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Flashcards in Toxicology Deck (198):
1

What is te earliest effect of chronic cadmium poisoning?

Proteinuria

2

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

RBC cholinesterase

3

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

cardiac arrhythmia and simple asphyxia

4

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.

5

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.

6

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.

7

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.

8

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.

9

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

d.

10

Which of the following can cause parkinsonian movement disorder?
a. trichloroethylene
b. MPTP
c. arsine
d. acrylamide

b. MPTP (a meperidine derivative)

11

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)

12

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)

13

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)

14

What is the best use of Maneb?

fungicide (aka mancozeb, metiram, EBDC)

15

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

16

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

17

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

18

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)

19

Solvent associated with "coasting" (continued decrement after exposure ceases)
a. n-hexane
b. formaldehyde
c. trichloroethanol
d. methyl-n-butyl ketone

a. n-hexane

20

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

21

Chronic elemental Hg effects

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

22

Methyl-Hg effects

"DCATS"-deafness, cognitive/visual constriction, ataxia, tremor, spasticity

23

Inorganic Hg effects

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

24

Thallium exposure associated with:

hair loss, tremor, peripheral neuropathy, CN neuropathy

25

Trichloroethylene associated with:

trigeminal neuralgia, optic neuropathy

26

Skin cancer is associated with exposure to:

arsenic, UV radiation, ionizing radiation, PAH

27

Bladder cancer is associated with:

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

28

Hemangiosarcoma is associated with:

vinyl chloride, arsenic

29

Hepatocellular cancer is associated with:

aflatoxin, Hep C, Hep B

30

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.

31

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

32

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

33

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

34

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

35

What wavelength UV light is of greatest health concern?

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

36

What agents are associated with urologic cancers?

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

37

Why are slow acetylators at higher risk of bladder cancer?

N-acetylation reduces carcinogenicity

38

IARC Category 1 means:

carcinogenic

39

IARC Category 2 means:

probable, possible carcinogenic

40

IARC Category 3 means:

not classifiable with regard to humans

41

IARC Category 4 means:

probably not carcinogenic

42

Name the single agent in IARC Category 4

caprolactam

43

What is the major route of exposure for solvents?

respiratory

44

How are solvents metabolized?

Primarily metabolized by P450 in liver

45

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

exhalation

46

BEI for benzene?

urine phenol or end exhaled air

47

BEI for xylene?

urine methyl hippuric acid

48

BEI for toluene?

urine hippuric acid

49

BEI for styrene?

urine mandelic acid or phenylglycolic acid, blood styrene

50

BEI for trichloroethylene?

urine trichlorethanol or trichloracetic acid

51

BEI for N-hexane?

urine 2,5 hexanedione

52

Symptoms of acute solvent syndrome?

headache, confusion, dizziness, malaise, seizures

53

acute solvent exposure acts like what on the brain?

alcohol; reversible encephalopathy

54

Chronic Solvent Syndrome is AKA?

Painters' syndrome

55

Symptoms of Painters syndrome?

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

56

2,5 hexanedione is responsible for what?

neurotoxicity

57

Toluene can cause what cardiac condition?

arrhythmias

58

Fetal Solvent Syndrome is associated with?

toluene

59

What is Blackfoot Disease? Agent?

peripheral vasospasm and gangrene; arsenic

60

What cardiac condition is associated with acute arsenic exposure?

prolonged QT

61

Symptoms of acute inorganic arsenic toxicity?

GI

62

Symptoms of subacute inorganic arsenic toxicity?

blackfoot, PN, Mees lines, hyperkeratosis

63

Symptoms of chronic arsenic toxicity?

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

64

Symptoms of Thallium toxicity?

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

65

Agent associated with Mad Hatter?

elemental Hg

66

Symptoms of acute elemental Hg toxicity?

cough, stomatitis, GI, pneumonia, bronchitis

67

Symptoms of chronic elemental Hg toxicity?

Triad: tremor, gingivitis, erethism; acrodynia

68

Health effects of acute inorganic Hg?

GI mucosal necrosis (bloody emesis and diarrhea); ATN

69

Exposure index for elemental Hg?

urine

70

Exposure index for inorganic Hg?

urine

71

Exposure index for Organic Hg (Methyl Mercury)

blood, hair

72

Chronic Inorganic Pb toxicity?

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

73

Another name for organic Pb?

Alkyl Pb.

74

Parkinsonism is associated with which exposures?

manganese; CO; carbon disulfide; MPTP; Hg.

75

What neurotoxicant is associated with blindness?

methanol

76

What neurotoxicants are associated with chronic toxic encephalopathy?

Pb, solvents, carbon disulfide

77

NCS: Amplitude

reflects number of conducting fibers (reduced in axonal loss)

78

NCS: Latency

reflects stimulus to response; prolonged in demyelination

79

NCS; Conduction velocity

reduced in demyelinating disorders

80

EMG:

used to investigate weakness

81

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

benzene exposure

82

Biomarker for benzene?

urine phenol

83

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

hydroquinone, benzoquinone; cause marrow toxicity

84

How do benzene metabolites cause marrow toxicity?

by destroying pluripotent stem cells

85

Agents associated with aplastic anemia?

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

86

What syndrome is associated with solvent nephropathy?

Goodpasture Syndrome (pulmonary hemorrhage and rapidly progressive glomerulonephritis)

87

What syndrome is associated with Pb nephropathy?

Fanconi Syndrome (amino aciduria, hyperphosphaturia, hypercalcemia)

88

Chronic renal failure, hypertension and gout may represent exposure to

Pb.

89

Glomerulonephritis is associated with exposure to

mercury, organic solvents

90

Acute tubular necrosis is associated with exposure to

Pb, Cd, Hg, arsenic, solvent

91

Solvent induced liver damage is associated with exposure to

carbon tetrachloride, trichloroethylene, tetrachloroethane, hydroflurocarbons, halothane

92

Hepatic cancer (angiosarcoma) is associated with

vinyl chloride, arsenic, anabolic steroids, thorotrast

93

Hepatic cancer (hepatocellular) is associated with

Hep B, Hep C, aflatoxin exposure

94

Hepatic necrosis is associated with

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

95

Hepatic Steatosis is associated with

halogenated hydrocarbons, DDT, kepone, TNT, dimethyl formamide

96

Halogenated hydrocarbons include

carbon tetrachloride, trichloroethane

97

Occupational causes of squamous cell cancer include

sunlight, arsenic, PAH, phenolic compounds, ionizing radiation

98

PAH includes

asphalt, shale oils, coal and oil products

99

Cancers associated with PAH include

lung, renal, bladder, skin

100

Chloracne is associated with

hydrogenated aromatic hydrocarbons

101

Hydrogenated aromatic hydrocarbons include

dioxin, PCB, herbicides, Agent Orange

102

Associated with toxic porphyrias

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

103

Fetal solvent syndrome is associated with

toluene

104

Sensorimotor axonal degeneration and hyperhydrosis is associated with

acrylamide

105

Associated with hemolytic anemia

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

106

Associated with aplastic anemia

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

107

Associated with Parkinson's

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

108

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

arsenic

109

Agents associated with lung cancer

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

110

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

b. peripheral neuropathy

111

Agents associated with nasal cancer

hardwood dust, nickle, chromates, radium

112

Associated with toxic porphyrias

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

113

Fetal solvent syndrome is associated with __?

toluene

114

What is another name for toxic encephalopathy?

"white matter disease"

115

What exposure affects CN5?

trichlorethylene

116

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

trichlorothylene

117

Trichloroethylene is potentieted by ?

etOH

118

What is the normal level of blood mercury?

119

Carbon disulfide is used in which industry?

viscose rayon fiber; cellophane film manufacture

120

What is the prevalence of OSA in general?

3-7%

121

Treatment of OSA is recommended at ?

AHI greater than or equal to 15

122

Metabolite(s) of benzene?

hydroquinone and benzoquinone

123

Health effects of benzene metabolite(s)?

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

124

Occ med exposures related to aplastic anemia?

BAPICA

125

RBC basophilic stippling is related to___ toxicity?

Pb

126

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

5 mcg/dL

127

What organ is affected in acquired porphyrias?

liver (impaired heme synthesis)

128

Heinz bodies are associated with ?

MetHgb

129

Myelodysplastic Syndrome is associated with?

Benzene, Ionizing radiation

130

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

antabuse

131

Solvents tend to distribute to ____-rich tissue?

lipid-rich

132

Toluene is found in?

gasoline, thinner, benzene substitute

133

Causes of hemolytic anemia include?

stibine gas, arsine gas

134

what % of cancer occurs secondary to occ exposures?

2-8%

135

IARC Category 1:

human carcinogen

136

IARC Category 2:

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

137

IARC Category 3:

insufficient data; not classifiable

138

IARC Category 4:

not a human carcinogen

139

What form of arsenic is associated with skin cancer?

Inorganic

140

BEI for benzene:

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

141

BEI for xylene:

urine methyl hippuric acid

142

BEI for toluene:

urine hippuric acid

143

BEI for styrene

urine mandelic acid or phenylglycoxylic acid

144

BEI for N-hexane

urine 2,5 hexanedione

145

What exposure potentiates hearing loss?

styrene

146

What exposure affects color vision?

styrene

147

What exposure is associated with psychosis?

carbon disulfide

148

what exposure is uniquely associated with autonomic dysfunction?

acrylamide monomer

149

Does carbon disulfide have cardiovascular effects?

Yes, it is associated with accelerated atherosclerosis.

150

Mee's lines are associated with?

arsenic

151

Alkyl lead is also known as?

organic lead

152

What kind of Pb is added to gasoline?

organic/alkyl lead

153

Which neurotoxin is associated with opsoclonus?

chlordecone (aka Kepone)

154

What exposure is associated with bladder neuropathy?

DMAPN (dimethyl amino propio nitrile)

155

Name exposures associated with nasal cancer:

hardwood dust, chromates, nickel, radium, formaldehyde

156

Name exposures associated with lung cancer:

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

157

Name exposures associated with mesothelioma:

asbestos

158

Name exposures associated with bladder cancer:

smoking, aniline, methylene dianiline

159

Name exposures associated scrotal cancer:

coal tar

160

Name occupations associated with PAH exposures:

petrochemical, firefighting, coke oven

161

Are coke oven workers covered under OSHA standard?

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

162

Is Vinyl Chloride monomer under OSHA standard?

Yes; requires LFT annually x 10 years then q6mo

163

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

164

Disorder associated with cadmium?

metallotheionein complex

165

Disorder associated with mercury?

membranous glomerulonephritis

166

Disorder associated with solvent?

Goodpastures's syndrome

167

Disorder associated with lead?

gout

168

Disorder associated with B-naphthalene?

bladder cancer

169

Disorder associated with vinyl chloride?

hepatic angiosarcoma

170

Disorder associated with methylene dianiline (MDA)?

cholestasis

171

Disorder associated with trichloroethylene?

degreaser's flush

172

Disorder associated with dimethylforamide

microsteatosis

173

T or F: ADA includes pregnancy.

False. Specifically excludes pregnancy.

174

What are reproductive effects of Pb exposure?

SA, stillbirths, preterm, delayed cognitive development, LBW

175

Why may Pb levels increase after exposure in pregnancy?

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

176

Chemical properties of breast milk contaminants?

LMW, non-polar, lipophylic

177

T or F: Solvents can cross placenta?

True.

178

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

2003 study: no associations

179

Decreased sperm production or motility due to?

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

180

What are the two leading causes of occupational death?

MVA, homicide respectively.

181

What is "Epping jaundice" and what is exposure?

cholestatic jaundice due to MDA

182

Methylene dianiline is a what?

epoxy resin hardener

183

Cirrhosis and fibrotic response due to what exposures?

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

184

Hepatic angiosarcomas due to?

VCM, arsenic, anabolic steroids, thorotrast

185

Hepatocellular carcinoma exposures?

aflatoxin, HBV, HCV

186

Exposures associated with ATN?

cadmium, lead, mercury, arsenic, solvents

187

Exposure associated with renal tubular acidosis?

cadmium

188

Beta-2-microglobulin is a marker for?

cadmium exposure

189

Examples of LMW proteinuria?

Beta-2-microglobulin, retinol binding protein

190

Examples of HMW proteinuria? Indicative of?

albumin, glomerulonephritis

191

Name the disorder associated with low altitude agricultural workers?

Central America Chronic Kidney Disease

192

Analgiesics can cause what type of renal effects?

interstitial nephritis

193

"Light hydrocarbon nephropathy" exposures?

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

194

combination of hemoptysis and glomerulonephritis should make one thing of?

Goodpastures's syndrome

195

What is OSHA standard for Beta-2-microglobulin?

300 mcg/g Cr or less

196

What is OSHA standard for blood cadmium?

5 mcg/l or less

197

What is OSHA standard for urine cadmium?

3 mcg/g Cr or less

198

Beta-2-microglobulin is an early indicator of?

cadmium nephrotoxicity