Assessment and Posttest

1. What is arsenic?

1. A naturally occurring mineral.
2. An element.
3. Commercially useful.
4. All of the above.

2. Most of the arsenic used industrially in recent years in the United States has been for the manufacture of

1. Pesticide.
2. Wood preservative.
3. Metal ores.
4. Power plants

3. The major route(s) of exposure to arsenic is/are

1. Inhalation.
2. Ingestion.
3. Dermal contact.
4. A and B
5. All are equally important.

4. Of the following, the U. S. population most at risk of exposure to arsenic today is

1. People who work in farming.
2. People who work in copper smelting or cutting and sawing of CCA pressure-treated lumber.
3. People in the Mississippi river valley.
4. People who live in major urban areas.

5. Which of the following is FALSE regarding U.S. standards for arsenic levels?

1. There is a standard level for permissible air levels of arsenic in the workplace.
2. There is a standard level for allowable arsenic in drinking water.
3. There is a standard level for allowable arsenic in ambient air in the environment.
4. There are permissible levels of organic arsenic set for foodstuffs by the FDA.

6. After ingestion, most arsenic is

1. Retained in the kidneys.
2. Retained in the bones.
3. Rapidly excreted in the urine.
4. Stored in the liver.

7. Arsenic initiates cellular injury by

1. Oxidation of lipid membranes.
2. Ubiquitination.
3. Methylation.
4. Binding with sulfhydryl groups.

8. Of the neurologic effects associated with arsenic exposure, the most common one is

1. Peripheral neuropathy in a stocking-glove pattern.
2. Pseudotumor cerebri.
3. Thrombotic stroke.
4. Autonomic neuropathy.

9. Which dermatologic condition(s) may occur from chronic arsenic ingestion?

1. Psoriasis.
2. Hyperpigmentation and hyperkeratosis
3. Verucca vulgaris.
4. Melanoma.

10.  Abnormal laboratory tests in arsenic toxicity include

1. Elevated amylase.
2. Reduced serum B12.
3. Elevated liver enzymes.
4. White blood cell casts on urinalysis.

11.  A 64-year-old male who worked in a copper smelter in the United States in the 1960s and 1970s presents complaining of hemoptysis, 30 lb weight loss, and constant chest pain. He says his symptoms began several months ago. Of the arsenic-associated diseases, the MOST LIKELY culprit is

1. Bronchial irritation from acute inhalation.
2. Cardiomyopathy.
3. Lung carcinoma.
4. Pleural mesothelioma.

12.  As part of the exposure history, you should explore

1. Possible occupational exposures to arsenic.
2. Possible home environmental exposures to arsenic.
3. Use of personal protective equipment.
4. All of the above.

13.  In a patient with an occupational exposure to arsenic several years ago, urinary arsenic is likely to show

1. Persistently high levels.
2. No arsenic.
3. Low levels consistent with normal population dietary intake of arsenic.
4. None of the above.

14.  On peripheral blood smear, basophilic stippling of red cells is suggestive of

1. Arsenic or lead toxicity.
2. Chronic liver disease.
3. Promyelocytic leukemia.
4. Chronic renal disease.

15.  In caring for a patient who has been exposed to arsenic, it is important to

1. Identify the source or sources of exposure.
2. Take steps to avoid further exposure to arsenic.
3. Monitor the patient to assure that exposure has ceased.
4. All of the above

16.  Patients who have been diagnosed with an arsenic-associated disease should be instructed to

1. Consider the possibility of exposure both from home or workplace.
2. Inquire with employer if there is any possibility of workplace exposure.
3. If drinking from a private well, have the well tested for arsenic
4. All of the above.