Environmental / Nutritional Pathology

Question 1

Anorexia Nervosa is what?

what do they present with?

what symptoms do they have?

Answer 1

self-induced starvation

marked weight loss

Amenorrhea, low thyroid hormone, low bone density.

Question 2

Ozone:

how is ground level ozone toxicity mediated? what does it injure?

what does it lead to?

when is exposure more dangerous for people?

Answer 2

free radicals –> injury to respiratory tract epithelial cells, alveolar cells

inflammatory mediators –> mild sx

more dangerous for people with asthma or emphysema

Question 3

why is cigarette smoke a direct irritant?

why is smoking associated with emphysema?

what is the importance of the constituents polycyclic hydrocarbons/nitrosamine?

Answer 3

it leads to inflammation and increased mucus production (bronchitis)

smoking –> recruits leukocytes to the lung –> increase elastase production an then injury to the lung –> emphysema

DIRECTLY linked to lung cancer

Question 4

Acute Vitamin A toxicity:

Chronic Toxicity?

Answer 4

headache, vomiting, dizziness, stupor and blurred vision. confused.

wt loss, anorexia, N/V, bone and joint pain.

Question 5

What toxicant is heavily associated with leukemia?

liver angiosarcoma?

Answer 5

Benzene

Vinyl Chloride

Question 6

Vitamin D:

function

what is it required for in the prevention of?

Answer 6

maintenance of adequate plasma levels of calcium and phosphorus to support metabolic functions…. bone mineralization

Rickets, osteomalacia and hypocalcemia tetany

Question 7

Arsenic:

where does it come from

1) what does it interfere with? when is toxicity most prominent?
2) you have a large quantity ingested, what parts of your body are most affected?
3) what do you get 2-8 weeks post exposure?
4) what about on your skin?

Answer 7

Contaminated Water / Food

cellular metabolism –> GI tradt, nervous system, skin and heart

GI, CNS, cardiovascular

sensorimotor neuropathy; parathesias, numbness, pain

chronic changes lead to hyperpigmentation and hyperkeratosis

Question 8

Particulate matter (soot):

1) what effects does it have on us?
2) what is most harmful?

Answer 8

pulmonary inflammation and secondary cardiovascular effects

particulates less than 10um in diameter –> because it can be inhaled into the alveoli which leads to a release of a number of inflammatory mediators.

Question 9

Adverse drug reactions:

Acetaminophin –> what happens to people that use to them when using this improperly. what pattern of necrosis is associated?

Aspirin –> acute vs chronic? what else can it damage?

Answer 9

unintentional overdose –> gives acute liver failure a week or two after OD with 30% mortality –> centrilobular necrosis

ACUTE salicylate poisoning effects the brain –> nausea –> coma…. CHRONIC (salicylism) leads to HA, dizziness, tinnitus, bleeding, coma;

can also damage the kidneys –> analgesic nephropathy

Question 10

What happens when the body is burned more than 20%?

in this scenario, what can you generally get?

what about metabolism?

Answer 10

you get rapid shifts in body fluids into the INTERSTITIAL COMPARTMENT –> go into SHOCK

generalized edema, including pulmonary edema!

hyper metabolic state –> excess heat loss and increase need for nutritional support

Question 11

What xenobiotic is responsible for free radical injury in the liver that may have worked in a laundromat?

Answer 11

CCL4 which uses Cytochrome P450 to create ROS as it goes from CCL4 to CCL3-.

Question 12

A mother smokes, what does she have an increased risk of with her pregnancy? (3 things)

Answer 12

spontaneous abortions, preterm births, intrauterine growth retardation (IUGR)

Question 13

What does Lead do to heme? (3 things)*****

what kind of problems would you see in kids with a lead level of 10 ug/mL?

what about 40?

Answer 13

we get a deficiency of it that gives us –> Hypochromic microcytic anemia, BASOPHILIC STIPPLING, and ring sideroblasts (red cell precursors with iron-laden mitochondria that are detected with a PRUSSIAN BLUE stain)

developmental toxicity –> decreased IQ, decreased hearing, decreased growth, impaired peripheral nerve function, fetal effects.

decreased hemoglobin synthesis

Question 14

Bone Marrow signs and symptoms with radiation? 4)

again, what Sv would this be the main site of injury from total-body ionizing radiation?

how long does this take to develop?

is it lethal?

Answer 14

leukopenia, hemorrhage, hair loss, vomiting

2-10 Sv

2-6 weeks

variable (0-80%)

Question 15

What is the main site of injury with total body ionizing radiation within the following Sv’s:

0-1Svs

1-2Sv

2-10Sv

10-20 Sv

> 50Sv

Answer 15

None

Lymphocytes

Bone Marrow

Small Bowel

Brain

Question 16

Ozone:

What effects would it have on healthy adults and children? (3)

what effects would it have on athletes, outdoor workers, and asthmatics? (2)

Answer 16

decreased lung function, increased airway reactivity, lung inflammation

decreased exercise capacity, increased hospitalizations

Question 17

Adverse Drug Reactions:

Oral Contraceptives: what 2 things do people on these have an increased risk of? what cancer is more prevalent and at what age?

Anabolic Steroids (in males, then in females)

Answer 17

increase risk of cervical cancer especially HPV. 3-6x higher risk of thrombosis and PE if you also smoke….. HEPATIC ADENOMA –> older patient with prolonged use

stunted growth, acne, gynecomastia, testicular atrophy, PSYCHIATRIC ISSUES (ROID RAGE)…. facial hair and menstrual changes in females… both increase risk of MI

Question 18

Lead:

1) what does it bind to in our body, what does it interfere with?
2) when could this be exposed to kids? what about adults (be specific)?
3) what does most of the absorbed lead incorporate into? what’s the half life?
4) what do you see on Xray? (3 things)

Answer 18

it’s absorbed and binds to sulfhydryl groups –> interferes with CALCIUM metabolism

flaking lead paint and soil contamination for kids, occupational exposure (battery manufacturing, car radiators, pigment work, tin can stuff)

Bone and developing teeth because it competes with calcium. 20-30 years.. so lasts forever

Lead lines on the metaphyses and lead lines on the gums! Lead “colic” which is super severe and leads to people having poorly localized abdominal pain.

Question 19

Normal BMI?

obese BMI?

Overweight BMI?

Answer 19

18.5 - 25

30+

25-30

Question 20

Someone is an asbestos worker or a uranium miner and they smoke, what is their chances of lung carcinoma compared to someone who just smokes?

what has a multiplicative interaction with smoking? what does this give people?

Answer 20

10x higher

alcohol + tobacco –> laryngeal and oral cancers

Question 21

Rickets, what are the presentations?

Answer 21

Frontal bossing, squared head, pigeon breast deformity, rachitic rosary (prominent bone at costochondral joints), lumbar lordosis, bowing of the legs

Question 22

what is metabolic syndrome?

Answer 22

visceral/intraabdominal fat gives us insulin resistance and hyperinsulinemia

Question 23

Complication of both anorexia and bulimia?

Answer 23

both susceptible to cardiac arrhythmia and sudden death due to hypokalemia.

Question 24

Occupational Health Risks:

Mineral dusts: what is included in this?

what generally do all 4 of these give you?

What is specific with asbestos? what do you see on stains?

Answer 24

Coal dust, silica, asbestos, beryllium

Pneumoconiosis –> also called “BLACK LUNG”

Asbestosis (workers AND family members) –> mesothelioma. –> FERRUGINOUS BODIES Asbestos fibers coated in iron (can be seen with Prussian blue)

Question 25

Occupational Health Risks: Vinyl Chloride, what can this lead to? Bisphenol A (BPA) --> where is this found? what is it possibly disrupting?

Answer 25

angiosarcomas in the liver all food bottles and cans --> potential endocrine disruptor

Question 26

role of obesity in cancer? (3 of them)

Answer 26

insulin resistance leading to hyperinsulinemia --> directly or indirectly contribute to cancer by increasing free IGF-1 which is A MITOGEN obesity increases synthesis of estrogen --> higher risk of cancer stuff the general proinflammatory state of obesity might be carcinogenic

Question 27

What are 3 examples of emerging infectious diseases in our environment?

Answer 27

multidrug resistant TB pathogens endemic to other species jumped to ours --> HIV pathogens recently present but increased in incidence --> Dengue fever

Question 28

What's considered "indoor air pollution"? (4 things) 1) what kind of smoke indoors could be considered as indoor air pollution? 2) what includes pet dander, fungi, and molds and is a common cause of Legionnaires Dzviral pneumonia? 3) what is shown to have a higher risk of lung cancer and where does it come from? 4) What did FEMA trailers do that shed light on indoor air pollution?

Answer 28

Wood smoke --> polycyclic hydrocarbons are carcinogenic Bioaerosols Radon --> radioactive gas derived from uranium Formaldehyde --> building materials that lead to cancer.

Question 29

How do drugs and solvents enter cells?

Answer 29

they are lipophilic, facilitating their transport and penetration through the basement membrane!

Question 30

what stance do patients show that are burned beyond recognition? what can be normal in this?

Answer 30

Pugilistic stance (contracts up and looks like a boxer) internal organs are "normal", just a little cooked

Question 31

within 24-48 hours of a burn, what happens to breathing?

Answer 31

direct heat and inhalation of noxious gases affects the airway, so people end up with RESPIRATORY INSUFFICIENCY

Question 32

what can lead to less cytochrome P450 activity?

Answer 32

fasting and starving

Question 33

Bulimia is what? what do they present with? (3 things)

Answer 33

binging then purging electrolyte imbalance (hypokalemia) from throwing up so much --> leads to cardiac arrhythmia Pulmonary aspiration of gastric contents Esopaghageal and gastric rupture

Question 34

Cadmium: 1) what is it preferentially toxic to? 2) where does it come from? 3) what three things does it lead to? 4) living next to zinc smelters gives you an increased risk of what?

Answer 34

kidneys and lungs nickel-cadmium batteries, soil, plants --> so FOOD obstructive lung dz, renal tubular damage, skeletal abnormal associated with calcium loss. increased risk of lung cancer

Question 35

Chronic alcoholism: 1) what happens if they want to have kids? 2) what kind of cancers are they more likely to have? 3) why might they have malnutrition? 4) what are the positive things to note about alcohol?

Answer 35

fetal alcohol syndrome --> microcephaly, growth and mental retardation, ABSENT PHILTRUM oral, esophageal, liver, breast in women malnutrition and nutritional deficiency, especially B vit. moderate amounts INCREASES HDL, inhibits platelet aggregation and lowers fibrinogen levels protecting against CHD

Question 36

What can happen if burns get colonized? (happens in almost all burns). what are the 3 common ones?

Answer 36

Sepsis --> Pseudomonas aeruginosa, MRSA, Candida

Question 37

What's the difference between a primary and secondary dietary insufficiency? what would diabetes be considered?

Answer 37

primary = missing from diet secondary = malabsorption, impaired utilization or storage, excess loss, or increase need secondary malabsorption

Question 38

What is Cachexia? 1) what is it happening in? 2) what do people present with? 3) How do they die from it?

Answer 38

Malnutrition complication in AIDS or advanced cancers extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, edema atrophy of the diaphragm and other respiratory muscles.

Question 39

Drugs of Abuse: Opiates --> what 4 things does it do to users? what do these lead to? what infections are they likely to have? Methamphetamine --> what do people with this present with (3 things) Marijuana does what to patients? what if someone with CAD uses marijuana? what about if they continue to use it? What's to note about the smoke itself?

Answer 39

profound respiratory depression, arrhythmia, cardiac arrest, and pulmonary edema ... (foam at the mouth)--> leads to sudden death UNRELATED to OD --> 10% right heart valve endocarditis violent behavior, confusion, psychotic symptoms (paranoia + hallucinations) increase HR, may increase/decrease BP. CAD pts may cause angina. cognitive and psychomotor impairment. TONS of carcinogens in the smoke.

Question 40

What is the function of Cytochrome P-450 (CYP) as it relates to xenobiotics? 1) where is it primarily located 2) what does it do with xenobiotics? 2 possibilities 3) what do both of these possibilities produce as a byproduct?

Answer 40

primarily in the ER of the liver, but also in the skin, lungs, GI mucosa, and others. detoxifies xenobiotics, or less commonly convert xenobiotics into active compounds that cause cellular injury both can produce ROS which causes cellular damage.

Question 41

Chronic Alcoholism: 1) what do they have wrong with their liver (3 things). what are they associated with and at a higher risk for? 2) GI system? 3) Any vitamin problems? what does this give you? 4) heart problems? 5) what are they more likely to get?

Answer 41

1) MAIN site of chronic injury --> steatosis, hepatitis, cirrhosis... --> associated with portal hypertension and increased risk for hepatocellular carcinoma bleeding from gastritis or ulcers associated with cirrhosis Thiamine --> peripheral neuropathy and WERNICKE KORSAKOFF --> MAMILLARY BODIES ARE SCREWED, degeneration and optic neuropathy dilated congestive cardiomyopathy and hypertension... pretty much lowers your HDL leading to higher likelihood of coronary heart disease acute and chronic pancreatitis

Question 42

Vitamin K Vitamin B1 (thiamine) Niacin Bitamin B6 (pyridoxine)

Answer 42

bleeding problems wernicke Korsakoff syndrome, dry and wet beriberi 3 D's, Dementia, dermatitis, diarrhea Cheilosis, glossitis, peripheral neuropathy, maintenance of myelinization of spinal cord tracts.

Question 43

What toxicants are associated with lung cancer? (5 ones)

Answer 43

radon, asbestos, silica, nickel, arsenic, chromium

Question 44

What toxicants give heart disease? Ataxic gait? Renal Toxicity? Female infertility/stillbirths?

Answer 44

CO and lead Mercury Mercury Lead, Mercury

Question 45

What is Sick Building Syndrome? what specific groups of people are affected by this?

Answer 45

people living in damp homes with common molds, indoor pollutants and with poor ventilation --> sickness involving chest congestion, congestion of nose and around the eyes, headache, etc. people living in flood-hit buildings.

Question 46

What is Marasmus? 1) what categorizes someone with this? 2) what do they have generally? 3) what is being used as fuel for these kids? what does it lead to?

Answer 46

less than 60% normal weight for sex, height, and age growth retardation and muscle loss. subQ fat and muscle proteins --> leads to emaciated extremities

Question 47

What are the EPA's guidelines on what constitutes outdoor air pollution? (6 of them)

Answer 47

sulfur dioxide, CO2, Ozone, NO2, lead and particulate matter.

Question 48

Mercury: 1) what does it bind to and what does it damage? 2) what are the 2 main sources that you can see this in? 3) what disease is it associated with and what are the problems associated with it?

Answer 48

sulfhydryl groups --> damage CNS (developing brain) and kidney contaminated fish and mercury Vapors from metallic mercury in dental stuff Minamata disease --> cerebral palsy, deafness, blindness, mental retardation, major CNS defects in children exposed in utero

Question 49

What has climate change done with regards to health? 1) what has worsened because of the heatwaves and air pollution? 2) what about because of contamination from floods and disruption of clean water supplies? 3) what about infectious disease? why does this happen? 4) what general health problem is now more prevalent because of disrupted crop production?

Answer 49

Cardiovascular, cerebrovascular, respiratory diseases Gastroenteritis, cholera, and other foodborne/waterborne infectious diseases. malaria and dengue fever --> increase temperatures, crop failures and more extreme weather favoring different vectors malnutrition

Question 50

Malnutrion 1) what is this the consequence of? (2 things) 2) clinical presentation

Answer 50

it's the consequence of inadequate intake of proteins or calories or deficiencies in the absorption of proteins loss of fat and muscle tissue. weight loss, lethargy, muscle weakness

Question 51

What is Kwashiorkor? 1) what defines it? 2) what do they have low levels of? 3) what do they use as fuel? 4) what is the main reason for this in Africa?

Answer 51

THIS is MUCH more severe than marasmus. way less protein. Hypoalbuminemia --> this is why they have edema. depletion of visceral protein compartment; FATTY LIVER; spares subQ fat and muscle. they're weaned too early and fed a carbohydrate diet.

Question 52

what are the 3 most common diseases involving the lung and cigarette smoking?

Answer 52

emphysema, chronic bronchitis, COPD

Question 53

Occupational health risks: Organochlorines: what are they? what is ONE used for historically? how was this affecting an animal? what are the other two to know? what does this give people? what is a famous story to know about this one?

Answer 53

synthetic lipophilic products that resist degradation DDT --> pesticides, killing eagle eggs. PCBs and Dioxins --> folliculitis and dermatosis called "CHLORACNE" characterized by acne, cyst formation, hyperpigmentation and hyperkeratosis all over the face. --> this was given to the president of Ukraine.

Question 54

Carbon Monoxide: 1) why is it easy to die from this? 2) when would someone have chronic poisoning of this? 3) acute? (include time). What % saturation would you need to die from this? 4) what feature would they present with? what about anatomy lab and seeing a brain, when would you consider it to have been involved with CO poisoning?

Answer 54

it's non-irritating, non colorless, tasteless, odorless working in tunnels, underground garages, highway toll booths with tons of automobile fumes 5 minutes in a closed garage with the car running, 60-70% cherry red color of BOTH the skin and mucous membranes it's red despite the addition of formaldehyde

Question 55

What does Cocaine do once ingested? how might cocaine give us myocardial ischemia? is it dose dependent? what about using cocaine when you have a fetus? when taken in high doses, what happens?

Answer 55

Tachycardia, HTN, and peripheral vasoconstriction coronary artery vasoconstriction + platelet aggregation + thrombus formation --> myocardial ischemia NOT DOSE DEPENDENT --> lethal arrhythmia lowers blood flow to the placenta --> fetal hypoxia and spontaneous abortion hyperpyrexia (high fever) and seizures

Question 56

How is alcohol metabolized? what does it become and what uses it? in high concentrations, what does it compete with? this is why on pill bottles it says what?

Answer 56

alcohol oxidized to acetaldehyde in the liver by Alcohol Dehydrogenase (ADH) --> becomes acetate through ALDH --> used by the mitochondrial respiratory chain competes with other CYP2E1 substrates and delays drug catabolim, POTENTIATING the depressant effects of narcotics, sedative, and psychoactive drugs in the CNS --> don't drink and take this at the same time.

Question 57

Sulfur dioxide: what effects would it have on healthy adults? (1) individuals with chronic lung disease? (1) asthmatics? (2)

Answer 57

increased airway reactivity increased mortality increased hospitalization and decreased lung function

Question 58

How does CO kill you? when would you see morphological changes? what changes would you see? (3) what if the pt recovers from this? what's to note about CO and it's relationship to hemoglobin?

Answer 58

induces DNS depression --> widespread ischemic changes to the BASAL GANGLIA and LENTICULAR NUCLEI (pallidum) if death happened rapidly, no morphologic changes. if longer, brain is edematous, punctate hemorrhages, and hypoxia-induced neuronal changes they have impaired memory, vision, hearing, and speech 200X GREATER AFFINITY FOR CO THAN OXYGEN

Question 59

Vitamin A: function secondary deficiency of vitamin A is from what? what would happen if you have vitamin A deficiency and the eye? what about in the lungs?

Answer 59

maintenance of normal vision, regulation of cell growth and differentiation/regulation of lipid metabolism. secondary deficiency = fat malabsorption night blindness, epithelial/squamous metaplasia and keratinization, and Bitot spots squamous metaplasia of respiratory epithelium --> increased pulmonary infections

Question 60

What toxicants are associated with fibrosis? (3)

Answer 60

silica, asbestos, cobalt

Question 61

what would you see on histo of rickets?

Answer 61

cartilage palisades are lost so instead of growing straight in bones (which normally happens), its abnormal and more squiggly than straight.

Question 62

Cigarrete smoking is associated with cancers of what regions? what are you more likely to develop because of smoking? what does this lead to? what has a multiplicative effect on MIs?

Answer 62

esophagus, pancreas, bladder, kidney, cervix, bone marrow Atherosclerosis --> MI smoking with HTN and hypercholesterolemia

Question 63

Clinical significance of a burn injury depends on what 3 things? what is the treatment for burns?

Answer 63

depth of the burn % of body surface covered by the burn Internal injuries -- including inhalation of toxic fumes and heat. fluid and electrolyte management, along with infection control

Question 64

Sulfur dioxide: 1) when does it become "witches' brew"? how is it produced? (3) what would sulfuric acid and sulfuric trioxide do to someone if inhaled/ingested?

Answer 64

sulfur dioxide + ozone power plants burning fossil fuels, copper smelting, paper mill byproduct burning sensation in nose and throat, difficulty breathing, asthma attacks in those susceptible

Question 65

What are the classifications of burns?

Answer 65

1st degree --> superficial; epidermis only 2nd degree --> partial thickness; epidermis and dermis 3rd degree = full thickness; extend into the subcutaneous tissue

Question 66

Rubber workers are exposed to what that gives them an increased risk of LEUKEMIA? depending on the dose, what happens?

Answer 66

Benzene and 1,3 butadiene benzene is oxidized by hepatic CYP2E1 to toxic stuff that disrupts the differentiation of hematopoeitic cells in the bone marrow dose dependent marrow aplasia and increased risk of AML (acute myeloid leukemia)

Question 67

Lead: 1) what happens if lead levels are low, what subtle effects can it give kids? what about if the kid isn't even born yet? 2) what CNS problems do adults get with lead poisoning? (2 things)

Answer 67

1) intellect, behavioral problems, hyperactivity, poor organizational skills; BRAIN DAMAGE....... mother can impair brain development if lead poisoned. Adults get peripheral neuropathies --> Extensor muscles of the wrist and fingers often first --> Wrist- Drop Followed by paralysis of the peroneal muscles (foot-drop)

Question 68

Acute Alcoholism: 1) what is mostly affected? what three things do we se with this? 2) is it reversible?

Answer 68

1) mostly CNS effects (depressant) --> see fatty liver (steatosis), acute gastritis, and ulcers yes, if you stop drinking

Question 69

Lymphocyte signs and symptoms with radiation? (2) again, what Sv would this be the main site of injury from total-body ionizing radiation? how long does this take to develop? is it lethal?

Answer 69

Moderate granulocytopenia and lymphopenia 1 day to 1 week NO

Question 70

Huffing/glue sniffing --> what happens if you do this? Bath salts --> what does it cause (4 things)

Answer 70

MRI-detectable brain damage that ranges from MILD to SEVERE dementia. agitation, psychosis, MI and suicide.

Question 71

Brain signs and symptoms with radiation? (4) again, what Sv would this be the main site of injury from total-body ionizing radiation? how long does this take to develop? is it lethal?

Answer 71

Ataxia, coma, convulsions, vomiting >50Sv 1-4 hours 100% yes

Question 72

Global Disease Burden: from 1990 to 2010, what has increased in mortality rate? what is the leading cause of health loss? what is the leading cause of death in developed countries? 5 of 10 leading causes of death are what? 50% of all deaths in kidless than 5 have what 3 conditions which are preventable?

Answer 72

HIV/AIDS, cardiovascular, and a bit of cancer Undernutrition Ischemic heart disease and cerebral vascular disease infectious disease Pneumonia, diarrheal disease, malaria

Question 73

Cancer from radiation exposure: 1) what do they have increased incidence for? 2) what develops after they survive?

Answer 73

increase incidence of leukemias and solid tumors (due to destroying bone marrow hematopoiesis in radiation therapy), or from Chernobyl SECOND cancers happen after radiation therapy for cancers such as Hodgkin

Question 74

what syndrome is obesity associated with (not metabolic syndrome)?

Answer 74

hypoventilation syndrome/pickwinian --> intense sleepiness feeling at day and at night leads to eventual right sided heart failure (cor pulmonate)

Question 75

Adverse drug reactions: Minocycline Anticoagulants, what are the two common types and what happens with insufficient dosage or too much. Menopausal Hormone Therapy... when is it okay to use them? not okay?

Answer 75

discoloration of the skin, like a bluish tinge from iron/melanin pigment deposits in the skin warfarin (vit k antagonist) and dabigatran (inhibits thrombin) --> bleeding with too much; thrombosis due to insufficient dosage. was Hormone replacement therapy: estrogens with progesterone.. okay early menopause, but not long term --> higher risk for cancer

Question 76

despite al the attention for illicit drugs, what's to note about alcohol? what's up with the police breath test, how does it work?

Answer 76

alcohol abuse is more widespread and claims more lives --> 100,000 deaths annually, 15,000 due to liver cirrhosis ethanol that is unabsorbed goes to the tissues and fluids of the body. when you exhale its proportional to your blood level.

Question 77

What is hyperthermia? what is considered "heat-stroke like"? when does this happen? what is the gene usually associated with this?

Answer 77

heat stroke = Lack of sweating malignant hyperthermia --> heat stroke like rise in core body temp and muscle contractors --> COMMON reaction to ANESTHETICS RyR1 gene

Question 78

What is the leading exogenous cause of human cancers? what is 90% of it? how many deaths happen per year usually? how much of that is lung cancer? what's to note about how much tobacco you use? What's important to know about stopping smoking and risk of mortality? how much of a decrease is it for lung cancer? how long does this risk stay?

Answer 78

Tobacco --> 90% of lung cancers 400K, 1/3 lung cancer lower overall survival through it's dose-dependent effects --> more pack years, less likelihood of survival. stopping smoking within 5 years decreases mortality and risk of death from CVD. lung cancer mortality down 21% within 5 years, but the risk persists for 30 years

Question 79

How is vitamin D metabolized? when would you have a deficiency in vitamin D?

Answer 79

endogenous synthesis from a precursor 7-dehydrocholesterol in a photochemical reaction that requires solar or artificial UV light. insufficient sunlight

Question 80

Arsenic: 1) what do you have an increased risk of? 2) what do you see on fingernails?

Answer 80

cancers of the lung, bladder, skin (palm and soles) MEES lines

Question 81

Occupational Health Risks: 1) what organic solvents are considered health risks? what are they seen in? what happens to people if at high levels of vapors?

Answer 81

Chloroform and CCL4 --> found in degreasing agents, dry cleaning products, paint removers exposure to high levels gives people dizziness and confusion --> CNS depression and coma.

Question 82

Occupational Health Risks: Polycyclic hydrocarbons, where do they come from? what do chimney sweeps have a higher risk for? what is polycyclic hydrocarbons considered as?*** industrial exposure to these are implicated in what?

Answer 82

combustion of fossil fuels scrotal cancer among the most POTENT CARCINOGENS lung and bladder cancer

Question 83

What's the story behind Cadmium in Japan? what does it give people?

Answer 83

Itai Itai disease --> Cadmium pollution due to mining activities --> got in the river basin and accumulated in the rice fields --> accumulated in people eating the contaminated rice. Osteoporosis and osteomalacia with the renal problems.

Question 84

Small Bowel signs and symptoms with radiation? (4) again, what Sv would this be the main site of injury from total-body ionizing radiation? how long does this take to develop? is it lethal?

Answer 84

Diarrhea, fever, electrolyte imbalance, vomiting 10-20 Sv 5-14 days 100% yes

Question 85

Vitamin C: deficiency leads to what in kids? what about adults? where do we get it? when would someone have a secondary deficiency?

Answer 85

scurvy --> bone disease in kids, hemorrhage and healing problems in adults entirely from diet older individuals who live alone and are chronic alcoholics

Question 86

What is Toxicology? What is a "poison"? what is it dependent on? what is a Xenobiotic?

Answer 86

Distribution, effects, and mechanisms of action of toxic agents everything is a poison; the right dosage differentiates a poison from a remedy exogenous chemicals in the environment (air, water, food, soil) that may be absorbed into the body via inhalation, ingestion, or skin contact

Question 87

What's the difference between Marasmus and Kwashiorkor?

Answer 87

Marasmus --> uses muscle proteins and subQ fat. Serum albumin normal Kwashiorkor --> spares the subQ fat and muscle, instead uses visceral protein compartments. hypoalbuminemia + fatty liver

Question 88

Consequences of obesity | (4)

Answer 88

increased risk of CAD from hypertriglyceridemia and low HDL Nonalcoholic fatty liver disease 6x higher association of gallstones degenerative bone disease (osteoarthritis)

Question 89

Malnutrition: 1) who is susceptible to this? what are signs of secondary malnutrition?

Answer 89

50% of deaths ininfants and childhood in developing countries OR older and debilitated patients in nursing homes and hospitals depletion of fat, chest wall, arms or hands. Wasting of quads and deltoids, ANKLE OR SACRAL EDEMA

Question 90

Passive smoke inhalation (environmental) has what risk of lung cancer? what about kids in the home?

Answer 90

1.3X risk compared to unexposed non-smoker increased risk of asthma and other respiratory problems in children exposed in the home