Easy Points: Pathology - Environmental Pathology

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Easy Points: Pathology - Environmental Pathology
2013-11-26 10:12:28
easy points pathology environmental olfu2016
Pathology: Environmental Pathology, OLFU2016
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  1. Global warming affects these diseases/disorders
    • ¤Cardiovascular,
    • cerebrovascular  and respiratory diseases- heat waves

    • ¤Gastroenteritis,
    • and infectious diseases- consequence of floods, enviromental
    • disasters

    • ¤Vector
    • borne infectious diseases

  2. ¨-“science of poisons”

    the distribution, effects, and mechanism of
    action of toxic agents

    the study of the physical effects such as radiation and heat
  3. chemicals in the environment in air
    water or food and soil that may absorbed into the body through inhalation
    ingestion or skin contact
  4. The most important catalyst of Phase 1 reactions
    Cytochrome P-450-dependent monooxygenase system
  5. 10 to 30 miles above earths surface; protects by absorbing the UV radiation
    emitted from the sun
    "Good" ozone
  6. ¤ozone that
    accumulates in the lower atmosphere

    nFormed by reaction of
    nitrogen oxides and volatile organic compounds in presence of sunlight

    nDue to industrial
    emissions and motor vehicle exhaust
    "Bad" ozone
  7. ¨Non irritating, colorless, odorless gas

    ¨Produced by incomplete oxidation of carbonaceous

    ¨Sources: Fossil fuels, burning wood, charcoal with
    inadequate supply of oxygen and cigarette smoke

    ¨Hgb is 200-fold greater affinity for CO than O2

    ¤Systemic hypoxia : (Hgb)  20 -30 % saturation

    ¤Unconsciousness and
    death : 60 -70% saturation
    Carbon monoxide
  8. ¤People in
    confined environments, underground garages and highway workers

    developing hypoxia   →  ischemic changes to CNS ( Basal ganglia and lenticular nuclei)

    neutrologic sequelae-
    impairment of vision, memory speech, hearing
    Chronic CO poisoning
  9. ¤Accidental
    exposure or suicide (lethal coma ~ 5 min)

    dependent on the ID of significant levels of carboxyhemoglobin in the blood.
    Acute CO poisoning
  10. contain various oxides of  nitrogen and carbon
    Wood smoke
  11. ¨radioactive gas derived from uranium

    ¤Occupational hazard
    can cause lung CA in miners
  12. ¨range  from
    microbiologic agents capable causing infectious disease

    disease, viral pneumonia, common cold, pet dander, dust mites, fungi
  13. ¨manufacturing of building materials

    ¤At concentrations of > 0.1 ppm – difficulty of
    breathing , burning sensation of the eyes and throat

    ¤Classified as a
  14. ¨Exposure occurs
    through contaminated food or water

    ¨Sources of exposure

    ¤paints- in older homes, often exceed 10 μg/ dL


    manufacturing of batteries, pigments, mining etc.
  15. Symptoms of lead poisoning


    ¨Reduced sensations

    ¨Aggressive behavior

    ¨Difficulty sleeping

    ¨Abdominal pain

    ¨Poor appetite

    ¨Constipation Anemia
  16. Parts of the body that absorbs most of lead
    bones and teeth
  17. 3 types of mercury:
    ¨Metallic mercury – “elemental mercury”

    • ¤Found in dental
    • amalgams (occupational hazard)

    • ¨Inorganic mercury- 
    • mostly mercuric chloride

    ¨Organic mercury- mostly methyl mercury
  18. Which agent causes the following effects?
    ¤“Minamata disease”-
    cerebral palsy, deafness, blindness and major CNS defects

    ¤Developing brain –
    extremely sensitive to mercury (lipid solubility)

    ¤Bind to thiol groups – contributes to its
  19. Which agent causes the following effects?
    intestinal absorption; more permeable blood brain barrier

    children- low Iqs, behavioral problem (hyperactive and poor organizational

    brain development in prenatal infant

    peripheral neuropathies predominate

    drop and footdrop

    effects → inhibition of
    neurotransmitters due to disruption of calcium homostasis
  20. edema,
    flattened gyri, congestion,
    petechial hemorrhages and neuroneal necrosis
    Lead encephalopathy
  21. ¤Inhibits the activity
    of δ- aminolevulilinic
    acid dehydrase  and ferrochelatase in heme synthesis
  22. Causes Microcytic hypochromic anemia- stemming from suppression from hemoglobin synthesis
  23. red precurser cells with lead laden cells
  24. clustering
    of ribosomes
    basophilic stippling
  25. Agent that causes ↑chondogenesis and delaying cartilage
  26. Which agent causes the following?
    tubular damage (intranucelar lead inclusions); chronic renal damage leads to
    fibrosis and possible renal failure; “saturnine gout”(↓ uric acid excretion)
  27. Diagnostic markers for lead poisoning?
    detection of elevated levels of lead and free (zinc bound) red cell protophyrin
  28. cerebral
    palsy, deafness, blindness and major CNS defects
    Minamata disease
  29. act as a thiol donor is a main protective mechanism
    against mercury induced CNS and kidney damage
    Intracellular glutathione
  30. ¨Found in wood preservers, herbicides and other
    agricultural products

    ¨Released into the environment  from mines and smelting industries
  31. The most toxic forms of arsenic
    ¤Arsenic trioxide

    ¤Sodium arsenide

    ¤Arsenic trichloride
  32. Which agent causes the following?
    ¤Interference of
    mitrochondrial oxidative phosphorylation-trivalent phosphates replace PO4 in

    ¤Neurologic effects-
    2-8 weeks after exposure, consists of sensorimotory neuropathy- parathesias,
    numbness and pain
  33. Which agent causes the following?
    ¤Skin changes-
    hyperpigmentation and hyperkeratosis→development of Basal cell CA and SCCA

    ¤Mechanism not
    elucidated, but may involve defects in necleotide excision repair systems that
    protect against DNA damage
  34. Which form of CA has Palisading cells
    in the periphery?
    Basal cell CA
  35. Which form of CA has pleomorphism and enlargement of
    nucleus and prominent nucleoli, more invasive and can metastisize?
    Squamous cell CA
  36. ¨Occupational and environmental pollutant (mining,
    electroplating and production of nickel- cadmium batteries)

    ¨Contamination of soil and plants or through fertilizers
    and irrigation

  37. The most common diseases caused by smoking?
    • emphysema,
    • chronic bronchitis and lung cancer
  38. Causes Polycyclic
    hydrocarbons and nitrosamines
  39. Amount of alcohol consumed to be considered drunk driving.
    • 3 standard drinks about 3 (12) ounce beer, 15 ounces of wine or 4-5 ounces of 80
    • proof distilled spirits = 80 mg/dl
  40. Blood level that causes Decrease
    in complex cognitive functions and motor performance
    80 mg/dl
  41. Blood level that causes Obvious
    slurred speech, motor incoordination, irritability, and poor judgment (stupor)
    200 mg/dL
  42. Blood level that causes Light
    and depressed vital signs
    300 mg/dL
  43. Blood level that causes Decreased
    inhibitions, a slight feeling of intoxication
    20 mg/dL
  44. Blood level that causes Death
    400 mg/dL
  45. Effects of acute excess of alcohol

    • ¤Higher levels of
    • alcohol-depressed cortical neurons and lower respiratory centers
  46. Effects of chronic excess of alcohol
    • ¤Liver- fatty liver,
    • alcoholic hepatitis, cirrhosis

    • ¤GI tract- bleeding from
    • gastritis, ulcer, esophageal varices

    • ¤CNS- Peripheral
    • neuropathies and Wernicke- Koraskoff syndrome

    • ¤CVS- alcoholic
    • cardiomyopathy

    • ¤Acute and chronic
    • pancreatitis

    • ¤Fetal alcohol
    • syndrome

    • ¤↑ incidence of
    • cancer- oral cavity, esophagus liver and possibly breast- Acetyaldehyde- forms DNA adducts

    • nCA of esophagus-
    • individuals with one copy of ALDH2*2 gene

    • ¤Malnutrition and
    • nutritional deficiencies
    • (particularly B vitamins)
  47. ¤confusion, ataxia,
    and diplopia from ophthalmoplegia

    ¤damage to mammillary bodies, cerebellum
    and periaqueductal gray matter of the

    ¤due to thiamine

    ¤may respond to prompt
    thiamine replacement
    Wernicke syndrome
  48. ¤memory loss and

    ¤Dorsal nucleus and

    ¤results from thiamine
    deficiency and direct toxicity
    Korsakov syndrome
  49. Drug associated with the following conditions:
    ¤Approximately 3 fold
    risk of venous thrombosis and pulmonary thromboembolism

    nRisk in carriers of
    factor V leiden mutation

    ¤↑ the risk of MI in
    smoking women at all ages and non- smoking women > 35 years

    ¤↓ the incidence of
    endometrial and ovarian CA; do not increase the lifetime risk for breast CA

    ¤Well defined
    association with hepatic adenoma
    Oral contraceptives
  50. ¨Synthetic versions of testosterone

    ¨For performance enhancement

    ¨↑ concentrations- inhibit production and release of LH
    and FSH  by feedback mechanism

    ¨Effects: stunted growth(adolescents), acne, gynecomastia, and testicular
    atrophy in males; in women, growth of facial hair and menstrual changes
    anabolic steroids
  51. ¨50% cases of acute live failure, with 30% mortality

    ¨Ordinarily safe 0.5 grams (therapeutic), 15- 25 grams
    (toxic dose)

    ¨Therapeutic doses:

    ¤95% - detoxification
    by Phase II reactions and excreted in urine as glucuronate or sulfate conjugates

    ¤5% or less- activity
    of CYPs (CYP2E) to NAPQI (N- acetyl-p-benzoquinoneimine) à conjugated to
    glutathione (GSH)
  52. ¨50% cases of acute live failure, with 30% mortality

    ¨Ordinarily safe 0.5 grams (therapeutic), 15- 25 grams
    (toxic dose)

    ¨Therapeutic doses:

    ¤95% - detoxification
    by Phase II reactions and excreted in urine as glucuronate or sulfate conjugates

    ¤5% or less- activity
    of CYPs (CYP2E) to NAPQI (N- acetyl-p-benzoquinoneimine) à conjugated to
    glutathione (GSH)
  53. ¨Can be snorted, dissolved in water, injected
    subcutaneously and intravenously

    ¨Produces euphoria and 
    stimulation, Acute overdose can produce seizures and cardiorespiratory arrest
  54. more
    potent; crytallization of pure alkaloid,
    due to cracking sound when heated to produce vapors that are inhaled
  55. Drug that causes the following: behaves
    as a symphatomimetic (inhibits reuptake
    of epinephrine, norepinephrine and dopamine in  peripheral and central nervous systems) –
    tachycardia, hypertension and peripheral vasoconstriction
  56. Drug that causes the following: Hyperpyrexia
    (aberrations of dopaminergic pathways that
    control temperature), seizures
  57. ¨Derived from the poppy plant that is closely related to
    morphine, more harmful than cocaine

    ¨It is cut (diluted) with an agent (talc or quinine)

    ¨Is self administered intravenously or subcutaneously

    ¨Effects: euphoria, hallucinations, somnolence and

    ¨Physical effects related to

    ¤Pharmacologic action
    of the agent

    ¤Reactions t cutting
    agents or contaminants

    reaction to the drug or adulterants
  58. ¨Acts by releasing dopamine in the brain which inhibits
    neurosymphathetic transmission & slowing glutamine release

    ¨Produces a feeling a eurphoria followed by a “crash”

    ¨Long term use: violent behavior, confusion and psychotic features (paranoia,
    hallucination etc)
  59. ¨Effects: euphoria and hallucinogen- like feelings that
    last 4 to 6 hours due to the ↑ serotonin release in the CNS, coupled with
    interference of serotonin synthesis

    ¨Also ↓ the number of serotonegenic axon terminals and peripheral effects of dopamine
    MDMA (Ecstasy)
  60. ¨CNS- Distorts sensory preception and impairs motor coordination (effects clear in 4 -5

    ¨↑heart rate and , sometimes blood pressure, may cause
    angina in persons with CAD

    ¨Cigarette- large number of carcinogens and 3 fold
    increase in tar

    ¨Lungs- Laryngitis , pharyngitis, bronchitis, cough, hoarseness with asthma like
  61. produced
    by scrapping or rubbing, resulting from the removal of the superficial layer
  62. produced
    by a blunt object and is characterized by blood vessels and extravasation of blood into
  63. tear
    or disruptive stretching caused by the the application of force by a blunt object
  64. inflicted
    by a sharp instrument
    incised wound
  65. ¨caused by a long narrow instrument

    instrument pierces the tissue

    traverses the tissue and create an exit wound “through and through”

    ¤Gunshot wound
    Puncture wound
  66. Causes of inhalation injury
    • ndirect effect of heat
    • to the mouth, nose upper airways

    • nInhale Water soluble
    • gases (chlorine, sulfur oxides and ammonia)- may react with H20 to produce acid
    • or alkali →produce inflammation and swelling of the airways

    • nLipid soluble gases
    • (nitrous oxide, products of burning plastics) likely to reach the deeper
    • airways
  67. result
    from loss of electrolytes via sweating
    heat cramps
  68. most
    common hyperthermic syndrome; results
    from a failure of the CVS to compensate for hypovolemia
    heat exhaustion
  69. ¨associated with high ambient temperature and high
    humidity, Mortality rate 50%

    ¤Body temperatures 112
    to 113 F, rectal temperature of 106 F

    ¤Mechanism : marked
    peripheral vasodialtion
    heat stroke
  70. energy
    that travels in waves and or high speed particles