotransformation because it helps increase lipolysis and therefore faster clearance of xenobiotics
c.Fasting may not be a good idea because biotransformation requires energy that in a fasting state could only be spared at the expense of gluconeogenesis
d.Fasting may not be a good idea because biotransformation requires energy that in a fasting state could only be spared at the expense of glycosylation

A

B. Fasting is likely a good idea for biotransformation because it helps increase lipolysis and therefore faster clearance of xenobiotics

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6
Q

Which heavy metal is common in its organic form in shellfish and is one of the reasons you want to have your patients avoid seafood in the week prior to testing?
a.Mercury
b.Lead
c.Arsenic
d.Aluminum

A

mercury

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7
Q

These 2 metal exposures can lead to an inability to kill candida:
a.Lead and Arsenic
b. Arsenic and Mercury
c.Mercury and Lead
d.Arsenic and Aluminum

A

c.Mercury and Lead

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8
Q

Which of the following is the primary component of smog?
a.Ground level ozone
b.Particulate matter
c.Mercury vapor
d.Sulfur dioxide

A

a.Ground level ozone

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9
Q

What two pollutants combine to form ground level ozone?
a.Particulate matter and sulfur dioxide
b.Particulate matter and VOCs
c.Nitrogen oxides and sulfur dioxide
d.Nitrogen oxides and VOCs

A

d.Nitrogen oxides and VOCs

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10
Q

What is the main health effect, if any, of carbon monoxide?
a.RBCs pick of CO quicker than O2, which can cause tissue necrosis and death
b.RBCs pick up CO slower than O2, which can cause cyanosis over a long period of time
c.RBCs pick up CO at the same rate as O2, which causes an equal rate of perfusion of the two gases into the tissue
d.RBCs do not pick CO, thus there is no health effect.

A

a.RBCs pick of CO quicker than O2, which can cause tissue necrosis and death

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11
Q

This form of mercury builds up in fish and is of most concern to humans consuming fish.
a.Elemental mercury
b.Methylmercury
c.Ethylmercury
d.Inorganic mercuric compounds

A

b.Methylmercury

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12
Q

DDT is an example of this type of pesticide
a.Organochlorine
b.Organophosphate
c.Acetylcholinesterase inhibitor
d.Muscarinic receptor agonist

A

a.Organochlorine

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13
Q

Methemoglobinemia is a serious result of:
a.Acetylcholinesterase pesticide exposure
b.Mercury exposure
c.Nitrate fertilizer exposure
d.Organophosphate exposure

A

c.Nitrate fertilizer exposure

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14
Q

The recommended lead level for children is
a.Below 20 micrograms/dL
b.Below 5 micrograms/dL
c.Below 1 micrograms/dL
d.Below 3.5 micrograms/dL

A

d.Below 3.5 micrograms/dL

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15
Q

Bioaccumulation is defined as:
a.The accrual of toxic chemicals in a tissue of a particular organism
b.The increased concentration of a toxic chemical the higher an animal is on the food chain
c.The increased amount of toxin building up in an ecosystem
d.The increased amount of toxin buildup on the planet

A

a.The accrual of toxic chemicals in a tissue of a particular organism

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16
Q

On microscopic evaluation of a CBC from a person with extended lead exposure, what may be present?
a.Neutrophilic hypersegmentation
b.Basophilic stippling
c.Spherocytosis
d.Sickle cells

A

b.Basophilic stippling

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17
Q

The blood lead level that is acceptable for adults is:
a.Below 10 micrograms/dL
b.Below 5 micrograms/dL
c.Below 1 micrograms/dL
d.Below 0.1 micrograms/dL

A

a.Below 10 micrograms/dL

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18
Q

DMPS has a primary affinity for __________while DMSA has an affinity for ___________.
a.Herbicides, Pesticides
b.Mercury, Lead
c. Blood, Urine
d.Arsenic, Cadmium

A

b.Mercury, Lead

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19
Q

What is the theory behind using colon hydrotherapy as part of a depuration treatment protocol?
a.Colon hydrotherapy may increase bile dumping and therefore help with excretion of toxins stored in the liver
b.Colon hydrotherapy may decrease bile dumping and therefore help with excretion of toxins stored in the liver
c.Colon hydrotherapy may increase colonic peristalsis and therefore help with the excretion of toxins stored in the intestinal wall
d.Colon hydrotherapy may increase colonic peristalsis and therefore help with the excretion of toxins stored in the appendix

A

a.Colon hydrotherapy may increase bile dumping and therefore help with excretion of toxins stored in the liver

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20
Q

What temperature of sauna is preferred for a depuration protocol?
a.Low temperature because it increases detoxification through sweat loss
b.High temperature because it increases detoxification through sweat loss
c.Low temperature because it helps increase detoxification through lipolysis
d.High temperature because it helps increase detoxification through lipolysis

A

c.Low temperature because it helps increase detoxification through lipolysis

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21
Q

What tests should be done first in a patient with an environmental exposure history?
a.Heavy metal blood testing
b.Heavy metal urine testing
c.EKG and x-rays
d.CBC, CMP, lipid panel

A

d.CBC, CMP, lipid panel

22
Q

Which of the following is an advantage of hair testing?
a.Good evaluator of body burden of heavy metals
b.Good for evaluating elemental mercury
c.Good for evaluating methylmercury
d.Hair is a highly stable tissue and testing is highly standardized

A

c.Good for evaluating methylmercury

23
Q

Which of the following people is a good candidate for stool testing for heavy metals?
a.Small Child
b.Elderly Person
c.Patient with needle phobia
d.All of the above

A

a.Small Child

24
Q

There is no test that can determine an accurate body burden of heavy metals.
True
False

A

True

25
Q

In one animal study, this supplement seemed to be somewhat protective of immune function when there was cadmium exposure:
a.Chromium
b.Selenium
c.Vitamin D
d.Vitamin K

A

b.Selenium

26
Q

What is the difference, if any, between detoxification and depuration?
a.Detoxification is the action or process of freeing something of impurities and depuration is the process of transforming a toxic substance into a non-toxic substance.
b.Detoxification is the process of transforming a toxic substance into a non-toxic substance and depuration is the action or process of freeing something of impurities.
c.Detoxification is the process of transforming a non-toxic substance into a toxic substance and depuration is the process of ingesting impurities.
d.Detoxification and depuration are the same, there is no difference.

A

Detoxification is the process of transforming a toxic substance into a non-toxic substance and depuration is the action or process of freeing something of impurities

27
Q

Acid rain is defined as:
a.Any form of wet precipitation that has a pH <5.6
b.Any form of wet precipitation that has a pH <6.5
c.Precipitation in the form of rain only with a pH <5.6
d.Precipitation in the form of rain only with a pH < 6.5

A

Any form of wet precipitation that has a pH <5.6

28
Q

For chelation using DMSA, which route is the best for administration?
a.IV
b.Oral
c.Suppository
d.None of the above

A

b.Oral

29
Q

What is LD50?
a.Median Lethal Dose; used to measure long-term chronic exposure
b.Median Lethal Dose; used to measure short-term acute poisoning
c.Medium Lethal Dose; used to measure long-term chronic exposure
d.Medium Lethal Dose; used to measure short-term acute poisoning

A

b.Median Lethal Dose; used to measure short-term acute poisoning

30
Q

What are some of the main products where lead is still found?
a.Computers
b.Automotive batteries
c.Ceramic glazes
d.All of the above

A

All of the above

31
Q

In a person who has a significant hx of lead exposure, what may be found on x-ray?
a.Osteonecrosis
b.Dense metaphyseal lines
c.Metal pooling in storage sinks
d.Lead lines in the spinal column

A

b.Dense metaphyseal lines

32
Q

Mercury can cross the blood-brain barrier. How does it do this and what supplement may be controversial to use because the theory is that if you give this supplement it may upregulate the body’s ability to allow mercury to cross the BBB?
a.Cross the BBB by binding to the sulfhydryl group on cysteine; therefore NAC is controversial
b.Cross the BBB by binding to the sulfhydryl group on glutathione; therefore giving glutathione is controversial
c.Crosses the BBB by binding to the sulfhydryl group on glycine; therefore giving glycine is controversial
d.Crosses the BBB by binding to the sulfhydryl group on methionine; therefore giving SAMe is controversial

A

a.Cross the BBB by binding to the sulfhydryl group on cysteine; therefore NAC is controversial

33
Q

What is one of the predominant uses for cadmium?
a.Brake Pads
b.Battery manufacturing
c.Refrigerants
d.Insulation

A

b.Battery manufacturing

34
Q

Where does cadmium accumulate in the body?
a.Liver and heart
b.Kidneys and the heart
c.Liver and the kidney
d.Lungs and the heart

A

c.Liver and the kidney

35
Q

How does cadmium contribute to osteomalacia and/or osteoporosis?
a.Cadmium increases utilization of vitamin D, thus leading to calcium depletion
b.Cadmium increases urinary excretion of calcium and phosphorus
c.Cadmium increases fecal excretion of calcium and phosphorus
d.Cadmium replaces calcium in the bone, therefore weakening the bone structure

A

b.Cadmium increases urinary excretion of calcium and phosphorus

36
Q

What is the main idea regarding biotransformation?
a.Transforming a lipid soluble xenobiotic into a more water soluble substance for excretion
b.Transforming a water soluble xenobiotic into a more lipid soluble substance for excretion
c.Mobilizing heavy metals from their major storage sinks for excretion
d.Mobilizing xenobiotics in general from their major storage sinks for excretion

A

a.Transforming a lipid soluble xenobiotic into a more water soluble substance for excretion

37
Q

What is the best way to test for possible acute acetylcholinesterase toxicity?
a.Best to test whole blood and serum
b.Best to test whole blood and plasma
c.Best to test serum and plasma
d.Best to test whole blood and urine

A

b.Best to test whole blood and plasma

38
Q

Glutathione is well absorbed orally:
True
False

A

False

39
Q

One of the main ways that DES, Dioxin, and DDT affect the body is:
a.Causing atrophy of lymph channels
b.Causing atrophy of the cells of the thymus
c.Causing overabundance and secretion of WBCs (lymphocytosis)
d.Causing thymic hyperplasia

A

b.Causing atrophy of the cells of the thymus

40
Q

This type of mercury is the one found in amalgam fillings:
a.Inorganic mercury
b.Elemental mercury
c.Methyl mercury
d.Ethyl mercury

A

b.Elemental mercury

41
Q

Arsenic has highest absorption:
a.Through the skin
b.Through inhalation
c.Through the GI tract
d.Through ocular infiltration

A

c.Through the GI tract

42
Q

Arsenic can be found in:
a.Cigarette smoke
b.Treated lumber
c.Poultry feed
d.All of the above

A

d.All of the above

43
Q

What are the major storage sinks for xenobiotics:
a.Liver and kidneys
b.Kidneys and bone
c.Bone and adipose
d.Adipose and liver

A

c.Bone and adipose

44
Q

Heavy Metals, Trauma and Obesity are all inducers of the CYP 450 system?
True
False

A

False

45
Q

What is one of the major problems when comparing xenoestrogens?
a.Phytoestrogens have comparatively longer half-lives than synthetic xenoestrogens such as PCBS and DDT.
b.Phytoestrogens have comparatively shorter half-lives than synthetic xenoestrogens such as PCBS and DDT.
c.Although phytoestrogens are considered a xenoestrogen, they have no risk to the human biochemistry and are incomparable to synthetic xenoestrogens which are significantly more potent and pervasive.
d.There is no problem when comparing xenoestrogens because the basic biochemistry and metabolic outcome in terms of endocrine effects is the same.

A

b.Phytoestrogens have comparatively shorter half-lives than synthetic xenoestrogens such as PCBS and DDT

46
Q

This endocrine disrupter is structurally similar to thyroid hormone and can cause dysfunction because of this:
a.PCBs
b.DDT
c.DES
d.PAHs

A

a.PCBs

47
Q

Which of the following supplements may help support glutathione production?
a.Fiber
b.Vit. C
c.Zinc
d.Magnesium
e.All of the above

A

a.Fiber

48
Q

Jaime is a 27 y.o. female with chronic fatigue. She has a history of multiple occupational chemical exposures through her job as an industrial painter, and she also reports chronic splenic enlargement after mononucleosis infection 3 years ago. You are devising a detoxification support protocol for her that includes a lymphagogue to target the splenic enlargement. Which of the following herbs has the highest tissue specificity for the spleen?
a.Gallium aparine - Cleavers
b.Ceanothus americanus – Red Root
c.Calendula officinalis – Calendula
d.Echinacea purpurea – Echinacea

A

b.Ceanothus americanus – Red Root

49
Q

Which of the following is a hepatic herb that is used specifically to enhance glutathione and protect hepatocytes from oxidative damage?
a.Silybum marianum – Milk Thistle Seed
b.Avena sativa – Oatstraw
c. Gallium aparine – Cleavers
d.Echinacea purpurea – Echinacea

A

a.Silybum marianum – Milk Thistle Seed

50
Q

In order to target the kidney as an emunctory, which of the following herbs would be the best choice due to its nourishing and diuretic effects?
a.Rheum palmatum – Rhubarb Root
b.Urtica dioica – Nettle Leaf
c.Mahonia spp. – Oregon Grape Root Bark
d.Cassia senna – Senna

A

b.Urtica dioica – Nettle Leaf

Environmental Medicine (2 decks)

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