Environment Pollution 1

Question 1

Most harmful air pollutant

Answer 1

Ground level Ozone O3
From industry & motor vehicles Leads to free radical production

Question 2

Which SO3 is dangerous & what is the most dangerous causes polycyclic aromatic hydrocarbon (wood smoke)

Answer 2

Smaller ones are more damaging & lung cancer

Question 3

Leaving in the basement (radon)

Answer 3

Cancer

Question 4

CO monoxide poisoning

Answer 4

Higher affinity for hemoglobin than O2
Changes in skin “cherry pink” CNS depression
Systemic asphyxiant

Question 5

Tobacco

Answer 5

Lung cancer
Pack year: packs/day x years smoking

Question 6

Most potent carcinogens

Answer 6

Nitrosamine
PAH
Benzopyrene
Aromatic Amines
Tar (has benzene)

Question 7

Arsenic poisoning

Answer 7

Interferes with cellular metabolism
Lung cancer
Skin cancer (high yield)

Question 8

Lead toxicity

Answer 8

Lead old housing paints, Soil, Painters, Miners
Lead ingested in bone & cartilage with long half-life
Ca absorption low “Lead Lines” in bone & gum
Renal failure

Question 9

Lead poisoning

Answer 9

Adult: peripheral neuropathy
Kids: irreversible central & peripheral neuropathy

Question 10

Atherosclerosis

Answer 10

CAD, peripheral vascular disease, cerebrovascular disease

Question 11

Basophilic Stippling

Answer 11

Lead poisoning

Question 12

Inorganic dust (occupational)

Answer 12

Pneumoconiosis, PAH, Scrotal cancers (chimneys), Vinyl Chloride

Question 13

Organochlorine (ddt)

Answer 13

Neurological toxicity

Question 14

Pregnancy complications

Answer 14

Spontaneous abortion
Preterm birth & perinatal mortality
Intrauterine growth retardation (fetal hypoxia)
Sudden infant death syndrome

Question 15

Passive smoke increases risk of

Answer 15

Asthma, Acute illnesses in the children, respiratory illnesses later in life

Question 16

Cotinine

Answer 16

Metabolite of nicotine can be measured in blood for passive smoke inhalation or to see if a patient has quit smoking

Question 17

CARBON MONOXIDE POISONING

Answer 17

**Asphyxiant ** That is what causes death - O2 deprivation/“suffocation” CO binds to hemoglobin in a stable manner (200-fold greater affinity than O2)
Cherry red skin and mucous membrane color (usually after death)

Question 18

Ethanol Metabolism

Answer 18

NAD is needed for beta oxidation and then fats starts accumulating
Lactic acid needs to be converted to pyruvate. When no NAD too much lactic acid.

Question 19

ORGANIC SOLVENTS

Answer 19

FREE RADICAL FORMATION = TOXIC
** Hepatocellular carcinoma **
acute myeloid leukemia (AML) **

Question 20

Fetal Alcohol Syndrome

Answer 20

No limit
Related to pregnancy
Microcephaly
Facial dysmorphology
Growth retardation

Question 21

Occupation health hazards

Answer 21

ß- Napththylamine (aniline dyes) – rubber, chemical, metal
Transitional cell bladder cancer
Polycyclic hydrocarbons Among the most potent carcinogens
scrotal cancer (squamous cell) *** from tar and soot (1775)
Lung and bladder cancer **

Question 22

Organochlorines

Answer 22

Anti-estrogenic or anti-androgenic Disrupt hormonal/endocrine systems
Can cause Chloracne: Dermatitis from PCB and dioxins
– Face acne, cysts, hyperpigmentation and hyperkeratosis
– Clinical evidence of Dioxin exposure – can be permanent

Question 23

OTHER CHEMICALS

Answer 23

Vinyl Chloride
• Increased ** angiosarcoma of liver ** in exposed workers, PVC pipe Cyanide
• Inhibits intracellular cytochrome oxidase
** Prevents cellular oxidation ** • Death within minutes Petechial hemorrhage and “bitter almonds” scent
Ethylene Glycol – Causes renal acute tubular necrosis Obstruction of tubules by calcium oxalate crystals

Question 24

Acetaminophen toxicity

Answer 24

Necrosis of liver
Centrolobular hepatic necrosis
NAPQI accumulates

Question 25

Lead

Answer 25

Lead lines” from dense thick bone in metaphysis Gingival lead lines”: Blue discoloration Children absorb more ingested lead than adults Lower IQ – Behavior problems (eg hyperactive) Foot drop and wrist drop microcytic hypochromic anemia Must know this!! Basophilic stippling of RBCs from ribosomal RNA aggregates • Bone marrow ringed sideroblasts :

Question 26

Aspirin Toxicity Chronic Aspirin Toxicity

Answer 26

Its Acute --> Respiratory alkalosis --> metabolic acidosis mixture of the two--> Renal Papillary necrosis **** Salicylism

Question 27

Reye Syndrome

Answer 27

Dont use Aspirin for kids Acute Febrile Viral Illness Fatty liver

Question 28

Lead

Answer 28

MICROCYTIC HYPOCHROMIC ANEMIA ANEMIA BASOPHILIC STIPPLING: Punctate aggregates of RNA in RBC Iron stain: RINGED SIDEROBLASTS

Question 29

Mercury and Arsenic

Answer 29

Most toxic form: Methyl mercury developing brain highly sensitive *** Fish and shellfish *** Pregnant women should decrease fish consumption Symptoms • Nephrotoxic proximal convoluted tubule necrosis Fetus through childhood: Major CNS damage – deafness, blindness, mental retardation Adults: • Tremors • Gingivitis “Mad as a hatter” - Alice In Wonderland Hg used to cure felts for hats mitochondrial oxidative phosphorylation ***** Cancers, especially lung, bladder and skin (palms and soles) – Hyperpigmentation/hyperkeratosis of palms and soles

Question 30

Pneumoconiosis (Mineral Dust in the Lungs)

Answer 30

Non neoplastic lung reaction to inhalation of mineral, organic or inorganic dust particulates Macrophages--> cytokines-->progressive fibrotic scarring

Question 31

Thermal Injury Burns

Answer 31

Promptness of therapy - BURN UNIT & PLASTIC SURGEON ASAP a. Fluid loss Hypovolemic shock b. Poor thermoregulation c. Infection pseudomonas and candida

Question 32

DEPTH OF BURN – KNOW THESE

Answer 32

Superficial (first degree) burn – Limited to epidermis – Sunburn – Painful • Partial thickness (second degree) burn – Involves dermis – Blisters – Painful • Full-thickness (third degree) burn – Involves subcutaneous tissue – Charring of tissue – NOT painful (nerves destroyed) Fourth Degree Burns muscle, bone, fat Burn Edema Caused by… - Increased capillary permeability - High Protein and osmotic pressure in interstitial space - Chemical mediators

Question 33

Cocaine

Answer 33

Becomes crack when crystallized Blocks reuptake of dopamine in CNS in brain Block the reuptake of Catecholamines in PNS Sudden death (Myocardial Infarction) Arrhythmia Nasal Septum Perforation (Nose)

Question 34

Body surface Area Estimate

Answer 34

Rule of 9’s” for an adult 20% causes massive fluid shifts to interstitial space = Burn shock !! 40% burn area = doubles metabolic rate Post-burn therapy: - fluid and electrolyte management - prevention of shock - control infection (pseudomonas)

Question 35

INTERNAL INJURY FROM INHALATION OF HOT AND TOXIC FUMES

Answer 35

In a house fire the most common cause of death – SMOKE INHALATION **** Can lead to pulmonary edema ****

Question 36

CONSEQUENCES OF SIGNIFICANT BURNS

Answer 36

1. Hypovolemic shock – rapid onset Shift of fluids into interstitial sites If die in early phase/hours, this is what they will die from 2. Sepsis – common cause of late fatalities septic shock – Pseudomonas and candida most common, MRSA Pneumonia or septic shock with renal failure and/or ARDS *** Can get pulmonary edema from smoke inhalation injury ***

Question 37

Heroin

Answer 37

More harmful than cocaine People who can't sleep FOAM CONE from Nose ***** Die from Pulmonary EDEMA ****

Question 38

Marijuana

Answer 38

Chronic Effects: Psychomotor impairment make you wanna commit crime

Question 39

HYPERTHERMIA – KNOW THESE ***

Answer 39

Heat exhaustion: Sudden collapse Dehydration/Hypovolemia beyond capacity of cardiovascular system to compensate Equilibrium quickly and spontaneously re-established if able to rehydrate Skin – profuse sweating Heat stroke: High ambient temperature, high humidity and exertion Shock CNS dysfunction (throbbing headache) **** Core temperature > 40o C (104°F) multiorgan dysfunction rapidly fatal Vasodilation (peripheral pooling) *** Generally sweating ceases *** Heart: Tachycardia and arrhythmias Hyperkalemia Can develop rhabdomyolysis (skeletal muscle necrosis), arrhythmias, DIC

Question 40

HYPOTHERMIA

Answer 40

Severe Frostbite *** intracellular ice crystals which cause membrane disruption *** Intravascular thrombosis gangrene Generalized hypothermia < 90oF (32°C) core temperature Loss of consciousness Bradycardia and atrial fibrillation

Question 41

Amphetamines and MDMA

Answer 41

Make you feel good (euphoria) Paranoid (destroying things) Agressive behavior Increase serotonin release Euphoria and hallucination

Question 42

Complication of Intravenous Drug Abuse

Answer 42

Infective Endocarditis HIV Hepatitis B and C Intravenous injection of Talc Track mark