Trace elements and heavy metal

Question 1

Essential elements are?

Answer 1

Required in the diet in micrograms (mcg) level

Question 2

Zinc levels in plasma will ______________ when the patient is fasting.

Answer 2

decrease

Question 3

How will zinc and copper levels be affected when patient is in acute phase reaction?

Answer 3

Zinc: decreases
Copper: increases

Question 4

Zinc and copper are not assessed in isolation. How are they assessed?

Answer 4

They are assessed together with their major binding protein:
Zinc: albumin
Copper: ceruloplasmin

Question 5

Example of tissue marker that reflects Se status?

Answer 5

RBC glutathione peroxidase reflects Se status.

Question 6

Iodine deficiency is associated with?

Answer 6

Goitre,
chornic: hypothyroidism;
cretinism in children

Question 7

Copper deficiency is associated with?

Answer 7

impaired immunity, hair, nail growth, anemia, leucopenia, bone demineralization

(component of many enzymes)

Question 8

Copper toxicity is associated with?

Answer 8

Wilson disease

Question 9

Which of the following is true about Wilson disease?

A. It is due to the decifict in copper transport
B. It leads to multi-organ damage, esp. the brain and the liver
C. It is due to mutations in ATP7B gene, which is used as the golden standard in ananysis
D. It is treatable by copper-chelation therapy at any stage of the disease
E. It is autosomal recessive

Answer 9

except D: only in early detection

Question 10

Which of the following is false about Wilson disease?
A. It can present in any age
B. It causes nonspecific liver disease <30 years of age
C. Kayser-Fleicher rings can be observed, due to deposition of copper in the cornea
D. Kayser-Fleicher rings will disappear after copper-chelation therapy
E. High ceruloplasmin can be seen in copper toxicity

Answer 10

E

Should be low, first line screening test

Question 11

Chromium toxicity is usually associated with?

Answer 11

Artificial joints and dermatitis

Question 12

Which of the following about Selenium is correct?
A. It is the component of glutathione peroxidase
B. Its deficiency common in Heilongjiang and is associated with Keshan disease - cardiomyopathy
C. Its toxicity is associated with dermatitis
D. Tissue marker for Se is albumin

Answer 12

Except D

should be RBC glutathione peroxidase

Question 13

Zinc deficiency is associated with?

Answer 13

1. Growth retardation
2. Acrodermatitis enteropathica: inherited, alopecia, diarrhea (defect in transmembrane proten required for Zn uptake in gut)

Question 14

Zinc toxicity is associated with?

Answer 14

Pneumonitis

Question 15

Non-essential elements are?

Answer 15

toxic in any amount

Question 16

Lead toxicity is well known for its hemopoietic toxicity. Which of the following enzymes does it inhibit?
A. AlaDH (Delta Ala dehydratase)
B. Coproporphyrinogen decarboxylase
C. Ferrorchelatase

Also state the consequences of the inhibition of the enzymes

Answer 16

All
- reduced Hb synthesis > anemia
Ala dehydratase decreases at Pb~10ug, most sensitive marker

Question 17

How can Pb toxcity be treated?

Answer 17

Chelation: EDTA, penicillamine, dimercapol

Question 18

Determine the degree of toxicity of element, organic, inorgainic mercury and state some clinical manifestations.

Answer 18

Organic > Inorganic > Element

Organic Hg: Blurring of vision, neuro-symptoms
Inorganic Hg: Erethism, Acrodynia, affect GIT and kidney s

Question 19

We detect mercury toxicity in?

Answer 19

hair and blood if organic Hg

Question 20

How is mercury toxicity treated?

Answer 20

Chelation: DMSA (Dimercaptosuccinic acid)

Question 21

Sources of Cadmium toxicity?

Answer 21

Smoking, shellfish, pork

Question 22

Toxicity of cadmium may cause?

Answer 22

Acute: pneumonitis
Chronic: Itai-itai disease (osteomalacia, bone pain, pathological) , irreversible renal tubule damage

Question 23

How is cadmium toxicity treated?

Answer 23

Avoid exposure

C/I chelation!! released Cd exacerabtes renal damage!

Question 24

Sources of arsenic toxicity?

Answer 24

Insecticides, seafood

Question 25

Which of the following about arsenic toxicity is incorrect?
A. Toxicity of As V is greater than As III
B. organic arsenic is non-toxic and can be found in seafood
C. Treatment is by chelation: DMSA, BAL, penicillamine
D. Clinical symptoms include peripheral neuropathy, intravasacular hemolysis..

Answer 25

A

should be AsIII> As V