Robbins Chapter 9

Question 1

What is the single leading global cause for health loss?

Answer 1

Undernutrition

Question 2

What 3 global complications have increased and what 2 have decreased?

Answer 2

Inc. = CV disease, cancer, HIV/AIDS/TB

Dec. = neonatal conditions, diarrhea/lower respiratory infections

Question 3

What environmental conditions inc. risk of:

1. CV, cerebrovascular, respiratory diseases
2. gastroenteritis, cholera
3. vector-borne infectious diseases

Answer 3

1. heatwaves and air pollution
2. flood contamination and disrupted clean water supply
3. inc. temp, crop failures

Question 4

What decreases CYP activity?

Answer 4

fasting and starvation

Question 5

Ozone (Outdoor Air Pollutant)

Answer 5

free radicals injure respiratory tract epi/type 1 alveolar

release inflammatory mediators

• dangerous for asthma/emphysema pts

Question 6

Sulfur Dioxide (Outdoor Air Pollutant)

Answer 6

“Witches Brew” –> combine w/ozone, particulate matter

from fossil fuel burning, copper smelting, paper mills

sulfuric acid/trioxide = burning sensation in nose/throat

Question 7

Particulate Matter (Outdoor Air Pollutant)

Answer 7

pulmonary inflammation/secondary CV effects

particles < 10 um get into alveoli = inflammatory release

Question 8

Carbon Monoxide and how it works on bodies

Answer 8

CNS depression (basal ganglia/lenticular nuclei); 200x greater affinity for Hb (60%-70% sat. = DEATH

rapid death = NO morphological changes
long term survival = edema, hemorrhages, neuronal changes

cherry-red skin and mucous membranes

Question 9

Indoor Air Pollutants

1. Wood Smoke
2. Bioaerosols
3. Radon
4. Formaldehyde
5. Sick Building Syndrome

Answer 9

1. polycyclic hydrocarbons
2. leginnaires dz, viral pneumonia
3. radioactive gas = INC. LUNG CANCER RISK
4. building material, poorly ventilated trailers
5. black mold from damp homes

Question 10

Where is Lead poisoning acquired and what changes can it cause in both KIDS and ADULTS?

Answer 10

KIDS: paint chips, contaminated soil

• severe brain damage (low Pb lvls)
• behavioral problems, hyperactivity, poor organizer

ADULTS: tin cans, battery maker, car radiators

• peripheral neuropathies
• foot drop and wrist drop

Lead Lines: gums and metaphyses, hypochromic microcytic anemia (MCV<80), basophilic stippling, ring sideroblasts (iron laden macrophages)

Lead Colic: severe, poorly localized abdominal pain

Question 11

Mercury Poisoning and Minimata Disease

Answer 11

• damages CNS and kidney
• main source: contaminated FISH, mercury vapors (dental amalgams)

Minimata Disease: cerebral Palsy, blindness, CNS

Question 12

Arsenic Poisoning

Answer 12

interfere w/cellular metabolism (GI TRACT, CNS, heart)

2-8 wks: sensorimotor neuropathy, paresthesia, numbness; MEES LINES on nails

hyperpigmentation/hyperkeratosis of palms/soles

Question 13

Cadmium Poisoning and Itai-Itai

Answer 13

toxic to Kidneys and Lungs (batteries, soil, plants)

renal tubular damage, skeleton abnormalities

Itai-Itai: osteoporosis and osteomalacia w/renal dz

Question 14

What 3 things can cause Respiratory Fibrosis? (SAC)

Answer 14

silica, asbestos, cobalt

Question 15

What causes leukemia and liver angiosarcoma?

Answer 15

Leukemia = BENZENE (rubber workers)

• marrow aplasia, acute myeloid leukemia
• 30 yo with 80 yo bones

Liver Angiosarcoma = Vinyl Chloride

Question 16

Where 2 cancers are Polycyclic Hydrocarbons associated with?

Answer 16

lung and bladder cancer (scrotal cancer in chimney sweeps)

Question 17

Organochlorines and DDT

Answer 17

synthetic lipophilic product = no degradation

DDT –> disrupt hormonal balance (antiestrogenic and antiandrogenic activity)

Question 18

What problems arise from Mineral Dust exposure?

Answer 18

pneumonconioses (insulation and shipyards)

asbestosis –> MESOTHELIOMA, black lung
Ferruginous Bodies: iron coating on asbestos fibers

pork chop lung = mesothelioma

Question 19

Dioxin and PCB exposure

Answer 19

folliculits and dermatosis (CHLORACNE)

• acne, cyst formation, hyperpigmentation, hyperkeratosis behind ears and face

Question 20

What does cessation of smoking within 5 years lead to?

Answer 20

dec. in mortality of CVD and 21% dec. in lung cancer mortality

Question 21

What are Nicotine/Phenol and Formaldehyde/Nitrogen Oxides related to in smoking?

Answer 21

N/P –> tumor promotion

F/N –> cilia toxicity, mucosal irritation
- “smokers cough”

Question 22

How does alcohol potentiate the effects of other substrates?

Answer 22

competitively binds to CYP2E1, delaying drug catabolism

• potentiates the depressant effects of drugs in the CNS

Question 23

Alcohol and Hypertension

Answer 23

heavy EtOH use = liver damage, which decreases the production of HDL causing an increased likelihood of coronary artery disease

Question 24

Wernicke Encephalopathy and Korsakoff Syndrome

Answer 24

THIAMINE DEFICIENCY

WE: reversible, hemorrhage/necrosis of mammillary bodies

KS: irreversible, short term memory disturbance and confabulation

atrophy of anterior vermis = truncal ataxia

Question 25

Problems with Oral Contraceptive Use

Answer 25

inc. risk of cervical cancer, 3-6x risk of venous thrombosis/PE, 2x inc. risk of CAD in smokers HEPATIC ADENOMA - rare; older prolonged OC use

Question 26

Acetaminophen Toxicity

Answer 26

CYP2E1 causes production of NAPQ normally can conjugate with Glutathione, but when it can't --> protein adducts and lipid peroxidation ultimately: HEPATOCYTE NECROSIS, LIVER FAILURE

Question 27

Opiates, Meth, MDMA, Marijuana, Huffing, Bath Salts

Answer 27

O: profound respiratory depression, "foam cone", infections (endocarditis right heart valve) Meth: violent, confusion, hallucinations, paranoia MDMA: spike other drugs to enhance CNS effects Marijuana: inc. HR/BP, large # carcinogens in smoke Huffing: MRI-brain damage --> severe dementia Bath Salts: agitation, psychosis, MI, suicide

Question 28

Cocaines effects on the body (2)

Answer 28

tachycardia, HTN, peripheral vasoconstriction --> MI! lethal arrythmias (NOT DOSE RELATED) --> dec. blood flow to placenta = spont. abortion and fetal hypoxia

Question 29

Burn Classification (1st-3rd degree)

Answer 29

1st = superficial, epidermis only 2nd = partial thickness, epidermis and dermis 3rd = full thickness, subQ tissue

Question 30

Hyperthermia (Malignant) vs Hypothermia

Answer 30

Hyper: "heat-stroke" rise in core body temp w/muscle contractures --> common anesthetics (RYR1 gene) Hypo: body temp < 90F, bradycardia --> atrial fibrillation, no consciousness

Question 31

Marasmus vs Kwashiorkor

Answer 31

M: serum albumin lvl normal, emaciated extremities K: hypoalbuminuria (edema), spare extremities, fatty liver

Question 32

Anorexia Nervosa vs Bulimia

Answer 32

A: self-induced starvation, highest death of any psychiatric disorder (amenorrhea, dec. thyroid, bone) B: binge/purge; more common and better prognosis - pulmonary aspiration of gastric contents BOTH: susceptible to cardiac arrhythmia due to electrolyte imbalance = HYPOKALEMIA

Question 33

Acute vs Chronic Vitamin A toxicity

Answer 33

Acute: headache, dizziness, stupor - Pseudotumor cerebri: unexplained cranial pressure - eskimo eating polar bear livers Chronic: wt loss, anorexia, bone/joint pain

Question 34

Vitamin D Deficiency

Answer 34

- maintain adequate calcium/phosphate lvls - prevent rickets, osteomalacia, and Hypocalcemic Tetany --> tingling around mouth and finger twitch **loss of cartilage palisades in bone**

Question 35

Importance of Vitamin K, B1, B3, and B6

Answer 35

K --> procoagulant (bleeding diasthesis) B1 (thiamine) --> dry/wet Beriberi, Wernicke/Korsakoff B3 (Niacin) --> NAD/NADP - Pellagra = dementia, diarrhea, dermatitis B6 (Pyridoxine) --> myelination of spinal cord - dermatitis, peripheral neuropathy

Question 36

BMI Ranges (3)

Answer 36

Normal: 18.5 - 25 kg Overweight: 25 - 30 kg Obese > 30 kg

Question 37

Where are Leptin, PPY, and Ghrelin located and what do they bind to?

Answer 37

Leptin (adipose) --> POMC/CART --> NRG consumption PYY (intestines) --> NPY/AgRP --> NRG consumption - inhibitor Ghrelin (stomach) --> NPY/AgRP --> Food Intake

Question 38

What is Pickwickian Syndrome and what is it related to?

Answer 38

hypoventilation syndrome associated w/obesity - hypersomnolence --> sleep apnea, polycythemia, right-sided heart failure (cor pulmonale)

Question 39

IGF-1, Obesity, and Cancer

Answer 39

IGF-1 inc. during hyperinsulinemia (due to obesity) IGF-1 = inc. cell proliferation and dec. apoptosis (perfect environment for tumor development) obesity itself is a pro-inflammatory state = may be carcinogenic itself

Question 40

Aflatoxin, Nitrosamines/Nitrosamides/High animal fat and low fiber on Cancer development

Answer 40

Aflatoxin - hepatocellular carcinoma N/N - gastric carcinoma High Animal/Low Fiber - colon cancer **total dietary fat = inc. risk of breast cancer**