Toxicology Flashcards by Gerard deGuzman

What is te earliest effect of chronic cadmium poisoning?

Proteinuria

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What is the test of choice for monitoring organophosphate insecticide exposure?

RBC cholinesterase

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What is the probable mechanism of sudden death involving fluorocarbon exposure?

cardiac arrhythmia and simple asphyxia

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Workers exposed to which of he following agents are required to participate in medical surveillance?

a. cadmium
b. Pb
c. asbestos
d. none of the above

d. none of the above
NB: employers are required to provide medical surveillance programs but workers are not required to participate. However, employers may make medical removal protection benefits contingent on participation in surveillance programs.

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What is specifically required under OSHA benzene standard?

a. use of accredited laboratory only
b. spirometry training for non-physicians who perform PFTs.
c. medical exam within 1 year of initial assignment
d. a & b

d. a & b. Also, medical exam must be offered PRIOR to initial assignment.

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Under OSHA Pb standard, the employer must provide up to ____ of medical removal protection (MRP) benefits to workers with blood Pb levels of 50 mcg.

a. 30 days
b. 3 months
c. 6 months
d. 18 months

d. 18 months. During this MRP, the employer must maintain earnings, benefits, seniority and other rights for workers removed due to Pb exposure.

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Under the OSHA Pb standard for medical surveillance, the employer is required to provide biological monitoring and Pb exposure medical examination because of:

a. employee complaints
b. MSDS info
c. air monitoring results
d. EPA requirements

c. air monitoring results.

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What Pb level of exposure triggers the need for employer to provide biological monitoring and medical surveillance?

When workplace inorganic Pb exposure exceeds 30 mcg/cubic meter per 8 hr TWA for 30 or more days annually.

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Which of the following statements regarding arsenic are false?

a. causes both lung and skin cancer
b. shown to be a cause of hepatic angiosarcoma
c. associated with peripheral vascular disease
d. causes bladder cancer

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Which of the following can cause parkinsonian movement disorder?

a. trichloroethylene
b. MPTP
c. arsine
d. acrylamide

b. MPTP (a meperidine derivative)

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Which of the ofllowin is associated with the developement of parkinsonian symptoms?

a. chromium
b. nickel
c. n-hexane
d. manganese

d. manganese (tremor, neurobehavioral dysfunction, dysarthria, gait disturbance)

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Which of the following agents is a potent GI carcinogen and has properties of cyanide at high concentrations?

a. acrylic resins
b. amino resins
c. acrylonitrile
d. epoxy resins

c. acrylonitrile (generates cyanide when burned, linked to colon cancer with 20 year latency)

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Which of the following is most likely to cause stomatitis, gingivitis and tremor?

a. beryllium
b. zinc
c. arsenic
d. elemental Hg

d. elemental mercury (“Mad Hatter” syndrome)

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What is the best use of Maneb?

fungicide (aka mancozeb, metiram, EBDC)

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Organ function testing (e.g. liver, renal function tests) is useful for surveillance monitoring of which of the following?

a. CO
b. cadmium
c. Pb
d. arsenic
e. organophosphate pesticides

b. cadmium

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Which of the following symptoms are most consistent with chronic INORGANIC Hg poisoning?

a. erythism, distal neuropathy
b. irritability, tremor, ataxia
c. spasticity, visual constriction
d. stomatitis, melena

d. stomatitis, melena

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Which of the following symptoms are most consistent with chronic ELEMENTAL Hg poisoning?

a. erythism, distal neuropathy
b. irritability, tremor, ataxia
c. spasticity, visual constriction
d. stomatitis, melena

a. erythism, distal neuropathy

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Which of the following symptoms are most consistent with methy-mercury (ORGANIC) poisoning?

a. erythism, distal neuropathy
b. irritability, tremor, ataxia
c. spasticity, visual constriction
d. stomatitis, melena

c. spasticity, visual constriction (mnemonic: DCATS)

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Solvent associated with “coasting” (continued decrement after exposure ceases)

a. n-hexane
b. formaldehyde
c. trichloroethanol
d. methyl-n-butyl ketone

a. n-hexane

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Trimellitic anhydride (TMA) has been associated with all of the following except:

a. rhinitis
b. hemorrhagic pneumonitis
c. lung cancer
d. hemolytic anemia

c. lung cancer

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Chronic elemental Hg effects

“Mad Hatter”-tremor, paresthesia, hyperexcitability, memory loss, erethism, sensory neuropathy, acrodynia

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Methyl-Hg effects

“DCATS”-deafness, cognitive/visual constriction, ataxia, tremor, spasticity

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Inorganic Hg effects

GI mucosal necrosis, stomatitis, ATN (acute tubular necrosis)

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Thallium exposure associated with:

hair loss, tremor, peripheral neuropathy, CN neuropathy

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Trichloroethylene associated with:

trigeminal neuralgia, optic neuropathy

Skin cancer is associated with exposure to:

arsenic, UV radiation, ionizing radiation, PAH

Bladder cancer is associated with:

smoking, napthylamine, benzidine, 4-amino-biphenyl, aniline derivative dyess, methylene dianiline

Hemangiosarcoma is associated with:

vinyl chloride, arsenic

Hepatocellular cancer is associated with:

aflatoxin, Hep C, Hep B

Regarding methyl mercury poisoning, all of the following are possible except: a. fulminant chemical pneumonitis b. ferrotoxicity c. speech disturbance d. hemiparesis

d. hemiparesis has NOT been linked to methyl mercury poisoning.

A refinery worker presents for an "emergency" medical surveillance evaluation a reported overexposure to benzene during tank maintenance. Which substance would likely be elevated in his urine? a. creatinine b. phenol c. methyl hippuric acid d. beta 2 microglobulin

b. phenol

A print assembly worker presents with numbness in his feet and hands. The most likely cause is: a. methy-n-butyl ketone b. formaldehyde c. trichloroethanol d. methyl ethyl ketone

a. methyl-n-butyl ketone

A chemical plant worker liquid end-product is shipped to a company that makes 'plastic' pipes for the construction industry is more likely to develop: a. acro-osteolysis b. peripheral neuropathy c. lung cancer d. bladder cancer

a. acro-osteolysis

Which of the following agents has not been associated with peripheral neuropathy? a. N-hexane b. arsenic c. toluene diisocyanate (TDI) d. Pb

c. toluene diisocyanate

What wavelength UV light is of greatest health concern?

280-320 nm can cause skin cancer, photokeratosis, erythema

What agents are associated with urologic cancers?

aniline dyes; benzidine; 4-amino biphenyl; beta naphthalene

Why are slow acetylators at higher risk of bladder cancer?

N-acetylation reduces carcinogenicity

IARC Category 1 means:

carcinogenic

IARC Category 2 means:

probable, possible carcinogenic

IARC Category 3 means:

not classifiable with regard to humans

IARC Category 4 means:

probably not carcinogenic

Name the single agent in IARC Category 4

caprolactam

What is the major route of exposure for solvents?

respiratory

How are solvents metabolized?

Primarily metabolized by P450 in liver

Solvents that are poorly metabolized such as tetrachloroethylene are excreted primarily by?

exhalation

BEI for benzene?

urine phenol or end exhaled air

BEI for xylene?

urine methyl hippuric acid

BEI for toluene?

urine hippuric acid

BEI for styrene?

urine mandelic acid or phenylglycolic acid, blood styrene

BEI for trichloroethylene?

urine trichlorethanol or trichloracetic acid

BEI for N-hexane?

urine 2,5 hexanedione

Symptoms of acute solvent syndrome?

headache, confusion, dizziness, malaise, seizures

acute solvent exposure acts like what on the brain?

alcohol; reversible encephalopathy

Chronic Solvent Syndrome is AKA?

Painters' syndrome

Symptoms of Painters syndrome?

psychomotor slowing, decreased memory, dementia, fatigue, irritability, headaches

2,5 hexanedione is responsible for what?

neurotoxicity

Toluene can cause what cardiac condition?

arrhythmias

Fetal Solvent Syndrome is associated with?

toluene

What is Blackfoot Disease? Agent?

peripheral vasospasm and gangrene; arsenic

What cardiac condition is associated with acute arsenic exposure?

prolonged QT

Symptoms of acute inorganic arsenic toxicity?

Symptoms of subacute inorganic arsenic toxicity?

blackfoot, PN, Mees lines, hyperkeratosis

Symptoms of chronic arsenic toxicity?

PN, anemia, skin cancer (squamous), brown hyperpigmentation

Symptoms of Thallium toxicity?

PN, CN neuropathy,tremor, chorea, gait abnl.

Agent associated with Mad Hatter?

elemental Hg

Symptoms of acute elemental Hg toxicity?

cough, stomatitis, GI, pneumonia, bronchitis

Symptoms of chronic elemental Hg toxicity?

Triad: tremor, gingivitis, erethism; acrodynia

Health effects of acute inorganic Hg?

GI mucosal necrosis (bloody emesis and diarrhea); ATN

Exposure index for elemental Hg?

urine

Exposure index for inorganic Hg?

urine

Exposure index for Organic Hg (Methyl Mercury)

blood, hair

Chronic Inorganic Pb toxicity?

fatigue, apathy, vague GI, arthalgias, myalgias, distal motor neuropathy, lead lines (in gums), HTN, CRF, gout.

Another name for organic Pb?

Alkyl Pb.

Parkinsonism is associated with which exposures?

manganese; CO; carbon disulfide; MPTP; Hg.

What neurotoxicant is associated with blindness?

methanol

What neurotoxicants are associated with chronic toxic encephalopathy?

Pb, solvents, carbon disulfide

NCS: Amplitude

reflects number of conducting fibers (reduced in axonal loss)

NCS: Latency

reflects stimulus to response; prolonged in demyelination

NCS; Conduction velocity

reduced in demyelinating disorders

EMG:

used to investigate weakness

Prior to 1950, the most common cause of toxic aplastic anemia was?

benzene exposure

Biomarker for benzene?

urine phenol

What are the metabolites of benzene and what do they cause?

hydroquinone, benzoquinone; cause marrow toxicity

How do benzene metabolites cause marrow toxicity?

by destroying pluripotent stem cells

Agents associated with aplastic anemia?

benzene; arsenic; pesticides; ionizing radiation; chemotherapy agents; antibiotics (chloramphenicol)

What syndrome is associated with solvent nephropathy?

Goodpasture Syndrome (pulmonary hemorrhage and rapidly progressive glomerulonephritis)

What syndrome is associated with Pb nephropathy?

Fanconi Syndrome (amino aciduria, hyperphosphaturia, hypercalcemia)

Chronic renal failure, hypertension and gout may represent exposure to

Pb.

Glomerulonephritis is associated with exposure to

mercury, organic solvents

Acute tubular necrosis is associated with exposure to

Pb, Cd, Hg, arsenic, solvent

Solvent induced liver damage is associated with exposure to

carbon tetrachloride, trichloroethylene, tetrachloroethane, hydroflurocarbons, halothane

Hepatic cancer (angiosarcoma) is associated with

vinyl chloride, arsenic, anabolic steroids, thorotrast

Hepatic cancer (hepatocellular) is associated with

Hep B, Hep C, aflatoxin exposure

Hepatic necrosis is associated with

TNT, carbon tet, chloroform, APAP, heat stroke, arsenic, halothane, yellow phosphorus

Hepatic Steatosis is associated with

halogenated hydrocarbons, DDT, kepone, TNT, dimethyl formamide

Halogenated hydrocarbons include

carbon tetrachloride, trichloroethane

Occupational causes of squamous cell cancer include

sunlight, arsenic, PAH, phenolic compounds, ionizing radiation

PAH includes

asphalt, shale oils, coal and oil products

Cancers associated with PAH include

lung, renal, bladder, skin

Chloracne is associated with

hydrogenated aromatic hydrocarbons

Hydrogenated aromatic hydrocarbons include

dioxin, PCB, herbicides, Agent Orange

Associated with toxic porphyrias

hexachlorobenzene, vinyl chloride, Pb, Aluminum, Dioxin, chloramphenicol

Fetal solvent syndrome is associated with

toluene

Sensorimotor axonal degeneration and hyperhydrosis is associated with

acrylamide

Associated with hemolytic anemia

stibine gas; lead; arsine gas; copper sulfate "slacs"

Associated with aplastic anemia

benzene; arsenic; pesticide; ionizing radiation; chemotherapy; antibiotics (chloramphenicol)

Associated with Parkinson's

manganese, carbon disulfide, MPTP, carbon monoxide, mercury C2M3

Mee's lines, blackfoot disease, anemia, neuropathy associated with

arsenic

Agents associated with lung cancer

asbestos, radon, arsenic, chromium, chloromethyl ether, PAH, nickle

Nickle compounds can cause all of the following except: a. lung cancer b. peripheral neuropathy c. ARDS d. contact dermatitis

b. peripheral neuropathy

Agents associated with nasal cancer

hardwood dust, nickle, chromates, radium

Associated with toxic porphyrias

Hexachlorobenzene, vinyl chloride, lead, aluminum, dioxin, chloramphenicol.

Fetal solvent syndrome is associated with __?

toluene

What is another name for toxic encephalopathy?

"white matter disease"

What exposure affects CN5?

trichlorethylene

"Degreaser's flush" is associated with which exposure?

trichlorothylene

Trichloroethylene is potentieted by ?

etOH

What is the normal level of blood mercury?

Carbon disulfide is used in which industry?

viscose rayon fiber; cellophane film manufacture

What is the prevalence of OSA in general?

3-7%

Treatment of OSA is recommended at ?

AHI greater than or equal to 15

Metabolite(s) of benzene?

hydroquinone and benzoquinone

Health effects of benzene metabolite(s)?

hydroquinone and benzoquinone are bone marrow toxic; destroys pluripotent stem cells.

Occ med exposures related to aplastic anemia?

BAPICA

RBC basophilic stippling is related to___ toxicity?

What is"level of concern" for Pb re: children?

5 mcg/dL

What organ is affected in acquired porphyrias?

liver (impaired heme synthesis)

Heinz bodies are associated with ?

MetHgb

Myelodysplastic Syndrome is associated with?

Benzene, Ionizing radiation

Degreaser's flush is similar to what kind of reaction?

antabuse

Solvents tend to distribute to ____-rich tissue?

lipid-rich

Toluene is found in?

gasoline, thinner, benzene substitute

Causes of hemolytic anemia include?

stibine gas, arsine gas

what % of cancer occurs secondary to occ exposures?

2-8%

IARC Category 1:

human carcinogen

IARC Category 2:

2A: probable human carcinoger; 2B possible human carcinogen

IARC Category 3:

insufficient data; not classifiable

IARC Category 4:

not a human carcinogen

What form of arsenic is associated with skin cancer?

Inorganic

BEI for benzene:

urine S-phenylmercapturic acid, urine t,t-muconic acid

BEI for xylene:

urine methyl hippuric acid

BEI for toluene:

urine hippuric acid

BEI for styrene

urine mandelic acid or phenylglycoxylic acid

BEI for N-hexane

urine 2,5 hexanedione

What exposure potentiates hearing loss?

styrene

What exposure affects color vision?

styrene

What exposure is associated with psychosis?

carbon disulfide

what exposure is uniquely associated with autonomic dysfunction?

acrylamide monomer

Does carbon disulfide have cardiovascular effects?

Yes, it is associated with accelerated atherosclerosis.

Mee's lines are associated with?

arsenic

Alkyl lead is also known as?

organic lead

What kind of Pb is added to gasoline?

organic/alkyl lead

Which neurotoxin is associated with opsoclonus?

chlordecone (aka Kepone)

What exposure is associated with bladder neuropathy?

DMAPN (dimethyl amino propio nitrile)

Name exposures associated with nasal cancer:

hardwood dust, chromates, nickel, radium, formaldehyde

Name exposures associated with lung cancer:

asbestos, radon, arsenic, chromium, PAH, nickel, silica, bis-chloromethyl ether.

Name exposures associated with mesothelioma:

asbestos

Name exposures associated with bladder cancer:

smoking, aniline, methylene dianiline

Name exposures associated scrotal cancer:

coal tar

Name occupations associated with PAH exposures:

petrochemical, firefighting, coke oven

Are coke oven workers covered under OSHA standard?

Yes; requires history, skin exam, CXR, PFT, urine studies

Is Vinyl Chloride monomer under OSHA standard?

Yes; requires LFT annually x 10 years then q6mo

Match: a. B-napthalene 1. hepatic angiosarcoma b. vinyl chloride 2. microsteatosis c. methylene dianiline (MDA) 3. cholestatis d. trichlorethylene 4. degreasers flush e. dimethylforamide 5. bladder cancer

``` a 5 b 1 c 3 d 4 e 2 ```

Disorder associated with cadmium?

metallotheionein complex

Disorder associated with mercury?

membranous glomerulonephritis

Disorder associated with solvent?

Goodpastures's syndrome

Disorder associated with lead?

gout

Disorder associated with B-naphthalene?

bladder cancer

Disorder associated with vinyl chloride?

hepatic angiosarcoma

Disorder associated with methylene dianiline (MDA)?

cholestasis

Disorder associated with trichloroethylene?

degreaser's flush

Disorder associated with dimethylforamide

microsteatosis

T or F: ADA includes pregnancy.

False. Specifically excludes pregnancy.

What are reproductive effects of Pb exposure?

SA, stillbirths, preterm, delayed cognitive development, LBW

Why may Pb levels increase after exposure in pregnancy?

lead stored in bones, mobilized for fetal skeleton in 2nd and 3rd trimester.

Chemical properties of breast milk contaminants?

LMW, non-polar, lipophylic

T or F: Solvents can cross placenta?

True.

T or F: Exposure to anesthetic gases shows reproductive effects?

2003 study: no associations

Decreased sperm production or motility due to?

Pb, heat, ion rad, etOH, cannabis, pesticides

What are the two leading causes of occupational death?

MVA, homicide respectively.

What is "Epping jaundice" and what is exposure?

cholestatic jaundice due to MDA

Methylene dianiline is a what?

epoxy resin hardener

Cirrhosis and fibrotic response due to what exposures?

carbon tetrachloride, arsenic, TNT, etOH, schistosomiasis, viral hepatides

Hepatic angiosarcomas due to?

VCM, arsenic, anabolic steroids, thorotrast

Hepatocellular carcinoma exposures?

aflatoxin, HBV, HCV

Exposures associated with ATN?

cadmium, lead, mercury, arsenic, solvents

Exposure associated with renal tubular acidosis?

cadmium

Beta-2-microglobulin is a marker for?

cadmium exposure

Examples of LMW proteinuria?

Beta-2-microglobulin, retinol binding protein

Examples of HMW proteinuria? Indicative of?

albumin, glomerulonephritis

Name the disorder associated with low altitude agricultural workers?

Central America Chronic Kidney Disease

Analgiesics can cause what type of renal effects?

interstitial nephritis

"Light hydrocarbon nephropathy" exposures?

gasoline, glue sniffers (no sustained RF or decreased GFR)

combination of hemoptysis and glomerulonephritis should make one thing of?

Goodpastures's syndrome

What is OSHA standard for Beta-2-microglobulin?

300 mcg/g Cr or less

What is OSHA standard for blood cadmium?

5 mcg/l or less

What is OSHA standard for urine cadmium?

3 mcg/g Cr or less

Beta-2-microglobulin is an early indicator of?

cadmium nephrotoxicity

Toxicology Flashcards

(198 cards)