Environmental and Nutritional Disorders: Part I

Question 1

What does the global disease burden estimate?

Answer 1

the burden imposed by environmental disease

Question 2

what is disability adjusted life year (DALY)?

Answer 2

sum of years of life lost due to immature mortality and disability in a population

Question 3

What was the GDB in 1990-2010 for HIV/AIDS?

Answer 3

there was a worldwide dramatic increase of mortality due to HIV/AIDS and associated infections

Question 4

what was the single leading global cause of health loss (morbidity and premature death)?

Answer 4

undernutrition

Question 5

what was the leading cause of death in developed countries?

Answer 5

ischemic heart disease and cerebral vascular disease

Question 6

what was the leading cause of death in developing countries?

Answer 6

infectious disease

Question 7

In the postnatal period, ~50% of all deaths in kids less than 5 years attributed to 3 conditions which are all preventable. What are these conditions?

Answer 7

PNA, diarrheal disease, and malaria

Question 8

What is the trend associated with neonatal conditions in the GBD for 1990-2010?

Answer 8

its still wide, but its going down

Question 9

what is the trend associated with diarrhea, lower respiratory infections, and other common infectious diseases in the GBD for 1990-2010?

Answer 9

still wide, but going down

Question 10

what is the trend associated with HIV/AIDS and tuberculosis in the GBD for 1990-2010?

Answer 10

it had an increase around 2006/2007

Question 11

Without immediate action, what stands to become the preeminent global cause of environmental disease in the 21st century and beyond?

Answer 11

climate change

Question 12

climate change will have a serious negative impact on human health by increasing the incidence of a number of diseases; what is the effect of climate change on cardiovascular, cerebrovascular, and respiratory diseases?

Answer 12

these are all worsened by heatwaves and air pollution

Question 13

climate change will have a serious negative impact on human health by increasing the incidence of a number of diseases; what is the effect of climate change on gastroenteritis, cholera, and other foodborne and waterborne infectious diseases?

Answer 13

contamination of foods and disruption of clean water supplies

Question 14

climate change will have a serious negative impact on human health by increasing the incidence of a number of diseases; what is the effect of climate change on vector-borne infectious diseases?

Answer 14

there will be an increase in malaria and dengue fever due to increased temps, crop failures, and more extreme weather variations

Question 15

climate change will have a serious negative impact on human health by increasing the incidence of a number of diseases; what is the effect of climate change on malnutrition?

Answer 15

climate change will increase the incidence of malnutrition by disrupting the crop production

Question 16

what is toxicology?

Answer 16

the study of the distribution, effects, and mechanisms of action of toxic agents (physical agents, radiation and heat)

Question 17

What limits the value of establishing “safe levels” for entire populations?

Answer 17

complex interactions between various pollutants and age, genetic predisposition, and different tissue sensitivities of exposed persons create wide variations

Question 18

the definition of a poison is strictly dependent on what?

Answer 18

dosage

Question 19

what are xenobiotics?

Answer 19

exogenous chemicals in the environment that may be absorbed into the body

Question 20

most solvents and drugs are said to be what? and what does this allow them to do?

Answer 20

lipophilic; allows their transport and penetration through the basement membrane

Question 21

What happens to most solvents, drugs, and xenobiotics in the body?

Answer 21

they are either metabolized to an inactive water-soluble product (detoxification) or activated to form toxic metabolites

Question 22

What enzyme system is responsible for either detoxifying xenobiotics or convert them into active compounds that cause cellular injury?

Answer 22

Cytochrome P-450

Question 23

where is the cytochrome P450 enzyme system primarily located?

Answer 23

endoplasmic reticulum of the liver; also present in the skin, lungs, GI mucosa, and other organs

Question 24

What is produced when P450 metabolizes xenobiotics?

Answer 24

ROS

Question 25

what are three examples of xenobiotics that P450 metabolizes?

Answer 25

carbon tetrachloride cigarette smoke, and EtOH

Question 26

What effect does fasting and starvation have on P450?

Answer 26

decreases its activity

Question 27

Air pollution is especially hazardous to whom?

Answer 27

people with preexisting pulmonary or cardiac disease

Question 28

The US EPA sets limits on what environmental pollutions? (6)

Answer 28

sulfur dioxide, ozone, carbon monoxide, nitrogen dioxide, lead, and particulate matter

Question 29

What populations are at risk of ozone exposure?

Answer 29

healthy adults and children; athletes, outdoor workers, and asthmatics

Question 30

what happens if healthy adults and children are exposed to ozone?

Answer 30

decreased lung function, increased airway reactivity, lung inflammation

Question 31

what happens if athletes or outdoor workers are exposed to ozone?

Answer 31

they will have a decreased exercise capacity

Question 32

what happens if asthmatics are exposed to ozone?

Answer 32

increased hospitalizations

Question 33

What populations are at risk when exposed to sulfur dioxide?

Answer 33

healthy adults, individuals with chronic lung disease, and asthmatics

Question 34

what happens if a healthy adult is exposed to sulfur dioxide?

Answer 34

they will have increased respiratory symptoms

Question 35

what happens if individuals with chronic lung disease are exposed to sulfur dioxide?

Answer 35

increased mortality

Question 36

what happens if asthmatics are exposed to sulfur dioxide?

Answer 36

increased hospitalizations and decreased lung function

Question 37

What is ozone?

Answer 37

UV radiation + Oxygen

Question 38

ground level ozone toxicity is largely mediated by what? and these injure what?

Answer 38

free radicals; injure respiratory tract epithelial cells and type I alveolar cells, which cause mild symptoms

Question 39

What is sulfur dioxide produced by?

Answer 39

power plants burning fossil fuels, copper smelting, and as a byproduct of paper mills

Question 40

what are the effects of sulfuric acid and sulfuric trioxide?

Answer 40

a burning sensation in the nose and throat, difficulty breathing, and asthma attacks in those susceptible

Question 41

What particulate matter (soot) particles are the most harmful?

Answer 41

fine or ultrafine particles less than 10 micrometers in diameter

Question 42

What happens to the particulate matter (soot) that is larger than 10 micrometers in diameter?

Answer 42

they are typically removed in the nose, trapped by the mucociliary epithelium of the airways

Question 43

Who is at risk for chronic poisoning of carbon monoxide?

Answer 43

those who work in tunnels, underground garages, and highway toll booths with high exposures to automobile fumes

Question 44

who is at risk for acute toxicity of CO?

Answer 44

improper use of gasoline-powered generators (e.g. during power outages)

Question 45

How does CO kill?

Answer 45

by inducing CNS depression; widespread ischemic changes

Question 46

Where is CO concentrated in the brain following toxicity?

Answer 46

basal ganglia and lenticular nuclei

Question 47

What would you see if someone has survived 24-48 hours after they have been exposed to the CO?

Answer 47

the brain may be slightly edematous, they may have hemorrhages in the pallidum, and there may be hypoxia-induced neuronal changes

Question 48

What are the likely symptoms a patient will have if they recover from CO poisoning?

Answer 48

impaired memory, vision, hearing, and speech

Question 49

What is a gross indicator that a patient has been poisoned by CO?

Answer 49

there is a generalized cherry-red color of the skin and mucous membranes

Question 50

What is the most common indoor pollutant?

Answer 50

tobacco smoke

Question 51

What makes wood smoke carcinogenic?

Answer 51

polycyclic hydrocarbons

Question 52

What is associated with bioaerosols as indoor air pollution?

Answer 52

legionnaires disease, viral PNA, pet dander, fungi, molds

Question 53

what is radon?

Answer 53

a radioactive gas derived from uranium

Question 54

what is the effect of radon exposure?

Answer 54

it increases the risk for lung cancer (2nd leading cause of lung cancer)

Question 55

Where might you be exposed to formaldehyde?

Answer 55

building materials, poorly ventilated trailers following disasters

Question 56

What is sick building syndrome?

Answer 56

when an indoor space to poorly ventilated and indoor pollutants build up

Question 57

What does lead in the body interfere with?

Answer 57

calcium metabolism

Question 58

how are children exposed to lead?

Answer 58

flaking lead paint and soil

Question 59

what are the occupational exposures of lead?

Answer 59

battery manufacturing, pigments, car radiators, and tin cans

Question 60

Where is most of the lead that is absorbed into the body incorporated? and what is the half life of lead?

Answer 60

bone and developing teeth; half life is 20-30 years

Question 61

What effect do low levels of lead in the body have?

Answer 61

intellectual issues, behavioral problems, hyperactivity, poor organizational skills in kids

Question 62

What effect does lead poisoning have on kids?

Answer 62

brain damage

Question 63

what effect does lead poisoning have on adults?

Answer 63

peripheral neuropathy (wrist drop/ foot drop)

Question 64

What are lead lines?

Answer 64

radiodense deposits in the metaphyses (which interferes with remodeling of cartilage); also lead lines in the gums

Question 65

What does lead do to you hematologically?

Answer 65

gives you hypochromic microcytic anemia, basophilic stippling, and ring sideroblasts

Question 66

What is lead colic?

Answer 66

extremely severe, poorly localized abdominal pain

Question 67

how can you diagnose microcytic hypochromic anemia with a lab test?

Answer 67

if MVC is less than 80 fL

Question 68

What is the effect of exposure to mercury?

Answer 68

damages the CNS in the developing brain and also the kidney

Question 69

what are the main sources of mercury?

Answer 69

contaminated fish (methyl mercury), mercury vapors from metallic mercury in dental amalgams

Question 70

what are the effects of minamata disease?

Answer 70

cerebral palsy, deafness, blindness, mental retardation, and major CNS defects in children exposed in utero

Question 71

What are the effects of arsenic exposure?

Answer 71

it interferes with cellular metabolism--> toxicities most prominent in the GI tract, nervous system, skin, and heart

Question 72

Where might you be exposed to arsenic?

Answer 72

in the soil and water naturally; wood preservatives, herbicides, and herbal medicines

Question 73

what might you notice after 2-8 weeks post exposure to arsenic?

Answer 73

sensorimotor neuropathy, paresthesias, numbness, and pain

Question 74

What is a very unique characteristic of arsenic poisoning?

Answer 74

there are chronic skin changes- hyperpigmentation and hyperkeratosis on the palms and soles too; mees lines in the nails

Question 75

what cancers are you at risk for if exposed to arsenic?

Answer 75

lungs, bladder, and skin (multiple on palms and soles)

Question 76

What is cadmium poisoning preferentially toxic to?

Answer 76

kidneys and lungs (involve increased ROS

Question 77

What are the main sources of cadmium?

Answer 77

nickel-cadmium batteries, soil, plants (aka food)

Question 78

what are the effects of cadmium poisoning?

Answer 78

obstructive lung disease, renal tubular damage, skeletal abnormalities associated with calcium loss

Question 79

What is Itai-Itai?

Answer 79

a disease in Japan; osteoporosis and osteomalacia with renal disease- came from cadmium pollution in the Jinzu river in the 1950s

Question 80

What cancer are you more at risk for if you are exposed to cadmium? and where might this happen?

Answer 80

increased risk of lung cancer (if you liver near zinc smelters)

Question 81

What cancer could benzene cause?

Answer 81

leukemia

Question 82

What cancer could vinyl chloride cause?

Answer 82

liver angiosarcoma

Question 83

What toxicants could cause fibrosis?

Answer 83

silica, asbestos, and cobalt

Question 84

What toxicants could cause lung cancer?

Answer 84

radon, asbestos, and silica

Question 85

What are two examples of organic solvents that cause occupational health risks?

Answer 85

chloroform and carbon tetrachloride

Question 86

what does acute exposure to chloroform and carbon tetrachloride cause?

Answer 86

dizziness and confusion leading to CNS depression and coma

Question 87

what are lower levels of exposure to chloroform and carbon tetrachloride toxic for?

Answer 87

the liver and the kidneys

Question 88

What are rubber workers exposed to?

Answer 88

benzene and 1,3-butadiene

Question 89

Benzene is oxidized by hepatic CYP to toxic metabolites that disrupt what?

Answer 89

the differentiation of hematopoietic cells in the bone marrow--> leads to marrow aplasia and increased risk of AML

Question 90

what is the main source of polycyclic hydrocarbons, and what does exposure to these lead to?

Answer 90

combustion of fossil fuels; scrotal cancers

Question 91

what are chimney sweeps at risk for?

Answer 91

prostate cancer due to being exposed to polycyclic hydrocarbons

Question 92

polycyclic hydrocarbons are among the most potent carcinogens and industrial exposure implicated in what cancers?

Answer 92

lung and bladder

Question 93

What are organochlorines?

Answer 93

synthetic lipophilic products that resist degradation

Question 94

what are common organochlorines?

Answer 94

pesticides (such as DDT) or non pesticides such as PCBs and dioxin

Question 95

what effect do organochlorines have on the body?

Answer 95

they disrupt hormonal balance because of antiestrogenic and antiandrogenic activity

Question 96

What do dioxins and PCBs cause?

Answer 96

folliculitis and a dermatosis known as chloracne

Question 97

what is chloracne?

Answer 97

an acne with cyst formation, hyperpigmentation, and hyperkeratosis of the face and behind the ears

Question 98

What do mineral dusts such as coal dust, silica, asbestos, and beryllium cause?

Answer 98

pneumonconioses

Question 99

What does asbestosis cause?

Answer 99

mesothelioma and black lung

Question 100

what are ferruginous bodies?

Answer 100

asbestos fibers coated in iron

Question 101

what is BPA known as?

Answer 101

a potential endocrine disruptor