Gen Path: Environmental Pathology (Lec 28)

Front 1

Which are more common causes of environmental diseases?

a. major disasters
b. chronic exposure to low levels of contaminants
c. occupational injuries and illnesses

Back 1

b and c

Front 2

How can initially non-toxic xenobiotics become toxic?

Back 2

metabolism in the body --> becomes toxic

Front 3

Where are most xenobiotics detoxified? what enzyme?

Back 3

in the Liver by cytochrome P450 enzyme system

Front 4

What is the most common toxic xenobiotic?

Back 4

Drugs

Front 5

How does ozone affect human body acutely? chronically?

Back 5

Acute - oxidizes lipids to H2O2 and aldehyldes --> irritative and proinflammatory

chronic - pulmonary dysfunction

Front 6

A patient is exposed to smog particulates and shows following symptoms: inflammation, arrhtymia, and increase in BP.

are these fine or ultrafine particulates?

Back 6

ultrafine particulates.

Both cause inflammation via cytokine release from alveolar macrophages

Only ultrafine particulates enter blood stream --> thicken blood and arrhythmia.

Front 7

List 3 most common indoor pollutants.

Back 7

1. carbon monoxide
2. Radon
3. Nitrogen dioxide

Front 8

what is the mechanism behind CO poisoning?

Chronic symptoms of CO poisoning?
Acute symptoms of CO poisoning?

How is CO poisoning similar to Cyanide poisoning?

Back 8

mechanism - binds to hemoglobin --> carboxyhemoglobin --> hypoxia

Chronic (low levels, persistent exposure) - CNS ischemia

Acute - high levels of carboxyhemoglobin --> cherry red hue to skin

both cyanide and CO poisoning result in cherry red hue to skin

Front 9

What is the leading cause of lung cancer in non-smokers?

Back 9

Radon

Front 10

What is radon?

Where can you find this in residential areas?

Back 10

radioactive gas, decay product of uranium

widely distributed in soil and concentrates in basements

Front 11

List 6 common heavy metals that can cause toxicity.

List common sources of each metal. List main diseases from each metal

Back 11

Mercury - contaminated fish, dental amalgrams; renal tubular necrosis, fetal toxicity (CNS)

Arsenic - soil, water, wood preservatives, herbicides; GI, CV, CNS disturbances

Cadmium - plants (food); renal tubular damage, obstructive lung disease, lung cancer

Cobalt - hard metal from grinding, polishing, cutting; asthma and fibrosing lung disease

Chromium/Nickel - soil; lung cancer

Lead - occupational (adults), paints and soil (children); CNS, PNS toxicity, anemia, renal fialure, and deposits ephyses of children's bones

Front 12

List 3 major manifestations of lead poisoning.

Back 12

1. CNS, PNS toxicity
2. anemia
3. renal tubular damage b/c excreted by kidney

Front 13

High levels of petroleum products (gasoline and Kerosene) can cause?

Back 13

CNS depression

Front 14

High levels of aromatic hydrocarbons (benzene) can cause?

Back 14

Leukemia

Front 15

Exposure to vinyl chloride can cause?

Back 15

hepatic angiosarcoma

Front 16

List 3 toxic components in the insecticides.

Back 16

1. organochlorines
2. organophosphates
3. carbamates

Front 17

What are Dioxins?

Dioxins can cause?

Back 17

Herbicides

Teratogenesis, immunosuppression, carcinogenesis

Front 18

what is paraquat?

Causes?

Back 18

Herbicides

Can cause acute lung injury (pulmonary fibrosis)

Front 19

List 3 non-CV, non-neoplastic diseases caused by tobacco.

Back 19

COPD
insulin resistance
osteoporosis

Front 20

What is third-hand smoke?

Back 20

Ingestion of residual nicotine (esp. on indoor surfaces) and reaction with nitrogen dioxide --> forming Tobacco-specific nitrosamines ( TSNA)

Front 21

Smokeless tobacco is associated with what cancers.

It is syngergistic with?

Back 21

Any upper aerodigestive cancer.

Especially oral cancer.

Alcohol

Front 22

Name 4 enzymes that are involved in metabolizing ethanol.

Back 22

1. CYP2E1
2. Alcohol dehydrogenase
3. catalase
4. aldehyde dehydrogenase

Front 23

Mallory hyaline is associated with what environmental agent?

Back 23

ethanol

Front 24

Wernicke encephalopathy and Korsakoff psychosis are associated with what environmental agent?

Back 24

Ethanol

Front 25

What is the ultimate metabolic product of methanol? Ethylene glycol?

What symptom is caused by the product of methanol? product of ethylene glycol?

Back 25

methanol --> formic acid --> can cause blindness

Ethylene glycol --> oxalic acid --> can cause acute renal failure

Front 26

Oral contraceptives are associated what diseases?

Back 26

thromboembolic disease
CV diseases
hepatic adenoma

Front 27

Estrogen HRT is highly associated with what cancer?

Back 27

endometrial carcinoma

Front 28

High dose of acetaminophen can cause what? how?

Back 28

high dose of acetamiphen --> accumulation of unconjugated NAPQI --> hepatic injuries

liver failure
hepatocyte necrosis

Front 29

what is the most common side effect of chloramphenicol?

Back 29

marrow hypoplasia

Front 30

Which is more dangerous? hyperthermia or hypothermia?

why?

Back 30

Hyperthermia

Humans are more efficient at generating heat

Front 31

which layers are penetrated in full thickness burn?

Back 31

subcutaneous tissue (3rd degree)
muscle (4th degree)

Front 32

What is the #1 organism associated with severe burn patients?

Back 32

Pseudomonas aeruginosa

Front 33

Define following terms:

Heat cramps
Heat exhaustion
Heat stroke

Back 33

Heat cramps - sweating --> electrolyte loss

Heat exhuastion - more sweating --> hypovolemia

Heat stroke - thermoregulatory failure (no sweating)

heat stroke is the worst type.

Front 34

Define systemic hypothermia.

Back 34

core temperature ≤ 95oF

Front 35

How does ethanol exacerbate hypothermia?

Back 35

dilation of superficial blood vessels --> lose heat

Front 36

Define frostbite.

Back 36

freezing of intracellular water + circulatory changes--> pallor

Front 37

define trench (immersion) foot.

Back 37

vasoconstriction + increase in vascular permeability
--> edema, atrophy, fibrosis

Front 38

What is result of electrical shock on high resistant tissue? low resistant tissue?

Back 38

high resistant - thermal effects

low resistant - cardiorespiratory failure

Front 39

What type of embolism can arise form pressure injuries?

Back 39

air/gas embolism

Front 40

What are the symptoms associated with acute mountain sickess?

What is chronic mountain sickness?

Back 40

1. hypoventilation but compensates with increased respiratory rate
2. increased hematocrit (from adaptation)
3. mild CNS symptoms (headache, weakness, insomnia)

CMS - continued acute mountain sickness symptoms due to lack of adaptation and/or decompensation
Symptoms - chronic hypoventilation, symptomatic polycythemia.

Front 41

What is the pathogenesis behind high-altitude pulmonary edema?

Back 41

hypoxia --> pulmonary vasoconstriciton + intravascular thrombosis --> pulmonary hypertension (also increased vascular permeability) --> right ventricular overload and pulmonary edema

Front 42

What is the pathogenesis behind high-altitude cerebral edema?

Back 42

cerebral hypoxia --> inhibition of Na/K pump --> intracellular edema

Front 43

this patient is showing cherry red hue to skin. what are some possible poisons that can cause this?

Back 43

CO and cyanide

Front 44

This is an electron microscope slide of the renal tubule. What are the dark stains?

Back 44

Lead inclusions

Front 45

This is a slide of liver from and chronic alcohol abuser. What is the item indicated by the arrow called?

Back 45

mallory hyaline

Front 46

This brain exhibits mammilary body hemorrhage (indicated by the arrows).
What can cause this? what is this called?

List 3 symptoms of Wernicke encephalopathy.

Back 46

ethanol

Wernicke encephalopathy due to mammilary body hemorrhage

1. ataxia
2. ophthalmoplegia
3. deranged mentation (normal human brain fxn)

Front 47

This is a carcinoma of the vocal cord. What environmental substance can cause this?

Back 47

ethanol