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BHP Exam 2 > Environmental Factors > Flashcards

Environmental Factors Flashcards

1
Q

How can mechanical trauma produce damage?

A
  • cutting, tearing, or crushing tissues
  • severe blood loss
  • interruption of blood or air supply
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2
Q

What are skin and soft tissue terminology (mechanical trauma)?

A
  • incision
  • abrasion or scrape
  • laceration
  • puncture
  • contusion
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3
Q

incision

A

clean cut by a sharp object

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4
Q

abrasion or scrape

A

superficial tearing away of epidermal cells

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5
Q

laceration

A

jagged tear, often with stretching of the underlying tissue

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6
Q

puncture

A

deep tubular wound produced by a sharp, thin object

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7
Q

contusion

A
  • bruise caused by disruption of underlying small blood vessels
  • commonly involves skin but may also involve internal organs
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8
Q

What are bone and tendon terminology (mechanical trauma)?

A
  • fracture
  • acute musculotendinous injuries
  • chronic musculoskeletal injuries
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9
Q

fracture

A

break of a bone

  • closed or compound
  • often bleeding into surrounding muscle, other tissues
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10
Q

What are acute musculotendinous injuries?

A

torn muscle fibers, ruptured tendons, dislocated joints

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11
Q

What are chronic musculoskeletal injuries?

A
  • osteoarthritis of joints

- thickening of tendon sheaths (e.g. repetitive strain)q

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12
Q

What are mechanical trauma causes of death?

A
  • hemorrhage into body cavities
  • fat embolism from bone fractures
  • ruptured viscera
  • secondary infection
  • renal shutdown (acute tubular necrosis especially myoglobin casts arise from crush injury of skeletal mm.)
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13
Q

What are blunt force injuries to the head?

A

head injury

  • brain damage with possible skull fracture
  • brain laceration
  • brain contusion
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14
Q

What can cause brain damage with possible skull fracture

A
  1. cerebral trauma

2. intracranial hemorrhage

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15
Q

What is a brain laceration?

A

fracture–> penetrating injury by skull fragments

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16
Q

What is a brain contusion?

A

-may occur at point of impact (coup injury) or opposite side of brain (contrecoup injury)

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17
Q

blunt force abdominal injury can result in

A
  • contusion
  • rupture of spleen or liver sometimes with severe hemorrhage
  • rupture of the intestine can result in peritonitis
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18
Q

blunt force thoracic injury

A

rib fracture
-penetration into pulmonary parenchyma
or thoracic wall vessels

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19
Q

rib fracture penetration into pulmonary parenchyma

A

pneumothorax

  • air in the pleural cavity
  • lung collapse
  • shift of mediastinum and circulatory disturbances
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20
Q

What can penetration into thoracic wall vessels lead to?

A

hemothorax

-hemorrhage in the pleural cavity

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21
Q

knife and stab wounds

A
  • incisions or puncture wounds

- result in highly variable consequences depending on site of injury

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22
Q

entrance wound on gunshot

A

usually smaller and rounder than exit wound (can be smaller than bullet due to skin elasticity

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23
Q

exit wound of gunshot

A
  • can be significantly larger than the bullet due to tumbling of the bullet
  • usually irregular or stellate rather than round
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24
Q

contact wound of gunshot

A
  • there may be burning around the margins of the wound (abrasion ring)
  • over the skull, and other areas with skin closely overlying bone, may demonstrate stellate appearance due to gases from the gun undermining skin margins
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25
Q

close range gunshot wounds (20” or less)

A
  • demonstrate unburned powder
  • particles in skin tattooing or stippling
  • deposits of soot on skin
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26
Q

long range gun wound

A
  • usually round or oval
  • clean margins
  • no evidence of stippling or fouling
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27
Q

What are the effects of mechanical trauma?

A

inflammation= always present

necrosis=results in loss of tissue

hemorrhage= blood loss leading to compression, asphyxia, coma

infection= organisms can proliferate in wound, decontamination, debridement necessary to prevent infection

thrombosis= clot leading to infarction or embolism

shock= severe trauma-> circulatory disturbance-> renal and respiratory failure, brain damage

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28
Q

chronic low grade mechanical traumaeffects

A
  • results in proliferation of tissue
  • ex. epulis fissuratum
  • epithelial and fibrous hyperplasia
  • proliferation of tissue in the vestibule
  • due to poor fitting denture with an extended flange area
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29
Q

1st degree burns (partial thickness burns)

A
  • hyperemia without significant epi. damage

- generally heal without intervention

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30
Q

2nd degree burns (partial thickness burns)

A
  • blistering (bulla), destruction of epidermis
  • slight damage to underlying dermis
  • generally heal without intervention
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31
Q

3rd degree burns (full thickness burns)

A
  • damage to epidermis, dermis, and dermal appendages
  • skin and underlying tissue often charred and blackened
  • often requires skin grafting
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32
Q

superficial burns

A
  • 1st and 2nd degree burns
  • epithelium can regenerate
  • painful but not serious
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33
Q

deep burns

A
  • 3rd degree burns
  • all epithelium destroyed
  • dermis and appendages damaged
  • heals by scarring
  • may result in contractures of joints and disfigurement
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34
Q

thermal injury from heat complications

A
  • inhalation of smoke or toxic fumes
  • hypovolemia
  • curling ulcer
  • infection
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35
Q

inhalation of smoke or toxic fumes

A

pulmonary or systemic damage

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36
Q

hypovolemia

A

fluid and electrolyte loss

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37
Q

curling ulcer

A

acute duodenum ulcer associated with severe burns

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38
Q

infection

A
  • most common cause of late fatalities

- most frequent organism pseudomonas aeruginosa

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39
Q

death from thermal injury

A
  • dependent on percentage of body burned
  • mortality
  • 40% of body burned (death possible)
  • 60% of body burned (death 100%)
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40
Q

What can cause early death from thermal injury?

A

fluid loss which can cause shock

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41
Q

What can cause late death from thermal injury

A

due to infection in weeks or months

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42
Q

treatment of thermal injury

A

extensive grafting

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43
Q

frostnip

A

prolonged immersion in cold–> damaged endothelium with edema and swelling (leakage of fluid)

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44
Q

frostbite

A

-may be localized and usually affects exposed areas (fingers, toes, earlopes, or nose)

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45
Q

-severe, prolonged frostbite may result in

A
  • erythema and pruritus
  • intracellular ice crystals
  • intravascular thrombosis
  • sometimes local gangrene
  • may be generalized and lead to death
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46
Q

electrical injury (burns and shock)

A

-electric current passes through an individual (electric circuit completed)

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47
Q

mortality

A

current passing through brain or heart

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48
Q

morbidity

A
  • cessation of activity in cardiorespiratory brain centers
  • cardiac arrest and arrhythmias
  • small cutaneous burns with blister (vesicle, bulla) formation- point of entry or exit of the electric current
  • at times burns may be severe
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49
Q

UV radiation injury

A
  • mostly sun damage to skin and eyes
  • acute injury of skin
  • chronic injury of skin
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50
Q

acute injury of skin

A
  • sunburn (1st degree)
  • onset of delayed vascular dilation–> erythema
  • often superficial desquamation
  • severe cases–> blister formation
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51
Q

chronic injury of skin

A
  • collagen and elastic tissue damage
  • epithelial changes
  • cosmetic damage-wrinkling
  • precancerous lesions- actinic keratosis
  • cancerous-basal cell carcinoma, squamous cell carcinoma, melanoma
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52
Q

ultraviolet irradiation injury mechanism

A

absorption of UV light by DNA–> DNA fractures or changes in sequences

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53
Q

irradiation injury examples

A
  • x-ray, radioactive waste, nuclear disasters

- short wavelength, high frequency (x-rays and gamma rays, particulate radiation (electrons, protons, and neutrons))

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54
Q

transfer of energy to molecules leads to ionization

A

-molecules reactive and capable of doing
-damage
damage cells–> toxic free radicals

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55
Q

toxic free radicals

A

affect vital cell components (DNA and intracellular membranes)

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56
Q

damage to the DNA (ionizing radiation)

A
  • direct action (hit) on vital molecule
  • indirect action (ionization of water–> free radicals–> damage to vital molecules)
  • damage repairable but very slow
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57
Q

ionizing radiation

A

some damage directed to cell membranes and others to cell organelles

58
Q

ionizing damage dependent on

A

total dose, rate of delivery, and type of tissue irradiated

59
Q

sequelae of localized radiation (ionizing radiation)

A
  • skin and mucosa changes
  • pulmonary changes
  • gastrointestinal inflammation/ulceration
  • hematopoietic alteration
60
Q

skin and mucosa changes

A
  • dermatitis (mucositis)
  • ulceration
  • vaculitis
  • malignancies
61
Q

pulmonary changes

A
  • acute-similar to ARDS (acute respiratory syndrome)
  • chronic- septal fibrosis, bronchiolar metaplasia, hyaline thickening of blood vessel walls

-

62
Q

hematopoietic alterations

A

bone marrow depression or leukemia

63
Q

neoplasia

A
  • localized radiation sequellae

- neoplasia: myeloid leukemias, cancers of bone, skin, thyroid, lung or breast

64
Q

severe + generalized ionization radiation

A
  • whole body-nuclear disasters
  • severe CNS injury (Capillary damage)
  • GI mucosal denudation
  • Acute bone marrow failure
65
Q

morphologic changes in IR with Brain

A
  1. adult-resisistant

2. embryonic- destruction of neurons and glial cells (weeks to months)

66
Q

morphologic changes in IR with Skin

A
  1. erythema, edema (Early)
  2. dyspigmentation (wks to mos)
  3. atrophy, cancer (mos to yrs)
67
Q

morphologic changes in IR with lungs

A
  1. edema
  2. ARDS
  3. interstitial fibrosis (mos. to years)
68
Q

morphologic changes in IR with lymph nodes

A
  1. acute tissue loss

2. atrophy and fibrosis (late)

69
Q

morphologic changes in IR with gastrointestinal tract

A
  1. mucosal injury (early)
  2. ulceration (early)
  3. fibrosis of wall (late)
70
Q

morphologic changes in IR with gonads

A
  1. testis early (destruction)
  2. ovaries early (destruction)
  3. atrophy and fibrosis (late)
71
Q

morphologic changes in IR with blood and bone marrow

A

early

  1. thrombocytopenia
  2. Granulocytopenia
  3. anemia
  4. lymphopenia
72
Q

IR radiosensitivity of specialized cells

A
  1. tissues with a high mitotic rate and /or rapid turnover are most susceptible
  2. lympocytes- earliest blood cells to be affected
73
Q

IR- radiosensitivity of specialized cells

A
  1. most sensitive- regularly actively divide
  2. intermediate sensitive
  3. resistant-division ceases after fetal development
74
Q

most sensitive (IR radiosensitivity)-regularly actively divide

A
  1. lymphoid
  2. hematopoietic
  3. germ
  4. gastrointestinal mucosa
  5. rapidly dividing tumor cells
75
Q

intermediate sensitive (IR radiosensitivity)

A
  1. fibroblasts
  2. cells of endothelium
  3. elastic tissue
  4. salivary glands
  5. eye
76
Q

resistant (IR radiosensitivity) -division ceases after fetal development

A
  1. bone
  2. cartilage
  3. muscle
  4. CNS
  5. Kidney
  6. liver
  7. most endocrine glands
77
Q

50 Gy (5,000 rads) to any one body region

A
  • no severe or lethal consequences
  • may be minor changes: therapeutic radiation to the jaw may cause obliterative endarteritis to the salivary glands and bone
78
Q

3 Gy (300 rads) to the whole body

A

20-50% death

79
Q

10 Gy (1,000 rads) to the whole body

A

100% death

80
Q

hematopoietic system syndrome

A

206 Gy–> 2 week latency–> system fails–> death at about 3 weeks post irradiation

81
Q

cerebral system syndrome

A

10Gy–> 1hr latency–> death in 1 day post irradiation

82
Q

less than .5 Gy=mutation (whole body radiation)

A
  • no systemic effects

- may cause mutation ion stem cells, predisposing to neoplasia

83
Q

.5-2 Gy= radiation sickness (whole body irradiation)

A
  • lethargy, nausea, and anorexia
  • transiet drop in neutrophils and lymphocytes
  • not fatal
84
Q

2-6 Gy= haemopoietic syndrome (whole body radiation)

A
  • bone marrow hypoplasia
  • leukopenia, thrombocytopenia, and developing anaemia after 2 weeks
  • death in about 50% of cases caused by infection due to impaired immunity
85
Q

3-10 Gy=gastrointestinal syndrome

A

-death of epithelial cells in gut
-hair loss
nausea and diarrhea within hrs of exposure
-dose: 3-4 Gy gut function may recover after month

86
Q

10 Gy= cerebral syndrome (whole body radiation)

A
  • heamorrhagic necrosis
  • deathin within hours of exposure
  • convulsions, delirium, and coma
87
Q

effects on fetus

.25 Gy or more from A-bomb

A
  • reduced head size
  • mental and growth retardation
  • ther anomalies
88
Q

effects on fetus

-IR 14 days gestation

A

-.25 Gy needed for anomalies to occur

=3 Gy can result in abortion

89
Q

how many Gys are there in a diagnostic X-ray ?

A

.005

-anomalies in fetus are unlikely

90
Q

acute alcoholism

A
  • affects CNS
  • associated with automobile and industrial incidents; suicide
  • acute intoxication may cause death
91
Q

chronic alcoholism

A
  • fatty change, alcoholic hepatitis and cirrrhosis (Scar)
  • acute and chronic pancreatitis
  • gastritis, gastric ulcers, poor absorption
  • oral, pharyngeal, laryngeal, esophageal and gastric carcinomas (Especially when combined with tobacco use)
  • alcoholic (dilated) cardiomyopathy; arrythmias, low outpu
92
Q

chronic alcoholism

A
  • aspiration pneumonia
  • myopathy-muscle weakness
  • peripheral neuropathy
  • cerebral dysfunction
93
Q

Wernicke-Korsakoff syndrome (alcholic encephalopathy)

A
  • thiamine deficiency-mediated
  • often associated w/ hemorrhagic necrosis of mamillilary bodies
  • ataxia, confusion, ophthalmoplegia, nystagmus
  • memory loss and confabulation
94
Q

fetal alcohol syndrome

A
  • microcephaly
  • mental retardation
  • facial and cardiac defects
95
Q

active smoking (tobacco substance abuse)

A

cancer associations

  • lung cancer and bronchogenic carcinoma
  • acute myeloid leukemia
  • cervical, kidney, pancreas, stomach, lip, and oral cavity
96
Q

other condition associated with active smoking

A
  • pneumonia, abdominal aortic aneurysm, cataracts
  • periodontitis
  • myocardial infarction slide 57
97
Q

What conditions are associated with active smoking?

A

*periodontitis
*saliva of smokers accelerates growth of oropharngeal cancers (destroys antioxidants)
-penumonia, abdominal aortic aneruysm, cataracts
-myocardial infarction
bronchitis and emphysema
-systemic atherosclerosis, stroke
-pregnancy complications

98
Q

What is tobacco abuse associated with?

A
  • squamous cell carcinoma of they larynx
  • squamous cell and small cell bronchogenic carcinoma
  • transitional cell carcinoma (urinary bladder)
  • chronic obstructive pulmonary disease
  • atherosclerosis
  • other vascular occlusive diseases
  • –>Buerger’s disease
99
Q

What are 4 common smoking complications?

A
  • cancer of the lung
  • chronic bronchitis emphysema
  • myocardial infarction
  • systemic atherosclerosis
100
Q

What are the risk factors for oral squamous cell carcinoma?

A

smoking +alcohol–> synergistic affect

101
Q

What does Cocaine (Crack) do to your mood?

A
  • mood elevation
  • irritability
  • anxiety
  • depression—> suicide
102
Q

What does Cocaine do to your myocardium/

A
  • Increased myocardial irritability–> fatal arrythmias

- myocardial infarction

103
Q

How does cocaine cause a hemorrhage?

A

hypertension-> cerebral infarction/hemorrhage

104
Q

what does intranasal cocaine use cause?

A
  • nasal congestion
  • ulceration
  • septal perforation
105
Q

What does the free base prep of cocaine cause

A

burn injury

106
Q

What can cocaine lead to?

A
  • Viral (HIV or Hep B)
  • bacterial (infective endocarditis) infection from IV use– Bacterial often right side of the heart valves are involved
  • muscle necrosis
  • epileptic seizures
  • respiratory arrest
  • newborn of addicted mothers have multiple small cerebral infarcts
107
Q

how is heroin usually administered?

A

IV

108
Q

What are the consequences of heroin?

A
  • physical dependence w/ withdrawal syndromes
  • infections (HIV, HEP B, INfective endocarditis)
  • ARDS
  • DEATH (respiratory/cardiac arrest, pulmonary edema)
109
Q

what is the most common direct chemical cause of death, accidental or suicidal?

A

carbon monoxide

110
Q

How does CO inhibit the capacity of hemoglobin to function as an oxygen carrier?

A
  1. hemoglobin has an infinity for CO that is 200x greater than that for Oxygen
  2. oxyhemoglobin is displaced by carboxyhemoglobin
111
Q

What are early symptoms of CO?

A

headache and dizziness

112
Q

How can CO be fatal?

A

-irreversible hypoxic injury–> possible death

113
Q

What neurons of the brain are most vulnerable with CO?

A

basal ganglia, lenticular nuclei, cortical gray areas

114
Q

What happens when CO becomes fatal?

A
  • cherry red skin colo

- blood,viscera, and mms

115
Q

What are the routes of administration with lead?

A
  1. inspiration (breathing) especially automotive emissions

2. ingestions especially lead based paint

116
Q

What does lead do to RBCs?

A

RBC changes like hypochromic microcytic anemia and basophilic stippling

117
Q

What is hypochromic microcytic anemia?

A
  • deficient heme synthesis mediated by the inhibition of delta-aminolevulinic acid (ALA) dehydratase and decreased incorporation of iron into heme
  • accumulation of ALA and erythrocyte protoporphyrin–> protoporphyrinemia, porphyrinuria, and ALA acidurea
118
Q

What can toxic amounts of lead lead to?

A

-encephalopathy, neuropathy, fanconi syndrome, lead line in ginigva, increased radiodensity of the epiphyses of long bones

119
Q

Where does mercuric chloride come from and what can it lead to?

A
  1. ingested seafood

2. acute focal gastrointestinal ulceration and severe renal damage

120
Q

What leads to widespread necrosis and calcification of the proximal convoluted tubules

A

mercuric chloride

121
Q

what leads to chronic poisoning like CNS symptoms, psychosis, paranoia, and irritability?

A

mercuric chloride

122
Q

What develops drug-resistant organisms mediated by plasmids carrying specific drug resistant genes?

A

antibiotics

123
Q

what causes fatal aplastic anemia?

A

antibiotics

124
Q

what is fatal aplastic anemia

A

idiosyncratic reaction to chloramphenicol

125
Q

What act as haptens to stimulate antibody production like immune complex diseases (polyarteritis nodosa)

A

sulfonamides

126
Q

What can sulfonamides lead to?

A
  1. cystallization of sulfonamides within the renal collecting system–> calculi with obstruction, infection or both
  2. bone marrow failure
  3. acute, self limited hemolytic anemia induced inpersons with erythrocyte glucose-6-phosphate dehydrogenase deficiency (G6PD)
127
Q

What leads to Gastroduodenol bleeding?

A

aspirin

128
Q

How does aspirin make the gastroduodenum bleed?

A
  • gastric or peptic ulcer

- inhibition of platelet cyclooxygenase–> thromboxane A2 deficiency and impaired platelet plug formation

129
Q

What is reye syndrome?

A

following acute, febrile, firal inlles

130
Q

What follows acute, febrile, viral ilness in child?

A

reye syndrome

131
Q

What is Reye syndrome associated with

A

aspririn use

132
Q

What happens to the liver in reye syndrome?

A

microvesicular fatty change (liver) and encephalopathy

133
Q

What are the toxic effects of cancer chemotherapeutic drugs?

A
  1. hair loss (alopecia)
  2. gastrointestinal erosions/ulcerations
  3. bone marrow failure
134
Q

What can cancer chemotherapeutic drugs cause?

A

acute leukemia and other malignancies

135
Q

What are adverse drug reactions involved blood dyscrasias?

A

aplastic anemia

136
Q

What are adverse drug reactions involved with the skin?

A

hives, eruptions, erythema

137
Q

What are adverse drug reactions involved with the cardiac?

A

arrythmias and cardiomyopathy

138
Q

What are adverse drug reactions involved with the renal system?

A

inflammation and necrosis

139
Q

What are adverse drug reactions involved with the liver?

A

fatty change or necrosis

140
Q

What are adverse drug reactions involved with the lung?

A

asthma

141
Q

What are adverse drug reactions involved systemically?

A

severe allergy or anaphylaxis

142
Q

What are adverse drug reactions involved with the CNS?

A

respiratory depression

BHP Exam 2 (6 decks)

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