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Flashcards in Mentals Deck (58)
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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