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E2 - Cunningham
Environmental Diseases
53
Medical
Graduate
05/11/2011

Additional Medical Flashcards

 


 

Cards

Term
global burden of disease
-5 preventable causes of child deaths
Definition
undernutrition
ischemic HD and CVD
infxn: Bacteria & Rickettsia (54%), viral (25%)

pneumonia, diarrhea, malaria, measles, perinatal/neonatal (prematurity, neonatal infxns)
Term
emerging infectious diseases
Definition
MRSA
SARS
Dengue fever: a recent increase in incidence
Term
what is the DALY?
Definition
disability-adjusted life year, time based measure that adds the years of life lost to premature mortality with the years lived with illness and disability

used to measure premature mortality and disease morbidity

uniformity for health info in different parts of the world
Term
effects of greenhouse gases & global warming on health
Definition
CVD, cerebrovascular, respiratory diseases

gastroenteritis and infectious disease epidemics (contamination)

vector-borne infectious diseases (West Nile, hantavirus pulmonary syndrome)

malnutrition
Term
Xenobiotics
-characteristics
-metabolism
Definition
lipophilic, penetrate membranes by diffusion, and transported by lipoproteins in blood

phase I: hydrolysis, oxidation, or reduction
-most imp: CYP, catalyze rxns that either detoxify or activate into active compounds that cause cellular injury
phase II make them water-soluble: glucuronidation, sulfation, methylation, conjugation -> readily excreted
both types may produce ROS
Term
Cytochrome P450 enzyme system
-purpose of drug metabolism?
-where do you find CYP?
-potential toxic byproduct?
Definition
The basic purpose of drug metabolism in the body is to make drugs more water soluble and thus more readily excreted in the urine or bile.

One common way of metabolizing drugs involves the alteration of functional groups on the parent molecule (e.g., oxidation) via the cytochrome P450 enzymes.

These enzymes are most predominant in the liver (ER, microsomes) but can also be found in the intestines, lungs and other organs.

may produce ROS
Term
Acetominophen metabolism & toxicity
Definition
95% -
detox by phase II enzymes
excretion in urine as glucuronate or sulfate conjugates
no toxicity

5% -
CYP2E1
NAPQ
-> conjugation with GSH, no toxicity
OR
-> protein adducts, lipid peroxidation
--> liver failure, hepatocyte necrosis
Term
Ozone pollutant; effects in:
-healthy people
-athletes, outdoor workers
-asthmatics
Definition
d/c lung function, i/c airway reactivity, lung inflammation

d/c exercise capacity

i/c hospitalizations
Term
Nitrogen dioxide, effects in:
-health adults
-asthmatics
-children
Definition
i/c airway reactivity

d/c lung function

i/c respiratory infxns
Term
Sulfur dioxide, effects:
-health adults
-people with chronic lung disease
-asthmatics
Definition
i/c respiratory symptoms

i/c mortality

i/c hospitalization
d/c lung function
Term
Acid aerosols, effects in:
-health adults
-children
-asthmatics
Definition
altered mucociliary clearance

i/c respiratory infxns

d/c lung function
i/c hospitalizations
Term
Particulates, effects in:
children
people with chronic lung or heart disease
asthmatics
Definition
i/c respiratory infxn

d/c lung function

excess mortality
i/c attacks
Term
CO poisoning
-describe the gas
-effects on O2 curve
-skin changes
-CNS changes, CV changes
Definition
odorless, colorless, byproduct of combustion
worse with low atm pressure, i/c rain & humidity

CO binds Hb -> COHb
250x stronger than O2 and Hb
left shifts in O2 dissociation curve
*hypoxemia*

"cherry red," bright pink lividity

asphyxia, cell hypoxia

white matter demyelination
liquefactive necrosis in the brain
hypotension
myocardial depression
Term
Formaldehyde
Definition
sealants, furnishings, perm press
old homes - resins

burning, tingling in ENT
chest tightness, wheezing
acute hypersensitivity (esp asthmatics)
toxicity to cilia
mucosal irritation
Term
Radon
Definition
#2 cause of lung cancer (squamous cell carcinoma)
decay of radium (uranium)
high-energy alpha particles
underground miners
i/c risk to smokers 10-20x
Term
"sick building syndrome"
Definition
eye and/or nasopharyngeal irritation
rhinitis or nasal congestion
inability to concentrate
general malaise-complaints

commonality of symptoms
no symptoms when occupants leave the building

humidity makes it worse
low levels of pollutants work synergistically
Term
Lead poisoning
-what kind of anemia do you get?
-kids (what test would you do?)
-adults
-sources of lead in the environment
-how do you measure lead poisoning (blood, urine)
-histologically, what would you see in the peripheral blood? the BM?
Definition
microcytic, hypochromic anemia (lead inhibits d-ALA dehydratase, ferrocheletase)- when poisoning is severe
i/c SI, d/c TIBC

low levels: intellect, behavior, organizational skills
impaired remodeling of calcified cartilage in epiphyses -> i/c radiodensity ("lead lines")
encephalopathy
lead lines in epiphysis and gums
Zinc protoporphyrin (will be high)

blood
CNS toxicity
peripheral motor nerve demyelination
lead colic
renal tubular acidosis
renal failure
gingivodental lead lines

lead paint, lead plumbing, and lead gasoline
batteries, spray painting, tin cans, car radiators

Blood - protoporphyrin IX
Urine - d-ALA

Blood - basophilic stippling
BM - ringed sideroblasts
Term
Mercury poisoning
-clinical manifestations
-problems
-environmental sources
Definition
"Mad Hatter" - tremor, gingivitis, bizarre behavior

-neurotoxicity
-nephrotoxicity

contaminated fish, dental amalgams
Term
Acute arsenic poisoning

Chronic arsenic poisoning
Definition
hemorrhage gastroenteritis
CNS manifestations (paresthesias, numbness, pain)

risk for squamous cell carcinoma of skin and lung
skin changes
abdominal pain
peripheral neuropathy
Term
Cadmium poisoning
-symptoms
-occupational hazards
Definition
COPD (necrosis of alveolar macrophages)
lung carcinoma
renal tubular damage, renal disease
osteoporosis and osteomalacia - calcium loss

mining, electroplating, production of nickel-cadmium batteries, food exposure
Term
Human Diseases Associated with Occupational Exposures
CV system
Definition
Heart disease:
Carbon monoxide
lead solvents
cobalt
cadmium
Term
Human Diseases Associated with Occupational Exposures
Respiratory system
Lung cancer
COPD
hypersensitivity
irritation
fibrosis
no significant disease
Definition
Lung cancer: radon, asbestos, silica, arsenic

COPD: cadmium

Hypersensitivity: beryllium

Irritation: formaldehyde

Fibrosis: Silica, asbestos

NSD: anthracosis (carbon)
Term
Benzene
-associated cancer?
-hematologic problems with chronic exposure?
-two major diseases can result from benzene toxicity
-occupational hazards?
Definition
leukemia (AML)

anemia, leukopenia, thrombocytopenia, pancytopenia
damage the DNA of pluripotent stem cells

aplastic anemia
AML

rubber workers
Term
Human Diseases Associated with Occupational Exposures
GI - liver angiosarcoma
Definition
vinyl chloride
Term
nervous sytem
peripheral neuropathies, ataxic gait
CNS depression
Definition
peripheral neuropathies, ataxic gait: Solvents, acrylamide, methyl chloride, mercury, lead, arsenic, DDT

CNS depression: Chlordane, mercury
Term
Human Diseases Associated with Occupational Exposures
Urinary system
toxicity
bladder cancer
Definition
toxicity: mercury, lead, glycol esthers, solvents
bladder cancer: naphthylamines, 4-aminobiphenyl, benzidine, rubber
Term
Human Diseases Associated with Occupational Exposures
Repro
Male infertility
Female infertility/stillbirths
Definition
Male infertility: Lead, phthalate plasticizers, cadmium

Female infertility/stillbirths: Lead, mercury
Term
Human Diseases Associated with Occupational Exposures
Repro
Male infertility
Female infertility/stillbirths
Definition
Male infertility: Lead, phthalate plasticizers, cadmium

Female infertility/stillbirths: Lead, mercury
Term
Human Diseases Associated with Occupational Exposures
Skin
Folliculitis & acneiform dermatosis
Cancer
Definition
Folliculitis & acneiform dermatosis: dioxins

Cancer: UV radiation
Term
pneumoconiosis
-associated dusts?
-respiratory symptoms
-what other disease is it associated with?
Definition
chronic, neoplastic lung diseases caused by inhalation of mineral dusts
-coal dust
-silica
-asbestos
-beryllium

interstitial; pulmonary fibrosis
calcified parietal pleura

associated with mesothelioma

*honeycomb lung - fibrosis*
Term
Organic solvents
-disease risk?
Definition
chloroform, carbon tetrachloride, benzene

AML
Term
Polycyclic hydrocarbons
Definition
fossil fuel combustion

lung, bladder cancer
Term
Organochlorines
Definition
DDT, PCBs, dioxin

endocrine disruptors, anti-estrogenic/anti-androgenic
Term
Dioxins, PCBs
Definition
folliculitis, chloracne, hyperpigmentation
President of Ukraine
Term
List the carcinogens and noxious chemical in tobacco smoke

most common diseases caused by smoking?

complications for pregnancy?

dangers of 2nd hand?
Definition
carbon monoxide, arsenic, formaldehyde, tar, and nicotine

emphysema, chronic bronchitis, COPD, lung cancer, atherosclerosis, MI, cancers of the lip, mouth, pharynx, esophagus, pancreas, bladder, kidney, cervix
-squamous and small cell carc of the lung, not adenocarcinoma

spontaneous abortion

lung cancer, coronary atherosclerosis, MI, i/c levels of cotinine in the blood
Term
Ethanol metabolism

The effects of the products of ethanol metabolism
Definition
ADH - rate-limiting!! -- cytosol
catalase - 5% -- peroxisome
CYP2E1 - oxidation -- ER/microsome
ALDH - metabolizes acetaldehyde -- mitochondria

Induction of CYP i/c the tolerance for alcohol

Acetaldehyde: oral cancers, acute alcohol effects; ppl with low ALDH can't drink
Increase in the NADPH/NAD ratio: NAD is req'd for fatty acid ox in the liver, def is main cause of fatty liver; also lactic acidosis
Production of ROS: lipid peroxidation of cell membranes
Term
Acute alcoholism
Chronic
Definition
mainly CNS, hepatic steatosis, acute gastritis and ulceration
disordered behavior, respiratory arrest

hepatitis & cirrhosis, portal HTN, hepatocellular carcinoma
gastritis, ulcers, esophageal varices
thiamine def: peripheral neuropathies, Wernicke-Korsakoff syndrome, cerebral atrophy, cerebellar degen, optic neuropathy
alcoholic cardiomyopathy, HTN
acute and chronic pancreatitis
FAS
cancer: oral cavity, esophagus, liver, breasts
malnutrition
Term
Adverse effects of HRT

Risks of OCs
Definition
i/c breast cancer risk
i/c risk of venous thromboembolism

Thromboembolism
CVD (higher in smokers)
Endometrial, ovarian cancers
*Hepatic adenoma*
Term
Adverse effects of anabolic steroids
Definition
inhibits LH, FSH
i/c estrogens
stunted growth, acne, gynecomastia, testicular atrophy, facial hair, menstrual changes
hepatic cholestasis
Term
adverse effects of acetaminophen
Definition
conversion to free radicals in the liver, liver and kidney damage

when taken in larger doses unconj NAPQI accumulates and causes hepatocelluar injury leading to centrilobular necrosis and liver failure
-covalent binding to hepatic proteins
-depletion of GSH
Term
acute aspirin toxicity/overdose

chronic aspirin toxicity
Definition
confusion, respiratory acidosis and metabolic acidosis
alkalosis followed by metabolic acidosis, enhances the formation of non-ionized forms of salicylates, diffuse into brain, nausea, coma

tinnitus, acute erosive gastritis and upper GI bleeding, impaired platelet function due to reduced platelet aggregation
Term
adverse effects of cocaine
Definition
euphoria, seizures, cardiac arrhythmias, perforated nasal septum, and sudden death
fetal hypoxia, spontaneous abortion
Term
adverse effects of heroin
prenatal effects
Definition
cardiopulmonary arrest and sudden death due to overdose; pulmonary foreign body granulomas, infections and pulmonary edema; infections of skin, heart valves, and liver
endocarditis
kidney disease
sudden death

baby born addicted to heroin
Term
List and define (giving appropriate examples of physical injuries) the following
Contusion
Abrasion
Laceration
Incised wound
Puncture wound, penetrating and perforating
Definition
bruise, blunt object, extravasation of blood

scraping/rubbing, removal of superficial skin layer (epidermis)

tear, blunt object, intact bridging BV and jagged, irregular edges, facial fractures

inflicted by a sharp instrument, bridging BV are severed

long, narrow instrument, penetrating (no exit) or perforating (exit wound)
Term
Thermal Injury
First-degree
Second-degree
Third-degree

what can make the prognosis worse?

the clinical significant of a burn injury depends on 4 factors:
Definition
First-degree
Painful, partial-thickness burns (e.g., sunburn)
Heal without scarring

Second-degree
Painful, partial-thickness burns
Damage to entire epidermis
Blister formation / Usually heal without scarring

Third-degree
Painless full-thickness burns
Extensive necrosis of epidermis and adnexa
Scarring is inevitable.

Inhalation injury

Depth of the burns
Percentage of body surface involved
Internal injuries caused by the inhalation of hot and toxic fumes
Promptness and efficacy of therapy, especially fluid and electrolyte management and prevention or control of wound infections
Term
Effects of hyperthermia
-3
Definition
Heat cramps
Painful, involuntary spasmodic contractions of muscle
Due to deficiency of sodium, potassium, and fluids in muscle fibers
May occur in individuals sweating profusely without proper fluid replacement

Heat exhaustion
Significant volume depletion (salt and water depletion) with or without increase in body temperature

Major heat syndrome: heat stroke
> 40° C (>104° F), anhidrosis (absence of sweating), impaired consciousness
Term
Hypothermia
-pathogenesis
-clinical findings
Definition
Frostbite
Pathogenesis
Localized tissue injury caused by direct damage (ice crystallization in cells)
Indirect damage (vasoconstriction, thrombosis)

Clinical findings
Loss of pain sensation or burning/tingling sensation
Discoloration of the skin; waxy appearance; cold to the touch
Left untreated, skin gradually darkens (becomes completely black) and blisters


vasoconstriction and increased viscosity of the blood in the local area cause ischemic injury
Term
Electrical injury
-AC vs DC
-resistance
-what's the most dangerous route for a current to travel?
Definition
AC-tetanic contractions
DC-single shot

Wet skin decreases resistance, which increases current.
Dry skin increases resistance, which decreases current.

Path: current moving from the left arm to the right leg
Most dangerous route, because it affects the heart
Death results from cardiorespiratory arrest
Term
List the tissues/cells that are the most radiosensitive

List the tissue/cells that are least radiosensitive

cancers caused by radiation?
-most frequent?
Definition
high mitotic index
lymphoid tissue, BM, GI mucosa, germinal tissue

bone, brain, muscle, skin

*AML*
Hodgkin's lymphoma
Papillary carcinoma of the thyroid
Term
Non-ionizing radiation

precursor for cancer?

associated cancers
Definition
UVB

actinic (solar) keratosis

basal cell carc: most common UVB cancer
squamous cell carc
malignant melanoma
Term
Asbestos
Definition
Asbestosis - calcified plaques
Mesothelioma - carcinoma that forms along the PLEURA of the lungs
Term
*How does tobacco cause its harmful effects?*
Definition
hydrocarbons, tar, benzopyrene, and nitrosames are carcinogens

CYP and phase II enzymes produce some intermediates that are electrophillic and form DNA adducts

*they cause mutations in oncogenes and tumor suppressor genes such as KRAS and p53 respectively*
Term
*what's the most dangerous sequelae to an electrical burn?*
Definition
V fib
left arm to right leg
can cause other heart arrythmias as well
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