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128 Cards in this Set

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Environmental diseases refer to conditions caused by exposure to what?
- Chemical or physical agents (workplace & personal environment)
- Includes nutritional diseases
What are the most current trends in morbidity and mortality?
- Malnutrition or undernutrition
- Ischemic heart disease
- Cerebrovascular disease
- Infectious diseases in developing countries
- Childhood diseases
- Emerging new infectious diseases
Toxicity is defined as...
The science of poisons.
With most poisons, what is the most important consideration?
Dosage
Pollutants are present where? How are they absorbed?
- Within the air, water and soil
- Through the lungs, gastrointestinal tract and skin.
Generally how do pollutants act on the body?
Either directly at the site of absorption
or
Travel through the blood to organs for storage or metabolism
_____ can be metabolized to nontoxic metabolites and eliminated from the body. What is this called?
Xenobiotics
Detoxification
What is the harmful effects of xenobiotics?
Formation of reactive metabolites that are toxic to cellular components
Where does the metabolism of toxic components occur?
What does it involve?
- Liver
- Cytochrome p-450 enzyme in the smooth ER
What are the air pollutants?
H2S, SO2, NO, NO2, Cl2, NH4 and ozone
What diseases do air pollutants lead to?
Pulmonary inflammation resulting in:
Edema
Bronchiolitis
Pneumonia
What are considered inhaled pollutants?
- Dust and carbon particles (anthracosis/pneumoconiosis – especially coal miners)
- Silicosis (miners, sandblasters, etc.)
- Asbestosis (asbestos manufacturing, demolition, etc.)
What can dust or carbon particles lead to?
Pulmonary fibrosis and cor pulmonale
What can silicosis lead to?
Diffuse nodular pulmonary fibrosis
What can asbestos lead to?
Pulmonary fibrosis and malignant mesothelioma formation
Heavy metal poisons include...
Lead
Mercury
Arsenic
Cadmium
Lead can cause what?
- CNS disturbances
- Peripheral neuropathy
- Interference with remodeling of cartilage and trabecular bone
- Inhibition of enzyme activity that leads to microcytic, hypochromic anemia.
What leads to:
- Cerebral palsy
- Deafness
- Blindness
- Mental retardation
- CNS defects, esp. in children.
Mercury toxicity
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.
Arsenic
Cadmium can lead to what?
- Obstructive lung disease
- Renal failure
- Skeletal abnormalities
What are the effects of tobacco usage?
- Increased risk for cancer (oral, laryngeal, esophageal, pulmonary, pancreatic and bladder)
- COPD and emphysema
- Chronic gastric peptic ulceration
- Systemic and coronary atherosclerosis
Maternal smoking increases the risk of what?
Spontaneous abortions and preterm births.
Tobacco is the most common exogenous cause of what?
Human cancers and the most preventable of human deaths
What are the acute effects of alcohol consumption?
- CNS depression
- Acute fatty liver
What are the chronic effects of alcohol consumption? (11)
- 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
What is most of the alcohol in the blood transformed into?
Biotransformed to acetaldehyde in the liver.
What may be toxic and responsible for some of the acute alcohol effects and oral cancers?
Acetaldehyde
Alcohol metabolism produces what?
ROS and lipid peroxidation of cell membranes.
What are the therapeutic drugs that can lead to adverse drug reactions?
- Hormonal replacement therapy
- Oral contraceptives
- Anabolic steroids
- Acetaminophen
- Aspirin
_____ along with _____ therapy may increase the risk for breast cancer and venous thromboembolism.
Estrogens, progesterone
Oral contraceptives increase the risk of ...
- Venous thrombosis and thromboembolism
- Cardiovascular disease
- Hepatic adenoma formation
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
Anabolic steroids
Acetaminophen toxicity can result in...
Centrilobular liver necrosis and hepatic failure.
What are the negative effects of aspirin?
Blocks cyclooxygenase pathway (bleeding disease and gastric ulceration)
What are the nontherapeutic drugs that lead to injury and abuse?
Primarily includes:
cocaine, heroin, amphetamines, and marijuana.
What are the damaging effects of nontherapeutic drugs?
Death due to overdose and IV drug-related conditions (vegetative valvular endocorditis, sepsis, etc.).
Results when sufficient outside force is applied to body tissues to disrupt their structure or function.
Mechanical trauma
How is the type of physical injury determined?
- Amount of force
- Rate at which it is applied
- Surface area of the tissues involved
- Type of tissue
Mechanical injury produces wounds such as ...
- Abrasion
- Contusion
- Laceration
- Incision
- Avulsion
- Puncture Wounds
Loss of superficial cells as the result of friction or crushing
Abrasions
Disruption of blood vessels produced by blunt force
Contusions
The tearing of tissue resulting from excessive stretching
Lacerations
Cuts produced by a sharp instrument
Incisions
Tearing away of body parts
Avulsions
Piercing or penetration of tissue caused by a sharp object or instrument
Puncture wounds
In general, cells with a _____ natural turnover rate are most radioresistant while those with a _____ natural turnover are most radiosensitive.
low, high
What influences the effect of radiation?
- Type of radiation
- Dosage
- Mode of delivery
- Oxygenation of the tissues
High levels of ionizing radiation will produce....
Acute cell death
Low levels of ionizing radiation may lead to what?
Genetic mutations
Loss of reproductive ability without causing overt cell death
How does ionizing radiation cause cellular injury?
- Transfer of radiant energy (radiolysis of intracellular water, making free radicals /hydroxyl ions).
- Disrupts molecular bonding in DNA (single or double-stranded breaks)
What can the damage from ionizing radiation lead to?
- 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
It is not surprising that _____ alterations of the nucleus (giant cells, bizarre pleomorphism, etc) may become apparent by _____ _____ and mimic changes seen in _____ _____.
morphologic, light microscopy, neoplastic cells
What are the acute cellular changes of ionizing radiation?
Depending on the tissues:
- Acute dermatitis
- Pneumonitis
- Enteritis, etc.
What are the chronic cellular changes of ionizing radiation?
Development of neoplasms (primarily sarcomas) even after an interval of ten years or more.
What are the acute vascular changes of ionizing radiation?
- Vessels may dilate, thrombose, or rupture
What are the chronic vascular changes of ionizing radiation?
Interstitial fibrosis of various tissues
How does chronic ionizing radiation lead to ischemic vessels?
Over time reactive endothelial cell proliferation & mural scarring may lead to narrowing or even obliteration of the vessel lumens causing tissue ischemia.
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?
Hematopoietic Syndrome
200-500 rads
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?
GI Syndrome
500-1000 rads
Vascular endothelial damage results in cerebral edema, convulsions, coma, and death within hours of exposure.
How many rads?
Cerebral Syndrome
>2500 rads
These penetrate the skin only superficially and induce injury after a latent period of several hours (sunburn).
Ultraviolet Rays
What are the systemic symptoms of ultraviolet rays?
Fever
Headache
Nausea and vomiting.
What can repeated exposure of ultraviolet rays lead to?
- Progressive pigmentation
- Skin thickening
- Increased risk of developing cutaneous malignancies
These can produce heat and, in overdoses, may cause thermal burns, edema, and vesiculation of the skin
Infrared Rays
These can also release energy in the form of heat.
Microwaves
What are the temperature extremes that lead to cell injury and/or death?
< 22°C (71.6°F) or > 42°C (107.6°F). Severity of injury related to duration of exposure.
What is the immediate effect of localized hypothermia?
- Damages vascular endothelium
- Increases vascular permeability leading to edema and blister formation (frostbite).
What causes extensive ischemic injury due to poor blood perfusion of surrounding tissue?
Prolonged localized hypothermia
In addition to vascular damage what does freezing of tissue damage locally?
- Interferes with ionic concentrations due to crystallization of intracellular water
- Denatures proteins
- Physically disrupts cell membranes leading to cell death.
When do the effects of vascular damage appear in frozen tissue?
May not appear until the tissue is reperfused as it thaws.
What are the effects of systemic hypothermia?
- Decrease in metabolic activity
- Mental confusion
- Lethargy
- Coma
What are the major causes of death that stems from systemic hypothermia?
- Vascular collapse
- Cardiac arrhythmias
What does localized hyperthermia (burns) lead to?
- Vasodilation
- Increased vascular permeability (edema and blister)
What will occur with severe localized hyperthermia?
Nuclear swelling
Disruption of nuclear membranes
Coagulation of intracellular proteins.
The clinical significance of cutaneous burns depends on the _____ and the _____ _____ covered
depth, surface area
What is the clinical significance of third degree burns?
Full thickness burns
- Most severe
- Destroy the epidermis & underlying dermis and dermal appendages
- Prevents reepithelialization
What is the clinical significance of first and second degree burns?
(Partial thickness burns)
Leaves basal epithelium or some of the dermal appendages intact
Allows epithelial cell regeneration
What are some complications that come from burns?
- Shock (loss of circulating blood volume)
- Hemoconcentration
- Electrolyte imbalance
- Infection (responsible for over 50% of deaths).
What causes systemic hyperthermia?
- Increased heat production
- Decreased heat loss
- Alteration of the "set point" of the hypothalamic regulatory centers
Compensatory peripheral vasodilation leads to...
Pooling of blood and hypotension
Severe fluid and electrolyte imbalances which could induce shock can arise from what?
Excessive sweating
How can electricity cause cell injury or death?
Interruption of neural transmissions of the cardiac conduction/respiratory control systems
or
By the generation of heat
What occurs when the body completes a circuit between two conductors?
Electrothermal injury
What does the outcome of electrothermal injury depend on?
- 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.
Tissues with relatively _____ water content (primarily _____) have _____ resistance and are most likely to be affected by what?
low, skin, increased
production of heat (electrical burns)
True/False: Electrocution burns are the only morphological evidence in fatal electrocutions.
True
What does the degree of injury depend on with respect to pressure change?
Magnitude
Direction
Rate
Duration
In general, _____ pressure is tolerated better than _____ pressure
increased, decreased
What does a sudden decrease in pressure lead to?
Produces free gas bubbles as nitrogen is released from solution in the plasma.
These act as emboli with variable clinical results (Caisson disease)
The decreased pressure of high altitude leads to...
Hypoxia and alteration of vascular permeability
Can lead to death from pulmonary and/or cerebral edema.
Slow _____ in pressure are tolerated fairly well, but _____ _____ in pressure (_____ _____) may produce considerable damage due to the variable densities and compressibility of tissues.
increases, rapid increases, blast injuries
What does malnutrition refer to?
What does malnutrition result from?
- 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
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
Causes of malnutrition
What are the clinical symptoms of PEM
marasmus and kwashiorkor from a dietary intake of protein and calories inadequate to meet the body’s needs
What is marasmus?
Emaciated appearance related to marked loss of muscle mass and subcutaneous fat
What is kwashiorkor?
Characterized by generalized edema seen as ascites and puffiness of the face, hands and legs
What are the secondary causes of PEM?
Cachexia
Anorexia nervosa
Bulimia
What is characterized by
- Patients with AIDS or advanced cancers.
- Extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, and edema
Cachexia
How does death come about in cachexia?
Atrophy of the diaphragm and respiratory muscles
Characterized as self-induced starvation with the highest death rate of any psychiatric disorder.
Anorexia nervosa
What is a condition where an individual binges on food and then induces vomiting.
Bulimia
What are the two basic types of vitamin deficiencies?
Primary (diet origin)
Secondary (disturbances in intestinal absorption).
How do Vitamin A deficiencies manifest themselves?
- Night blindness
- Keratinization of normally non-keratinizing epithelium, (resp epithelium, sclera, conjunctiva and oral mucous membranes)
What are the main functions of Vitamin A?
- Maintenance of normal vision
- Cell growth and differentiation
- Resistance to infection.
What maintains calcium balance by aiding in the absorption of calcium from the intestine?
Vitamin D
What are the effects of a Vitamin D deficiency?
Rickets in children
Osteomalacia in adults.
What happens when a child has rickets?
Failure of calcification of cartilage at growing epiphyses.
Cartilage not resorbed producing weak “knobby” bones
What happens to the bone in Osteomalacia?
Osteoid does not calcify and ultimately much of the bone consists of osteoid that can lead to bone deformities.
What is the use for Vitamin C (ascorbic acid)?
Needed for synthesis of collagen
What occurs when there is a vitamin C deficiency?
Scurvy
What are the adult manifestations of Vitamin C deficiency?
- Swelling and bleeding of the gingiva
- Ecchymoses and petechiae of the skin and mucus membranes.
What are the infantile manifestations of vitamin C deficiency?
- Subperiosteal hemorrhage
- Bone deformities due to decreased osteoid formation (secondary to defective collagen formation)
What is Vitamin K's role and what would a deficiency cause?
Functions in blood coagulation and a deficiency results in hemorrhaging
What are the different parts to the Vitamin B Complex that could have deficiencies?
Thiamine
Riboflavin
Niacin
Pyridoxine
Folic Acid
What is the manifestation of a thiamine deficiency?
Degeneration of sensory and motor nerves
What occurs in a Riboflavin deficiency?
Leads to:
- Cheilitis
- Angular cheilosis
- Atrophy of filiform papillae.
What deficiency is characterized by diarrhea, dermatitis, dementia and diffuse erythema of the tongue and mucous membranes?
Niacin
What does Pyridoxine deficiency resemble?
What can explain a recent increase in this deficiency?
Pellagra
Use of isoniazid and oral contraceptives
What does a folic acid deficiency lead to?
Macrocytic anemia and glossitis
What can obesity lead to?
- 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)
What are these characteristics related to:
- Visceral or intra-abdominal adiposity
- Insulin resistance
- Hyperinsulinemia
- Glucose intolerance
- Hypertension
- Hypertriglyceridemia
- Low HDL cholesterol levels
Metabolic syndrome
What can non-alcoholic fatty liver disease lead to?
Hepatic fibrosis and cirrhosis
What are the factors of a diet being related to cancer?
- 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
What are considered exogenous carcinogens?
Aflatoxins, food additives, artificial sweeteners and pesticides
What are considered to be endogenously synthesized carcinogens from dietary components?
Nitrosamines and nitrosamides
What is an example of a lack of protective factors?
High animal fat intake combined with low fiber intake increase the incidence of colon cancer
What are the antioxidants to be avoided in large quantities?
Vitamin C and E, β-carotenes and selenium
What is the diet relationship to atherosclerosis?
- Ingestion of saturated animal fats and trans fats
- Possibly overeating related to obesity