environmental Flashcards
1
Q
are all chemical agents purposefully to cause problems
A
No, can be therapeutic and nontherapeutic
2
Q
injuries or disorders that are caused by chemical or physical agents
A
Environmetal disease
3
Q
where does protein energy malnutrition tend to occur
A
In poor countires
4
Q
what is the area of medicine focusing on injuries of the workplace
A
Occupational med
5
Q
what are the regulatory agencies to stop environment disorders
A
EPA
FDA
OSHA
consumer products safety commission
6
Q
how can chemical agents come in to cause problems
A
Inhalation
ingestion
injection
absorption throught the skin
7
Q
how often are people exposed to chem agents
A
2 mill/year is US
8
Q
how often are child exposed to chemical agents
A
60% of exposures
9
Q
what are the common chemical agents for children in the house
A
Cleaners Analgesics Cosmetics Plants Cold meds
10
Q
what are the factors that affect chemical injuries
A
CLADME Concentraion Liberation- how a drug comes to be Absorption Distribution Metabolism- some drugs need to be metabolised to be effective/cause problems Excretion
11
Q
how much chemical exposure is unintentional
A
90%
12
Q
how are most people exosed to chemical agents
A
oral:73%
adverse drug events: 2%
13
Q
what are the clinical signs of relatively minor Adverse drug reaction
A
Rashes
GI upset
14
Q
what are the major adverse drug reactions
A
Anaphylaxis (penicillin)
blood clots
arrhythmias
Hematologic (anemia, thrombocytopenia, leukopenia)
15
Q
what drugs tend to cause more adverse drug reactions
A
More potent drugs (commonly anti cancer)
16
Q
how often do adverse drug reactions lead to ER visits
A
7-9%
17
Q
how often do adverse drugs reactions lead to death once in the ER
A
10%
18
Q
how much asprin can you take to cause death
A
2-4 grams in kids
10-30 grams in adults
19
Q
how does asprin cause death
A
respiratory alkalosis
metabolic acidosis
20
Q
what does chronic asprin taking do to the body
A
headaches dizziness ringing in ears drowsiness Mental status changes gastritis GI bleeding Nausea and vomiting progress to seizures and coma
21
Q
how much must Acetaminophen must you take to OD
A
15-20 grams
22
Q
what does Acetaminophen OD lead to
A
Liver damage
liver failure
death
23
Q
what was the original use of exogenous estrogens
A
2002 HRT for menopausal symptoms
prevention of osteoporosis
24
Q
what is the problem with long term use of Exogenous estrogens
A
elevated risk of breast cancer, stroke, blood clots
25
can you use exogenous estrogens at all now a days
Short term may have better risk benefit relationships
26
what also may have similar problems to exogenous estrogens
Oral contraceptives
27
where is lead found
```
urban air
soil
water
food
house dust
batteries
older paints
gas
```
28
where are the sources of accupationlead
mining
| foundries
29
what happens to lead when taken up by the body
- 85% taken up by bones and developing teeth to compete with Ca
- interferes with remodeling
- blocks/binderes incorporation of Fe into hemoglobia
- anemia (microcytic, hypochromic)
- neuro disturbances
- wrist drop and footdrop
30
how does Lead show in X-rays
leads to lead lines
31
how does lead affect the teeth
Gingival hyperpigmentation (lead line of soft tissue)
32
what does lead do to the CNS
mild learn difficulties
sensory and motor deficits
wrist drop and footdrop
33
what does lead do to the GI
Colicky pain - severe no localized
34
what does lead do to the kidney
Damages tubules, fibrosis, renal failure
35
what is the Pb threshold blod levels for concern
greater than 5micrograms per decileter
36
when do you begin chelation therapy for lead
greater than 45 micrograms per decileter
37
what percent of lead is absorbed in children and adults
Children:50%
adults:15-20%
38
what are the sedative hypnotic drugs
EtOH
barbiturates
Benzodiazeprines
39
what are the CNS stimulates
Coke
| Amphetamines
40
what are opioids
```
Heroin
morphine
methadone
codeine
fentanyl
```
41
what are the hallucinogens
LSD
PCP
Mescaline
MDMA
42
what nonprescription drugs do people tend to abuse
Analgesics
Antihistamines
scopolamine
atropine
43
what is the negative effect of club drugs as dentist
Clenching of teeth
44
what is mechanical trauma
A physical agent such as an abrasion, contusions, laceration, incisions, punctions
45
what is the ideal body temp rnage
89-106F(31-41 C)
46
how much death does hyperthermia cause
greater than 5000 deaths per year in US
47
what causes hypothermia
prolonged exposure to low temps
48
what is a wond produced by scraping/rubbing leading to removal of a superfical layer of skin
Abrasion
49
what is a wound caused by a blunt object, doesn't break the skin
damages blood vessles and extravasation of blood in tissues
Contusion
50
what is a tear in tissue, usually with irregular jagged edges
Lacerations
51
what affects the clinical significance of burns
percentage of total body surface involved
depth of burn
possible internal injuries from inhalation of hot gases and fumes
age
how fast
how well treated
52
what is the rule of 9 for determineing the total body surface invovled
```
head and neck: 9%
trunk front: 18%
trunk back: 18%
arms: 9%
hands: 1% each
legs: 18% each
perineum: 1%
```
53
what happens if you greater than 50% of body surface is invovled in a burn
grave prognosis
54
how much should be burned for shock
greater than 20% of body surface area
55
what happens when burns lead to shock
Hypovolemia (massive fluid shift)
Infection (pseudomonas, candida)
Electrolyte & nutrition (hypermetabolic due to need to repair and rebuild)
56
what can cause internal injury from burns
Fumes
CO
HCN
57
what tends to get damaged internally from burns
Upper respiratory tract
| Lower respiratory tract
58
what cdelayed ondition may occur from internal injury due to burns
Acute respiratory distress syndrome (ARDS)
59
what is a prolonged exposure to increased ambient temp
Hyperthermia
60
what causes heat cramps
Related to exercise with loss of fluids and electrolytes
61
what causes heat exhaustin
Shock due to rapid hypovolemia
62
recovery from heat exhaustin
recover spontaneously
63
what happens in a state of heat exhaustin
colapse to allow blood to flow and redistribute
64
how high must temps be to cause heat stroke
greater than 40C
65
what are the symptoms of heat stroke
```
Peripheral vasodilation
confuction
coma
ischemia
muscle necrosis
DIC
```
66
how deadly is heat stroke
High mortality rate
67
what can lead to hypothermia
High humidity
wet clothes
Vasodilation(EtOH)
68
temp for mild hypothermia
32-35 celcius (89-95)
69
Temp for moderate hypothermia
28-32 celcius (82-89)
70
temp for severe hypothermia
less than 28 celcius (82)
71
what happens in hypothermia
bradycardia
atrial fibrillation
loss of consciousness
72
when does frost bite occur
Temp of extremities fals below freezing
73
how does frost bite occur at the cellular level
leads to crystallization of water and cell damage
74
what are the indirect effect of chilling
vasoconstriction
edema
longterm atrophy and fibrosis
75
sources of radiation
```
Cosmic
UV
elemental (From earths crust as radon)
med (diagnostic and therapeutic)
industrial
nuclear power
weapons
```
76
forms of radiation
```
Electomagnetic waves (x ray and gamma)
high energy neutrons and charged particles (alpha, beta, protons)
```
77
how can radiation causes cellular damage
Direct damage to DNA
| inrectly
78
how does indirect cellular damage to DNA occur
production of free radicals to damge membranes, nucleic acids, and enzymes
79
what the eventual outcome of radiation injuries
reversible
cell death
fibrosis
80
the amount of energy absorbed by target tissue
Gray
81
relative biologic effect of energy
Sievert
82
what does a sievert roughly equal
About a gray
83
sieverts of a single chest x-ray
.01mSv
84
sieverts of a CT
2mSv to head
| 8 mSv to ab
85
sieverts of a single dental intraoral image
.002 mSv
86
sieverts of cone beam CT
.02-.08 mSv
87
how many sieverts should you be exposed to as an occupation
less than or equal to 50 mSv/yr
88
what happens to the skin after 2-3 days of radiation
erythema (redness)
89
what happens tot he skin after 2-3 weeks of radiation
edema
90
what happens to the skin after 4-6 weeks of radiation
blistering/desquamation
91
What happens to the skin after months to years to decades of radiation
Atrophy
fibrosis
Neoplasia
92
are hematopoietic/lymphoid tissues sensitive to radiation or nah
Sensitive
93
how do lymphocytes respond to raidation
decrease in hours
| rebound in weeks to months
94
what happens to lymph nodes and spleen due to radiation
Lymph nodes and spleen shrink
95
what happens to PMN's due to radiation
decrease over 1-2 weeks
| rebound in 2-3 months
96
what is the problem with a decrease in PMN's from radiation
susceptible to infections(more bacterial)
97
what happens to platelets and RBC's due to radiation
Decrease
| take a while to rebound
98
what is the problem with a decrease in lymphocytes from radiation
susceptible to fungal infections
99
what does radiation do to the gonads
both sexes are sensitive and can make you sterile
100
why are the lungs sensitive to radiation
Vascularity
101
what does radiation do to the lungs
pulmonary congestion and edema
| ARDS
102
what does radiation do to the GI
very sensitive leading to ulcers, stricutres, increases risk for cancer
103
what does radation do to blood vessels
Endothelial cell injury then fibrosis and narrowing (ischemia)
104
how much radiation does it take to induce death
2Sv begins lethal range
| 7Sv death is certain
105
what dose of radiation is needed to cause hematopoietic acute radiation syndrome
2-10 Sv
106
what happens in hematopoietic acute radiation syndrome
```
Loss of WBC
hair loss
infection
sepsis
bleeding
death 2-6 weeks
```
107
what dose of radiation is needed to cause GI acute radiation syndrome
10-20 Sv
108
what does GI acute radiation syndrome lead to
```
Vomiting
Bloody diarrhea
shock
sepsis
death in 5-14 days
```
109
what dose of radiation is needed to lead to Cerebral acute radiation syndrome
greater than 50 Sv
110
what does Cerebral acute radiation syndrome lead to
```
listlessness
drowsiness
seizures
coma
death in 1-4 hours
```
111
what determines what aspect of the body gets hit the hardest by large doses of radiation
the dose amount
112
are nutritional disease qualitative or quantitative
Both
113
what does an adequate diet have
Carbs
more carbs
probably some bread
All the other things are an after thought
114
what is primary malnutrition
Diet deficient in 1+ component
115
what is secondary malnutrition
Supply is okay
| absorption, storage, utilization, excessive loss problem
116
causes of poor diet
```
SES
ignorance of needs
fads
acute illnesses (increase in BMR)
self imposed diet restrictions/habits (anorexia/bulimia)
malabsorption syndromes (CF, Crohn)
genetic disease
```
117
where is protein-energy malutrition common and how many are affected
in developing countires where 25% of children are affected
118
does protein-energy malnutrition lead to death
yes, major cause in kids less than 5 years old
119
how to asses nutritional status
```
body weight (age, sex, height norms)
growth charts
```
120
what are the two major disorders caused by protein-energy malnutrition
Marasmus
| Kwashiorkor
121
what are the two functional protein compartments
Somatic
| Visceral
122
what is the somatic protein compartment
Skeletal muscles
123
what is the visceral compartment for protein
Liver
124
what does marasmus affect
The somatic protein compartment
125
what does Kwashiorkor affect
The visceral compartment
126
what does marasmus lead to
skinfold thickness
127
what does Kwashiorkor lead to
serum proteins (Albumin and trasferrin)
128
when can you tell that a child has marasmus clinically
when weight falls below 60% of normal
129
what causes marasmum
Deficiency of caloric intake
130
what happens in the body to respond to marsmus
Carabolize proteins for energy
| Somatic protein compartment are depleted (visceral in reserve)
131
how do you look externally in marsmus
Extremities appear emaciated
| head's out of proportion (too large)
132
what are the affects of marasmus
```
Growth retard
anemia
Vitamine deficiency
Immune deficiency
bradycardia
low body temp
```
133
what happens to the bone marrow in marsum
Hypoplastic
134
what happens to the immune sstem in marasmum
Tcell defects with infections such as thrush common
135
what happens to serum albumin in marsmum
relatively normal
136
what disease do marsmum tend to get
Thrush
137
what causes Kwashiorkor
Protein deficiency, not calorie deficiency
138
what is more severe Kwashiorkor or marasmus
Kwashiorkor
139
where is PEM found
africa
| SE asia
140
what does the low albumin from kwashiorkor lead to
Generalized edema
141
what is the weight of kwashiorkor
60-80% of normal, but is due to edema
142
what happens to the skin in Kwashiorkor
Alternating zones of hyper and hypo pigementation with desquamation
143
what happens tot he hair in Kwashiorkor
change texture and color
144
what happens to the liver in Kwashiorkor
enlarged and fattty
| lack of transprot proteins
145
what happens to the immune system in kwashiorkor
defects lead to infrections
146
what does kwashiorkor do to growth
retards it
147
where do we find PEM in the US
chronic illness
| hospitalized patient
148
what is the form of PEM in cancer patients
Cachexia
149
what causes cachexia
decreased appettie of cancer patients
150
what happens in Cachexia
increased catabolism
151
what mediates Cachexia
Cytokines (IL-1, IL-6, TNF)
152
where do vitamine deficiencies come from
low socioecon with overall malnutrtion
153
what are the fat soluble vitamines
A
D
E
K
154
what do fat soluble vitamines need to be absorbed
healthy intestinal mucosa
bile
pancreatic secretions
155
where are vitamins stored
body tissues (not water)
156
what decreases absorbtion of vitameines
Inflammatory bowel disease (Crohn)
Cystic fibrossis
Alcoholic liver disease
157
what does vitamine A do
Prevent night blindness
augments differentiation of specialized epithelial cells
Enhanves immunityot infections
158
what are the three active forms of vitamine A
REtinol
Retinal
Retinoic acid
159
where does Vitamin A comefrom
Beta-arotenes
160
where is Vitamin A stored
liver for 6-12 months
161
where is Beta-carotenes found
```
yellow and green veggies
animal products (liver, fish, eggs, milk)
```
162
what is vitamin A released with
Carrier, retinol binding protein
163
where is vitamin A deficiency common
worldwide, especially in 3rd countries
164
what is th eearly sign of vit A deficiency
impaired night vision
165
persistnace Vitamin A deficiency leads to what
- Dry eyes (xerosis and xerophthalmia) to corneal damage
- respiratory and urinary tracts undergo squamous metaplasia causing infection
- immune deficiency leads to measles, pneumonia, infectious diarrhea
