[TOXICOLOGY] Chelator & Heavy Metals

Proverbs 16:3

c. Desferal®

[CHELATOR]

DEFEROXAMINE

a. Cuprimine®

b. BAL

c. Desferal®

d. DMSA

a. a lone pair of electrons

[CHELATOR]

Chelators are substances that contain:
a. a lone pair of electrons
b. free radicals only
c. positively charged metals
d. carbohydrates

a. -NH
c. -SH
d. -OH

[CHELATOR]

Which functional groups commonly acts as a metal-binding site in chelators?

a. -NH
b. -CH₃
c. -SH
d. -OH

c. iron (Fe)

[CHELATOR]

Deferoxamine is the drug of choice (DOC) for poisoning with:
a. lead
b. mercury
c. iron (Fe)
d. arsenic

a. IV
b. IM
c. SC

[CHELATOR]

Which route of administration can be used for deferoxamine?
a. IV
b. IM
c. SC
d. PO

b. ferric iron (Fe³⁺)

[CHELATOR]

Deferoxamine binds primarily to:
a. ferrous iron (Fe²⁺)
b. ferric iron (Fe³⁺)

d. ferrioxamine

[CHELATOR]

The complex formed between deferoxamine and ferric iron is called:
a. cyanomethemoglobin
b. sulfmethemoglobin
c. carboxyhemoglobin
d. ferrioxamine

c. urine

[CHELATOR]

Ferrioxamine is primarily eliminated through:
a. feces
b. sweat
c. urine
d. bile

b. hemoglobin

[CHELATOR]

Which iron-containing structure is NOT significantly bound by deferoxamine?
a. ferric iron stores
b. hemoglobin
c. free ferric iron
d. ferric iron complexes

b. cytochromes

[CHELATOR]

Deferoxamine does not significantly bind:
a. ferric iron
b. cytochromes
c. urinary iron
d. transferrin-bound iron

a. arsenic gas

[CHELATOR]

Dimercaprol (BAL) was originally developed for poisoning with:
a. arsenic gas
b. cyanide
c. iron
d. methanol

a. arsenic, gold, and mercury

[CHELATOR]

Dimercaprol is effective in poisoning with:
a. arsenic, gold, and mercury
b. iron, calcium, and magnesium
c. sodium, potassium, and chloride
d. cyanide, carbon monoxide, and methanol

c. intramuscular route

[CHELATOR]

Dimercaprol is administered via:
a. oral route
b. intravenous route
c. intramuscular route
d. subcutaneous route

c. peanut oil

[CHELATOR]

The vehicle used in dimercaprol injections is:
a. mineral oil
b. olive oil
c. peanut oil
d. castor oil

b. calcium EDTA

[CHELATOR]

In severe lead poisoning, dimercaprol is commonly used with:
a. deferoxamine
b. calcium EDTA
c. penicillamine
d. methylene blue

b. dimercaptide

= dimercaprol:metal

=2:1

[CHELATOR]

Dimercaprol forms a stable complex known as:
a. ferrioxamine
b. dimercaptide
c. cyanomethemoglobin
d. carboxyhemoglobin

c. 2:1

[CHELATOR]

What is the chelator-to-metal ratio in the dimercaptide complex?
a. 1:1
b. 1:2
c. 2:1
d. 3:1

b. most toxic among chelators

[CHELATOR]

Which statement about dimercaprol toxicity is correct?
a. least toxic chelator
b. most toxic among chelators
c. no significant toxicity
d. safer than all other chelators

b. acute poisoning only

[CHELATOR]

Dimercaprol is indicated primarily for:
a. chronic poisoning only
b. acute poisoning only
c. prophylaxis only
d. food poisoning only

d. 1 mmcl/kg

[CHELATOR]

Median lethal dose of dimercsprol

a. 10 mmcl/kg
b. 0.1 mmcl/kg
c. 100 mmcl/kg
d. 1 mmcl/kg

c. increased systolic and diastolic blood pressure by 50 mmHg

[CHELATOR]

A common adverse effect of dimercaprol is:
a. decreased systolic and diastolic blood pressure by 50 mmHg
b. increased systolic and diastolic blood pressure by 10 mmHg
c. increased systolic and diastolic blood pressure by 50 mmHg
d. decreased systolic and diastolic blood pressure by 10 mmHg

a. pain at the injection site

[CHELATOR]

Another common adverse effect of dimercaprol is:
a. pain at the injection site
b. blindness
c. renal stones
d. pulmonary fibrosis

b. may redistribute arsenic from tissues to the brain

[CHELATOR]

Why is dimercaprol contraindicated in chronic arsenic poisoning?
a. causes iron deficiency
b. may redistribute arsenic from tissues to the brain
c. blocks renal excretion and severe hypotension
d. causes severe hypocalcemia

b. increases tissue uptake of these substances

[CHELATOR]

Dimercaprol (BAL) is contraindicated in poisoning with Cd, Se, Tc, Fe, and organomercurials because it:
a. decreases metal absorption
b. increases tissue uptake of these substances
c. blocks renal excretion completely
d. forms inactive complexes excreted in urine

b. organomercurials &
c. iron poisoning

[CHELATOR]

Which of the followings are contraindication to dimercaprol therapy?
a. arsenic poisoning
b. organomercurials
c. iron poisoning
d. fluorine poisoning

d. arsenic

[CHELATOR]

Dimercaprol should be avoided in poisoning with all EXCEPT:
a. cadmium
b. selenium
c. technetium
d. arsenic

c. succimer &
d. DMSA

[CHELATOR]

DIMERCAPTOSUCCINIC ACID aka
a. dimercaprol
b. BAL
c. succimer
d. DMSA

a. a water-soluble form of dimercaprol (BAL)

[CHELATOR]

DIMERCAPTOSUCCINIC ACID / Succimer (DMSA) is best described as:
a. a water-soluble form of dimercaprol (BAL)
b. an iron chelator
c. a cyanide antidote
d. a nitrate antidote

d. oral

[CHELATOR]

The usual route of administration for succimer is:
a. IV
b. IM
c. SC
d. oral

b. chronic poisoning

• DMSA- chronic poisoning

• BAL- acute poisoning

[CHELATOR]

Succimer (DMSA) is particularly useful in:
a. acute poisoning
b. chronic poisoning
c. cyanide poisoning
d. carbon monoxide poisoning

b. monothiol chelator

[CHELATOR]

D-Penicillamine is classified as a:
a. dithiol chelator
b. monothiol chelator

d. oral

[CHELATOR]

The usual route of administration for D-Penicillamine is:
a. IV
b. IM
c. SC
d. oral

a. Cuprimine®

[CHELATOR]

D-Penicillamine

a. Cuprimine®

b. BAL

c. Desferal®

d. DMSA

b. copper toxicity

[CHELATOR]

D-Penicillamine is the drug of choice (DOC) for:
a. iron toxicity
b. copper toxicity
c. lead toxicity
d. mercury toxicity

d. Wilson's disease

[CHELATOR]

D-Penicillamine is commonly used in the treatment of:
a. cyanide poisoning
b. methanol poisoning
c. methemoglobinemia
d. Wilson's disease

a. iron, mercury, lead, zinc, and arsenic

[CHELATOR]

Besides copper, D-Penicillamine can also bind:
a. iron, mercury, lead, zinc, and arsenic
b. sodium, potassium, chloride, and arsenic
c. calcium, potassium, chloride and magnesium
d. carbon monoxide only

c. penicillin allergy

[CHELATOR]

D-Penicillamine is contraindicated in patients with:
a. sulfa allergy
b. aspirin allergy
c. penicillin allergy
d. iodine allergy

b. divalent and trivalent metals

[CHELATOR]

Calcium EDTA binds:
a. monovalent metals
b. divalent and trivalent metals
c. tetravalent metals
d. nonmetal toxins

d. IV and IM

[CHELATOR]

Which route of administration is used for Calcium EDTA?
a. PO and IM
b. SC and PO
c. SC only
d. IV and IM

a. water-soluble

[CHELATOR]

Calcium EDTA forms a complex that is:
a. water-soluble
b. lipid-soluble

c. kidneys

[CHELATOR]

The metal-Calcium EDTA complex is primarily eliminated through the:
a. lungs
b. liver
c. kidneys
d. skin

a. lead (Pb)

[CHELATOR]

Which heavy metal poisoning can be treated with Calcium EDTA?
a. lead (Pb)
b. carbon monoxide
c. cyanide
d. methanol

a. cadmium, cobalt, copper, and zinc

[CHELATOR]

Calcium EDTA is also used in poisoning with:
a. cadmium, cobalt, copper, and zinc
b. sodium and potassium
c. fluoride and chloride
d. carbon dioxide and oxygen

c. calcium EDTA with dimercaprol (BAL)

[CHELATOR]

The initial antidote of choice for severe lead poisoning is:
a. succimer with d-penicillamine
b. deferoxamine alone
c. calcium EDTA with BAL
d. penicillamine alone

d. binding to sulfhydryl (-SH) groups of enzymes, causing inactivation

[HEAVY METALS]

The common mechanism of toxicity of heavy metals is:
a. stimulation of sulfhydryl (-SH) groups of enzymes, causing activation
b. stimulation to (-NH) groups of enzymes, causing activation
c. binding to (-NH) groups of enzymes, causing inactivation
d. binding to sulfhydryl (-SH) groups of enzymes, causing inactivation

b. chelators (chelating agents)

[HEAVY METALS]

The main treatment for heavy metal poisoning involves:
a. anticholinergics
b. chelators (chelating agents)
c. anticonvulsants
d. antihistamines

c. water-soluble

[HEAVY METALS]

Chelator-heavy metal complexes are generally:
a. lipid-soluble
b. protein-bound
c. water-soluble
d. insoluble

d. ARSENIC

[HEAVY METALS]

Lewisite metal

a. LEAD
b. COPPER
c. ZINC
d. ARSENIC

d. ARSENIC

[HEAVY METALS]

Salvarsan

a. LEAD
b. COPPER
c. ZINC
d. ARSENIC

d. ARSENIC

[HEAVY METALS]

Arsphenamine

a. LEAD
b. COPPER
c. ZINC
d. ARSENIC

d. ARSENIC

[HEAVY METALS]

Compound 606

a. LEAD
b. COPPER
c. ZINC
d. ARSENIC

d. ARSENIC

[HEAVY METALS]

Magic Bullet

a. LEAD
b. COPPER
c. ZINC
d. ARSENIC

a. garlic odor on the breath

[HEAVY METALS]

A characteristic finding in acute arsenic poisoning is:
a. garlic odor on the breath
b. cherry-red skin
c. jaundice
d. hematuria

b. diarrhea = dehydration

[HEAVY METALS]

Which gastrointestinal manifestation is common in acute arsenic poisoning?
a. constipation
b. diarrhea

a. delirium

[HEAVY METALS]

Which CNS manifestation may occur in acute arsenic poisoning?
a. delirium
b. myopia
c. tinnitus
d. aphasia

a. seizure and coma

[HEAVY METALS]

Severe acute arsenic poisoning may progress to:
a. seizure and coma
b. cirrhosis only
c. nephrolithiasis only
d. bronchospasm

a. Aldrich-Mee's lines

[HEAVY METALS]

A classic sign of chronic arsenic poisoning is:
a. Aldrich-Mee's lines
b. Koplik spots
c. Roth spots
d. Janeway lesions

a. white lines on the nails

[HEAVY METALS]

Aldrich-Mee's lines, from chronic arsenic poisoning, are described as:
a. white lines on the nails
b. blue lines on the gums
c. red lines on the skin
d. black streaks on the hair

a. keratosis

[HEAVY METALS]

Which skin finding may occur in chronic arsenic poisoning?
a. keratosis
b. urticaria
c. cyanosis
d. petechiae

b. hair loss

[HEAVY METALS]

Which hair-related manifestation is associated with chronic arsenic poisoning?
a. excessive hair growth
b. hair loss
c. hair pigmentation
d. brittle nails

a. milky and rosy complexion

[HEAVY METALS]

Chronic arsenic poisoning may produce a:
a. milky and rosy complexion
b. jaundiced complexion
c. cyanotic complexion
d. bronze complexion

a. Abnormal weigh gain

[HEAVY METALS]

Chronic arsenic poisoning may lead to:
a. Abnormal weigh gain
b. Abnormal weight loss

b. dimercaprol (BAL)

[HEAVY METALS]

The chelator of choice for arsenic poisoning is:
a. deferoxamine
b. dimercaprol (BAL)
c. calcium EDTA
d. methylene blue

a. BAL + penicillamine

[HEAVY METALS]

In severe arsenic poisoning, treatment may include:
a. BAL + penicillamine
b. deferoxamine + leucovorin
c. methylene blue + atropine
d. naloxone + flumazenil

a. leaded gasoline

[HEAVY METALS]

Which of the following is a common source of lead exposure?
a. leaded gasoline
b. distilled water
c. table sugar
d. oxygen tanks

a. paint &

d. newspapers

[HEAVY METALS]

Lead may also be found in:
a. paint
b. antihistamines
c. vaccines
d. newspapers

c. earthenware &
d. automobile exhaust

[HEAVY METALS]

Lead may also be found in:
a. silver utensils
b. wire conductors
c. earthenware
d. automobile exhaust

c. 32 years

• T1/2 (Bones) - 32 years

• T1/2 (Kidneys) - 7 years

[HEAVY METALS]

The approximate half-life of lead in bone is:
a. 32 days
b. 32 months
c. 32 years
d. 3.2 years

c. 7 years

• T1/2 (Bones) - 32 years

• T1/2 (Kidneys) - 7 years

[HEAVY METALS]

The approximate half-life of lead in the kidneys is:
a. 7 days
b. 7 months
c. 7 years
d. 70 years

b. interfering with heme synthesis

[HEAVY METALS]

Lead toxicity causes anemia primarily by:
a. increasing erythropoietin production
b. interfering with heme synthesis
c. stimulating hemoglobin synthesis
d. increasing iron absorption

c. Interferes with heme synthesis and cytochrome production

[HEAVY METALS]

Lead poisoning can result in anemia because it:

a. Increases RBC destruction and cytochrome production
b. Decreases platelet production
c. Interferes with heme synthesis and cytochrome production
d. Causes vitamin B12 deficiency

c. Basophilic stippling

[HEAVY METALS]

A classic peripheral blood smear finding in lead poisoning is:

a. Heinz bodies
b. Spherocytes
c. Basophilic stippling
d. Schistocytes

b. Burton's line

[HEAVY METALS]

The gingival discoloration seen in chronic lead poisoning is called:

a. Koplik spots
b. Burton's line
c. Bitot spots
d. Roth spots

c. Anemia + basophilic stippling + Burton's line

[HEAVY METALS]

Which combination is most characteristic of lead poisoning?

a. Hemolytic anemia + Heinz bodies
b. Megaloblastic anemia + hypersegmented neutrophils
c. Anemia + basophilic stippling + Burton's line
d. Polycythemia + thrombocytosis

a. Ferrochelatase and ALA dehydratase

[HEAVY METALS]

Lead inhibits which two key enzymes in heme synthesis?

a. Ferrochelatase and ALA dehydratase
b. Cyclooxygenase and lipoxygenase
c. Glucokinase and hexokinase
d. MAO and COMT

b. Incorporation of iron (Fe) into protoporphyrin IX

[HEAVY METALS]

Lead poisoning prevents:

a. Formation of bilirubin
b. Incorporation of iron (Fe) into protoporphyrin IX
c. Absorption of vitamin B12
d. Production of erythropoietin

c. 3',5'-Pyrimidine nucleotidase

[HEAVY METALS]

Basophilic stippling in lead poisoning results from inhibition of:

a. Ferrochelatase
b. ALA synthase
c. 3',5'-Pyrimidine nucleotidase
d. Carbonic anhydrase

b. Encephalopathy with decreased IQ

[HEAVY METALS]

A child with lead poisoning is most likely to present with:

a. Hyperactivity and improved IQ
b. Encephalopathy with decreased IQ
c. Hyperthyroidism
d. Polycythemia

b. Wrist drop

• Peripheral neuropathy – wrist / foot drop

[HEAVY METALS]

Which neurologic finding is classically associated with lead toxicity?

a. Bell's palsy
b. Wrist drop
c. Hemiballismus
d. Nystagmus

a. Ataxia
b. Delirium
c. Coma

[HEAVY METALS]

Which of the following may occur in severe lead encephalopathy?

a. Ataxia
b. Delirium
c. Coma
d. Seizure

b. Saturnine gout

[HEAVY METALS]

Chronic lead nephropathy may lead to:

a. Diabetes insipidus
b. Saturnine gout
c. Nephrotic syndrome
d. Renal stones

b. Burton's line

[HEAVY METALS]

The classic gingival finding in lead poisoning is:

a. Koplik spots
b. Burton's line
c. Bitot spots
d. Roth spots

d. CaNa₂EDTA + BAL

[HEAVY METALS]

Initial treatment of severe lead poisoning commonly includes:

a. Naloxone + atropine
b. Pralidoxime + atropine
c. Flumazenil + N-acetylcysteine
d. CaNa₂EDTA + BAL

c. 5 days

[HEAVY METALS]

The duration of initial treatment with CaNa₂EDTA + BAL should not exceed:

a. 24 hours
b. 3 days
c. 5 days
d. 14 days

a. Succimer (DMSA)

[HEAVY METALS]

Which oral chelating agent is used for lead poisoning?

a. Succimer (DMSA)
b. Methimazole
c. Deferoxamine
d. Acetazolamide

c. DMPs

[HEAVY METALS]

Which oral chelating agent is used for lead poisoning?

a. Deferoxamine
b. Methimazole
c. DMPs
d. Acetazolamide

c. Itai-itai disease

[HEAVY METALS]

Cadmium poisoning is classically associated with:

a. Minamata disease
b. Wilson's disease
c. Itai-itai disease
d. Mad Hatter's disease

b. Displacement of Ca²⁺ in bones

[HEAVY METALS]

The mechanism of toxicity of cadmium is:

a. Inhibition of MAO
b. Displacement of Ca²⁺ in bones
c. Inhibition of heme synthesis
d. Free radical scavenging

b. Osteomalacia

[HEAVY METALS]

Which bone disorder is commonly seen in cadmium poisoning?

a. Osteopetrosis
b. Osteomalacia
c. Osteoarthritis
d. Osteomyelitis

a. Proteinuria, aminoaciduria, glucosuria

[HEAVY METALS]

Cadmium toxicity may cause a Fanconi-like syndrome characterized by:

a. Proteinuria, aminoaciduria, glucosuria
b. Hematuria, pyuria, ketonuria
c. Polycythemia, thrombocytosis
d. Hypernatremia, hypokalemia

b. Decreased phosphate reabsorption

[HEAVY METALS]

A patient with cadmium poisoning is most likely to have:

a. Increased phosphate reabsorption
b. Decreased phosphate reabsorption
c. Hypercalcemia
d. Hyperuricemia

c. EDTA

[HEAVY METALS]

Which treatment is used for cadmium poisoning?

a. BAL
b. Deferoxamine
c. EDTA
d. Atropine

a. CADMIUM

[HEAVY METALS]

Gait disturbances (abnormalities in walking patterns) is associated with this toxicity

a. CADMIUM
b. IRON
c. Cu
d. Hg

a. Quicksilver

[HEAVY METALS]

Mercury is also known as:

a. Quicksilver
b. White lead
c. Calomel blue
d. Cinnabar

c. Minamata disease

[HEAVY METALS]

Mercury poisoning is associated with:

a. Itai-itai disease
b. Wilson's disease
c. Minamata disease
d. Saturnism

b. Inhibition of MAO

[HEAVY METALS]

The mechanism of toxicity of mercury is:

a. Inhibition of ferrochelatase
b. Inhibition of MAO
c. Displacement of calcium
d. Inhibition of acetylcholinesterase

a. HgCl2 (corrosive sublimate) = Inorganic Hg

b. amalgam = Elemental Hg

c. methyl mercury = Organic Hg

d. thermometers = Elemental Hg

e. Hg2Cl2 (calomel) = Inorganic Hg

f. thimerosal (Merthiolate) = Organic Hg

[HEAVY METALS]

Types of Hg

a. Elemental Hg

b. Inorganic Hg

c. Organic Hg

a. HgCl2 (corrosive sublimate) = _____

b. amalgam = _____

c. methyl mercury = _____

d. thermometers = _____

e. Hg2Cl2 (calomel) = _____

f. thimerosal (Merthiolate) = _____

a. Pink disease (Acrodynia)

[HEAVY METALS]

Mercury poisoning in children may cause:

a. Pink disease (Acrodynia)
b. Gray baby syndrome
c. Reye syndrome
d. Stevens-Johnson syndrome

b. Pink palms and soles &

d. Photophobia

[HEAVY METALS]

Which findings are characteristics of Acrodynia?

a. Blue gums
b. Pink palms and soles
c. Jaundice
d. Photophobia

d. Saturnism

[HEAVY METALS]

The triad of Mad Hatter's disease includes all EXCEPT:

a. Erethism (Neuropsychiatric disorder)
b. Gingivostomatitis
c. Tremor
d. Saturnism