Part 4- SPECIFIC TOXICANTS

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Which of the following is an example of a solvent?
a. alcohol (OH)
b. glycol
c. aldehydes
d. hydrocarbons

All

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Increased lipophilicity of solvents increases the risk of:
a. renal obstruction
b. CNS disturbances
c. thrombosis
d. jaundice

b. CNS disturbances

↑ lipophilicity = ↑ chances of CNS disturbances

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Aldehydes are generally known to be:
a. sedatives
b. irritating
c. antihypertensive
d. anticonvulsant

b. irritating

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Amides commonly act as:
a. bronchodilators
b. anticoagulants
c. CNS stimulants only
d. sensitizers

d. sensitizers causing allergic reactions

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Halogenated hydrocarbons are associated with:
a. cytotoxicity and mutagenicity
b. bronchodilation and vasodilation
c. increased acetylcholine activity
d. protein synthesis stimulation

a. cytotoxicity and mutagenicity

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Alcohol toxicity commonly produces:
a. CNS stimulation
b. CNS depression
c. severe hypertension
d. muscle rigidity

b. CNS depression

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Ethylene glycol is commonly found in:
a. antifreeze preparations
b. oral antiseptics
c. antihistamines
d. bronchodilators

a. antifreeze preparations

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

The first stage of ethylene glycol poisoning is characterized by:
a. renal stone formation
b. transient excitation → CNS depression → coma resembling ethanol (EtOH) intoxication
c. cardiopulmonary sx, tachypnea, tachycardia, metabolic acidosis
d. isolated hypertension

b. transient excitation → CNS depression → coma resembling ethanol (EtOH) intoxication

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

The second stage of ethylene glycol poisoning is characterized by:
a. renal stone formation
b. transient excitation → CNS depression → coma resembling ethanol (EtOH) intoxication
c. cardiopulmonary sx, tachypnea, tachycardia, metabolic acidosis
d. isolated hypertension

c. cardiopulmonary sx, tachypnea, tachycardia, metabolic acidosis

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

The third stage of ethylene glycol poisoning is characterized by:
a. renal stone formation
b. transient excitation → CNS depression → coma resembling ethanol (EtOH) intoxication
c. cardiopulmonary sx, tachypnea, tachycardia, metabolic acidosis
d. isolated hypertension

a. renal stone formation

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Which treatment for toxic alcohol poisoning works by competing with alcohol dehydrogenase?
a. ethanol (EtOH)
b. thiamine/pyridoxine
c. leucovorin
d. fomepizole

a. ethanol (EtOH)

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Thiamine and pyridoxine help by facilitating conversion to:
a. α-hydroxy-β-ketoadipate
b. cyanomethemoglobin
c. formate
d. acetaldehyde

a. α-hydroxy-β-ketoadipate

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Leucovorin facilitates the conversion of:
a. methanol to formaldehyde
b. formate to CO₂
c. ethanol to acetaldehyde
d. glycolate to oxalate

b. formate to CO₂

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Which drug is a direct alcohol dehydrogenase inhibitor?
a. pyridoxine
b. leucovorin
c. fomepizole (4-methylpyrazole)
d. ethanol

c. fomepizole (4-methylpyrazole)

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Methanol (wood alcohol) is best described as a:
a. colored solid compound
b. colorless liquid volatile
c. nonvolatile gas
d. viscous oil

b. colorless liquid volatile at room temperature

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Wood alcohol

a. EtOH

b. Formaldehyde

c. HC

d. Methanol

d. Methanol

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Methanol itself is relatively:
a. highly toxic immediately
b. non-toxic until metabolized
c. mutagenic and toxic
d. nephrotoxic

b. non-toxic until metabolized

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

The toxic metabolite of methanol responsible for major toxicity is:
a. acetaldehyde
b. glycolic acid
c. formic acid
d. lactic acid

c. formic acid

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Methanol is metabolized in which sequence?
a. methanol → formaldehyde → formic acid
b. methanol → formic acid → formaldehyde
c. methanol → ethanol → formate
d. methanol → ketone → acid

a. methanol → formaldehyde → formic acid

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Formic acid causes blindness by inhibiting:
a. acetylcholinesterase
b. dopamine receptors
c. cytochrome oxidase in the optic nerve
d. sodium-potassium ATPase

c. cytochrome oxidase in the optic nerve

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A major acid-base disturbance seen in methanol poisoning is:
a. respiratory alkalosis
b. metabolic alkalosis
c. metabolic acidosis
d. respiratory acidosis

c. metabolic acidosis

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Hyperventilation in methanol poisoning occurs as:
a. a toxic side effect only
b. compensation for metabolic acidosis
c. evidence of pneumonia only
d. a sign of renal failure

b. compensation for metabolic acidosis

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Which skin finding may accompany methanol-induced metabolic acidosis?
a. flushed, dry skin
b. cyanotic rash
c. jaundiced skin
d. pale and clammy skin

d. pale and clammy skin

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Confusion and lethargy in methanol poisoning are related to:
a. increased intracerebral pH
b. decreased intracerebral pH

b. decreased intracerebral pH

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Hypotension in methanol poisoning occurs because H⁺ acts as a:
a. positive inotrope
b. negative inotrope

b. negative inotrope causing myocardial depression

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Arrhythmias in methanol poisoning may occur because:
a. H⁺ causes K⁺ to shift outside cells
b. calcium shifts into cells only
c. sodium is completely depleted
d. acetylcholine increases excessively

a. H⁺ causes K⁺ to shift outside cells

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A hallmark severe manifestation of methanol poisoning is:
a. blindness
b. jaundice
c. renal stone formation
d. urinary retention

a. blindness

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Ethanol (EtOH) helps treat methanol poisoning by:
a. increasing methanol metabolism
b. competing with alcohol dehydrogenase
c. neutralizing formic acid directly
d. increasing renal potassium excretion

b. competing with alcohol dehydrogenase

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Formaldehyde is best described as a:
a. colored gas with sweet odor
b. nonvolatile solid compound
c. colorless liquid with a pungent odor
d. tasteless powder

c. colorless liquid with a pungent odor

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Formaldehyde is commonly used as:
a. antifreeze
b. embalming liquid
c. bronchodilator
d. food preservative

b. embalming liquid

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Formaldehyde is commonly used as:
a. antifreeze
b. food preservative
c. bronchodilator
d. snowstorm

d. snowstorm

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A local effect of formaldehyde exposure is:
a. mucosal irritation
b. renal stone formation
c. hypertension
d. hyperglycemia

a. mucosal irritation

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A local effect of formaldehyde exposure is:
a. oral, oropharyngeal irritation
b. renal stone formation
c. hypertension
d. hyperglycemia

a. oral, oropharyngeal irritation

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A local effect of formaldehyde exposure is:
a. hyperglycemia
b. renal stone formation
c. hypertension
d. conjunctiva

d. conjunctiva

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

A systemic metabolic effect of formaldehyde poisoning is:
a. metabolic alkalosis
b. respiratory alkalosis
c. metabolic acidosis
d. respiratory acidosis

c. metabolic acidosis

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

The treatment for formaldehyde poisoning includes:
a. ammonium salts
b. atropine
c. methylene blue
d. naloxone

a. ammonium salts

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Hydrocarbons are organic compounds composed of:
a. hydrogen and carbon
b. sodium and chloride
c. oxygen and nitrogen
d. sulfur and phosphorus

a. hydrogen and carbon

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Petroleum distillates are mixtures of:
a. proteins and carbohydrates
b. aromatic and aliphatic HC
c. amino acids and fats
d. acids and bases

b. aromatic and aliphatic HC

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Matching Quiz: Physical Properties of Hydrocarbons and Petroleum Distillates

Column A: Physical Properties		Column B: Examples
1. Minimal volatility, high viscosity		A. Gasoline
2. High volatility, minimal viscosity		B. Petroleum spirits
3. Intermediate volatility, low viscosity		C. Butane
4. Low volatility, low viscosity		D. Lubricating oil
5. Intermediate volatility, low viscosity		E. Turpentine
6. High volatility, minimal viscosity		F. Methane
7. Low volatility, low viscosity		G. Kerosene
8. Minimal volatility, high viscosity		H. Mineral oil

1. D - Lubricating oil

2. F - Methane

3. A - Gasoline

4. B - Petroleum spirits

5. E - Turpentine

6. C - Butane

7. G - Kerosene

8. H - Mineral oil

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Hydrocarbon aspiration causing increased lung irritation is most associated with:
a. decreasing volatility and increasing viscosity
b. increased viscosity and reduced aspiration
c. low volatility and high protein binding
d. increasing volatility and decreasing viscosity

d. increasing volatility and decreasing viscosity

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Clinical Presentation of Hydrocarbons and Petroleum Distillates Toxicants:

Burning sensation or Cooling sensation?

Severe asthma or Choking
Pneumonia or Coughing?
Gagging or Severe nausea?
Pulmonary embolism or Atelectasis?

Bronchopneumonia or Aspiration pneumonia?
CNS manifestation or Dermal manifestation?

Burning sensation

Choking
Coughing
Gagging
Atelectasis, bronchopneumonia
CNS manifestation

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Initial supportive management includes:
a. respiratory oxygen support
b. insulin infusion
c. atropine administration
d. methylene blue

a. respiratory oxygen support

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Which treatment is used for bronchospasm in hydrocarbon poisoning?
a. selective β₂ agonist
b. naloxone
c. pralidoxime
d. leucovorin

a. selective β₂ agonist

[INDUSTRIAL + HOUSEHOLD TOXICANTS]

Mineral oil helps reduce aspiration by:
a. decreasing viscosity
b. increasing viscosity
c. inducing emesis
d. neutralizing acid

b. increasing viscosity

• Mineral oil – ↑ viscosity ↓ aspiration

[ACIDS AND ALKALIS]

Acids primarily cause tissue injury through:
a. liquefactive necrosis
b. coagulation necrosis
c. acetylcholinesterase inhibition
d. vasodilation

b. coagulation necrosis

• ACIDS – coagulation necrosis – eschar (protective) → deeper layer (protects)

• BASES – liquefactive necrosis → deeper penetration

[ACIDS AND ALKALIS]

Bases primarily cause tissue injury through:
a. liquefactive necrosis
b. coagulation necrosis
c. acetylcholinesterase inhibition
d. vasodilation

a. liquefactive necrosis

• ACIDS – coagulation necrosis – eschar (protective) → deeper layer (protects)

• BASES – liquefactive necrosis → deeper penetration

[ACIDS AND ALKALIS]

Initial management of acid or base poisoning is mainly:
a. supportive treatment
b. methylene blue administration
c. pralidoxime administration
d. induced emesis

a. supportive treatment

[ACIDS AND ALKALIS]

Surgery may be indicated in corrosive poisoning when:
a. bronchospasm occurs
b. perforation develops
c. mild nausea develops
d. headache persists

b. perforation develops

[ACIDS AND ALKALIS]

Which intervention should be avoided in corrosive ingestion?
a. oxygen support
b. surgical evaluation
c. supportive care
d. neutralization and dilution

d. neutralization and dilution

[HEAVY METALS]

The common mechanism of toxicity of heavy metals is:
a. activation of sulfhydryl groups
b. Anaphylaxis vs Anaphylactoid (not IgE mediated)
c. inhibition of dopamine reuptake
d. binding to sulfhydryl groups of enzymes, causing inactivation

d. binding to sulfhydryl groups of enzymes, causing inactivation

[HEAVY METALS]

The treatment of choice for heavy metal poisoning is:
a. antidopaminergics
b. chelators
c. anticholinergics
d. anticonvulsants

b. chelators

[FOOD ADDITIVES]

Tartrazine is also known as:
a. FD&C 1
b. FD&C 5
c. FD&C 40
d. FD&C 7

b. FD&C 5

[FOOD ADDITIVES]

The mechanism of tartrazine-induced reactions is most similar to:
a. anaphylaxis or anaphylactoid reactions
b. acetylcholinesterase inhibition
c. methemoglobin formation
d. coagulation necrosis

a. anaphylaxis or anaphylactoid reactions

[FOOD ADDITIVES]

An anaphylactoid reaction differs from anaphylaxis because it is:
a. IgE-mediated
b. not IgE-mediated

b. not IgE-mediated

[FOOD ADDITIVES]

Which manifestation is commonly seen with tartrazine reactions?
a. hives
b. jaundice
c. petechiae
d. cyanosis

a. hives

[FOOD ADDITIVES]

A serious manifestation of tartrazine hypersensitivity is:
a. hematuria
b. constipation
c. dysuria
d. difficulty breathing

d. difficulty breathing

[FOOD ADDITIVES]

Severe tartrazine reactions may progress to:
a. shock
b. renal stones
c. cirrhosis
d. hyperglycemia

a. shock

[FOOD ADDITIVES]

The drug of choice for severe tartrazine-induced anaphylactic reactions is:
a. atropine
b. epinephrine
c. naloxone
d. pralidoxime

b. epinephrine and antihistamines

[FOOD ADDITIVES]

The mechanism of Monosodium Glutamate or MSG reactions is most similar to:
a. anaphylaxis or anaphylactoid reactions
b. methemoglobin formation
c. acetylcholinesterase inhibition
d. coagulation necrosis

a. anaphylaxis or anaphylactoid reactions

[FOOD ADDITIVES]

Which symptom may occur in MSG sensitivity reactions?
a. difficulty breathing
b. hematuria
c. constipation
d. jaundice

a. difficulty breathing

[FOOD ADDITIVES]

A characteristic feature of MSG syndrome is:
a. facial flushing
b. cyanosis
c. hives
d. renal colic

a. facial flushing

[FOOD ADDITIVES]

Which symptom may occur in MSG sensitivity reactions?

a. shock
b. tachycardia
c. heart block
d. hypotension

b. tachycardia

[FOOD ADDITIVES]

The drug of choice for severe MSG-induced hypersensitivity reactions is:
a. naloxone
b. epinephrine
c. atropine
d. pralidoxime

b. epinephrine and antihistamine

[FOOD ADDITIVES]

[FOOD ADDITIVES]