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Clinical Occupational Medicine > Toxicology > Flashcards

Toxicology Flashcards

1
Q

What is te earliest effect of chronic cadmium poisoning?

A

Proteinuria

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2
Q

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

A

RBC cholinesterase

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3
Q

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

A

cardiac arrhythmia and simple asphyxia

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4
Q

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

A

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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5
Q

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

A

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

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6
Q

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

A

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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7
Q

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

A

c. air monitoring results.

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8
Q

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

A

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

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9
Q

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

A

d.

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10
Q

Which of the following can cause parkinsonian movement disorder?

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

A

b. MPTP (a meperidine derivative)

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11
Q

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

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

A

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

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12
Q

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

A

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

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13
Q

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

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

A

d. elemental mercury (“Mad Hatter” syndrome)

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14
Q

What is the best use of Maneb?

A

fungicide (aka mancozeb, metiram, EBDC)

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15
Q

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

A

b. cadmium

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16
Q

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

A

d. stomatitis, melena

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17
Q

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

a. erythism, distal neuropathy

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18
Q

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

A

c. spasticity, visual constriction (mnemonic: DCATS)

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19
Q

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

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

A

a. n-hexane

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20
Q

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

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

A

c. lung cancer

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21
Q

Chronic elemental Hg effects

A

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

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22
Q

Methyl-Hg effects

A

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

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23
Q

Inorganic Hg effects

A

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

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24
Q

Thallium exposure associated with:

A

hair loss, tremor, peripheral neuropathy, CN neuropathy

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25
Q

Trichloroethylene associated with:

A

trigeminal neuralgia, optic neuropathy

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26
Q

Skin cancer is associated with exposure to:

A

arsenic, UV radiation, ionizing radiation, PAH

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27
Q

Bladder cancer is associated with:

A

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

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28
Q

Hemangiosarcoma is associated with:

A

vinyl chloride, arsenic

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29
Q

Hepatocellular cancer is associated with:

A

aflatoxin, Hep C, Hep B

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30
Q

Regarding methyl mercury poisoning, all of the following are possible except:

a. fulminant chemical pneumonitis
b. ferrotoxicity
c. speech disturbance
d. hemiparesis

A

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

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31
Q

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

A

b. phenol

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32
Q

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

a. methyl-n-butyl ketone

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33
Q

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

a. acro-osteolysis

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34
Q

Which of the following agents has not been associated with peripheral neuropathy?

a. N-hexane
b. arsenic
c. toluene diisocyanate (TDI)
d. Pb

A

c. toluene diisocyanate

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35
Q

What wavelength UV light is of greatest health concern?

A

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

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36
Q

What agents are associated with urologic cancers?

A

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

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37
Q

Why are slow acetylators at higher risk of bladder cancer?

A

N-acetylation reduces carcinogenicity

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38
Q

IARC Category 1 means:

A

carcinogenic

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39
Q

IARC Category 2 means:

A

probable, possible carcinogenic

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40
Q

IARC Category 3 means:

A

not classifiable with regard to humans

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41
Q

IARC Category 4 means:

A

probably not carcinogenic

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42
Q

Name the single agent in IARC Category 4

A

caprolactam

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43
Q

What is the major route of exposure for solvents?

A

respiratory

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44
Q

How are solvents metabolized?

A

Primarily metabolized by P450 in liver

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45
Q

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

A

exhalation

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46
Q

BEI for benzene?

A

urine phenol or end exhaled air

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47
Q

BEI for xylene?

A

urine methyl hippuric acid

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48
Q

BEI for toluene?

A

urine hippuric acid

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49
Q

BEI for styrene?

A

urine mandelic acid or phenylglycolic acid, blood styrene

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50
Q

BEI for trichloroethylene?

A

urine trichlorethanol or trichloracetic acid

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51
Q

BEI for N-hexane?

A

urine 2,5 hexanedione

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52
Q

Symptoms of acute solvent syndrome?

A

headache, confusion, dizziness, malaise, seizures

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53
Q

acute solvent exposure acts like what on the brain?

A

alcohol; reversible encephalopathy

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54
Q

Chronic Solvent Syndrome is AKA?

A

Painters’ syndrome

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55
Q

Symptoms of Painters syndrome?

A

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

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56
Q

2,5 hexanedione is responsible for what?

A

neurotoxicity

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57
Q

Toluene can cause what cardiac condition?

A

arrhythmias

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58
Q

Fetal Solvent Syndrome is associated with?

A

toluene

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59
Q

What is Blackfoot Disease? Agent?

A

peripheral vasospasm and gangrene; arsenic

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60
Q

What cardiac condition is associated with acute arsenic exposure?

A

prolonged QT

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61
Q

Symptoms of acute inorganic arsenic toxicity?

A

GI

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62
Q

Symptoms of subacute inorganic arsenic toxicity?

A

blackfoot, PN, Mees lines, hyperkeratosis

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63
Q

Symptoms of chronic arsenic toxicity?

A

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

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64
Q

Symptoms of Thallium toxicity?

A

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

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65
Q

Agent associated with Mad Hatter?

A

elemental Hg

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66
Q

Symptoms of acute elemental Hg toxicity?

A

cough, stomatitis, GI, pneumonia, bronchitis

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67
Q

Symptoms of chronic elemental Hg toxicity?

A

Triad: tremor, gingivitis, erethism; acrodynia

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68
Q

Health effects of acute inorganic Hg?

A

GI mucosal necrosis (bloody emesis and diarrhea); ATN

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69
Q

Exposure index for elemental Hg?

A

urine

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70
Q

Exposure index for inorganic Hg?

A

urine

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71
Q

Exposure index for Organic Hg (Methyl Mercury)

A

blood, hair

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72
Q

Chronic Inorganic Pb toxicity?

A

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

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73
Q

Another name for organic Pb?

A

Alkyl Pb.

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74
Q

Parkinsonism is associated with which exposures?

A

manganese; CO; carbon disulfide; MPTP; Hg.

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75
Q

What neurotoxicant is associated with blindness?

A

methanol

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76
Q

What neurotoxicants are associated with chronic toxic encephalopathy?

A

Pb, solvents, carbon disulfide

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77
Q

NCS: Amplitude

A

reflects number of conducting fibers (reduced in axonal loss)

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78
Q

NCS: Latency

A

reflects stimulus to response; prolonged in demyelination

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79
Q

NCS; Conduction velocity

A

reduced in demyelinating disorders

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80
Q

EMG:

A

used to investigate weakness

81
Q

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

A

benzene exposure

82
Q

Biomarker for benzene?

A

urine phenol

83
Q

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

A

hydroquinone, benzoquinone; cause marrow toxicity

84
Q

How do benzene metabolites cause marrow toxicity?

A

by destroying pluripotent stem cells

85
Q

Agents associated with aplastic anemia?

A

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

86
Q

What syndrome is associated with solvent nephropathy?

A

Goodpasture Syndrome (pulmonary hemorrhage and rapidly progressive glomerulonephritis)

87
Q

What syndrome is associated with Pb nephropathy?

A

Fanconi Syndrome (amino aciduria, hyperphosphaturia, hypercalcemia)

88
Q

Chronic renal failure, hypertension and gout may represent exposure to

89
Q

Glomerulonephritis is associated with exposure to

A

mercury, organic solvents

90
Q

Acute tubular necrosis is associated with exposure to

A

Pb, Cd, Hg, arsenic, solvent

91
Q

Solvent induced liver damage is associated with exposure to

A

carbon tetrachloride, trichloroethylene, tetrachloroethane, hydroflurocarbons, halothane

92
Q

Hepatic cancer (angiosarcoma) is associated with

A

vinyl chloride, arsenic, anabolic steroids, thorotrast

93
Q

Hepatic cancer (hepatocellular) is associated with

A

Hep B, Hep C, aflatoxin exposure

94
Q

Hepatic necrosis is associated with

A

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

95
Q

Hepatic Steatosis is associated with

A

halogenated hydrocarbons, DDT, kepone, TNT, dimethyl formamide

96
Q

Halogenated hydrocarbons include

A

carbon tetrachloride, trichloroethane

97
Q

Occupational causes of squamous cell cancer include

A

sunlight, arsenic, PAH, phenolic compounds, ionizing radiation

98
Q

PAH includes

A

asphalt, shale oils, coal and oil products

99
Q

Cancers associated with PAH include

A

lung, renal, bladder, skin

100
Q

Chloracne is associated with

A

hydrogenated aromatic hydrocarbons

101
Q

Hydrogenated aromatic hydrocarbons include

A

dioxin, PCB, herbicides, Agent Orange

102
Q

Associated with toxic porphyrias

A

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

103
Q

Fetal solvent syndrome is associated with

104
Q

Sensorimotor axonal degeneration and hyperhydrosis is associated with

A

acrylamide

105
Q

Associated with hemolytic anemia

A

stibine gas; lead; arsine gas; copper sulfate “slacs”

106
Q

Associated with aplastic anemia

A

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

107
Q

Associated with Parkinson’s

A

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

108
Q

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

109
Q

Agents associated with lung cancer

A

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

110
Q

Nickle compounds can cause all of the following except:

a. lung cancer
b. peripheral neuropathy
c. ARDS
d. contact dermatitis

A

b. peripheral neuropathy

111
Q

Agents associated with nasal cancer

A

hardwood dust, nickle, chromates, radium

112
Q

Associated with toxic porphyrias

A

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

113
Q

Fetal solvent syndrome is associated with __?

114
Q

What is another name for toxic encephalopathy?

A

“white matter disease”

115
Q

What exposure affects CN5?

A

trichlorethylene

116
Q

“Degreaser’s flush” is associated with which exposure?

A

trichlorothylene

117
Q

Trichloroethylene is potentieted by ?

118
Q

What is the normal level of blood mercury?

119
Q

Carbon disulfide is used in which industry?

A

viscose rayon fiber; cellophane film manufacture

120
Q

What is the prevalence of OSA in general?

121
Q

Treatment of OSA is recommended at ?

A

AHI greater than or equal to 15

122
Q

Metabolite(s) of benzene?

A

hydroquinone and benzoquinone

123
Q

Health effects of benzene metabolite(s)?

A

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

124
Q

Occ med exposures related to aplastic anemia?

125
Q

RBC basophilic stippling is related to___ toxicity?

126
Q

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

127
Q

What organ is affected in acquired porphyrias?

A

liver (impaired heme synthesis)

128
Q

Heinz bodies are associated with ?

129
Q

Myelodysplastic Syndrome is associated with?

A

Benzene, Ionizing radiation

130
Q

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

131
Q

Solvents tend to distribute to ____-rich tissue?

A

lipid-rich

132
Q

Toluene is found in?

A

gasoline, thinner, benzene substitute

133
Q

Causes of hemolytic anemia include?

A

stibine gas, arsine gas

134
Q

what % of cancer occurs secondary to occ exposures?

135
Q

IARC Category 1:

A

human carcinogen

136
Q

IARC Category 2:

A

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

137
Q

IARC Category 3:

A

insufficient data; not classifiable

138
Q

IARC Category 4:

A

not a human carcinogen

139
Q

What form of arsenic is associated with skin cancer?

140
Q

BEI for benzene:

A

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

141
Q

BEI for xylene:

A

urine methyl hippuric acid

142
Q

BEI for toluene:

A

urine hippuric acid

143
Q

BEI for styrene

A

urine mandelic acid or phenylglycoxylic acid

144
Q

BEI for N-hexane

A

urine 2,5 hexanedione

145
Q

What exposure potentiates hearing loss?

146
Q

What exposure affects color vision?

147
Q

What exposure is associated with psychosis?

A

carbon disulfide

148
Q

what exposure is uniquely associated with autonomic dysfunction?

A

acrylamide monomer

149
Q

Does carbon disulfide have cardiovascular effects?

A

Yes, it is associated with accelerated atherosclerosis.

150
Q

Mee’s lines are associated with?

151
Q

Alkyl lead is also known as?

A

organic lead

152
Q

What kind of Pb is added to gasoline?

A

organic/alkyl lead

153
Q

Which neurotoxin is associated with opsoclonus?

A

chlordecone (aka Kepone)

154
Q

What exposure is associated with bladder neuropathy?

A

DMAPN (dimethyl amino propio nitrile)

155
Q

Name exposures associated with nasal cancer:

A

hardwood dust, chromates, nickel, radium, formaldehyde

156
Q

Name exposures associated with lung cancer:

A

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

157
Q

Name exposures associated with mesothelioma:

158
Q

Name exposures associated with bladder cancer:

A

smoking, aniline, methylene dianiline

159
Q

Name exposures associated scrotal cancer:

160
Q

Name occupations associated with PAH exposures:

A

petrochemical, firefighting, coke oven

161
Q

Are coke oven workers covered under OSHA standard?

A

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

162
Q

Is Vinyl Chloride monomer under OSHA standard?

A

Yes; requires LFT annually x 10 years then q6mo

163
Q

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 
a 5 
b 1
c 3
d 4
e 2
164
Q

Disorder associated with cadmium?

A

metallotheionein complex

165
Q

Disorder associated with mercury?

A

membranous glomerulonephritis

166
Q

Disorder associated with solvent?

A

Goodpastures’s syndrome

167
Q

Disorder associated with lead?

168
Q

Disorder associated with B-naphthalene?

A

bladder cancer

169
Q

Disorder associated with vinyl chloride?

A

hepatic angiosarcoma

170
Q

Disorder associated with methylene dianiline (MDA)?

A

cholestasis

171
Q

Disorder associated with trichloroethylene?

A

degreaser’s flush

172
Q

Disorder associated with dimethylforamide

A

microsteatosis

173
Q

T or F: ADA includes pregnancy.

A

False. Specifically excludes pregnancy.

174
Q

What are reproductive effects of Pb exposure?

A

SA, stillbirths, preterm, delayed cognitive development, LBW

175
Q

Why may Pb levels increase after exposure in pregnancy?

A

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

176
Q

Chemical properties of breast milk contaminants?

A

LMW, non-polar, lipophylic

177
Q

T or F: Solvents can cross placenta?

178
Q

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

A

2003 study: no associations

179
Q

Decreased sperm production or motility due to?

A

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

180
Q

What are the two leading causes of occupational death?

A

MVA, homicide respectively.

181
Q

What is “Epping jaundice” and what is exposure?

A

cholestatic jaundice due to MDA

182
Q

Methylene dianiline is a what?

A

epoxy resin hardener

183
Q

Cirrhosis and fibrotic response due to what exposures?

A

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

184
Q

Hepatic angiosarcomas due to?

A

VCM, arsenic, anabolic steroids, thorotrast

185
Q

Hepatocellular carcinoma exposures?

A

aflatoxin, HBV, HCV

186
Q

Exposures associated with ATN?

A

cadmium, lead, mercury, arsenic, solvents

187
Q

Exposure associated with renal tubular acidosis?

188
Q

Beta-2-microglobulin is a marker for?

A

cadmium exposure

189
Q

Examples of LMW proteinuria?

A

Beta-2-microglobulin, retinol binding protein

190
Q

Examples of HMW proteinuria? Indicative of?

A

albumin, glomerulonephritis

191
Q

Name the disorder associated with low altitude agricultural workers?

A

Central America Chronic Kidney Disease

192
Q

Analgiesics can cause what type of renal effects?

A

interstitial nephritis

193
Q

“Light hydrocarbon nephropathy” exposures?

A

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

194
Q

combination of hemoptysis and glomerulonephritis should make one thing of?

A

Goodpastures’s syndrome

195
Q

What is OSHA standard for Beta-2-microglobulin?

A

300 mcg/g Cr or less

196
Q

What is OSHA standard for blood cadmium?

A

5 mcg/l or less

197
Q

What is OSHA standard for urine cadmium?

A

3 mcg/g Cr or less

198
Q

Beta-2-microglobulin is an early indicator of?

A

cadmium nephrotoxicity

Clinical Occupational Medicine (13 decks)

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