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Environmental Medicine > Final Exam > Flashcards

Final Exam Flashcards

1
Q

When you think benzene exposure, which condition do you think of MC?

A

Leukemia

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2
Q

How are we exposed to VOCs (3)?

A

dermal
inhalation
ingestion

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3
Q

What main systems are affected by VOC exposure (3)?

A

neurologic
immune
hematologic (thrombocytopenia, leukemia)

  • these are oncogenic compounds, usually
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4
Q

Which compound are huffers after?

A

Toluene

  • also known as methyl benzene
  • smell of paint thinner
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5
Q

What compound is present in dry-cleaned clothing?

A

tetracholorethylene or PERCs

cause

  • developmental
  • neurological and
  • respiratory effects
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6
Q

histology lab uses which compound for tissue processing? what effect does this compound cause and why is it concerning?

A

Xylene

  • dimethylbenzene
  • CNS depressant
  • can penetrate most clothing
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7
Q

What compound is found commonly in chloroseptic and carmex?

A

phenol

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8
Q

Which condition is pathognomonic for asbestos?

A

Mesothelioma

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9
Q

What is the metabolite of nicotine?

A

cotinine

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10
Q

What is the major source of new car smell?

A

poly vinyl chloride

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11
Q

What does PAH stand for? And where does it come from?

A

Polycyclic aromatic hydrocarbon

- byproduct of burning

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12
Q

What are high and low molecular weight examples of PAH and where are they found?

A

LMW - naphthalene (found in mothballs)

HMW - benzo-a-pyrine (charred, grilled foods and tobacco smoke)

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13
Q

what compound is used a plasticizer and is easily leached?

A

phthalates

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14
Q

What compound can you find in metal cans, plastic or plastic wrap? It increases risk for (3)?

A

BPA

  • xenoestrogen
  • increases risk for diabetes, heart and liver problems
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15
Q

What are the 6 criteria for air pollutants?

A
  • Carbon monoxide
  • nitrogen oxide
  • sulfur dioxide
  • lead
  • ground level ozone
  • particulate matter
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16
Q

What is a xenobiotic?

A

anything that is foreign to the body

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17
Q

what are the primary routes of excreting environmental contaminants? (3)

A

Biliary
Urinary
Respiratory

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18
Q

What is the predominant CYP in the body?

A

3A4

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19
Q

Generally speaking, is fasting a good idea when considering environmental medicine? Why or why not?

A

No, biotransformation requires energy and it can only be spared at the expense of GLUCONEOGENESIS*

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20
Q

what is the definition of a fossil fuel?

A

when layers of buried plant and animal matter is exposed to heat and pressure over thousands of years

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21
Q

What heavy metal is common in shellfish and the reason we ask patients to avoid eating this food prior to testing.

A

arsenic

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22
Q

Which two pollutants combine to form ground level ozone?

A

VOC

Nitrogen oxide

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23
Q

What is the primary cause of acid rain? What is the pH of acid rain?

A

nitrogen and sulfur oxides combing with water
pH < 5.6 *

  • caused by fossil fuel emissions
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24
Q

what is NOT included, when considering environmental medicine?

A

microbiology

otherwise, we consider: air pollution, heavy metal exposure, toxic chemical exposure and mold

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25
Q

What does ecology stand for?

A

the study of relationships between organisms and their environments

  • for us to be healthy, the environment must be healthy
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26
Q

What are the common patient demographics (3) of multiple chemical sensitivity?

A

upper SES (85%)
caucasian
middle age female

-often found as co-morbidity to fatigue and mental health conditions

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27
Q

What are the three most common types of occupational cancers?

A

lung
bladder
mesothelioma

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28
Q

hair stylists are at high risk of exposure to this chemical marketed as “keratin-based” hair smoothing products?

A

formaldehyde

- some say formaldehyde free or dissolving formaldehyde (methylene glycol) or can be released during heating

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29
Q

At high levels, this compound can cause parkinsonism symptoms and is a higher exposure risk for welders

A

manganese

- parkinsonism sis called MANGANISM when at high levels

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30
Q

These release a small amount of mercury into the environment when broken

A

Compact Fluorescent Lightbulbs (CFL)

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31
Q

What should we be recommending to patients regarding their windows?

A

keep them open as much as possible

  • maintains moderate humidity and temperature
  • lets in some fresh air!
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32
Q

What does PTFE stand for and where can you find it?

A

polytetrafluoroethylene (PTFE)

  • found in TEFLON cookware
  • can cause PTFE toxicosis

when tested in birds with high respiratory efficiency, killed all 7 recently hatched chickens after heat lamp coated with PTFE exposure

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33
Q

How do organophosphates work in the body? What clinical picture do they create?

A

acetylcholinesterase inhibitors
- induce neurotoxicity

clinically:
- fatigue, HA, brain fog, slow response time, mm weakness

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34
Q

what can you replace mothballs with that work just as well?

A

cedar chips

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35
Q

is indoor air quality better or worse than outdoor air quality?

A

indoor air is 2-5x worse than outdoor

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36
Q

this compound has mostly resp. and mucous membrane health effects to the URT but not LRT because solubility prevents access to LRT - what compound is this?

A

Formaldehyde

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37
Q

What are the VOCs to be known? (6)

A 
Benzene
Formaldehyde
Phenol
Toluene
Vinyl Chloride/PVC
Xylene
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38
Q

this compound is a byproduct of volcanoes, forest fires, carbon combustion as well as glues and paints?

A

benzene

- leukemia (cause cells not to work effectively)

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39
Q

this compound is 25x more reactive than benzene

A

methyl benzene otherwise known as:

TOLUENE

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40
Q

what is the primary target for toxicity in both acute and chronic toluene exposure?

A

CNS**

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41
Q

What is the Dx criteria for multiple chemical sensitivity

A
  • Reproducible Sx
  • Condition Persisted
  • Low exposure leads to sx
  • Sx improve when chemical removed
  • Sx involve multiple organ systems
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42
Q

Difference between sick-building syndrome and building related illness

A

Sick building:
sx of ill health seem linked to a building but no specific cause is identified

Building related illness:
recognized diseases caused by being in a building

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43
Q

Main chemical in Brazilian Blow-Outs

A

Formaldehyde

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44
Q

What are the health effects of the natural gas exposure see on blood work?

A

High RBC, Hct, Hgb, and platelets
Low WBC.
(found after increased exposure to hydrogen sulfide in Iranian study)

Respiratory sx in people who use gas appliances

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45
Q

What can you potentially be exposed to if a Compact Fluorescent Bulb Breaks?

A

Mercury

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46
Q

What is found in Teflon Cookware?

A

Polytetrafluorethylene (PTFE)

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47
Q

What is a Maximum Residue Limit (MRL)? What is the MC agent?

A

the limit that the EPA has set for how much pesticide can remain on food
MC - organophosphates

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48
Q

What three chemicals are found in Fabric Softeners?

A
  • Quaternary Ammonium Compounds
  • Phthlates
  • Synthetic Musks
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49
Q

What chemical is found in dry cleaned clothes?

A
  • Tetrachloroethylene (PERC)

- a type of VOC

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50
Q

What is the concerning additive found in Child Vaccines?

A

Aluminum

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51
Q

What does OSHA stand for?

A

Occupational Safety and Health Administration

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52
Q

What does MSDS Stand for

A

Material Safety Data Sheet

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53
Q

What is the Fourth National Report on Human Exposure to Environmental Chemicals?

A
  • CDC report using data from NHANES to assess levels of environmental chemicals in a U.S. subsample
  • Utilizes blood and urinary markers
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54
Q

Main System Affected by VOC

A
  • Hematological
  • Nervous
  • Immune System
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55
Q

What are phenols produced from

A
  • Petroleum
  • used in the conversion to precursors of plastics
  • used in plywood, construction, automotive and appliance industries
  • Precursor to many drugs
  • Oral anesthetic in Chloraseptic and Carmex but considered to be quite toxic via oral exposure
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56
Q

Where do you find formaldehyde?

A
  • Adhesives
  • Glues and Dyes
  • Pressed Wood Products
  • Carpet
  • Particle board
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57
Q

What is the main health effect of formaldehyde?

A

attacks respiratory tract and mucous membranes

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58
Q

Where do you find Vinyl Chloride?

A
  • New car smell
  • Pipes
  • Insulation
  • Siding
  • Shower curtains
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59
Q

Which VOC causes hepatic angioscarcoma?

A

Vinyl Chloride

other diseases:

  • raynaud’s
  • acroosteolysis
  • Scleroderma-like skin changes
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60
Q

What are the two types of polycyclic aromatic hydrocarbons (PAH)

A
  • LMW/Naphthalene

- HMW/Benzo(a)pyrene

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61
Q

What was the first carcinogen discovered

A

Benzo(a)pyrene

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62
Q

Heterocyclic Amines are formed by what?

A

burning at high temperatures

ex: Benzo(a)pyrene

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63
Q

What are some prevention strategies to protect against Polycyclic Aromatic Hydrocarbons (PAH)

A
  • Tobacco cessation/non-grilled meat
  • Brassicas
  • Antioxidants
  • Marinade in Acidic base
64
Q

What metabolite can you test for to measure second hand smoke exposure?

A

Cotinine

65
Q

Where is asbestos found?

WHAT IS IT?

A
  • Fire proofing
  • Insulation
  • Friction products
  • Tile

component of PM 10 and 2.5 (PARTICULATE MATTER)

66
Q

What are 3 health effects of asbestos

A
  • Asbestosis
  • Mesothelioma
  • Lung Cancer
67
Q

What are the safest numbers of plastic

A

2
4
- no leeching, no detection in humans

68
Q

What are the just ok plastics?

A

1
5
- some leeching, no detected health effects

69
Q

What are the un-safe plastic?

A

3
6
7
- known leeching, known health effects*

70
Q

Polyvinyl Chloride is what number plastic?

Is it safe? Where is it found, medically?

A

3

Not safe
- significantly increases risk of CV and nervous disease*

-found in IV bags and tubing

71
Q

What number plastic is in trans-vaginal mesh and diapers?

A

5

polypropylene

72
Q

3 facts about phthalates

A
  • plasticizer
  • leeches easily
  • causes endocrine disruption
73
Q

What are the health effects of Polystyrene: acute and chronic?

A
  • acute - RESPIRATORY - effects mucous membranes and leads to irritation
  • chronic - NEURAL TOXIC - dizziness, fatigue, n/v
74
Q

2 facts about Bisphenol A (BPA)

A
  • Used in food packaging, metal can coating

- Endocrine disruptor

75
Q

What species is black mold?

A

Stachybotrys chartarum

76
Q

What is the AQI?

A

Air Quality Index

77
Q

What are 3 MAJOR sources of air pollution?

A
  • power plants
  • refineries
  • transportation
78
Q

What are 3 smaller sources of air pollution?

A
  • Nail salons
  • Dry cleaner
  • Autobody shops
79
Q

How is particulate matter classified?

A

PM10: all particles < or = 10 microns
-asbestos

PM2.5: fine fraction particles

  • asbestos
  • haze

PM 1.0-2.5: coarse fine fraction particles

Ultrafine: all particles <0.1 microns

80
Q

What is smog and what is the main component?

A

Mixture of air pollutants and fine particles

Components:

  • Ground level ozone (MAIN COMPONENT)
  • Nitrogen oxide
  • Volatile Organic Compounds
  • Sulfur Dioxide
  • particulate matter
81
Q

What are the health effects and symptoms of carbon monoxide poisioning

A

-RBC pick up CO quicker than O2 > tissue necrosis > death

-SX: HA, dizziness, weakness, N/V, chest pain, confusion
At high levels - LOC and death

82
Q

What is the main cause of haze?

A

PM 2.5, fine fraction particles

83
Q

What is the primary cause of acid rain?

A

Sulfur dioxide

84
Q

What are Chlorofluorcarbons (CFC)

A
  • Compound consisting of chlorine, fluorine and carbon

- broken down by strong UV light in stratosphere; releasing Cl, which destroys ozone layer

85
Q

What are 3 uses of Chlorofluorcarbons

A
  • Refrigerants
  • Solvents
  • Foam Blowing Agents

(UV breaks down into Cl, destroying ozone)

86
Q

These were commonly used in the past, but have been removed from the market because of health/environmental effects - what are they?

A

OrganoCHLORINE pesticides

  • DDT
  • Chlordane
  • Dieldrin
  • Heptochlor
87
Q

Two types of acetylcholinesterase inhibitors

A

organophosphates (more toxic)

carbamates

88
Q

What does the nitrate in fertilizers do?

A

alter the iron in hemoglobin (ferrous to ferric)

ultimately decreases oxygen carrying capacity of the blood

89
Q

What are the exposure routes of heavy metals?

A
  • Inhalation
  • Ingestion
  • Dermal Absorption
90
Q

What is LD50?

A
  • Median lethal dose; short term acute poisoning
  • Dose given that causes death in 50% of test group

con - wide variability b/w species

91
Q

What are mechanisms of heavy metal toxicity (5)?

A
  • Enzyme/cofactor inhibition or potentiation
  • Disruption of membrane and other transport processes
  • Disrupt mitochondrial function and fatigue
  • Decreased neuronal function and nerve conduction
  • Bind sulfhydrl groups on proteins
92
Q

What are potential sources of lead (4)

A
  • Dust (directly correlated with child lead levels)
  • Paint
  • Soil
  • Pre-1978 homes
93
Q

Where is lead still found (7)

A
  • Computers
  • Solder
  • Pewter
  • Ceramic Glaze
  • Jewlery
  • Auto Batteries
  • Imported or older pre-regulation products
94
Q

Who are at most risk for lead exposure

A

Children and pregnant women’s fetus

95
Q

What are sx of lead toxicity

A
  • Decreased learning and memory
  • Paralysis
  • Encephalopathy
  • Fatigue
  • Difficulty concentrating
  • Irritability
96
Q

What is the best test for lead toxicity screening?

A

Blood

97
Q

Adult level of lead toxicity

A

> 20mcg/dL

98
Q

Child levels of lead toxicity

A

<5mcg/DL

99
Q

What may imaging of lead toxicity reveal?

A
  • Abdomen: lead items swallowed

- Long bones: Lead lines

100
Q

What is the difference between elemental, organic and inorganic mercury.

What are their exposure sources

A

Elemental (inhaled)
- combustion of fossil fuels, solid waste, minning, smelting - source: thermometers, barometer, DENTAL AMALGAMS

Organic (methyl mercury) (GI ABS)

  • bioaccumulates in fish; infant born with cerebral palsy
  • ethyl mercury - Thimerisol*

Inorganic:

  • mercuric chloride, mercuric sulfide,
  • source: batteries, disinfectants, health remedies and skin lightening creams
101
Q

What is bioaccumulation

A

accumulation of substances in an organism

102
Q

What is biomagnification

A

As you move up the food chain, concentration increases

103
Q

What does mercury bind to, in order to cross BBB - why?

A

Methylmercury binds to CYSTEINE molecule
-looks similar to methionine, replaces it in the membrane transport system

Not fat soluble must be transported into brain

104
Q

What is contraindicated when you suspect mercury exposure?

A

NAC because it helps transport mercury into the brain, same mechanism methionine uses

105
Q

What is the predominant use of Cadmium?

What are other sources (3)?

A

Battery Manufacturing (PREDOMINANT)

  • Pigment products
  • Coatings
  • Plastic Stabilizers
106
Q

What increases cadmium absorption?

A

Iron deficiency

107
Q

Where does cadmium accumulate in the body

Why is this Concerning?

A

liver and kidneys

  • irreversible proteinuria, progressive loss in GFR
    concerning because if you chelate a person with elevated cadmium and try to mobilize for excretion, the key route is through the urine so you risk further damage
108
Q

How does cadmium contribute to osteomalacia and/or osteoporosis

Other health effects?

A

Increased urinary excretion of
-calcium
-phosphorus
and decreased hydroxylation of Vit D*

Effects lung: pneumonititis, emphysema, lung ca

109
Q

Where is arsenic found?

A
  • Medicine
  • Cosmetic lighteners
  • Paint pigments
  • Industrial wood preservation
110
Q

Where is arsenic best absorbed in the body?

A

GI tract

111
Q

What is the best test for acute exposure of arsenic

what is another source?

A

Blood is best

Hair - pros and cons

112
Q

What are the PROs of hair testing for heavy metals

A
  • Good for METHYLMERCURY
  • cheap and easy
  • Qualitative screening for exposure

NOT DIAGNOSTIC

113
Q

What are cons for hair testing of heavy metals? Which metals are unreliable with this method (3)?

A
  • Only a screen must be confirmed by blood
  • No indication of net retention
  • Highly vulnerable to external contamination
  • No standard procedure

Not reliable for Hg, Cd, Pb

114
Q

What is depuration

A
  • Action or process of freeing something of impurities

- Removal of xenobiotics by the body

115
Q

What is Detoxification

A

transforming a toxin into a non-toxic substance

116
Q

What is nasal fatigue

A

you ever notice how when you walk into a room with a terrible smell and you stay there long enough you don’t notice it anymore

well your in luck ;)

117
Q

What are the effect of starvation on NADPH and why is starvation not a good idea for biotransformation?

A

NADPH: component of phase 1 detox

Not a good idea for biotransformation because it can only be produced at expense of gluconeogenesis

118
Q

What is the main CYP in the liver

A

CYP-3A4

119
Q

Are heavy metals inducers or inhibitors

A

INHIBITORS

120
Q

What are major TYPES of absorption of biotransformation

A
  • simple diffusion
  • passage through pores
  • specialized transport systems
121
Q

What are major SITES of absorption of biotransformation

A
  • ingestion
  • inhalation
  • dermal absorption
122
Q

Major Storage sinks in the body (4)

A
  • Adipose (pesticides)
  • Bone (Al, Cd, Pb)
  • Liver
  • Kidney
123
Q

What are a couple of our barriers?

A
  • BBB

- Placenta

124
Q

What is the MAJOR idea of biotransformation

A

Conversion of lipid soluble xenobiotic into polar water soluble for excretion

125
Q

Difference between TH1 and TH2 response?

A

THI:
INFECTION (intracellular bacteria and some viruses)
- IL-2, INF gamma, TNF beta, activates macs

TH2:
WORMS (infestation by GI nematodes)
- IL-4,IL-5, Il-10, IL-14, antibody response and eosinophil activation

126
Q

How do toxins cause immune deficits

A
  • Hypersensitivity reaction (includes allergy)

- Autoimmunity

127
Q

DES, DIOXINE and DDT - cause what?

A

Atrophy and/or death of the cells of the thymus gland

128
Q

Polychlorinated Biphenols - PCB exposure make people more prone to what?

A

Allergic reponse

129
Q

PAH exposure does what?

A

Decreases splenic and thymic activity

130
Q

Lead and Mercury lead to an inability to do what?

A

kill candida

131
Q

When may selenium supplementation be protective?

A

cadmium exposure

- can be protective of immune function

132
Q

What is the main problem with Diethylstilbestrol (DES)?

A

reproductive problems in the offspring

133
Q

What is an endocrine disruptor?

A

Xenoestrogen

-Phytoestrogen is specifically extracted from plants

134
Q

What are problems with the ways we study xenoestrogens (2)?

A
  • Mostly Animal Studies

- Differing half-lives

135
Q

What environmental exposures can cause infertility in females? (5)

A
  • PAH
  • Chemotherapeutic agents
  • Solvents
  • BPA
  • Particulate Matter
136
Q

What causes infertility in males? (2)

A
  • Organophosphates

- Heavy metals

137
Q

What compound looks like thyroid?

A

-PCBS

polychlorinated biphenyls

138
Q

What are two exposure history forms

A
  • Crinnion

- ATSDR

139
Q

What tests should be ran before doing any specialty heavy metal testing? (7)

A
  • CBC
  • CMP
  • Lipids
  • Complete UA
  • Urine HCG
  • G6PD
  • TB test
140
Q

Is there a good test to determine ACCURATE body burden of heavy metals?

A

NO

141
Q

Who is a good candidate for stool testing?

A

Pediatric patients

142
Q

Binding affinities for metals with chelating agents in order of greatest to least. Which is chelated best?

A

Hg>Ag>CH-Hg>Cu>Pb>Zn

best for mercury

143
Q

is IV or oral administration of chelating agent best?

A

IV

144
Q

What are the side effects of chelation (3)?

A
  • Decrease in essential minerals
  • Increase liver transaminases
  • Allergic reaction occasionally
145
Q

Why do you need to avoid seafood for a week prior to metal challenge testing?

A

Arsenic and Mercury bioaccumulation

146
Q

How do you test for acetylcholinesterase pesticide exposure?

A

Whole blood AND plasma

Test both

147
Q

What is the theory behind colon hydrotherapy as tx?

A

Increases bile dumping

148
Q

Why low temp sauna

A
  • Increases lipolysis
  • Helpful for excretion of metals in adipose tissue, solvents, plastics and pesticides
  • Tolerate longer times
149
Q

Food and supplements that help increase glutathione (7)

A
  • Cysteins (l-cysteine, NAC)
  • Glutathione
  • Cruciferous veggies
  • Dietary Fiber
  • Undenatured whey protein
  • Dietary Fibers
  • Onions and Garlic
150
Q

List some of the basic supportive supplements (4)

A
  • Vit. C
  • Fiber
  • Selenium
  • Zinc
151
Q

this occupation for mothers increases the risk of their children having cleft palate, what occupation is this?

A

preschool teacher

152
Q

What is being used to replace CFCs (chlorofluorocarbons)?

A

HCFC (hydrochlorofluorocarbons)

- still break down ozone, but not AS extensively

153
Q

what are heavy metal’s main mechanism of detox from the body (i.e. - which phase II mechanism)?

A

glutathione conjugation

154
Q

blood work for lead poisoning will show?

A

microcytic hypochromic anemia with basophilic stippling

155
Q

What homeostasis is disrupted by mercury in the body?

A

calcium homeostasis

156
Q

Whole blood levels for mercury should be?

A

< 5 mcg/dl

Environmental Medicine (1 decks)

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