++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
++
++
++
++
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).
++
++
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.
++
++
++
++
++
++
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.