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CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e

Section IV: Occupational and Environmental Exposures

Section IV. Occupational and Environmental Exposures

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Chronic arsenic ingestion

a. may result in chronic renal failure

b. causes severe CNS disturbances and mental illness

c. causes arthralgias and myalgias

d. may cause cancer of the skin, lung, and bladder

d. Chronic arsenic inhalation may cause lung cancer, and chronic arsenic ingestion may cause cancer of the skin, lung, and bladder.

Chronic berylliosis

a. seldom presents with exertional dyspnea

b. may develop following a single acute exposure

c. does not cause chest pain

d. is associated with parkinsonism

b. Chronic berylliosis may develop after months or years of exposure or following a single acute exposure.

The beryllium lymphocyte proliferation test (BeLPT)

a. confirms sensitization

b. leaves no room for error or misinterpretation

c. requires only one borderline test to confirm sensitization

d. requires two borderline tests to confirm sensitization

a. The beryllium lymphocyte proliferation test (BeLPT) confirms sensitization.

Chronic exposure to cadmium

a. may lead to diabetes mellitus

b. may result in diabetic nephropathy

c. can result in nephrolithiasis and osteomalacia

d. is associated with an excess risk of testicular cancer

c. Renal tubular dysfunction resulting from chronic exposure to cadmium can result in nephrolithiasis and osteomalacia.

Exposures to chromic acid or chromates

a. always lead to immediate symptoms

b. do not result in cough, chest pain, and dyspnea

c. may result in chromium-induced asthma

d. are associated with an increased incidence of bone cancer

c. Cough, chest pain, and dyspnea may indicate exposure to irritant levels of soluble chromium compounds or the development of chromium-induced asthma.

Acute high-dose lead exposure

a. may induce a hemolytic anemia

b. depresses hepatic aminotransferases

c. causes persistent azotemia

d. may cause bronchospasm

a. Acute high-dose lead exposure may induce a hemolytic anemia (or anemia with basophilic stippling if exposure has been subacute).

Chronic lead intoxication

a. presents with classic symptoms that lead to rapid diagnosis

b. affects the peripheral nervous system only in children

c. primarily results from workplace exposure in adults

d. may result in gastrointestinal bleeding

c. Approximately 95% of all elevated blood lead levels among adults in the Untied States are work related.

Workers should be removed from workplace lead exposure

a. for a single blood lead level greater than 20 μg/dL

b. when two successive blood lead levels measured over a 4-week interval are equal to or greater than 10 μg/dL

c. when the ZPP exceeds 25 μg/dL

d. with a prenatal blood lead level of equal to or greater than 10 μg/dL

d. In 2010, the CDC issued guidelines recommending medical removal from workplace exposure of any woman with a prenatal blood lead level of equal to or greater than 10 μg/dL.

Industrial exposure to manganese

a. results in chronic nervous system stimulation without damage

b. may cause fatigue, headache, apathy, but no observable behavioral changes

c. may lead to a clinical syndrome that is similar to idiopathic parkinsonism

d. causes a tremor that is more pronounced than parkinsonism

c. Exposure to manganese may lead to a clinical syndrome that is similar to idiopathic parkinsonism, with slow speech, masked facies, bradykinesia, gait dysfunction, and micrographia.

Mercury

a. is an essential element in humans

b. exposure in the environment is of no consequence

c. is a powdery gray metal at room temperature

d. emissions have led to global distribution of this element

d. The release of mercury into the atmosphere from both natural sources, such as volcanoes, and industrial emissions has led to global distribution of this element.

Nickel

a. is nontoxic

b. is a common cause of allergic contact dermatitis

c. may cause septal perforation

d. may cause brain cancer

b. Nickel is a common cause of allergic contact dermatitis.

Hydrofluoric acid (hydrogen fluoride)

a. occupational exposure can occur both by direct skin contact and by inhalation of fumes

b. treatment is aimed at deactivation of the fluoride ion in blood and tissue

c. burns may cause vesicles and bullae, but they should not be debrided

d. systemic effects from absorption occur only from skin burns

a. Hydrofluoric acid (hydrogen fluoride) occupational exposure can occur both by direct skin contact and by inhalation of fumes.

Formaldehyde

a. is a colorless, nonflammable gas with an irritating odor

b. is no longer found in wood industry products

c. is primarily a by-product of the incomplete combustion of heavy metals

d. is found in small amounts in automobile exhaust and cigarette smoke

d. Formaldehyde is a by-product of the incomplete combustion of hydrocarbons and is found in small amounts in automobile exhaust and cigarette smoke.

Nitroglycerine

a. acute illness symptoms include loss of consciousness, severe headache, difficulty breathing, weak pulse, and pallor

b. symptoms increase in dynamite production with continued exposure

c. headache (powder headache) frequently begins in the occipital region

d. headache is relieved by alcohol ingestion

a. Symptoms of acute nitroglycerine illness include loss of consciousness, severe headache, difficulty breathing, weak pulse, and pallor.

Pentachlorophenol

a. is used as a wood preservative, herbicide, defoliant, and fungicide

b. may explode if used in pressure treatment of lumber

c. is usually applied to wood products as a 50% solution in mineral spirits, fuel oil, or kerosene

d. is registered by the FDA as a disinfectant and as an ingredient in antifouling paint

a. PCP is used as a wood preservative, herbicide, defoliant, and fungicide.

Polychlorinated biphenyls

a. causes acute symptoms of nasal and pharyngeal irritation

b. chronic workplace exposure predictably always results in chloracne

c. have an efficient transplacental transfer

d. prenatal exposure predicts accelerated cognitive abilities

c. PCBs have an efficient transplacental transfer, and adverse reproductive effects of PCBs have been reported in many animal species.

Styrene

a. exposure acutely diminishes serum pituitary hormone secretion

b. chronic exposure may cause weakness, headache, fatigue, poor memory, and dizziness

c. may increase mean reaction time and visuomotor performance in exposed workers

d. exposure produces no abnormal electroencephalographs (EEGs) effects

b. Styrene chronic exposure may cause weakness, headache, fatigue, poor memory, and dizziness.

Vinyl chloride disease

a. is a syndrome consisting of Raynaud phenomenon, acroosteolysis, joint and muscle pain, enhanced collagen deposition, stiffness of the hands, and scleroderma-like skin changes

b. has a decrease in circulating immune complex levels, cryoglobulinemia, B-cell proliferation, hyperimmunoglobulinemia, and complement activation

c. resistance has been associated with the HLA-DR5 allele

d. is ruled out by a finding of circulating immune complexes

a. Vinyl chloride disease is a syndrome consisting of Raynaud phenomenon, acroosteolysis, joint and muscle pain, enhanced collagen deposition, stiffness of the hands, and scleroderma-like skin changes.

Solvents

a. are unstable liquids at room temperature

b. dissolve other substances resulting in a layered mixture

c. may be classified as aqueous (water-based) or organic (hydrocarbon-based)

d. are usually inorganic chemicals because most of the industrial substances they are used to dissolve are inorganic

c. Solvents may be classified as aqueous (water-based) or organic (hydrocarbon-based).

Percutaneous absorption of solvents

a. is determined solely by their lipid solubility

b. varies widely among individuals

c. is independent of water solubility and volatility

d. may be enhanced with highly volatile substances

b. Skin absorption rates vary widely among individuals by at least a factor of 4.

One isomer of hexane, n-hexane,

a. causes peripheral neuropathy

b. is found in household aerosol products

c. is less toxic when coupled with methyl ethyl ketone and methyl isobutyl ketone exposure

d. exposure can be assessed by measuring 2,5-hexanedione in the urine or hair samples

a. One isomer of hexane, n-hexane, causes peripheral neuropathy.

The aromatic hydrocarbons

a. generally are weaker irritants and anesthetics than the aliphatics

b. cause only subclinical anesthetic effects

c. cause only respiratory tract irritation and dermatitis

d. are associated with neurobehavioral dysfunction

d. Aromatic hydrocarbons cause acute anesthetic effects, respiratory tract irritation, and dermatitis and are associated with neurobehavioral dysfunction.

The alcohols

a. are more potent central nervous system depressants and irritants than the corresponding aliphatic hydrocarbons

b. are more potent skin and respiratory tract irritants than aldehydes or ketones

c. irritate the respiratory tract and eye at lower concentrations than central nervous system depression

d. have profound chronic neurobehavioral effects in many industries

c. Respiratory tract and eye irritation usually occurs at lower concentrations than central nervous system depression and thus serves as a useful warning property.

Methylene chloride

a. is more potent than perchloroethylene and trichloroethylene as an anesthetic

b. is less potent than perchloroethylene and trichloroethylene as a liver toxin

c. is unique in that it is metabolized to carbon monoxide, with formation of carboxyhemoglobin

d. exposure levels of 100 ppm are considered acceptable

c. Methylene chloride is unique in that it is metabolized to carbon monoxide, with formation of carboxyhemoglobin.

High-intensity exposure to toxic gases and other airborne toxicants

a. may result in clinical findings within seconds, minutes, or hours

b. affects only a small number of exposed individuals

c. will manifest only minor adverse effects

d. does not cause longer-term sequelae

a. High-intensity exposure to toxic gases and other airborne toxicants may result in clinical findings within seconds, minutes, or hours.

Simple asphyxiants

a. are health hazards only when encountered in confined spaces

b. are of less concern when they are heavier than air

c. are of no concern when encountered in semienclosed areas

d. include methane gas, argon, carbon dioxide, and nitrogen

d. Simple asphyxiants include methane gas, argon, carbon dioxide, and nitrogen.

Methane gas is

a. heavier than air

b. not explosive

c. released in the presence of organic material breakdown

d. not encountered in coal mining

c. Methane is also released in coal and other fossil fuel extraction settings and in the presence of organic material breakdown (including landfills).

Carbon dioxide is

a. lighter than air

b. not a direct acute stimulant to respiration at intermediate concentrations

c. not lethal at any concentration

d. a potent central nervous system depressant at high concentrations

d. Although carbon dioxide is considered a simple asphyxiant, at high concentrations it also acts as a potent central nervous system depressant.

Carbon monoxide

a. competes with oxygen for binding sites on hemoglobin

b. increases the oxygen-carrying capacity of the blood

c. is not toxic to fetal hemoglobin

d. is not treated if brain injury has occurred

a. Carbon monoxide competes with oxygen for binding sites on hemoglobin, thereby reducing the oxygen-carrying capacity of the blood.

Hydrogen cyanide is

a. encountered in metal plating operations

b. slowly absorbed through inhalation and skin exposures

c. recognized by all workers as a “bitter almond” odor

d. released from cyanide salt solutions if the pH increases to the alkaline range

a. Major current industrial use of cyanide is in metal plating operations and in the extraction of silver and gold salts from ores.

Hydrogen sulfide

a. exerts its toxicity by blocking oxygen utilization through the cytochrome oxidase pathway

b. has good warning properties through smell

c. does not cause mucous membrane and respiratory tract irritation

d. is not associated with burning eyes, headache, dizziness, nausea, and vomiting

a. Like cyanide, hydrogen sulfide exerts its toxicity by blocking oxygen utilization through the cytochrome oxidase pathway.

Smoke inhalation

a. only exerts toxicity through irritant effects

b. results in direct thermal injury

c. does not cause methemoglobinemia

d. produces clinical findings of both asphyxiant and irritant injury

d. Clinical findings in smoke inhalation injury can include features of both asphyxiant and irritant injury.

Arsine gas

a. is used as a dopant in the microelectronics industry

b. exposure may present as a characteristic triad of abdominal pain, hematuria, and cough

c. may cause headache, renal failure, and purple staining of urine and feces

d. exposure with massive hemolysis does not benefit from exchange transfusion

a. Preformed arsine gas, often stored under pressure in large quantities, is used as a dopant in the microelectronics industry.

Phosphine gas

a. is not used in agriculture

b. is generated from the hydrolysis of aluminum phosphide and sodium chloride

c. is not associated with chest pain

d. toxicity is marked by delayed-onset pulmonary edema

d. With lower-level exposure of phosphine gas, pulmonary toxicity may be the primary manifestation, marked by dyspnea, cough, chest pain, and delayed-onset pulmonary edema in the hours following the exposure.

In the United States, the Environmental Protection Agency (EPA)

a. regulates the registration, sale, and conditions of use of all pesticides

b. defers to OSHA the responsibility for the protection of agricultural workers exposed to pesticides

c. narrowly defines pesticides for registration for sale and use

d. ignores studies of hazards to nontarget organisms

a. In the United States, the Environmental Protection Agency (EPA) regulates the registration, sale, and conditions of use of all pesticides.

Organophosphates

a. are esters of phosphoric acid that exist in any number of forms

b. bind with the cholinesterase molecule

c. bind with the phosphate portion of the serine molecule

d. have no irreversible effects

b. Organophosphates potency depends on their ability to bind with the cholinesterase molecule.

Carbamates

a. share a common mechanism of chronic toxicity with organophosphates

b. present unique signs and symptoms of acute poisoning

c. differ from organophosphates in causing reversible rather than irreversible cholinesterase inhibition

d. typically have a longer clinical course than organophosphate poisoning

c. Carbamates differ from organophosphates in causing reversible rather than irreversible cholinesterase inhibition and typically have a short clinical course.

Treatment of organophosphate poisoning

a. should be instituted on clinical grounds alone

b. should be delayed pending determination of cholinesterase levels

c. may follow a test dose of atropine with marked signs of atropinization

d. may follow a test dose of atropine with no signs of atropinization

d. The initial diagnosis can be made on clinical grounds alone, samples sent to the laboratory, and a test dose of atropine delivered. A dose of atropine sulfate produces signs of mild atropinization in a normal adult; it has no effect in an individual with organophosphate poisoning.

Organochlorine insecticides

a. are chlorinated hydrocarbon compounds of cyclic structure and low molecular weight

b. are of low volatility and have CNS effects similar to general anesthetics

c. are poorly absorbed by inhalation or ingestion but are absorbed rapidly through the skin

d. are highly fat soluble and are distributed to adipose tissue, the liver, and the nervous system

d. The organochlorines are highly fat soluble and are distributed to adipose tissue, the liver, and the nervous system.

Fumigants

a. have innately high vapor pressures or by-products with high vapor pressure

b. have a low degree of chemical and biological reactivity

c. cause respiratory and eye irritation, CNS injury, and retinal injury

d. have no measurable carcinogenicity and reproductive effects in animal studies

a. The fumigants have in common innately high vapor pressures or by-products with high vapor pressure.

Halogenated hydrocarbon fumigants

a. are primary irritants with negligible potency

b. are excreted slowly leading to significant bioaccumulation

c. typically cause CNS stimulation

d. share many of the effects of the halogenated hydrocarbon solvents

d. The halogenated hydrocarbon fumigants share many of the effects of the halogenated hydrocarbon solvents, includ-ing cardiac sensitization, direct cellular toxicity to the liver and kidneys, and carcinogenicity in laboratory animals.

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Section IV: Occupational and Environmental Exposures

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