Flashcards in Mentals Deck (58):
Lead poisoning has been associated with motor neuropathy or sensory neuropathy ?
Moto neuropathy, with slow motor nerve conduction, wrist drop may occur
Wrist drop, lead colic, lead line and basophilic stippling are manifestation of inorganic lead poisoning or organic lead poisoning?
Inorganic lead toxicity
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
Methyl mercury poisoning can lead to?
1.Fulminant chemical pneumonitis
2. Fetal toxicity
3. Speech disturbances
Nickel compound can cause ?
1. Contact dermatitis
2. Adult respiratory distress syndrome
3. Lung cancer
Agent that causes Upper airway irritation and green tongue?
4 mentals that cause peripheral neuropathies are ?
Lead (motor >sensory)
Arsenic (painful, sensory>motor )
Mercury （+ tremor )
Red cell: 60-90 days
Lead'a biochemical effects?
Delta-aminolevulinic dehydratase (ALA-D)
Delta-aminolevulinic acid synthetase (ALA-S)
Lead mainly excreted through?
Mainly kidney, small amount through stool
Biological effects of lead in the blood?
FEP (Free erythrocyte protoporphyrin)
ZPP (zinc protoporphyrin ) - Fe++ not inserted into porphyrin ring
Basophilic stippling in RBC's
Whole Blood lead level
CBC & smear
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
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
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
Infertility, low birth weight
Health effects of Chromium?
Immune system sensitized
Chrome holes (painless skin ulcers)
Nasal septal perforation
Renal tubular acidosis
Septic ulcer, what could be the causes?
Heath effects of Arsenic (elemental)
Cancer: skin, lung, bladder
Peripheral vascular changes
Peripheral neuropathy - sensory, painful
Heath effect of Arsine Gas?
AsH3-interaction of arsenic with acids
Made & used in electronic indrustry
Massive intravascular hemolysis
Hemoturia, renal failure
Jaundice, abd pain
Tx: supportive, exchange transfusion
Best indicator of recent As (arsenic) exposure) is?
Sx of Chronic As (Arsenic ) intoxication?
Keratosis /hyper keratosis of palms and soles - Blackfoot disease
Mee's line on nail
At what year lead was banned from paint?
What year lead was banned from gasoline?
Why lead poisoning increase ZPP?
Lead inhibit enzyme ferrochelatase
Lead T1/2 in the bone?
>25 years in the bone in chronic lead exposure.
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)
OSHA lead standards?
Action level: air concentration 30mcg/m3
When air level > action level for >30days/year:
Initial medical evaluation including:
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
BLL for Medical removal in construction workers?
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
Tx of Cadmium acute poisoning?
Chelation with EDTA
(BAL is contraindicated )
What agent is associated with Garlic odor?
The garlic odor is very hard "To P.A.S"
Visual and auditory hallucinations are classically found in which mental?
Which mental is associated with stomatitis, gingivitis, tremor, and behavior change?
Elementary mercury causes "Mad Hatter Syndrome "
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
Metal fume fever is associated with exposure to?
Metal fume fever is an acute, self-limiting syndrome characterized by flu-like symptoms
chromium VI associated with ? Cancer?
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
Tremor, gingivitis, tremor, and behavioral changes, AKA erethism in the " Mad Hatter Syndrome" is seeing in
Elemental mercury chronic intoxication
Bloody emesis and diarrhea due to GI mucosal necrosis, stomatitis, ATN, what poisoning ?
Inorganic mercury (chloride or oxides of Hg)
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?
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
Heath effects of cadmium?
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
Phossy jaw, bone necrosis, which chemical ?
Skin and lung granulomas after chronic exposure, risk of lung cancer, which mental?
Cause type IV (delayed or cell- mediated hypersensitivity) reaction
Screening test: specific lymphocyte transformation test (LTT), which mental?
Beryllium - specific lymphocyte transformation test for screen of worked: may not develop disease if +, buy beats job reassignment
Painful erosive ulcer, nasal septal erosion and perforation, what metal ?
Hard metal disease, what metal?
Cobalt, causes pulmonary fibrosis, giant-cell pneumonitis
Causes asthma, # 1 mental allergen in general population, which mental?
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.
Asthma, rhinitis, urticaria, type I (IgE) sensitizer, what metal?
Garlic odor, sweat
Argyria - irreversible blue- grey skin discoloration
Tx of Metal Fume Fever?
Caused by zinc
Tx: EDTA, BAL
2nd leading cause of lung cancer?
Uranium ~> radium ~> radon~> lung cancer
The only metal that can cause Fanconi syndrome after chronic exposure
Garlic breath odor