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MOD Exam 2 > Ch. 9 Environmental & Nutritional Disorders > Flashcards

Ch. 9 Environmental & Nutritional Disorders Flashcards

1
Q

Global Disease Burden (GDB)

A

burden of environmental, communicable, and nutritional diseases

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2
Q

Disability Adjusted Life Year (DALY)

A

years of life lost due to premature mortality & disability

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3
Q

Give examples of trends in GDB have changed in the past 20 years

A

Increased: CVD/Circulatory Dz, Cancer, HIV/AIDS Decreased: Neonatal conditions, Diarrhea Fig. 9.1- look at the width of each disease color over time

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4
Q

Organ systems affected by heatwaves and air pollution

A

Cardiovascular Respiratory Cerebrovascular

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5
Q

With increased floods and disruption of clean water supply, what diseases would be expected to increase?

A

Gastroenteritis Cholera Food/waterborne infections

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6
Q

Describe Vector-borne infectious diseases

A

Vector-borne= transmitted from one species to another Malaria, Dengue fever

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7
Q

Toxicology

A

study of distribution, effect, mechanism of action of toxic agents

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8
Q

Poison

A

STRICTLY dependent on dosage. i.e. anything can be a poison in a high enough dose

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9
Q

Xenobiotic

A

exogenous chemical absorbed by the body that provides no nutritional value. Mostly absorbed by GI, skin, lungs

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10
Q

Number one cause of global health loss?

A

Undernutrition

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11
Q

In developing countries, what diseases are the leading cause of death?

A

Infectious Disease

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12
Q

In developed countries (i.e. FAT countries) what is the leading cause of death?

A

Ischemic heart and cerebrovascular disease

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13
Q

Pathway of Xenobiotic Metabolism (very broad)

A
  1. Exposure 2. Absorption 3. a) toxicity b) storage c) excretion
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14
Q

Describe how a xenobiotic can be metabolized to be eliminated

A

Phase I reaction: increase polarity (hydrolysis, reduction, oxidation): MOVE CHARGES

Phase II reaction: add a functional group (sulfation, methylation, conjugation) Goal: Make it water soluble

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15
Q

Name the major outdoor pollutants that the EPA limits

A
  1. Sulfur Dioxide
  2. Nitrogen dioxide
  3. Ozone
  4. Lead
  5. CO
  6. Particulate Matter
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16
Q

Describe the negative effects of ground level ozone (O3)

A

Injury to respiratory tract epithelium and Type I pneumocytes.

Decreased Lung function

Increased airway reactivity

Lung inflammation

decreased exercise capacity

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17
Q

Describe the negative effects of sulfur dioxide

A

Can combine with O3 and particulate to produce Allison’s (Witches) Brew

Burning sensation in nose and throat Increased mortality and hospitalization

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18
Q

Inhalation of Particulate matter smaller than 10um can produce what symptoms

A

pulmonary inflammation (Mo and Neutrophils) 2nd cardiovascular effects

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19
Q

Describe CO poisoning

A

chronic: areas of poor ventilation

Acute: me in the garage with a hose hooked up to the exhaust after the MOD exam.

Systemic hypoxia and CNS depression Punctate Hemorrhage (Petechiae) CHERRY-RED SKIN

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20
Q

Indoor Air Pollutants

A

Wood smoke

Bioaerosals

Radon

Formaldehyde

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21
Q

Describe sick building syndrome

A

Headache, chest infection, congestion caused by poor ventilated homes and trailers

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22
Q

4 common heavy metals of environmental pollutants

A
  1. Lead
  2. Cadmium
  3. Mercury
  4. Arsenic
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23
Q

Lead Poisoning

A

binds proteins and competes with calcium metabolism. Clinical:

Lead lines on X-ray and in gums

hypochromic microcytic anemia

basophilic stippling

ring siderblasts

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24
Q
A

Basophilic Stippling

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25
Q
A

Ringed Sideroblasts

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26
Q

Minamata Disease

A

Caused by Mercury exposure in utero

Cerebral palsy, deafness, blindness, mental retardation, CNS defects

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27
Q

Arsenic

A

interferes with cellular metabolism

GI, CV, and CNS toxicities

Clinical: Neuropathy, paresthesis, hyperpigmentation, hyperkeratosis

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28
Q

Cadmium

A

Toxic to kidneys and lungs

battery production, soil, plants

Increase ROS

Itai-Itai Dz

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29
Q

Itai-Itai Disease

A

caused by Cadmium toxicity

osteoporosis and osteomalacia with renal disease

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30
Q

Toxicities that can cause Lung Cancer

A

Radon

Asbestos

Arsenic

chromium

uranium

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31
Q

Fibrosis of the lungs can be caused by:

A

Silica

Asbestos

Cobalt

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32
Q

7 Occupational Health Risk Hazards Discussed

A
  1. Organic Solvents (tetrachloride and chloroform): Leukemia risk in rubber workers
  2. Polycyclic Hydrocarbons: wood burning
  3. Organochlorines
  4. Dioxins and Polychlorinated biphenyls (PCB)
  5. Mineral Dusts
  6. Vinyl Chloride
  7. BPA
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33
Q

Tobacco Usage

A
  1. 90% Lung Cancers
  2. Dose-dependent effects in pack years
  3. 20% decreased lung cancer mortality after 5 years of smoking cessation
  4. 2-4000 substances with over 60 carcinogens
  5. Nicotine is addictive factor
34
Q

What 2 substances found in cigarrettes are toxic to respiratory cilia and irritate mucosa?

A

Formaldehyde

Nitrogen Oxides

35
Q

Cigarrette smoking increases risk of atherosclerosis by:

A

Increasing platalet aggregation

Inducing O2 deprivation

Increased O2 need

36
Q

3 most common diseases associated with smoking

A

COPD

Bronchitis

Emphysema

37
Q

Alcohol abuse and related deaths

A

10 million chronic alcholics in US

implicated in 100,000 deaths annually 50% from drunk driving, homicide, and suicide

1.8 million deaths per year worldwide

38
Q

What is the average concentration of EtOH in the blood that is the legal definition of drunk? How many drinks is this for an average person?

A

80 mg/dL

3 standard drinks

39
Q

Describe EtOH metabolism

A

Absorbed in the stomach

Oxidized to acetaldeyde in the liver by alcohol dehydrogenase (ADH) NOT anti-diuretic hormone

Competes with other CYP2E1 substrates which delays drug catabolism

40
Q

Acute Alcoholism (Me in Austin)

A

CNS depression

hepatic steatosis

Gastritis & Ulceration

41
Q

Chronic Alcoholism (me in 30 years)

A

Shortened lifespan due to liver, GI, CNS, CV & pancreas damage

Thiamine (B1) deficiency= Wernicke-Korsakoff Syn

Cardiomyopathy

Portal HTN

42
Q

Fetal Alcohol Syndrome

A

Microcephaly

Growth Retardation

Facial anomalies

43
Q

Protective affects of moderate alcohol intake

A

Increased HDL

Decreased platelet aggregation

Decreased fibrinogen levels

44
Q

Wernicke-Korsakoff Syndrome

A

B1 deficiency

Hemorrhage and necrosis of mamillary bodies and 3/4 ventricles

Clinical: Short term memory and confabulation

45
Q

Acetaldehyde produced from EtOH metabolism final end product

A

Converted to acetate by acetaldehyde dehydrogenase in mitochondria and used in repiratory chain

46
Q

A 25 year old Asian-American male presents with chief complaint that he can’t drink as much as his friends Allison, Tanner, and Christian, who are all white. On PE he appears healthy and normal, no hepatomegaly or any other problems. What test would you possibly order next?

A

Genetic test for SNP in the ALDH2 gene that produces acetaldehyde dehydrogenase.

Mutation causes reduced activity and decreased ability to oxidize acetaldehyde.

47
Q

EtOH affect on risk of hypothermia

A

EtOH causes vasodilation which results in more rapid heat loss leading to hypothermia

48
Q

Menopausal Hormone Therapy (MHT)

A

estrogens with progestogen to alleviate menopause symtpoms. Ok in early menopause, not long term because of increased risk of breast cancer, VTE, and PE

49
Q

Oral Contraceptives

A

3-6x increased risk of VTE & PE

Hepatic adenoma risk with older women and prolonged OC use

50
Q

Acetaminophen OD

A

50% result in acute liver failure with a 30% mortality due to Centrilobular Necrosis

95% metabolized via CYPs and excreted

5% metabolized to NAPQI, which is conjugated using GSH

In OD, GSH is overun and NAPQI accumulates in liver causing necrosis by damaging cellular membranes and increasing hepatocyte vulnerability to ROS

51
Q

Aspirin OD

A

Respiratory Alkalosis followed my metabolic acidosis

Uncoupling of Oxphos pathway that leads to lactate buildup

Chronic use: headaches, dizziness, tinnitus, Vomitting, Diarrhea, BLEEDING via TxA2 inhibition

52
Q

Opiates

A

Respiratory depression, arrhythmias, cardiac arrest, PE

Right sided heart failure secondary to PE

53
Q

Marijuana usage

A

Increased HR

Angina

Cognitive impairment (hopefully)

54
Q

Cocaine mechanism of action

A

Blocks reuptake of dopamine from presynaptic vessels

Blocks reuptake of NE and Epinephrine form postsynaptic vessels

Basically it drives stimulation by blocking reuptake of all fun things

Clinical: HTN, Tachycardia, arrhythmias, Hyperpyrexia (fever)

55
Q

Thermal Injuries

A

Clinical: Depth, % of body surface Rule of 9’s

treatment: fluid & electrolyte management, infection control

Shock when >20% of BS burned

Sepsis

Respiratory Insufficiency

56
Q

Malignant Hyperthermia

A

Mutation in Ryanodine Receptor 1 (RYR1) gene that causes heat-stroke like reaction to anesthetics

57
Q

Ionizing Radiation presentation

A

Nuclear swelling, giant cells, pleomorphic nuclei, cytoplasmic swelling

Narrowing of vascular lumen due to fibrosis

58
Q

Describe Second Cancers caused by Ionizing Radiation

A

Individuals who receive radiation to treat cancer are at increased risk for developing secondary cancers such as AML

Myelodysplastic Syndrome

Solid Tumors

59
Q

Morphology of radiation injury in:

Lungs

GI

Gonads

A

Lungs: Edema, ARDS, Fibrosis

GI Tract: Ulceration, Fibrosis

Gonads: Atrophy and fibrosis

60
Q

Describe effects of total body ionizing radiation on the brain

A

The brain is protected until the radiation reaches high levels (50Sv) but once reached the development time is only 1-4 hours

61
Q

Chronic Radiation Dermatitis

A

Mediastinal fibrosis after radiotherapy to the thorax

62
Q

Primary vs. Secondary dietary insufficiency

A

Primary: Missing from diet

Secondary: malabsorption, impaired utilization, storage, excess loss

63
Q

Secondary PEM

A
  1. depletion of subQ fat
  2. Wasting of quads and delts
  3. ankle or sacral edema
64
Q

Marasmus

A

<60% of NL weight

Normal Serum Albumin

Emaciated look

65
Q

Kwashiorkor

A

Decreased protein more the problem compared to decreased calories

Hypoalbuminemia

Edema, sparing of SubQ fat & muscle

66
Q

Cachexia

A

PEM due to AIDs or advanced cancers

Mechanism of Action:

TNF and Cytokine activation of NFkB that causes muscle to be ubiquitinated and degraded by proteasomal activity

67
Q

Anorexia Nervosa

A

Highest deat rate of any psychiatric DO

Amenorrhea, decreased Thyroid hormone and bone density

Hypokalemia

68
Q

Bulimia

A

Binge/Purge (efficiency in my opinion)

Hypokalemia

69
Q

Vitamin A

A

Visual pigment

Antioxidant

Clinicla def: Night Blindness, Squamous metaplasia, Bitot Spots, Keratomalacia

70
Q

Vitamin D

A

Important for Ca and Phophorus absorption

Clinical Def: Rickets & Osteomalacia, Hypocalcemic Tetany

Helps clear TB

71
Q

Vitamin K

A

Cofactor for coagulation

Clinical Def: Bleeding

72
Q

Vitamin B1

A

Thiamine: coenzyme

Clinical: Beriberi, Wernicke Korsakoff

Beriberi: loss of appetite, weakness, pain in the limbs, shortness of breath, and swollen feet or legs.

73
Q

Niacin

A

Needed for NAD used in redox reactions

Clinical Def: 3 D’s- Dementia, Dermatitis, Diarrhea

74
Q

Vitamin B6

A

Pyridoxine

Glossitis, Dermatitis, Neuropathy

75
Q

Vitamin C

A

Collagen!

Scurvy

Hemorrhages and healing defects

76
Q

Iron Deficiency

A

Inadequate Diet or Chronic Blood loss

Clinical: Hypochromic Microcytic Anemia

77
Q

BMI range categories

A

Normal: 18.5- 25

Overweight: 25-30

Obesity: >30

Apple-shaped worse than Pear-shaped

78
Q

What hormone released from adipose drives anorexogenic pathway?

A

Leptin

Activates POMC/CART in Arcuate Nucleus and release of a-MSH

79
Q

What 2 hormones drive orexogenic pathway

A

Ghrelin

Release of NPY from Arcuate Nucelus that drives food intake

80
Q

Metabolic Syndrome

A

intra-abdominal adiposity

Insulin resistance

Hyperinsulinemia

HTN

Decreased HDL

Non-alcoholic Fatty Liver Dz

Cholelithiasis

81
Q

Describe how Obesity effects Cancer risk

A

Hyperinsulinemia drives IGF-1 which is a mitogen that drives the cell cycle

Chronic Proinflammatory state

Increased Estrogen availability

MOD Exam 2 (3 decks)

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