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Unit 9 > Week 1: environmental and Iatrogenic disease > Flashcards

Week 1: environmental and Iatrogenic disease Flashcards

1
Q

What is air pollution?

A

A dynamic and complex chemical mixture of gases and small particulate matter.

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2
Q

What is meant by particulate matter?

A

Particulate matter is made from many different compounds, normally a central carbon core with adsorbed organic chemicals, ions and metals around the outside

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3
Q

What are the different classifications of particulate matter?

A

PM10 diameter less than 10 micrometers
PM2.5 or fine diamter less than 2.5micrometers
PM0.1 or ultrafine - diameter less than 0.1 micrometers

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4
Q

What types of gases are included as air pollution?

A

Carbon monoxide
Sulphur dioxide
Nitrogen oxides
Ammonia
Volatile organic compounds
Ground level ozone

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5
Q

How does areodynamic diameter affect particulate toxicity?

A

Fine and ultrafine PM are considered a greater health hazard
1.Greater number of smaller PM in a given weight of material
2.Their larger SA:V ratio means there is more room to adsorb potentially harmful substances
3.Also small enough to reach the thin respiratory membrane

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6
Q

Why do larger PM not affect the respiratory membrane?

A

Larger than PM2.5 do not reach the alveoli
Are trapped in bronchial mucus and cleared via the mucociliary escalator.

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7
Q

What are the main sources of air pollution emission?

A

Classified as natural e.g wildfires or anthropogenic
PM2.5 - mainly from small combustion such as log burners
NOx - from road transport and power stations
SO2 - power station, small combustion and manufacturing
VOCs - industrial
Ammonia - from agriculture

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8
Q

What are the health effects of SO2?

A

Headache and anxiety
Cardiovascular disease

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9
Q

What health effects can potentially all air pollutions cause?

A

Irritation and inflammation and infection of the lungs
Irritation of eyes, nose and throat

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10
Q

What are the health effects of nitrous oxide gases?

A

Asthma and reduced lung function
Breathing problems
Impacts on the liver, spleen and blood

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11
Q

What are the health effects of particulate matter?

A

Chronic obstructive pulmonary disease
Lung cancer
Impacts of reproductive system
Breathing problems

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12
Q

What are the health effects of ozone?

A

Breathing problems
Cardiovascular diseases

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13
Q

Give a summary of the effects of air pollution on health

A

Indoor and outdoor air pollution is responsible for many premature deaths
Causes problems in the respiratory and cardiovascular system, can also affect unborn foetus and early development.
Is a risk for cancers, endocrine disorders and neurological problems
Is the 2nd leading risk factor for global burden of disease

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14
Q

What was air pollution link during 1952 The Great London SMog?

A

Very cold winter increased brungin of cheap low quality sulphurous coal
Temperature inversion led to pollutions being trapped in the colder air closer to the ground
Pollutants included more sulphurous gas

Results in 3,000 extra deaths in three weeks, alongside increase in hospital (especially respiratory) emission.
Inspiration for the clean air act

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15
Q

What are the trends in air pollution levels since 1970 in the UK?

A

Since 1970 most air pollutatns have decreased - thought to be due to changing technologies and regulations
Recently levels have remained constant or showed small increase
Levels plummeted during COVID-19
Ammonia has only decreased slightly and remains significantly higher than other pollutants.

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16
Q

What causes air pollution levels to fluctuate on a regular basis?

A

Level of emission - demand, rush hour traffic, heating bills in winter
Proximity to source of emission
Ambient conditions - direction of wind, temperature

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17
Q

What people are most vulnerable to the effects of air pollution?

A

Older people (65 plus)
Pregnant women
Children
Cardiovascular disease or respiratory disease sufferers
Communities with poorer air quality such as near roads.

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18
Q

What are the effects of air pollution on pregnancy?

A

Low birth weight

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19
Q

What are the effects of air pollution in children?

A

Asthma
SLower development of lung function
Wheezing and coughs
Start artherosclerosis

20
Q

What are the effects of air pollution in adults?

A

Astham
Coronary heart disease
Stroke
Lung cancer
Chronic obstructive pulmonary disease
Duabetes

21
Q

What are the effects of air pollution on the elderly?

A

Asthma
Accelerated decline in lung function
Lung cancer
Diabetes
Dementia
Cardiovascular risk - heart failure and stroke.

22
Q

What are the short term effects of air pollution?

A

Increase death rate especially for COPD patients
Increased hospitalisation and exacerbation of COPD and asthma symptoms

23
Q

What are the long term effects of air pollution?

A

Decreased lung development in children - more likley to develop asthma
Increased rate of lower respiratory tract infections
Increased lung cancer mortality rate
Increased cardiopulmonary mortality rate

24
Q

What are some recommendations for policies to reduce air pollution?

A

Local planning - clean air zones, keep key buildings away from main roads
Reduce emissions from public transport - change to electric vehicles
Reducing traffic jams - more efficient help
Encourage use of public transport or no CO2 transport
Slowing driving speed and encouraging smooth driving

25
Q

How does the Daily Air Quality Index help people manage their exposure to air pollution?

A

Give regional areas a daily score between 10 and 1 for the severity of air pollution (10 being worst)
Gives advice on who should and what activities to avoid e.g needed inhaler when exercsisgin, reduce outdoor activities.
Based on the predicted levels of PM and air pollution gases.

26
Q

What are some ways that vulnerable individuals should avoid air pollution exposure?

A

Ventilating homes - e.g closing windows that lead onto busy roads
Air cleansers
Planning appropriate times and locations to exercise
Wear face masks
Avoid main roads or polluting industrial areas

27
Q

Define iatrogenic disease?

A

A disease resulting from medical treatment or the actions of health care professionals

28
Q

Why is iatrogenic disease a problem?

A

Preventable cause of illness and mortality
responsible for 10% of UK hospital admissions
Responsible indirectly and directly for patient deaths
Can result in server disability or illness

29
Q

Why are some iatrogenic diseases not erroneous, rather unavoidable?

A

When the side effect or risk from treatment is known, but it is considered a lower risk than the progression of illness/diseases without intervention
For example, chemotherapy side effects are considered less dangerous in most patients than the progression of disease.

30
Q

What are some of the iatrogenic illnesses from chemotherapy?

A

Immunosuppression/ neutropenia***
Hair loss
Intestinal disturbances
aplasitc anaemia
Diabetes Inspidus
infertility etc

31
Q

What is febrile neutropenia/ neutropenic fever?

A

A term used to describe an acquired fever whilst suffering from neutropenia
Increased risks of mortality

32
Q

What are the risk factors for neutropenic fever?

A

Chemotherapy treatment - leading cause
Sepsis
hepatitis
Autoimmune disease
Bone marrow disorders
TB

33
Q

What are the symptoms of neutropenic fever?

A

Fever
Mucositis of the GIT
Abdominal pain
Increased risk of mortality for 6 months following infection
Long term increased risk of infection

34
Q

What is the purpose of the MASCC Risk index?

A

Used to identify patients with neutropenic fever that are high risk and give appropriate intervention.

35
Q

How does neutropenia relate to cancer?

A

Neutropenia hence risk of neutropenic fever is a side effect of chemotherapy
The risk varies by the type and stage of cancer, hence what treatment is given to the patient.
Leukemia is the most common cancer type amongst patients requiring treatment for neutropenic fever.

36
Q

What are the current costs of neutropenic fever in cancer patients?

A

$2.3 billion for hospitalised adults in US
$27.5 million for hospitalised children in US - 27% of all cancer related costs for children
Extends hospital stay and increased risk of rehospitalisation or emergency room treatment

37
Q

What is the current therapy neutropenia?

A

G-CSF - increase production of neutrophils from stem cells
GM-CSF - accelerate the production of neutrophils
Neupogen - treatment including G-CSF, aims to start the regeneration of neutrophils earlier, so lowest level of neutrophils occurs earlier and at a lower level, recruits stem cells.
- May also be given to a donor before bone marrow transplant to increase the level of stem cells in the donation

38
Q

What is the cost of therapy for neutropenia?

A

As a biological therapy is very expenisve
Requires over a week stay in hospital
Considered too expensive to be given to humans preventativly (before neutropenic fever) and is not given to animals at all.

39
Q

What types of errors lead to iatrogenic disease?

A

Errors in diagnosis
Improper performance
Failure to supervise or monitor
Failure to recognise a complication of treatment
Medication errors

40
Q

What is a diagnosist error?

A

Failure in diagnosis process that can lead to iatrogenic disease, such as delayed diagnosis, wrong diagnosis, no diagnosis.

41
Q

What are some consequences of errors in diagnosis?

A

Over screening - may be invasive
Over treatment
Incorrect treatment
Lack of correct treatment
Can lead to physical or psychological harm to patient.

42
Q

What actions are considered improper performace and can lead to iatrogenic disease?

A

Surgical wrongs - wrong site, wrong implant, retained foreign objects, damaging other structures or anaesthetic problems
Failure to obtain informed consent
Poor technique - vicious with endoscopy
Poor communication between members of the healthcare team

43
Q

What is considered a failure to monitor or supervise? (leading to iatrogenic disease)

A

Many drugs have monitoring requirements
- failure to arrange follow ups
- staff supervising are acting beyond their competence, miss symptoms
- inferior staff are not properly supervised and make incorrect decisions

44
Q

What are some examples of failing to recognise a complication as a cause of iatrogenic disease?

A

Side effects of drugs
Failing to identify medical cause of symptoms
Failure to foresee procedure complication e.g transplant rejection

45
Q

What can go wrong with a prescription to cause iatrogenic disease?

A

Incorrect transcription - misread
Faults in the dosage or frequency of drug
Fault in the drug name - wrong drug
Failure to check for interactions or contraindications
Failure to discontinue if possible

46
Q

What can go wrong with adminstering a drug to cause iatrogenic disease?

A

Given at the wrong rate
Given the wrong dose
Given at wrong time
Wrong technique
Deteriorated drug
Misread prescription

47
Q

As a doctor what are your responsibilities if you cause a medical error?

A

Must be disclosed and investigated
Follow formal mechanisms of recording errors as set by Health care Trusts and Clinical Commissioning Groups

Unit 9 (15 decks)

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