Environmental And Nutritional Diseases

Front 1

Environmental diseases refer to conditions caused by exposure to what?

Back 1

- Chemical or physical agents (workplace & personal environment)
- Includes nutritional diseases

Front 2

What are the most current trends in morbidity and mortality?

Back 2

- Malnutrition or undernutrition
- Ischemic heart disease
- Cerebrovascular disease
- Infectious diseases in developing countries
- Childhood diseases
- Emerging new infectious diseases

Front 3

Toxicity is defined as...

Back 3

The science of poisons.

Front 4

With most poisons, what is the most important consideration?

Back 4

Dosage

Front 5

Pollutants are present where? How are they absorbed?

Back 5

- Within the air, water and soil
- Through the lungs, gastrointestinal tract and skin.

Front 6

Generally how do pollutants act on the body?

Back 6

Either directly at the site of absorption
or
Travel through the blood to organs for storage or metabolism

Front 7

_____ can be metabolized to nontoxic metabolites and eliminated from the body. What is this called?

Back 7

Xenobiotics
Detoxification

Front 8

What is the harmful effects of xenobiotics?

Back 8

Formation of reactive metabolites that are toxic to cellular components

Front 9

Where does the metabolism of toxic components occur?
What does it involve?

Back 9

- Liver
- Cytochrome p-450 enzyme in the smooth ER

Front 10

What are the air pollutants?

Back 10

H2S, SO2, NO, NO2, Cl2, NH4 and ozone

Front 11

What diseases do air pollutants lead to?

Back 11

Pulmonary inflammation resulting in:
Edema
Bronchiolitis
Pneumonia

Front 12

What are considered inhaled pollutants?

Back 12

- Dust and carbon particles (anthracosis/pneumoconiosis – especially coal miners)
- Silicosis (miners, sandblasters, etc.)
- Asbestosis (asbestos manufacturing, demolition, etc.)

Front 13

What can dust or carbon particles lead to?

Back 13

Pulmonary fibrosis and cor pulmonale

Front 14

What can silicosis lead to?

Back 14

Diffuse nodular pulmonary fibrosis

Front 15

What can asbestos lead to?

Back 15

Pulmonary fibrosis and malignant mesothelioma formation

Front 16

Heavy metal poisons include...

Back 16

Lead
Mercury
Arsenic
Cadmium

Front 17

Lead can cause what?

Back 17

- CNS disturbances
- Peripheral neuropathy
- Interference with remodeling of cartilage and trabecular bone
- Inhibition of enzyme activity that leads to microcytic, hypochromic anemia.

Front 18

What leads to:
- Cerebral palsy
- Deafness
- Blindness
- Mental retardation
- CNS defects, esp. in children.

Back 18

Mercury toxicity

Front 19

What is characterized by:
- Interferes with mitochondrial oxidative phosphorylation resulting acutely to cardiovascular, gastrointestinal and CNS disturbances
- Chronic exposure may lead to increased risk of cancer development and skin hyperpigmentation and hyperkeratosis.

Back 19

Arsenic

Front 20

Cadmium can lead to what?

Back 20

- Obstructive lung disease
- Renal failure
- Skeletal abnormalities

Front 21

What are the effects of tobacco usage?

Back 21

- Increased risk for cancer (oral, laryngeal, esophageal, pulmonary, pancreatic and bladder)
- COPD and emphysema
- Chronic gastric peptic ulceration
- Systemic and coronary atherosclerosis

Front 22

Maternal smoking increases the risk of what?

Back 22

Spontaneous abortions and preterm births.

Front 23

Tobacco is the most common exogenous cause of what?

Back 23

Human cancers and the most preventable of human deaths

Front 24

What are the acute effects of alcohol consumption?

Back 24

- CNS depression
- Acute fatty liver

Front 25

What are the chronic effects of alcohol consumption? (11)

Back 25

- Liver cirrhosis and liver cancer
- Acute gastritis
- Portal hypertension
- Esophageal varices
- Thiamine (B12) deficiency
- Alcoholic cardiomyopathy
- Hypertension
- Acute and chronic pancreatitis
- Fetal alcohol syndrome
- Increased incidence of some cancers
- Malnutrition due to empty calories

Front 26

What is most of the alcohol in the blood transformed into?

Back 26

Biotransformed to acetaldehyde in the liver.

Front 27

What may be toxic and responsible for some of the acute alcohol effects and oral cancers?

Back 27

Acetaldehyde

Front 28

Alcohol metabolism produces what?

Back 28

ROS and lipid peroxidation of cell membranes.

Front 29

What are the therapeutic drugs that can lead to adverse drug reactions?

Back 29

- Hormonal replacement therapy
- Oral contraceptives
- Anabolic steroids
- Acetaminophen
- Aspirin

Front 30

_____ along with _____ therapy may increase the risk for breast cancer and venous thromboembolism.

Back 30

Estrogens, progesterone

Front 31

Oral contraceptives increase the risk of ...

Back 31

- Venous thrombosis and thromboembolism
- Cardiovascular disease
- Hepatic adenoma formation

Front 32

What has the following negative affects?
- Stunt growth in children
- Cause acne
- Gynecomastia and testicular atrophy in males
- Growth of facial hair and menstrual changes in women
- Premature heart attacks
- Hepatic cholestasis

Back 32

Anabolic steroids

Front 33

Acetaminophen toxicity can result in...

Back 33

Centrilobular liver necrosis and hepatic failure.

Front 34

What are the negative effects of aspirin?

Back 34

Blocks cyclooxygenase pathway (bleeding disease and gastric ulceration)

Front 35

What are the nontherapeutic drugs that lead to injury and abuse?

Back 35

Primarily includes:
cocaine, heroin, amphetamines, and marijuana.

Front 36

What are the damaging effects of nontherapeutic drugs?

Back 36

Death due to overdose and IV drug-related conditions (vegetative valvular endocorditis, sepsis, etc.).

Front 37

Results when sufficient outside force is applied to body tissues to disrupt their structure or function.

Back 37

Mechanical trauma

Front 38

How is the type of physical injury determined?

Back 38

- Amount of force
- Rate at which it is applied
- Surface area of the tissues involved
- Type of tissue

Front 39

Mechanical injury produces wounds such as ...

Back 39

- Abrasion
- Contusion
- Laceration
- Incision
- Avulsion
- Puncture Wounds

Front 40

Loss of superficial cells as the result of friction or crushing

Back 40

Abrasions

Front 41

Disruption of blood vessels produced by blunt force

Back 41

Contusions

Front 42

The tearing of tissue resulting from excessive stretching

Back 42

Lacerations

Front 43

Cuts produced by a sharp instrument

Back 43

Incisions

Front 44

Tearing away of body parts

Back 44

Avulsions

Front 45

Piercing or penetration of tissue caused by a sharp object or instrument

Back 45

Puncture wounds

Front 46

In general, cells with a _____ natural turnover rate are most radioresistant while those with a _____ natural turnover are most radiosensitive.

Back 46

low, high

Front 47

What influences the effect of radiation?

Back 47

- Type of radiation
- Dosage
- Mode of delivery
- Oxygenation of the tissues

Front 48

High levels of ionizing radiation will produce....

Back 48

Acute cell death

Front 49

Low levels of ionizing radiation may lead to what?

Back 49

Genetic mutations
Loss of reproductive ability without causing overt cell death

Front 50

How does ionizing radiation cause cellular injury?

Back 50

- Transfer of radiant energy (radiolysis of intracellular water, making free radicals /hydroxyl ions).
- Disrupts molecular bonding in DNA (single or double-stranded breaks)

Front 51

What can the damage from ionizing radiation lead to?

Back 51

- Mutations
- Inhibit cell division
- Alter the ability to divide
- Effect normal homeostasis by interfering w/ regulation and/or structure of protein products of the genes

Front 52

It is not surprising that _____ alterations of the nucleus (giant cells, bizarre pleomorphism, etc) may become apparent by _____ _____ and mimic changes seen in _____ _____.

Back 52

morphologic, light microscopy, neoplastic cells

Front 53

What are the acute cellular changes of ionizing radiation?

Back 53

Depending on the tissues:
- Acute dermatitis
- Pneumonitis
- Enteritis, etc.

Front 54

What are the chronic cellular changes of ionizing radiation?

Back 54

Development of neoplasms (primarily sarcomas) even after an interval of ten years or more.

Front 55

What are the acute vascular changes of ionizing radiation?

Back 55

- Vessels may dilate, thrombose, or rupture

Front 56

What are the chronic vascular changes of ionizing radiation?

Back 56

Interstitial fibrosis of various tissues

Front 57

How does chronic ionizing radiation lead to ischemic vessels?

Back 57

Over time reactive endothelial cell proliferation & mural scarring may lead to narrowing or even obliteration of the vessel lumens causing tissue ischemia.

Front 58

Radiation injury to hematopoietic precursors results in development of a pancytopenia within a few weeks of exposure. Bleeding and infection are the major complications.
How many rads?

Back 58

Hematopoietic Syndrome
200-500 rads

Front 59

Destruction of the gastrointestinal epithelium results in the development of nausea, vomiting, and severe diarrhea within several days of exposure. This may lead to severe metabolic disturbances, vascular collapse, sepsis, and death.
How many rads?

Back 59

GI Syndrome
500-1000 rads

Front 60

Vascular endothelial damage results in cerebral edema, convulsions, coma, and death within hours of exposure.
How many rads?

Back 60

Cerebral Syndrome
>2500 rads

Front 61

These penetrate the skin only superficially and induce injury after a latent period of several hours (sunburn).

Back 61

Ultraviolet Rays

Front 62

What are the systemic symptoms of ultraviolet rays?

Back 62

Fever
Headache
Nausea and vomiting.

Front 63

What can repeated exposure of ultraviolet rays lead to?

Back 63

- Progressive pigmentation
- Skin thickening
- Increased risk of developing cutaneous malignancies

Front 64

These can produce heat and, in overdoses, may cause thermal burns, edema, and vesiculation of the skin

Back 64

Infrared Rays

Front 65

These can also release energy in the form of heat.

Back 65

Microwaves

Front 66

What are the temperature extremes that lead to cell injury and/or death?

Back 66

< 22°C (71.6°F) or > 42°C (107.6°F). Severity of injury related to duration of exposure.

Front 67

What is the immediate effect of localized hypothermia?

Back 67

- Damages vascular endothelium
- Increases vascular permeability leading to edema and blister formation (frostbite).

Front 68

What causes extensive ischemic injury due to poor blood perfusion of surrounding tissue?

Back 68

Prolonged localized hypothermia

Front 69

In addition to vascular damage what does freezing of tissue damage locally?

Back 69

- Interferes with ionic concentrations due to crystallization of intracellular water
- Denatures proteins
- Physically disrupts cell membranes leading to cell death.

Front 70

When do the effects of vascular damage appear in frozen tissue?

Back 70

May not appear until the tissue is reperfused as it thaws.

Front 71

What are the effects of systemic hypothermia?

Back 71

- Decrease in metabolic activity
- Mental confusion
- Lethargy
- Coma

Front 72

What are the major causes of death that stems from systemic hypothermia?

Back 72

- Vascular collapse
- Cardiac arrhythmias

Front 73

What does localized hyperthermia (burns) lead to?

Back 73

- Vasodilation
- Increased vascular permeability (edema and blister)

Front 74

What will occur with severe localized hyperthermia?

Back 74

Nuclear swelling
Disruption of nuclear membranes
Coagulation of intracellular proteins.

Front 75

The clinical significance of cutaneous burns depends on the _____ and the _____ _____ covered

Back 75

depth, surface area

Front 76

What is the clinical significance of third degree burns?

Back 76

Full thickness burns
- Most severe
- Destroy the epidermis & underlying dermis and dermal appendages
- Prevents reepithelialization

Front 77

What is the clinical significance of first and second degree burns?

Back 77

(Partial thickness burns)
Leaves basal epithelium or some of the dermal appendages intact
Allows epithelial cell regeneration

Front 78

What are some complications that come from burns?

Back 78

- Shock (loss of circulating blood volume)
- Hemoconcentration
- Electrolyte imbalance
- Infection (responsible for over 50% of deaths).

Front 79

What causes systemic hyperthermia?

Back 79

- Increased heat production
- Decreased heat loss
- Alteration of the "set point" of the hypothalamic regulatory centers

Front 80

Compensatory peripheral vasodilation leads to...

Back 80

Pooling of blood and hypotension

Front 81

Severe fluid and electrolyte imbalances which could induce shock can arise from what?

Back 81

Excessive sweating

Front 82

How can electricity cause cell injury or death?

Back 82

Interruption of neural transmissions of the cardiac conduction/respiratory control systems
or
By the generation of heat

Front 83

What occurs when the body completes a circuit between two conductors?

Back 83

Electrothermal injury

Front 84

What does the outcome of electrothermal injury depend on?

Back 84

- Conduction path through the body (most direct path between contact points)
- Current
- Duration of flow
- Amperage
- Electrical resistance of the tissue in that conduction path.

Front 85

Tissues with relatively _____ water content (primarily _____) have _____ resistance and are most likely to be affected by what?

Back 85

low, skin, increased
production of heat (electrical burns)

Front 86

True/False: Electrocution burns are the only morphological evidence in fatal electrocutions.

Back 86

True

Front 87

What does the degree of injury depend on with respect to pressure change?

Back 87

Magnitude
Direction
Rate
Duration

Front 88

In general, _____ pressure is tolerated better than _____ pressure

Back 88

increased, decreased

Front 89

What does a sudden decrease in pressure lead to?

Back 89

Produces free gas bubbles as nitrogen is released from solution in the plasma.
These act as emboli with variable clinical results (Caisson disease)

Front 90

The decreased pressure of high altitude leads to...

Back 90

Hypoxia and alteration of vascular permeability
Can lead to death from pulmonary and/or cerebral edema.

Front 91

Slow _____ in pressure are tolerated fairly well, but _____ _____ in pressure (_____ _____) may produce considerable damage due to the variable densities and compressibility of tissues.

Back 91

increases, rapid increases, blast injuries

Front 92

What does malnutrition refer to?
What does malnutrition result from?

Back 92

- Refers to protein energy malnutrition (PEM)
- Results from inadequate intake of proteins and calories
or
deficiencies in digestion
or
absorption of proteins, resulting in the loss of fat and muscle tissue weight loss

Front 93

What is characterized by?
- poverty
- acute and chronic infections
- illness
- chronic alcoholism
- ignorance and failure of diet supplementation
- anorexia nervosa
- bulimia
- self-imposed dietary restriction
- gastrointestinal/malabsorption syndromes

Back 93

Causes of malnutrition

Front 94

What are the clinical symptoms of PEM

Back 94

marasmus and kwashiorkor from a dietary intake of protein and calories inadequate to meet the body’s needs

Front 95

What is marasmus?

Back 95

Emaciated appearance related to marked loss of muscle mass and subcutaneous fat

Front 96

What is kwashiorkor?

Back 96

Characterized by generalized edema seen as ascites and puffiness of the face, hands and legs

Front 97

What are the secondary causes of PEM?

Back 97

Cachexia
Anorexia nervosa
Bulimia

Front 98

What is characterized by
- Patients with AIDS or advanced cancers.
- Extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, and edema

Back 98

Cachexia

Front 99

How does death come about in cachexia?

Back 99

Atrophy of the diaphragm and respiratory muscles

Front 100

Characterized as self-induced starvation with the highest death rate of any psychiatric disorder.

Back 100

Anorexia nervosa

Front 101

What is a condition where an individual binges on food and then induces vomiting.

Back 101

Bulimia

Front 102

What are the two basic types of vitamin deficiencies?

Back 102

Primary (diet origin)
Secondary (disturbances in intestinal absorption).

Front 103

How do Vitamin A deficiencies manifest themselves?

Back 103

- Night blindness
- Keratinization of normally non-keratinizing epithelium, (resp epithelium, sclera, conjunctiva and oral mucous membranes)

Front 104

What are the main functions of Vitamin A?

Back 104

- Maintenance of normal vision
- Cell growth and differentiation
- Resistance to infection.

Front 105

What maintains calcium balance by aiding in the absorption of calcium from the intestine?

Back 105

Vitamin D

Front 106

What are the effects of a Vitamin D deficiency?

Back 106

Rickets in children
Osteomalacia in adults.

Front 107

What happens when a child has rickets?

Back 107

Failure of calcification of cartilage at growing epiphyses.
Cartilage not resorbed producing weak “knobby” bones

Front 108

What happens to the bone in Osteomalacia?

Back 108

Osteoid does not calcify and ultimately much of the bone consists of osteoid that can lead to bone deformities.

Front 109

What is the use for Vitamin C (ascorbic acid)?

Back 109

Needed for synthesis of collagen

Front 110

What occurs when there is a vitamin C deficiency?

Back 110

Scurvy

Front 111

What are the adult manifestations of Vitamin C deficiency?

Back 111

- Swelling and bleeding of the gingiva
- Ecchymoses and petechiae of the skin and mucus membranes.

Front 112

What are the infantile manifestations of vitamin C deficiency?

Back 112

- Subperiosteal hemorrhage
- Bone deformities due to decreased osteoid formation (secondary to defective collagen formation)

Front 113

What is Vitamin K's role and what would a deficiency cause?

Back 113

Functions in blood coagulation and a deficiency results in hemorrhaging

Front 114

What are the different parts to the Vitamin B Complex that could have deficiencies?

Back 114

Thiamine
Riboflavin
Niacin
Pyridoxine
Folic Acid

Front 115

What is the manifestation of a thiamine deficiency?

Back 115

Degeneration of sensory and motor nerves

Front 116

What occurs in a Riboflavin deficiency?

Back 116

Leads to:
- Cheilitis
- Angular cheilosis
- Atrophy of filiform papillae.

Front 117

What deficiency is characterized by diarrhea, dermatitis, dementia and diffuse erythema of the tongue and mucous membranes?

Back 117

Niacin

Front 118

What does Pyridoxine deficiency resemble?
What can explain a recent increase in this deficiency?

Back 118

Pellagra
Use of isoniazid and oral contraceptives

Front 119

What does a folic acid deficiency lead to?

Back 119

Macrocytic anemia and glossitis

Front 120

What can obesity lead to?

Back 120

- Type II diabetes and cardiovascular disease
- Metabolic syndrome
- Non-alcoholic fatty liver disease
- Gallstones
- Small number of cancers may be obesity related (function through the elevated insulin levels)

Front 121

What are these characteristics related to:
- Visceral or intra-abdominal adiposity
- Insulin resistance
- Hyperinsulinemia
- Glucose intolerance
- Hypertension
- Hypertriglyceridemia
- Low HDL cholesterol levels

Back 121

Metabolic syndrome

Front 122

What can non-alcoholic fatty liver disease lead to?

Back 122

Hepatic fibrosis and cirrhosis

Front 123

What are the factors of a diet being related to cancer?

Back 123

- Content of exogenous carcinogens
- Endogenous synthesis of carcinogens from dietary components
- Lack of protective factors such as a high fiber diet
- Diet high in antioxidants

Front 124

What are considered exogenous carcinogens?

Back 124

Aflatoxins, food additives, artificial sweeteners and pesticides

Front 125

What are considered to be endogenously synthesized carcinogens from dietary components?

Back 125

Nitrosamines and nitrosamides

Front 126

What is an example of a lack of protective factors?

Back 126

High animal fat intake combined with low fiber intake increase the incidence of colon cancer

Front 127

What are the antioxidants to be avoided in large quantities?

Back 127

Vitamin C and E, β-carotenes and selenium

Front 128

What is the diet relationship to atherosclerosis?

Back 128

- Ingestion of saturated animal fats and trans fats
- Possibly overeating related to obesity