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Flashcards in Mentals Deck (58):
0

Lead poisoning has been associated with motor neuropathy or sensory neuropathy ?

Moto neuropathy, with slow motor nerve conduction, wrist drop may occur

1

Wrist drop, lead colic, lead line and basophilic stippling are manifestation of inorganic lead poisoning or organic lead poisoning?

Inorganic lead toxicity

2

Symptoms of severe toxicity including delusions, hallucinations, hyperactivity, and loud shouting and laughing, are manifestations of inorganic lead or organic lead poisoning?

Organic lead such as tetraethyl lead toxicity are related to CNS irritability

3

Methyl mercury poisoning can lead to?

1.Fulminant chemical pneumonitis
2. Fetal toxicity
3. Speech disturbances

(F.F.S)

4

Nickel compound can cause ?

1. Contact dermatitis
2. Adult respiratory distress syndrome
3. Lung cancer

(C.A.L)

5

Agent that causes Upper airway irritation and green tongue?

Vanadium

6

4 mentals that cause peripheral neuropathies are ?

Lead (motor >sensory)
Arsenic (painful, sensory>motor )
Mercury (+ tremor )
Thallium


LAM Tea

7

Lead T1/2?

Red cell: 60-90 days
Bones: years

8

Lead'a biochemical effects?

Enzyme inhibition
Delta-aminolevulinic dehydratase (ALA-D)
Ferrochelatase
Coproporphyrinogen oxidase
Pyrimidine-5-nucleotidase
Enzyme stimulation
Delta-aminolevulinic acid synthetase (ALA-S)

9

Lead mainly excreted through?

Mainly kidney, small amount through stool

10

Biological effects of lead in the blood?

Increased:
ALA
FEP (Free erythrocyte protoporphyrin)
ZPP (zinc protoporphyrin ) - Fe++ not inserted into porphyrin ring
Basophilic stippling in RBC's

11

Lead biomonitoring?

Whole Blood lead level
ZPP
CBC & smear
Serum creatinine
Urinalysis

12

Distinguish between iron deficiency and lead poisoning ?

Lead poisoning with increase of both lead and ZPP
Iron deficiency anemia with high ZPP but normal lead level.
ZPP can also increase in old age

13

Situations that can have increased ZPP/FEP ?

Depends on new RBC synthesis
Except lead poisoning, ZPP/FEP Increase with age and iron deficiency anemia
In lead poisoning, at BLL>35, ZPP /FEP increase as BLL increases

14

Lead poisoning Sx?

Colic, abd pain, constipation
Motor neuropathy-wrist drop (radial and perineal N.)
Burtonian (blue) gum lines - indicate lead exposure not poisoning
Saturnine gout- urate nephropathy
Fanconi syndrome
Infertility, low birth weight

15

Health effects of Chromium?

Immune system sensitized
Chrome holes (painless skin ulcers)
Nasal septal perforation
Lung cancer
Pulmonary irritant
Renal tubular acidosis
Hepatic necrosis

16

Septic ulcer, what could be the causes?

Cocaine use
Chromium

17

Heath effects of Arsenic (elemental)

Cancer: skin, lung, bladder
Cardiomyopathy
Hepatic necrosis
Renal failure
Peripheral vascular changes
Peripheral neuropathy - sensory, painful

18

Heath effect of Arsine Gas?

Garlic odor
AsH3-interaction of arsenic with acids

Made & used in electronic indrustry

Massive intravascular hemolysis
Hemoturia, renal failure
Jaundice, abd pain
Tx: supportive, exchange transfusion

19

Best indicator of recent As (arsenic) exposure) is?

Urine As

20

Sx of Chronic As (Arsenic ) intoxication?

Hyper pigmentation
Keratosis /hyper keratosis of palms and soles - Blackfoot disease
Mee's line on nail
Painful neuropathy

21

At what year lead was banned from paint?

1976

22

What year lead was banned from gasoline?

1990

23

Why lead poisoning increase ZPP?

Lead inhibit enzyme ferrochelatase

24

Lead T1/2 in the bone?

>25 years in the bone in chronic lead exposure.

25

Indication of recent or long term lead exposure with kappa x-Ray fluorescence study?

Trabecular bone, eg. In patella, reflects relatively recent lead(Pb) exposure (T1/2 - years)

Cortical bone, eg. Tibia, reflects long term exposure (T1/2 - decades)

26

OSHA lead standards?

PEL: 50mcg/m3
Action level: air concentration 30mcg/m3

When air level > action level for >30days/year:
Surveillance program
Initial medical evaluation including:
BLL
ZPP

27

BLL in General industry, Medical removal at?

BLL= or>50 mcg/dL on repeated teat(mean of 3) or
BLL= or >60 mcg/dL once

28

BLL for Medical removal in construction workers?

BLL= or>50mcg/dL

29

Follow up after removal from work with high BLL?

Repeat BLL in 2 wks:
when BLL40mcg/dL, medical evaluation q2mos until 2 measurement are<40mcg/dL

30

Tx of Cadmium acute poisoning?

Chelation with EDTA

(BAL is contraindicated )

31

What agent is associated with Garlic odor?

Tellurium
Phosphorus
Selenium
Arsenic

The garlic odor is very hard "To P.A.S"

32

Visual and auditory hallucinations are classically found in which mental?

Manganese neurotoxicity

33

Which mental is associated with stomatitis, gingivitis, tremor, and behavior change?

Elementary mercury causes "Mad Hatter Syndrome "

34

Chronic exposure to organic mercury (Methyl Hg) can produce CNS disfunction associated with Sx of ?

Tremor, paresthesias, dysarthria, ataxia, decreased visual field, deafness, and mental disfunction

35

Metal fume fever is associated with exposure to?

Zinc oxide
Metal fume fever is an acute, self-limiting syndrome characterized by flu-like symptoms

36

chromium VI associated with ? Cancer?

Lung cancer
Skin cancer

37

Types of mercury?

1. Elementary Hg (metallic 'quicksilver')
2. Inorganic (chlorides HgCl2, oxides)
- found in disinfectants
3. Organic (methyl- or dimethyl mercury)
- mostly in fish from contaminated ocean and fresh water
-Minamata bay

38

Tremor, gingivitis, tremor, and behavioral changes, AKA erethism in the " Mad Hatter Syndrome" is seeing in

Elemental mercury chronic intoxication

39

Bloody emesis and diarrhea due to GI mucosal necrosis, stomatitis, ATN, what poisoning ?

Inorganic mercury (chloride or oxides of Hg)

40

Bioaccumulate, GI absorbes 100%, lipid soluble, crosses BBB, placenta and excreted in breast milk
CNS: numbness, ataxia, tremor, construction of visual field, hearing loss, rigidity, spasticity, what agent?

Organic mercury

41

Minamata Bay and organic mercury toxicity

Japan 1940s -1960s by by eating tunna etc fish
At least 30 cases of prenatal lay exposed infants
- cerebral palsy like Sx
- microencephaly, mental retardation, seizures
- nephrotic syndrome

42

Heath effects of cadmium?

Anosmia
Lung cancer
Metal fume fever
Prostate and testicular cancer
Renal tubular damage
-wasting calcium, causes osteomalacia - Itai Itai (weak and deformed Bone, spinal and leg bone pain)
Yellow gum lines

43

Phossy jaw, bone necrosis, which chemical ?

Phosphorus

44

Skin and lung granulomas after chronic exposure, risk of lung cancer, which mental?

Beryllium toxicity

45

Cause type IV (delayed or cell- mediated hypersensitivity) reaction
Screening test: specific lymphocyte transformation test (LTT), which mental?

Beryllium

Beryllium - specific lymphocyte transformation test for screen of worked: may not develop disease if +, buy beats job reassignment

46

Painful erosive ulcer, nasal septal erosion and perforation, what metal ?

Chromium

47

Hard metal disease, what metal?

Cobalt, causes pulmonary fibrosis, giant-cell pneumonitis

48

Causes asthma, # 1 mental allergen in general population, which mental?

Nickel
Allergic disorder caused by Nickel is permanent. Removed/avoid contact is the best Tx.
Nickel carbonyl Ni(CO)4 formed in the refining Ni, causes diffused interstitial pneumonitis.

49

Asthma, rhinitis, urticaria, type I (IgE) sensitizer, what metal?

Platinum

50

Garlic odor, sweat
Inhalation irritant
Hair loss
Nail discoloration
Tooth decay

What metal?

Selenium

51

Inhalation irritant
ARF
Argyria - irreversible blue- grey skin discoloration

Which metal?

Silver

52

Tx of Metal Fume Fever?

Caused by zinc
Tx: EDTA, BAL

53

2nd leading cause of lung cancer?

Radon
Uranium ~> radium ~> radon~> lung cancer

54

ARF
Hemolytic anemia
Rhabdomyolysis
Myocarditis

What metal?

Uranium

55

The only metal that can cause Fanconi syndrome after chronic exposure

Cadmium

56

Garlic breath odor

1. Arsenic
2. Phosphorus
3. Selenium
4. Tellurium

57

Metal that can cause nasal septum perforation?

Chromium
Nickel