Mentals Flashcards
Wrist drop, lead colic, lead line and basophilic stippling are manifestation of inorganic lead poisoning or organic lead poisoning?
Inorganic lead toxicity
Lead poisoning has been associated with motor neuropathy or sensory neuropathy ?
Moto neuropathy, with slow motor nerve conduction, wrist drop may occur
Symptoms of severe toxicity including delusions, hallucinations, hyperactivity, and loud shouting and laughing, are manifestations of inorganic lead or organic lead poisoning?
Organic lead such as tetraethyl lead toxicity are related to CNS irritability
Methyl mercury poisoning can lead to?
- Fulminant chemical pneumonitis
- Fetal toxicity
- Speech disturbances
(F.F.S)
Nickel compound can cause ?
- Contact dermatitis
- Adult respiratory distress syndrome
- Lung cancer
(C.A.L)
Agent that causes Upper airway irritation and green tongue?
Vanadium
4 mentals that cause peripheral neuropathies are ?
Lead (motor >sensory)
Arsenic (painful, sensory>motor )
Mercury （+ tremor )
Thallium
LAM Tea
Lead T1/2?
Red cell: 60-90 days
Bones: years
Lead’a biochemical effects?
Enzyme inhibition
Delta-aminolevulinic dehydratase (ALA-D)
Ferrochelatase
Coproporphyrinogen oxidase
Pyrimidine-5-nucleotidase
Enzyme stimulation
Delta-aminolevulinic acid synthetase (ALA-S)
Lead mainly excreted through?
Mainly kidney, small amount through stool
Biological effects of lead in the blood?
Increased: ALA FEP (Free erythrocyte protoporphyrin) ZPP (zinc protoporphyrin ) - Fe++ not inserted into porphyrin ring Basophilic stippling in RBC's
Lead biomonitoring?
Whole Blood lead level ZPP CBC & smear Serum creatinine Urinalysis
Distinguish between iron deficiency and lead poisoning ?
Lead poisoning with increase of both lead and ZPP
Iron deficiency anemia with high ZPP but normal lead level.
ZPP can also increase in old age
Situations that can have increased ZPP/FEP ?
Depends on new RBC synthesis
Except lead poisoning, ZPP/FEP Increase with age and iron deficiency anemia
In lead poisoning, at BLL>35, ZPP /FEP increase as BLL increases
Lead poisoning Sx?
Colic, abd pain, constipation
Motor neuropathy-wrist drop (radial and perineal N.)
Burtonian (blue) gum lines - indicate lead exposure not poisoning
Saturnine gout- urate nephropathy
Fanconi syndrome
Infertility, low birth weight
Health effects of Chromium?
Immune system sensitized Chrome holes (painless skin ulcers) Nasal septal perforation Lung cancer Pulmonary irritant Renal tubular acidosis Hepatic necrosis
Septic ulcer, what could be the causes?
Cocaine use
Chromium
Heath effects of Arsenic (elemental)
Cancer: skin, lung, bladder Cardiomyopathy Hepatic necrosis Renal failure Peripheral vascular changes Peripheral neuropathy - sensory, painful
Heath effect of Arsine Gas?
Garlic odor
AsH3-interaction of arsenic with acids
Made & used in electronic indrustry
Massive intravascular hemolysis
Hemoturia, renal failure
Jaundice, abd pain
Tx: supportive, exchange transfusion
Best indicator of recent As (arsenic) exposure) is?
Urine As
Sx of Chronic As (Arsenic ) intoxication?
Hyper pigmentation
Keratosis /hyper keratosis of palms and soles - Blackfoot disease
Mee’s line on nail
Painful neuropathy
At what year lead was banned from paint?
1976
What year lead was banned from gasoline?
1990
Why lead poisoning increase ZPP?
Lead inhibit enzyme ferrochelatase
Lead T1/2 in the bone?
> 25 years in the bone in chronic lead exposure.
Indication of recent or long term lead exposure with kappa x-Ray fluorescence study?
Trabecular bone, eg. In patella, reflects relatively recent lead(Pb) exposure (T1/2 - years)
Cortical bone, eg. Tibia, reflects long term exposure (T1/2 - decades)
OSHA lead standards?
PEL: 50mcg/m3
Action level: air concentration 30mcg/m3
When air level > action level for >30days/year:
Surveillance program
Initial medical evaluation including:
BLL
ZPP
BLL in General industry, Medical removal at?
BLL= or>50 mcg/dL on repeated teat(mean of 3) or BLL= or >60 mcg/dL once
BLL for Medical removal in construction workers?
BLL= or>50mcg/dL
Follow up after removal from work with high BLL?
Repeat BLL in 2 wks:
when BLL40mcg/dL, medical evaluation q2mos until 2 measurement are<40mcg/dL
Tx of Cadmium acute poisoning?
Chelation with EDTA
BAL is contraindicated
What agent is associated with Garlic odor?
Tellurium
Phosphorus
Selenium
Arsenic
The garlic odor is very hard “To P.A.S”
Visual and auditory hallucinations are classically found in which mental?
Manganese neurotoxicity
Which mental is associated with stomatitis, gingivitis, tremor, and behavior change?
Elementary mercury causes “Mad Hatter Syndrome “
Chronic exposure to organic mercury (Methyl Hg) can produce CNS disfunction associated with Sx of ?
Tremor, paresthesias, dysarthria, ataxia, decreased visual field, deafness, and mental disfunction
Metal fume fever is associated with exposure to?
Zinc oxide
Metal fume fever is an acute, self-limiting syndrome characterized by flu-like symptoms
chromium VI associated with ? Cancer?
Lung cancer
Skin cancer
Types of mercury?
- Elementary Hg (metallic ‘quicksilver’)
- Inorganic (chlorides HgCl2, oxides)
- found in disinfectants
- Organic (methyl- or dimethyl mercury)
- mostly in fish from contaminated ocean and fresh water
- Minamata bay
Tremor, gingivitis, tremor, and behavioral changes, AKA erethism in the “ Mad Hatter Syndrome” is seeing in
Elemental mercury chronic intoxication
Bloody emesis and diarrhea due to GI mucosal necrosis, stomatitis, ATN, what poisoning ?
Inorganic mercury (chloride or oxides of Hg)
Bioaccumulate, GI absorbes 100%, lipid soluble, crosses BBB, placenta and excreted in breast milk
CNS: numbness, ataxia, tremor, construction of visual field, hearing loss, rigidity, spasticity, what agent?
Organic mercury
Minamata Bay and organic mercury toxicity
Japan 1940s -1960s by by eating tunna etc fish
At least 30 cases of prenatal lay exposed infants
- cerebral palsy like Sx
- microencephaly, mental retardation, seizures
- nephrotic syndrome
Heath effects of cadmium?
Anosmia Lung cancer Metal fume fever Prostate and testicular cancer Renal tubular damage -wasting calcium, causes osteomalacia - Itai Itai (weak and deformed Bone, spinal and leg bone pain) Yellow gum lines
Phossy jaw, bone necrosis, which chemical ?
Phosphorus
Skin and lung granulomas after chronic exposure, risk of lung cancer, which mental?
Beryllium toxicity
Cause type IV (delayed or cell- mediated hypersensitivity) reaction
Screening test: specific lymphocyte transformation test (LTT), which mental?
Beryllium
Beryllium - specific lymphocyte transformation test for screen of worked: may not develop disease if +, buy beats job reassignment
Painful erosive ulcer, nasal septal erosion and perforation, what metal ?
Chromium
Hard metal disease, what metal?
Cobalt, causes pulmonary fibrosis, giant-cell pneumonitis
Causes asthma, # 1 mental allergen in general population, which mental?
Nickel
Allergic disorder caused by Nickel is permanent. Removed/avoid contact is the best Tx.
Nickel carbonyl Ni(CO)4 formed in the refining Ni, causes diffused interstitial pneumonitis.
Asthma, rhinitis, urticaria, type I (IgE) sensitizer, what metal?
Platinum
Garlic odor, sweat Inhalation irritant Hair loss Nail discoloration Tooth decay
What metal?
Selenium
Inhalation irritant
ARF
Argyria - irreversible blue- grey skin discoloration
Which metal?
Silver
Tx of Metal Fume Fever?
Caused by zinc
Tx: EDTA, BAL
2nd leading cause of lung cancer?
Radon
Uranium ~> radium ~> radon~> lung cancer
ARF
Hemolytic anemia
Rhabdomyolysis
Myocarditis
What metal?
Uranium
The only metal that can cause Fanconi syndrome after chronic exposure
Cadmium
Garlic breath odor
- Arsenic
- Phosphorus
- Selenium
- Tellurium
Metal that can cause nasal septum perforation?
Chromium
Nickel
