Environment and Nutritional

Question 1

Cut-off size for fine or ultrafine particles

Answer 1

<10 micrometers (more dangerous)

Question 2

Two mechanisms of toxicity of carbon monoxide

Answer 2

Decreased O2 delivery (200x greater affinity for hemoglobin) and decreased ATP (complex IV inhibitor)

Question 3

Level of CO saturation for systemic hypoxia

Answer 3

20-30%

Question 4

Level of CO saturation for coma and death

Answer 4

60-70%

Question 5

Found in acute CO poisoning

Answer 5

Cherry-red discoloration

Question 6

Found in chronic CO poisoning

Answer 6

Carboxyhemoglobin

Question 7

Disease from airconditioning

Answer 7

Legionella (Legionnaire’s disease)

Silver legion (use silver stain to identify organism)

Question 8

Mechanism of action of lead poisoning

Answer 8

Interferes with calcium metabolism

Question 9

Lead inhibits which enzymes?

Answer 9

ALA dehydratase (second step in heme synthesis) and ferrochelatase (incorporates iron into heme)

Question 10

Hematologic manifestation of lead poisoning

Answer 10

Microcytic, hypochromic anemia

Question 11

More common neurologic involvement of lead poisoning in children

Answer 11

CNS (vs peripheral neuropathy among adults)

Question 12

Iron-laden mitochondria

Answer 12

Ring sideroblasts

Question 13

Disease caused by impaired uric acid excretion in lead poisoning

Answer 13

Saturnine gout

Question 14

Primary target organ of metallic and inorganic mercury (Hg)

Answer 14

CNS (because it is nonpolar and can cross BBB)

Question 15

Organic form of mercury

Answer 15

Methylmercury

Question 16

Disease caused by organic mercury poisoning

Answer 16

Minamata disease (CP, blindness, MR, CNS defects in utero)

Question 17

“The poison of kings, the king of poisons”

Answer 17

Arsenic

Question 18

Complications of arsenic poisoning

Answer 18

Neurologic (parasthesias, pain), skin (hyperkeratosis and pigmentation), cancers (lung, bladder, and skin esp in non-sun exposed areas)

Question 19

Heavy metal preferentially toxic to kidneys by ROS production

Answer 19

Cadmium

Question 20

Osteoporosis and osteomalacia associated with renal disease in cadmium poisoning

Answer 20

Itai-itai (Japanese for masakit, kasi masakit ang bones nila; itay, ang sakit ng bones ko!)

Question 21

Smoking is NOT a risk factor for which cancer?

Answer 21

Breast cancer

Question 22

Lethal dose of alcohol (blood alcohol level)

Answer 22

500 mg/dl

Question 23

Metabolism of alcohol

Answer 23

Ethanol > (alcohol dehydrogenase) > acetaldehyde > (aldehyde dehydrogenase) > acetic acid

Question 24

How does alcohol cause lactic acidosis?

Answer 24

Because of increased NADH production, that pushes lactate dehydrogenase to create lactate (recall that if O2 not available, pyruvate will become lactate instead of acetyl CoA)

Question 25

Mechanism of heat cramps

Answer 25

Electrolyte loss thru sweating (no derangement of core body temp)

Question 26

Mechanism of heat exhaustion (most common)

Answer 26

Failure of CVS to compensate for hypovolemia from dehydration

Question 27

Mechanism of heat stroke

Answer 27

Failure of thermoregulatory mechanisms causing hyperthermia (>40 C) and multiorgan dysfunction

Question 28

Clinical findings of heat exhaustion

Answer 28

Syncope

Question 29

Clinical findings of heat stroke

Answer 29

Hyperthermia, generalized vasodilation, hyperK, arrhythmia, rhabdo

Question 30

Risk factors for hyperthermia

Answer 30

Inc ambient temp, inc humidity, exertion, older adults, CVDs, intense physical stress

Question 31

Which is more injurious, alternating current (AC) or direct current (DC)?

Answer 31

Alternating current

Question 32

Common sources of ionizing radiation

Answer 32

X-ray, gamma rays, high-energy neutrons, alpha and beta particles

Question 33

Why is ionizing radiation injurious?

Answer 33

Has enough energy to remove bound electrons (to create ions)

Question 34

Characteristic nuclear morphology of ionizing radiation damage

Answer 34

Nuclear swelling with chromatin clumping (BUT N:C ratio is maintained)

Question 35

Definition of protein-energy malnutrition

Answer 35

BMI < 16 or weight <80% of normal (although may not be present if edema is signficant)

Question 36

Characterized by greater protein than deprivation

Answer 36

Kwashiorkor

Question 37

Characterized by greater caloric than protein deprivation

Answer 37

Marasmus

Question 38

PEM with prominent edema and liver steatosis, cerebral atrophy, generally more complications

Answer 38

Kwashiorkor

Question 39

Mediators of cachexia

Answer 39

Proteolysis inducing factor, lipid mobilizing factor, TNF and IL-6 (pro-inflammatory cytokines)

Question 40

Interleukin / cytokine responsible for acute phase reactants

Answer 40

IL-6

Question 41

Eponym for calluses found on knuckles of bulimic patients

Answer 41

Russell sign

Question 42

Deficiency causes nyctalopia and epithelial keratinization

Answer 42

Vit A

Question 43

Deficiency causes Bitot spots

Answer 43

Vit A

Question 44

Excess causes pseudotumor cerebri

Answer 44

Vit A

Question 45

Cholesterol-derived vitamin

Answer 45

Vit D

Question 46

Found in yellow, leafy vegetables (caroteinoids)

Answer 46

Vit A

Question 47

Synthesized in the body and found in deep-sea fish, plants, and grains)

Answer 47

Vit D

Question 48

Vit D deficiency in children

Answer 48

Rickets (vs osteomalacia in adults)

Question 49

Craniotabes, frontal bossing, pectus carinatum, rachitic rosary

Answer 49

Rickets

Question 50

Disease of vit D deficiency resulting in fractures of vertebral bodies and femoral neck

Answer 50

Osteomalacia

Question 51

Biochemical role of Vit C

Answer 51

Hydroxylation of collage

Question 52

Vit that is also an antioxidant in combo with Vit C

Answer 52

Vit E

Question 53

Lack of this enzyme means humans cannot synthesize Vit C

Answer 53

L-gulonolactone oxidase

Question 54

Disease of vit C deficiency characterized by gum bleeding, impaired wound healing

Answer 54

Scurvy

Question 55

This means "to make you hungry"

Answer 55

Orexigenic (vs anorexigenic)

Question 56

Adipocyte signalling compound that is anorixgenic

Answer 56

Leptin (remember the leptin-deficient mouse is a fatty)

Question 57

Adipocyte signalling compound that stimulates beta-oxidation

Answer 57

Adiponectin

Question 58

Secreted by stomach and arcuate nucleus of hypothalamus that makes you hungry (orexigenic)

Answer 58

Ghrelin

Question 59

Adipocyte signalling compound secreted in ileum and colon that is deficient in Prader-Willi

Answer 59

PYY

Question 60

Consequence of obesity that results in hypoventilation, hypersomnolence, OSA, PCV, cor pulmonale

Answer 60

Pickwickian syndrome (he doesn't PICK what he EATS)