Flashcards in Final Exam Deck (156)
When you think benzene exposure, which condition do you think of MC?
How are we exposed to VOCs (3)?
What main systems are affected by VOC exposure (3)?
hematologic (thrombocytopenia, leukemia)
- these are oncogenic compounds, usually
Which compound are huffers after?
- also known as methyl benzene
- smell of paint thinner
What compound is present in dry-cleaned clothing?
tetracholorethylene or PERCs
histology lab uses which compound for tissue processing? what effect does this compound cause and why is it concerning?
- CNS depressant
- can penetrate most clothing
What compound is found commonly in chloroseptic and carmex?
Which condition is pathognomonic for asbestos?
What is the metabolite of nicotine?
What is the major source of new car smell?
poly vinyl chloride
What does PAH stand for? And where does it come from?
Polycyclic aromatic hydrocarbon
- byproduct of burning
What are high and low molecular weight examples of PAH and where are they found?
LMW - naphthalene (found in mothballs)
HMW - benzo-a-pyrine (charred, grilled foods and tobacco smoke)
what compound is used a plasticizer and is easily leached?
What compound can you find in metal cans, plastic or plastic wrap? It increases risk for (3)?
- increases risk for diabetes, heart and liver problems
What are the 6 criteria for air pollutants?
- Carbon monoxide
- nitrogen oxide
- sulfur dioxide
- ground level ozone
- particulate matter
What is a xenobiotic?
anything that is foreign to the body
what are the primary routes of excreting environmental contaminants? (3)
What is the predominant CYP in the body?
Generally speaking, is fasting a good idea when considering environmental medicine? Why or why not?
No, biotransformation requires energy and it can only be spared at the expense of GLUCONEOGENESIS*
what is the definition of a fossil fuel?
when layers of buried plant and animal matter is exposed to heat and pressure over thousands of years
What heavy metal is common in shellfish and the reason we ask patients to avoid eating this food prior to testing.
Which two pollutants combine to form ground level ozone?
What is the primary cause of acid rain? What is the pH of acid rain?
nitrogen and sulfur oxides combing with water
pH < 5.6 *
- caused by fossil fuel emissions
what is NOT included, when considering environmental medicine?
otherwise, we consider: air pollution, heavy metal exposure, toxic chemical exposure and mold
What does ecology stand for?
the study of relationships between organisms and their environments
- for us to be healthy, the environment must be healthy
What are the common patient demographics (3) of multiple chemical sensitivity?
upper SES (85%)
middle age female
-often found as co-morbidity to fatigue and mental health conditions
What are the three most common types of occupational cancers?
hair stylists are at high risk of exposure to this chemical marketed as "keratin-based" hair smoothing products?
- some say formaldehyde free or dissolving formaldehyde (methylene glycol) or can be released during heating
At high levels, this compound can cause parkinsonism symptoms and is a higher exposure risk for welders
- parkinsonism sis called MANGANISM when at high levels
These release a small amount of mercury into the environment when broken
Compact Fluorescent Lightbulbs (CFL)
What should we be recommending to patients regarding their windows?
keep them open as much as possible
-maintains moderate humidity and temperature
-lets in some fresh air!
What does PTFE stand for and where can you find it?
- found in TEFLON cookware
- can cause PTFE toxicosis
when tested in birds with high respiratory efficiency, killed all 7 recently hatched chickens after heat lamp coated with PTFE exposure
How do organophosphates work in the body? What clinical picture do they create?
- induce neurotoxicity
- fatigue, HA, brain fog, slow response time, mm weakness
what can you replace mothballs with that work just as well?
is indoor air quality better or worse than outdoor air quality?
indoor air is 2-5x worse than outdoor
this compound has mostly resp. and mucous membrane health effects to the URT but not LRT because solubility prevents access to LRT - what compound is this?
What are the VOCs to be known? (6)
this compound is a byproduct of volcanoes, forest fires, carbon combustion as well as glues and paints?
- leukemia (cause cells not to work effectively)
this compound is 25x more reactive than benzene
methyl benzene otherwise known as:
what is the primary target for toxicity in both acute and chronic toluene exposure?
What is the Dx criteria for multiple chemical sensitivity
-Low exposure leads to sx
-Sx improve when chemical removed
-Sx involve multiple organ systems
Difference between sick-building syndrome and building related illness
sx of ill health seem linked to a building but no specific cause is identified
Building related illness:
recognized diseases caused by being in a building
Main chemical in Brazilian Blow-Outs
What are the health effects of the natural gas exposure see on blood work?
High RBC, Hct, Hgb, and platelets
(found after increased exposure to hydrogen sulfide in Iranian study)
Respiratory sx in people who use gas appliances
What can you potentially be exposed to if a Compact Fluorescent Bulb Breaks?
What is found in Teflon Cookware?
What is a Maximum Residue Limit (MRL)? What is the MC agent?
the limit that the EPA has set for how much pesticide can remain on food
MC - organophosphates
What three chemicals are found in Fabric Softeners?
-Quaternary Ammonium Compounds
What chemical is found in dry cleaned clothes?
-a type of VOC
What is the concerning additive found in Child Vaccines?
What does OSHA stand for?
Occupational Safety and Health Administration
What does MSDS Stand for
Material Safety Data Sheet
What is the Fourth National Report on Human Exposure to Environmental Chemicals?
-CDC report using data from NHANES to assess levels of environmental chemicals in a U.S. subsample
-Utilizes blood and urinary markers
Main System Affected by VOC
What are phenols produced from
-used in the conversion to precursors of plastics
-used in plywood, construction, automotive and appliance industries
-Precursor to many drugs
-Oral anesthetic in Chloraseptic and Carmex but considered to be quite toxic via oral exposure
Where do you find formaldehyde?
-Glues and Dyes
-Pressed Wood Products
What is the main health effect of formaldehyde?
attacks respiratory tract and mucous membranes
Where do you find Vinyl Chloride?
-New car smell
Which VOC causes hepatic angioscarcoma?
- Scleroderma-like skin changes
What are the two types of polycyclic aromatic hydrocarbons (PAH)
What was the first carcinogen discovered
Heterocyclic Amines are formed by what?
burning at high temperatures
What are some prevention strategies to protect against Polycyclic Aromatic Hydrocarbons (PAH)
-Tobacco cessation/non-grilled meat
-Marinade in Acidic base
What metabolite can you test for to measure second hand smoke exposure?
Where is asbestos found?
WHAT IS IT?
component of PM 10 and 2.5 (PARTICULATE MATTER)
What are 3 health effects of asbestos
What are the safest numbers of plastic
- no leeching, no detection in humans
What are the just ok plastics?
- some leeching, no detected health effects
What are the un-safe plastic?
- known leeching, known health effects*
Polyvinyl Chloride is what number plastic?
Is it safe? Where is it found, medically?
- significantly increases risk of CV and nervous disease*
-found in IV bags and tubing
What number plastic is in trans-vaginal mesh and diapers?
3 facts about phthalates
-causes endocrine disruption
What are the health effects of Polystyrene: acute and chronic?
-acute - RESPIRATORY - effects mucous membranes and leads to irritation
-chronic - NEURAL TOXIC - dizziness, fatigue, n/v
2 facts about Bisphenol A (BPA)
-Used in food packaging, metal can coating
What species is black mold?
What is the AQI?
Air Quality Index
What are 3 MAJOR sources of air pollution?
What are 3 smaller sources of air pollution?
How is particulate matter classified?
PM10: all particles < or = 10 microns
PM2.5: fine fraction particles
PM 1.0-2.5: coarse fine fraction particles
Ultrafine: all particles <0.1 microns
What is smog and what is the main component?
Mixture of air pollutants and fine particles
-Ground level ozone (MAIN COMPONENT)
-Volatile Organic Compounds
What are the health effects and symptoms of carbon monoxide poisioning
-RBC pick up CO quicker than O2 > tissue necrosis > death
-SX: HA, dizziness, weakness, N/V, chest pain, confusion
At high levels - LOC and death
What is the main cause of haze?
PM 2.5, fine fraction particles
What is the primary cause of acid rain?
What are Chlorofluorcarbons (CFC)
-Compound consisting of chlorine, fluorine and carbon
-broken down by strong UV light in stratosphere; releasing Cl, which destroys ozone layer
What are 3 uses of Chlorofluorcarbons
-Foam Blowing Agents
(UV breaks down into Cl, destroying ozone)
These were commonly used in the past, but have been removed from the market because of health/environmental effects - what are they?
Two types of acetylcholinesterase inhibitors
organophosphates (more toxic)
What does the nitrate in fertilizers do?
alter the iron in hemoglobin (ferrous to ferric)
ultimately decreases oxygen carrying capacity of the blood
What are the exposure routes of heavy metals?
What is LD50?
-Median lethal dose; short term acute poisoning
-Dose given that causes death in 50% of test group
con - wide variability b/w species
What are mechanisms of heavy metal toxicity (5)?
-Enzyme/cofactor inhibition or potentiation
-Disruption of membrane and other transport processes
-Disrupt mitochondrial function and fatigue
-Decreased neuronal function and nerve conduction
-Bind sulfhydrl groups on proteins
What are potential sources of lead (4)
-Dust (directly correlated with child lead levels)
- Pre-1978 homes
Where is lead still found (7)
-Imported or older pre-regulation products
Who are at most risk for lead exposure
Children and pregnant women's fetus
What are sx of lead toxicity
-Decreased learning and memory
What is the best test for lead toxicity screening?
Adult level of lead toxicity
Child levels of lead toxicity
What may imaging of lead toxicity reveal?
-Abdomen: lead items swallowed
-Long bones: Lead lines
What is the difference between elemental, organic and inorganic mercury.
What are their exposure sources
- combustion of fossil fuels, solid waste, minning, smelting - source: thermometers, barometer, DENTAL AMALGAMS
Organic (methyl mercury) (GI ABS)
- bioaccumulates in fish; infant born with cerebral palsy
- ethyl mercury - Thimerisol*
- mercuric chloride, mercuric sulfide,
- source: batteries, disinfectants, health remedies and skin lightening creams
What is bioaccumulation
accumulation of substances in an organism
What is biomagnification
As you move up the food chain, concentration increases
What does mercury bind to, in order to cross BBB - why?
Methylmercury binds to CYSTEINE molecule
-looks similar to methionine, replaces it in the membrane transport system
Not fat soluble must be transported into brain
What is contraindicated when you suspect mercury exposure?
NAC because it helps transport mercury into the brain, same mechanism methionine uses
What is the predominant use of Cadmium?
What are other sources (3)?
Battery Manufacturing (PREDOMINANT)
What increases cadmium absorption?
Where does cadmium accumulate in the body
Why is this Concerning?
liver and kidneys
- irreversible proteinuria, progressive loss in GFR
concerning because if you chelate a person with elevated cadmium and try to mobilize for excretion, the key route is through the urine so you risk further damage
How does cadmium contribute to osteomalacia and/or osteoporosis
Other health effects?
Increased urinary excretion of
and decreased hydroxylation of Vit D*
Effects lung: pneumonititis, emphysema, lung ca
Where is arsenic found?
-Industrial wood preservation
Where is arsenic best absorbed in the body?
What is the best test for acute exposure of arsenic
what is another source?
Blood is best
Hair - pros and cons
What are the PROs of hair testing for heavy metals
-Good for METHYLMERCURY
-cheap and easy
-Qualitative screening for exposure
What are cons for hair testing of heavy metals? Which metals are unreliable with this method (3)?
-Only a screen must be confirmed by blood
-No indication of net retention
-Highly vulnerable to external contamination
-No standard procedure
Not reliable for Hg, Cd, Pb
What is depuration
-Action or process of freeing something of impurities
-Removal of xenobiotics by the body
What is Detoxification
transforming a toxin into a non-toxic substance
What is nasal fatigue
you ever notice how when you walk into a room with a terrible smell and you stay there long enough you don't notice it anymore
well your in luck ;)
What are the effect of starvation on NADPH and why is starvation not a good idea for biotransformation?
NADPH: component of phase 1 detox
Not a good idea for biotransformation because it can only be produced at expense of gluconeogenesis
What is the main CYP in the liver
Are heavy metals inducers or inhibitors
What are major TYPES of absorption of biotransformation
-passage through pores
-specialized transport systems
What are major SITES of absorption of biotransformation
Major Storage sinks in the body (4)
-Bone (Al, Cd, Pb)
What are a couple of our barriers?
What is the MAJOR idea of biotransformation
Conversion of lipid soluble xenobiotic into polar water soluble for excretion
Difference between TH1 and TH2 response?
INFECTION (intracellular bacteria and some viruses)
- IL-2, INF gamma, TNF beta, activates macs
WORMS (infestation by GI nematodes)
- IL-4,IL-5, Il-10, IL-14, antibody response and eosinophil activation
How do toxins cause immune deficits
-Hypersensitivity reaction (includes allergy)
DES, DIOXINE and DDT - cause what?
Atrophy and/or death of the cells of the thymus gland
Polychlorinated Biphenols - PCB exposure make people more prone to what?
PAH exposure does what?
Decreases splenic and thymic activity
Lead and Mercury lead to an inability to do what?
When may selenium supplementation be protective?
- can be protective of immune function
What is the main problem with Diethylstilbestrol (DES)?
reproductive problems in the offspring
What is an endocrine disruptor?
-Phytoestrogen is specifically extracted from plants
What are problems with the ways we study xenoestrogens (2)?
-Mostly Animal Studies
What environmental exposures can cause infertility in females? (5)
What causes infertility in males? (2)
What compound looks like thyroid?
What are two exposure history forms
What tests should be ran before doing any specialty heavy metal testing? (7)
Is there a good test to determine ACCURATE body burden of heavy metals?
Who is a good candidate for stool testing?
Binding affinities for metals with chelating agents in order of greatest to least. Which is chelated best?
best for mercury
is IV or oral administration of chelating agent best?
What are the side effects of chelation (3)?
-Decrease in essential minerals
-Increase liver transaminases
-Allergic reaction occasionally
Why do you need to avoid seafood for a week prior to metal challenge testing?
Arsenic and Mercury bioaccumulation
How do you test for acetylcholinesterase pesticide exposure?
Whole blood AND plasma
What is the theory behind colon hydrotherapy as tx?
Increases bile dumping
Why low temp sauna
-Helpful for excretion of metals in adipose tissue, solvents, plastics and pesticides
-Tolerate longer times
Food and supplements that help increase glutathione (7)
-Cysteins (l-cysteine, NAC)
-Undenatured whey protein
-Onions and Garlic
List some of the basic supportive supplements (4)
this occupation for mothers increases the risk of their children having cleft palate, what occupation is this?
What is being used to replace CFCs (chlorofluorocarbons)?
- still break down ozone, but not AS extensively
what are heavy metal's main mechanism of detox from the body (i.e. - which phase II mechanism)?
blood work for lead poisoning will show?
microcytic hypochromic anemia with basophilic stippling
What homeostasis is disrupted by mercury in the body?