SHIFTING EXAM (ENVIRONMENTAL PEADIATRIC POISONING

AND TOXIDROMES)
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1.Which of the following is not a primary pollutant?

(1 Point)

Carbon monoxide

Lead

Ozone

Nitrogen dioxide

2.Particulates may cause which of the following health hazards to humans?

(1 Point)

Respiratory distress

Damage to nervous system

Blindness

Learning disabilities

3.Carbon monoxide may produce one of the symptoms:

(1 Point)

Excess urination

Headache

Throat irritation

Hearing loss

4. _______ may be the primary health problem when a child’s airway is exposed to
allergens, pollution, etc. resulting in hyperactive airways.

(1 Point)
Cardiac arrest

Asthma

Laryngitis

Sneezing

5.Which is a potential source of indoor air pollution?

(1 Point)

Room air fresheners

Personal care products

molds

All of the above

6.The following statements are true about Children’s unique susceptible to

exposure to environmental hazards, except:

(1 Point)

Children drink more water, eat more food, and breathe more air per kilogram of body weight,
children are more heavily exposed to pollutants in water, food, and air.

Children’s hand-to-mouth and exploratory behavior

Children's habitus-lay close to the ground further magnify their exposures

Children exposed at an early age are less prone to environmental diseases

7.A smoker is exposed to nearly _______ compounds in mainstream cigarette

smoke.
(1 Point)

4700

320

9400

560

8.Biological contaminants are most likely aggravated by what problem?

(1 Point)

Auto exhaust

Unvented gas stove

Moisture

Household chemicals

9.Which of the following chemicals is most associated with systemic disease

involving the central nervous system, the gastrointestinal system, and the blood-
forming tissues?

(1 Point)

Lead

Pollen

Mercury

Carbon Monoxide

10.Which of the following is the most significant contributor to air pollution by

mass in sub- urban areas?
(1 Point)

Manufacturing

Transportation

Space heaters

Electric power generation

Waste disposal

11.Runoff that results from rain falling on roofs, roads, parking lots, loading
docks, storage areas, and other areas exposed to rain is referred to as _______.

(1 Point)

storm water

effluent
dirty water

fugitive effluent

12.Improperly canned foods can be contaminated with which of the following

bacteria, causing respiratory paralysis?

(1 Point)

C. perfringens

R. ricketsii

S. aureus

C. botulinum

E. coli

13.What is the mechanism of saxitoxin found in shellfish?

(1 Point)

Interference with ion channels

Direct neurotoxicity

Interference with DNA replication

Binding to haemoglobin

Interference with a stimulatory G protein

14.The following statements are true for pediatric exposures that may result in
health effects:
(1 Point)

Exposure prenatally and at birth result in spontaneous abortion, stillbirth, low birth weight, small
size for gestational age, infant mortality and malformation

Childhood exposure can cause asthma, cancer, neurological and behavioral effects

Exposure in adolescents may cause alterations in normal development and impaired

reproductive capacity

All of the above

15.True for lead toxicity in children, except:

(1 Point)

4.6-point decrement in IQ in children for each 10 mcg/dL increase in blood lead levels

Chronic exposures to lead in children cause poor school performance, cognitive function,
intellectual disability, memory loss and depression.

Saturnine gout is a known chronic effect of lead exposure

Acute kidney injury is a known acute effect of lead exposure

16.The antidote to Mercury toxicity;

(1 Point)

Dimercaprol 10 days in dosages of 5 mg/kg/dose every 4 hours IM for 48 hours, then 2.5 mg/kg
every 6 hours for 48 hours, followed by 2.5 mg/kg every 12 hours for 7 days.

Dimercaprol 10 days in dosages of 10 mg/kg/dose every 4 hours IM for 48 hours, then 5 mg/kg
every 6 hours for 48 hours, followed by 2.5 mg/kg every 12 hours for 7 days.

Dimercaprol 10 days in dosages of 8 mg/kg/dose every 4 hours IM for 48 hours, then 5 mg/kg
every 6 hours for 48 hours, followed by 2.5 mg/kg every 12 hours for 7 days.

Dimercaprol 10 days in dosages of 20 mg/kg/dose every 4 hours IM for 48 hours, then 10

mg/kg every 6 hours for 48 hours, followed by 2.5 mg/kg every 12 hours for 7 days.

17.Which of the following statements is not true?

(1 Point)

Arsenic, benzene, and vinyl chloride are known as human carcinogens.

Many peroxisome proliferators cause hepatic tumours in rats and are promoting agents for
hepatocarcinogenesis.

Benzidine, beta-naphthylamine, and derived dyes have caused urinary bladder tumors in
exposed workers.

Short asbestos fibres (<2 μm long) are thought to be predominately responsible for the
induction of mesotheliomas.

Butylated hydroxyanisole (BHA) acts as a non-mutagenic carcinogen in the forestomach of rats.

18.Sources of Arsenic include the following:

(1 Point)
rodenticides

mining

opium

all of the above

19.Arsenic poisoning can be detected in the following specimens:

(1 Point)

Blood

Hair and 24 hour urine collection

Nail

All of the above

20.What are the general toxic actions of lead resulting in anaemia (indicate all
that apply)?
(1 Point)

Enhancement of Na-permeability

Selective inhibition of resorption of nutrients

Disturbance of heme synthesis

Agglutination of red blood cells

21.The following are indoor pollutants:

(1 Point)

Aerosols, Allergens, Animal dander, house dust and second hand smoking

Ozone and Volatile hydrocarbons

Industrial emissions

Mining emissions

22.True for Outdoor pollutants;

(1 Point)

Single pollutants may be involved in a given situation.

Outdoor pollutants include multiple agents such as particulate matter, Sulfur compounds,
Nitrogen oxides and Ozone.

Establishing an environmental cause for a respiratory illness is specific for the given pollutant.

Diagnosis of an environmentally related disease requires diagnostic imaging modalities such as

high-resolution Chest CT scan.

23.Which of the following agents would not likely produce reactive airways
dysfunction syn- drome (RADS)?
(1 Point)

Carbon monoxide

Chlorine

Ammonia

Toluene diisocyanate

Acetic acid

24.Which of the following sites in the respiratory system is the most likely place
for the carbon dioxide and oxygen to exchange in the blood?
(1 Point)

Nose

Pharynx

Larynx

Trachea

Alveoli

25.The major mode of transmission of foodborne illnesses is ________.

(1 Point)

Via mosquito transmission

Via fecal–oral route

Via person to person contact

Via hypodermic syringes

26.What foodborne exposure poses the greatest human-health risk worldwide?

(1 Point)

Chemical contaminants/adulterants

Bacterial contamination

Mycotoxins and molds

Food additives

27.Which of the following do bacteria need to assist it to grow and multiply?

(1 Point)

Water

Food

Warm temperatures

All of the above

28.Hepatitis A can be transferred via ________.

(1 Point)

the fecal oral route

shellfish from polluted water

intravenous drug users

food handling by infected workers

all of the above

29.Which of the following leads to neurologic complications?

(1 Point)

Arsenic

Lead

Cadmium

Antimony

30.An important type of compound that is far more toxic in water than in air
is/are _______.
(1 Point)

organic compounds

vapours

lipid-soluble xenobiotics

metals

31.The cholinergic toxidrome includes the following symptoms:

(1 Point)

mental status changes, agitation and neuromuscular agitation

Coma, pinpoint pupils and respiratory depression

Diarrhea, urination, miosis, muscle fasciculations, bronchorrhea, bracycardia,

bronchoconstriction, emesis lacrimation and salivation

Mydriasis, agitation, arrhythmia, angina , tachycardia , hypertension, hyperthermia seizures and

sweating

32.True for Anticholinergic (antimuscarinic) syndrome.

(1 Point)

Tachycardia with mild hypertension is common.

The pupils are widely dilated and the skin is flushed, warm, and dry.

Peristalsis is decreased, and urinary retention occurs

All of the above

33.The following medications can cause anticholinergic syndrome

(1 Point)

metamphetamine and methylxanthines

atropine, scopolamine, benztropine, antihistamines and antidepressants

organophosphates , carbamates, neostigmine and pyridostigmine

all of the above

34.Triad of Opioid toxicity include:

(1 Point)
coma, metabolic acidosis and mydriasis

coma, miosis and respiratory depression

seizures, severe metabolic acidosis and coma

intractable seizures, severe metabolic acidosis and methemoglobinemia

35.Hyposedative xenobiotics include the following:

(1 Point)

Metamphetamine, LSD and GHB

Salicylates

Digoxin

Baclofen, Z drugs (Zolpidem, zaleplon, eszopiclone), barbiturates, benzodiazepines, Ethanol

36.The following statements are True for Marijuana:

(1 Point)

Marijuana causes central stimulation of the respiratory center results in hyperventilation, leading
to respiratory alkalosis.

include dehydration and compensatory metabolic acidosis.

Marijuana’s primary psychoactive component is delta-9-tetrahydrocannabinol (THC).

THC can cause respiratory depression

37.Hallucinogenic and psychedelic toxidrome includes the following:

(1 Point)

dissociative effects, altered perception, mild Sympathomimetic and nystagmus

anemia, encephapalopathy, growth retardation and decrease IQ

dizziness, rashes, peppery Taste, hypotension, headache

all of the above

38.Toxidromes are defined as;

(1 Point)

Observed and detectable signs and symptoms

Effect observed and experienced by a patient

Substances found within the organism not naturally inherent or produced by the body

Signs and symptoms which when taken collectively can characterize a suspected toxicant

39.True for Scromboid poisoning;

(1 Point)

Increased histamine levels due to bacterial degradation of histidine-rich fishes

Etiologic agent is Ciguatoxin

Scombroid intoxication should be treated with atropine

Symptoms may present 5-7 days after ingestion and requires hospitalization

40.Salicylate poisoning presents with the following symptoms:

(1 Point)

Seizures, metabolic Acidosis and agitation.

Mental status changes, agitation and anxiety, GI symptoms

Seizures, tinnitus, respiratory Alkalosis then metabolic Acidosis and changes in Sensorium

Hypertension, change in sensorium and GI symptoms

41.What is the route in which most solvents enter the environment?

(1 Point)

Chemical spills

Contamination of drinking water

Evaporation

Improper waste disposal

Wind

42.Which of the following lung diseases has the highest occupational death rate?
(1 Point)

Asbestosis

Coal workers’ pneumoconiosis

Byssinosis

Hypersensitivity pneumonitis

Silicosis

43.True for toxicants:

(1 Point)

Toxic substances produced by biological systems

Toxic agents produced by or by-product of human activity

A toxic substance produced by an insect or animal released by biting or stinging.

Any agent that can kill, injure or impair normal physiologic functions to a living organism.

44.True for Digoxin Toxidrome;

(1 Point)

Acute Digoxin poisoning presents with hypokalemia

GI symptoms are due to vagal stimulation in chemotherapeutic zone causing nausea, vomiting ,
abdominal pain and anorexia

Arrhythmia is rarely occurs in digoxin toxicity

ECG changes are only seen in chronic Digoxin toxicity

45.Methylxanthine toxidromes includes:

(1 Point)

Hypotension, bradycardia, diaphoresis and urination

Hot and cold reversal

Mood Elevation, tremors, tachycardia, hypokalemia, hypotension, hyperglycemia and lactic

Acidosis

Dizziness, integumentary Lesions and peppery Taste

46.True for Ciguatoxin

(1 Point)

Ciguatoxin are produced by dinoflagellates which are then consumed by reef fish.
Ciguatoxin binds to voltage-sensitive sodium channels, causing increased sodium permeability
and depolarization of excitable membranes.

Ciguatoxin causes stimulation of central or ganglionic cholinergic receptors

All of the above

47.Which of the following is not a modifying actor that can influence the
likelihood of disease?
(1 Point)

Age

Dose

Nutritional status

Gender

Genetic susceptibility

48.Asbestos exposure is unlikely to cause ________.

(1 Point)

lung cancer

GI cancer

emphysema

pulmonary fibrosis

mesothelioma

49.What form of mercury was the cause of Minamata Bay disease?

(1 Point)

Mercuric salts

Mercurous salts

Organic mercury

Elemental mercury

50.Molds generally grow in stored food stuffs containing a moisture content

more than ________.
(1 Point)

25%

15%

50%

20%

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