Chapter 7 - Environmental Pathology Flashcards Preview

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Flashcards in Chapter 7 - Environmental Pathology Deck (125):
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What is the leading cause of premature death in developed countries?

Tobacco use leading cause of premature death in developed countries

1

What is the most important preventable cause of death in the United States?

Smoking: most important preventable cause of death in United States

2

What is nicotine?

Nicotine: addictive component in tobacco

3

Besides addiction, nicotine patch can be used to treat what?

Nicotine patch used to Rx ulcerative colitis

4

What is cotinine?

Cotinine: nicotine metabolite; used for screening

5

What does tar in cigarette smoke contain?

Tar contains carcinogenic agents

6

What are the carcinogens in cigarette smoke?

Carcinogens: polycyclic hydrocarbons, phenol, nitrosamine

7

What can smokeless tobacco cause?

Smokeless tobacco: addictive; ↑risk for oral squamous cancer

8

What does passive smoke increase the risk of in children?

Passive smoke: ↑risk of respiratory/middle ear infections in children

9

What does secondhand smoke exacerbate in children?

Smoking exacerbates asthma

10

What does passive smoke increase the risk for in adults?

Passive smoke: risk for lung cancer; CAD

11

What are the beneficial effects of smoking cessation?

Live longer; ↓risk for heart disease, lung cancer, stroke

12

What is the most common recreational drug taken in the U.S.?

Alcohol MC recreational drug

13

Where is alcohol metabolized and reabsorbed?

Stomach/liver metabolize alcohol; stomach/small bowel reabsorb alcohol

14

Why are women at risk for acute/chronic alcohol complications?

Women at risk for acute/chronic alcohol complications; ↓alcohol dehydrogenase

15

What are the enzymes that metabolize alcohol?

Enzymes metabolizing alcohol: alcohol dehydrogenase, CYP2E1, catalase

16

What is the rate-limiting enzyme in alcohol metabolism?

ADH: rate-limiting enzyme in alcohol metabolism

17

What is key to lab abnormalities in alcohol metabolism?

↑NADH key to lab abnormalities

18

How does role of increased NADH in alcohol metabolism?

↑NADH: ↑synthesis lactic/β-OHB acids; ↑liver TG synthesis

19

Acetyl CoA is used to synthesize what?

Acetyl CoA used to synthesize fatty acids/ketoacids

20

Describe why there is increased risk for fasting hypoglycemia in alcohol metabolism.

NADH enhances pyruvate conversion to lactate → ↓pyruvate → fasting hypoglycemia

21

What anions are present in the increased anion gap metabolic acidosis of alcohol abuse?

↑Anion gap metabolic acidosis: lactic acid, β-OHB acid

22

Which ketone is not detected with standard urine/blood tests for ketone bodies?

β-OHB not detected with standard urine/blood tests for ketone bodies

23

Besides fasting hypoglycemia and acidosis, what are the other laboratory findings in alcohol abuse/alcoholic liver disease?

Lactic acid/β-OHB → hyperuricemia (potential for gout); hypertriglyceridemia
Alcohol liver disease: AST > ALT; ↑GGT

24

What is the most common systemic complication of IVDU?

Hepatitis C: MC systemic complication of IVDU

25

What are the effects of acetaminophen overdose?

Acetaminophen: chemical hepatitis; renal papillary necrosis

26

What are the general symptoms of aspirin overdose?

Aspirin: tinnitus, vertigo, tachypnea

27

What is the initial acid-base disorder in aspirin overdose?

Initial respiratory alkalosis

28

What is the mixed acid-base disorder in aspirin overdose in adults?

Mixed primary respiratory alkalosis and metabolic acidosis (adults)

29

What is there danger of in salicylate poisoning?

Salicylate poisoning: danger of hyperthermia

30

Both acetaminophen and aspirin toxicity may cause what?

Both acetaminophen and aspirin toxicity may cause fulminant hepatitis

31

Unopposed estrogen increases the risk for what?

Unopposed estrogen: adenocarcinoma endometrium/breast
Risk venous thromboembolism; intrahepatic cholestasis
Risk myocardial infarction/stroke

32

OCPs increase the risk for what?

OCP: risk breast adenocarcinoma, cervical SCC
Risk folic acid deficiency (macrocytic anemia)
OCP MCC hypertension in young women → ↑angiotensinogen → ↑ATII
Risk hepatic adenoma causing intraperitoneal hemorrhage
Risk of intrahepatic cholestasis/cholesterol gallstones

33

What is the most common cause of death due to a venomous bite?

Bee/wasp/hornet sting: MCC death due to a venomous bite

34

What is a contusion?

Contusion: blunt force injury to blood vessels with blood leaking into tissue

35

What is an abrasion?

Abrasion: superficial excoriation of epidermis

36

What is a laceration?

Laceration: jagged tear with intact bridging vessels/nerves/connective tissue

37

What is an incision?

Incision: wound with sharp margins; severed blood vessels

38

Describe contact gunshot wounds.

Contact wound: stellate-shaped; fouling (soot + gunpowder)

39

Describe an intermediate-range gunshot wound.

Intermediate-range wound: powder tattooing

40

Describe a long-range gunshot wound.

Long-range wound: no powder tattooing

41

Describe exit gunshot wounds.

Exit wounds: larger than entrance wound

42

What is the most common cause of death ages 1 to 44 years?

MVAs MCC death ages 1 to 44 years

43

What accounts for more than 50% of deaths from child abuse?

Shaken baby syndrome: >50% deaths from child abuse

44

What is the key finding in shaken baby syndrome?

Key finding: retinal hemorrhages

45

What is the most common cause of burns?

MCC burns is fire

46

What is the most common site for burns?

MC site for burn is upper extremities

47

What is the common denominator in all burns?

Common denominator in burns is protein denaturation

48

What does the center of a burn have?

Center of burn has irreversible coagulation necrosis

49

Describe the zone of ischemia of a burn.

Zone of ischemia has reduction in dermal microcirculation

50

Describe the zone of hyperemia in a burn.

Zone of hyperemia due to immediate and transient increase in perfusion

51

What does the depth of a burn determine?

Depth of burn determines potential for skin regeneration

52

What are the sources for skin regeneration?

Sources for skin regeneration: basal layer of cells at margins; dermal skin appendages

53

What is a first degree burn?

1st degree burn: limited to epidermis

54

What is a superficial second-degree burn?

2nd degree superficial: extends into papillary dermis; partial-thickness burn

55

What is a deep second-degree burn?

2nd degree deep: extends into reticular dermis; partial-thickness burn

56

What is a third-degree burn?

3rd degree burn: extends through epidermis/dermis; full-thickness

57

What common occurs following a third-degree burn? What can potentially develop?

SCC risk in keloids

58

What is a fourth-degree burn?

4th degree burn: extends thru skin, subcutaneous fat, muscle/bone

59

What is a possible effect of losing plasma from the burn surface?

Hypovolemic shock from loss of plasma; pitting edema

60

What is the most common cause of infection of a burn wound?

P. aeruginosa MCC infection of burn wound

61

What may develop in the small intestine as a complication of a severe burn?

Curling ulcers of proximal duodenum

62

What is hypermetabolic syndrome?

Hypermetabolic syndrome: heat loss from damaged skin surface → ↑BMR

63

Smoke inhalation may result in what type of poisoning?

Smoke inhalation: CO/CN poisoning

64

What is heat edema?

Heat edema: mild swelling feet, ankles, hands

65

What is heat edema due to?

Cutaneous vasodilation with gravitational pooling

66

Who is affected by heat edema?

Elderly in tropical/semitropical area; healthy traveler coming from cold to hot area

67

What are heat cramps?

Heat cramps: painful, spasmodic muscle contractions postexercise

68

Describe the electrolyte derangement in heat cramps.

Deficiency Na+, Cl−, and fluids in muscle

69

What is heat exhaustion?

Heat exhaustion: volume depletion under conditions of heat stress

70

What are the clinical findings in heat exhaustion?

Heat exhaustion: <104° F); profuse sweating/no mental status changes

71

Describe the laboratory findings in heat exhaustion.

Hemoconcentration, variable serum Na+

72

What are the predisposing factors for heatstroke?

CHS: high ambient temperature; poor, elderly without air-conditioning
CHS: chronic disorders (psychiatric, alcoholism) requiring medication

73

What are the clinical findings in classic heatstroke?

Core body temp >40° C (104° F); skin hot/dry; mental status abnormal; CNS dysfunction

74

What are the laboratory findings in classic heatstroke?

Mild respiratory alkalosis; mild ↑serum CK

75

What are the predisposing factors for exertional heatstroke?

EHS: athletes/military recruits; endogenous heat production overrides cooling mechanisms

76

What are the clinical findings in exertional heatstroke?

EHS: Core body temp >40° C (104° F); profuse sweating; severe CNS dysfunction

77

What are the lab findings in exertional heatstroke?

Lactic acidosis, rhabdomyolysis, ARF, DIC, liver damage, hypocalcemia

78

What is the most common freezing injury to tissue?

Frostbite MC freezing injury to tissue

79

What is trench foot/immersion foot?

Trench foot/immersion foot: nonfreezing injury; exposure to wet cold

80

What is chilblain?

Chilblain: nonfreezing injury; exposure to dry cold

81

What is the pathogenesis of frostbite?

Frostbite: tissue exposed to temperature <0° C
Frostbite: ice crystallization; stasis of blood flow

82

What occurs during the prefreeze phase of frostbite?

Prefreeze: endothelial plasma leakage; vasoconstriction; ↑plasma viscosity

83

What occurs during the freeze-thaw phase of frostbite?

Freeze-thaw phase: extracellular ice crystallization; intracellular volume depletion → death

84

What occurs during the postthaw phase of frostbite?

Postthaw: microvascular collapse → necrosis

85

Describe the epidemiology of electrical injury.

Most injuries in children or work-related

86

What is the main determinant of tissue injury in electrical injury?

Current main determinant of tissue injury

87

What is Ohm's law?

Ohm’s law: Current (I) = Voltage (V)/Resistance (R)

88

What change in resistance or voltage results in a decrease in current?

↑Resistance (R) or ↓Voltage (V) = ↓Current (I)

89

What change in resistance or voltage results in an increase in current?

↓Resistance (R) or ↑Voltage (V) = ↑Current (I)

90

How does AC exposure compare to DC exposure at the same voltage?

AC 3× more dangerous that DC at same voltage

91

How do muscle contractions differ during AC and DC exposure?

AC induces tetanic contractions (hold on); DC induces single muscle spasm (throws away)

92

How does wet skin affect resistance and current?

Wet skin ↓R causing ↑I

93

How does dry skin affect resistance and current?

Dry skin ↑R causing ↓I

94

What is the most common cause of death in an electrical injury?

Cardiorespiratory arrest MCC death electrical injury

95

What is the most common cause of death from lightening injury?

Cardiorespiratory arrest MCC death from lightening injury

96

Who is most at risk for drowning?

Children 1 to 4 and 10 to 14 years old most at risk for drowning

97

Define drowning.

Drowning: death by suffocation from immersion in a liquid

98

What is wet drowning?

Wet drowning: aspiration of water; MC type of drowning

99

What is immersion syndrome?

Immersion syndrome: sudden death from submersion in cold water; vagally mediated cardiac arrest

100

What is dry drowning?

Dry drowning: asphyxia from laryngospasm without aspiration

101

Describe two features of the diving reflex.

Diving reflex protective; shunts blood to vital areas

102

Describe the cause of death in drowning.

Death in drowning: laryngospasm/closed glottis; hypoxemia with respiratory/metabolic acidosis

103

How are O2 concentration and atmospheric pressure affected at high altitude?

High altitude: O2 concentration 21%, ↓atmospheric pressure

104

Describe the effect of hypoxemia at high altitude.

Hypoxemia stimulates peripheral chemoreceptors → respiratory alkalosis

105

Describe the effect of respiratory alkalosis on OBC.

Respiratory alkalosis → activates PFK → ↑2,3-BPG → right-shifted OBC

106

Acute mountain sickness occurs at what elevation?

AMS occurs at elevations >8000 feet (2440 m)

107

What are the clinical findings in acute mountain sickness?

Headache, fatigue, dizziness, anorexia, nauseous, insomnia

108

Describe the pulmonary edema in high altitude pulmonary edema.

HAPE: noncardiogenic pulmonary edema

109

What are the clinical findings in high altitude cerebral edema?

HACE: ataxia, stupor, coma

110

Give two examples of ionizing radiation.

Ionizing radiation: x-rays, γ-rays

111

Describe the pathophysiology of ionizing radiation.

Damage to DNA by hydroxyl free radicals

112

Which tissue is most sensitive to ionizing radiation?

Lymphoid tissue most sensitive to ionizing radiation

113

Which tissue is least sensitive to ionizing radiation?

Bone least sensitive to ionizing radiation

114

What is the first hematologic sign of total body radiation?

Total body radiation: lymphopenia first hematologic sign

115

What are the vascular effects of radiation?

Vascular system: thrombosis/fibrosis; ischemia

116

What are the acute integumentary effects of radiation?

Acute—erythema, edema, blisters

117

What are the chronic integumentary effects of radiation?

Chronic—radiodermatitis; danger of SCC

118

What are the acute and chronic GI effects of radiation?

Acute—diarrhea; chronic—bowel adhesions

119

What is the most common cancer caused by radiation?

Acute leukemia MC cancer caused by radiation

120

What other cancers are caused by radiation besides acute leukemia?

Other radiation cancers: papillary carcinoma of thyroid, osteogenic sarcoma

121

Describe the pathogenesis of injury with UVB light.

UVB: ↑pyrimidine dimers distort DNA helix
UVB: inactivates p53 suppressor gene; activates RAS proto-oncogene

122

What are the general effects of UVB light injury?

Sunburn, actinic (solar) keratosis (danger SCC), corneal burns from skiing

123

What are the cancers associated with UVB light injury?

UVB cancers: BCC (MC), SCC, melanoma

124

What type of radiation may cause third-degree burns?

Laser radiation: third-degree burns