MOD #234
Tues, June 17, 2003, 1pm
Dr. Putthoff, D.O., FCAP
Scribe: Cedric Pratt
Page 1 of 3
Dr. Putthoff stated that there will be no bioterrorism questions on the test and there will
also be no lecture after the test on Wednesday. He mentioned that we will start the CIL
with chapter 11 and he would hit most of the key points. This is a basic outline of the
topics he mentioned in class. Good luck!!!!
How much do you drink?
 Do you have an alcohol problem? It might be useful if you reflected upon it
 Do you have any friends who you think have, or may have a predilection for alcohol
abuse – but they seem oblivious?
I.
Tobacco uses is estimated to contribute to 30, 090 premature deaths/year in the
United States and linked to associated with pulmonary and cardiovascular chronic
diseases.
A.
Cardiovascular = accelerated coronary artery atherosclerosis,
aneurysms, peripheral vascular disease.
B.
Pulmonary = Chronic bronchitis, emphysema, bronchiotrachitis, asthma
C.
Don’t smoke and tell your patients not too!!
D.
Smokeless tobacco has been linked to leukoplacia erythroplasia in
the mouth.
II.
Alcohol
A.
The legal limit for serum alcohol while driving in Texas is .08
mg/dl and reaches lethality at .75 mg/dl.
B.
Pg 411 depicts acute alcoholic hepatitis= large vacuoles are were
hapatocytes used to be and they have been replaced by mature
adipose cells. Alcohol acts as a toxin generates acetaldehyde and
then alcohol dehydrogenase that causes the destruction. The
arrow is pointing to Mallory’s hyaline that is pathognomonic for
acute alcohol ingestion (disappears 10 days after drinking stops).
C.
There is also a picture of cirrhosis on this page fibrous tissue in
wedged between hepatocytes
D.
E.
III.
IV.
MOD #234
Tues, June 17, 2003, 1pm
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With chronic alcohol abuse you can get;fatty metamorphosis of the liver,
hepatic cirrhosis, acute alcohol hepatitis, gastritis, pancreatitis (leading
cause), and other CNS effects.
Varicies also tend to kill alcoholics due to portal hypertension ( also get
caput medusa, and hemorrhoids). Deaths from auto accidents are also
common.
Drugs of abuse.
A.
The common drugs that are screened for when one goes to the emergency
room: 1) CNS depressants; ethanol, barbiturates, benzodiazepines 2)
CNS stimulants; cocaine, amphetamine 3) Narcotics; morphine,
meperidine, propoxyphene 4) hallucinogens; marijuana, mescaline,
psilocyne (mushrooms), dimethyltryptamine, LSD, PCP.
B.
Cocaine in the CNS blocks dopamine reuptake and in PNS blocks
catecholamine reuptake. CNS effects include euphoria, hyperthermia,
increased energy.
Oral contraceptives and estrogen therapy
A.
B.
Estrogen therapy has been proven to increase the risk of endometrial
cancer.
Oral contraceptives increase the risk of thromboembolism and greatly
decrease the risk of ovarian cancer.
C.
Factor V Liden deficiency is very common and should be screened before
beginning oral contraceptives.
V.
Aspirin and Acetaminophen
A.
Tylenol tends to cause hepatic necrosis, so it is a very painful suicide.
B.
Aspirin overdose first appears with a respiratory alkalosis then metabolic
acidosis, acute erosive gastritis, analgesics nephropathy ( usually papillary
necrosis that can obstruct the ureter).
VI. Pollution
A.
Outdoor air pollution was not covered extensively and indoor air pollution
is more intensive. SEE LIST IN BOOK
B.
More importantly the sick building syndrome including things like; fumes
from perfumes, dust mites, aerosolized lead, asbestos fibers, air
conditioner cause Leigonella pneumonia. MAINLY DUE TO POOR
VENTILATION
MOD #234
Tues, June 17, 2003, 1pm
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VII. Industrial Exposures
Co2
Radon
asbestos
silica = diffuse pulmonary fibrosis
beryllium= granulomatous respiratory disease
mercury= glycol ethers
napthylamines + vinyl chloride = urothelial carcinomas of bladder
benzene = aplastic anemia, leukemia
lead = cognitive defects mainly in children, also in adults over time (longterm exposure), children, even at very low levels of lead poisoning, have very low IQ
scores; microcytic hypochromatic (pale) anemia & basophilic stippling in RBCs; order
preerythrocyte or zinc protoporphorin assay to test for lead poisoning; renal toxicity;
peripheral neuropathy (in adults and children); insomnia & fatigue
VIII. Pesticides
A. DDT – took care of our mosquito problem , but also destroyed many habitats
B. Diazonon – widely available
C. Malathion – half life of 8 hours
D. Nicotine – cigarettes; poison for plants
E. Arsenic – squamous cell carcinoma in humans
F. Paraquat – on marijuana plants
G. Warfarin – rat poison; rats bleed to death
H. Strychnine – poison
IV. Forensics
A. Natural Toxins – Alflatoxin from aspergillos and snake toxin (venoms); rest
are uncommon (occasional blowfish in Japan)
B. Radiation Injury – dirty bomb or routine x-rays; similar to gamma rays; UV
radiation from sun (squamous cell carcinoma, basal cell carcinomas, and
malignant melanomas of the skin, actinic caratoses)
C. Useful formula – wounding potential of an object is related to energy delivered
to source, inversely related to time and area (shorter time and area means greater
wounding potential), k is plasticity factor (Wounding = E x 1/T x 1/A x k)
D. Abrasion – scrape; superficial
E. Laceration – blunt force; overstretching of skin; term misused commonly;
irregular with soft tissue bridges (this separates from incision); cut is longer than
deep, stab is deeper than long
F. Contusion – bruise; can’t be dated accurately; yellow-brown color means it is
longer than 18 hours old
G. Gunshot wounds – cannot differentiate between entrance and exit wounds;
contact, intermediate, and distant gunshot wounds