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Arsenic Toxicity
Assessment and Posttest

Course: WB 1576
CE Original Date: October 1, 2009
CE Renewal Date: October 1, 2011
CE Expiration Date: October 1, 2013
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Introduction

    ATSDR seeks feedback on this course so we can asses its usefulness and effectiveness. We ask you to complete the assessment questionnaire online for this purpose.

    In addition, if you complete the assessment and posttest online, you can receive continuing education credits as follows.

Accrediting Organization

Credits Offered

Accreditation Council for Continuing Medical Education (ACCME)

The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Centers for Disease Control and Prevention designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC), Commission on Accreditation

The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity provides 1.8 contact hours.

National Commission for Health Education Credentialing, Inc. (NCHEC)

The Centers for Disease Control and Prevention is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is a designated event for the CHES to receive 2.0 Category I contact hours in health education, CDC provider number GA0082.

International Association for Continuing Education and Training (IACET)

The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer 0.2 IACET CEU's for this program.

Instructions

To complete the assessment and posttest, go to Training and Continuing Education Online and follow the instructions on that page.

You can immediately print your continuing education certificate from your personal transcript online. No fees are charged.

Online Assessment Questionnaire

1. The learning outcomes (objectives) were relevant to the goal(s) of the course

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

2. The content was appropriate given the stated objectives of the course

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

3. The content was presented clearly

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

4. The learning environment was conducive to learning

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

5. The delivery method (e.g., web, video, DVD, etc.) helped me learn the material

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

6. The instructional strategies helped me learn the material.

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

7. Overall, the quality of the course materials was excellent

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

8. The difficulty level of the course was

  1. Much too difficult.
  2. A little difficult.
  3. Just right.
  4. A little easy.
  5. Much too easy.

9. Overall, the length of the course was

  1. Much too long.
  2. A little long.
  3. Just right.
  4. A little short.
  5. Much too short.

10. The availability of CE credit influenced my decision to participate in this activity

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.
  6. Not applicable.

11. As a result of completing this educational activity, it is likely that I will make changes in my practice

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.
  6. Not applicable.

12. I am confident I can better provide appropriate clinical care for patients exposed to environmental hazards as described in this course

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.
  6. Direct patient care is not provided.

13. I intend to apply recommendations from this course in my clinical practice

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.
  6. Direct patient care is not provided.

14. The content expert(s) demonstrated expertise in the subject matter

  1. Strongly agree.
  2. Agree.
  3. Undecided.
  4. Disagree.
  5. Strongly disagree.

15. Do you feel this course was commercially biased? If yes, please explain

16. Please describe any technical difficulties you experienced with the course.

17. What could be done to improve future offerings?

18. Do you have any further comments?

Posttest
Select the one best answer

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.

Relevant Content

To review content relevant to the post-test questions, see:

Question

Location of Relevant Content

Learning Objective (s) Met

1

What is arsenic?

Where is arsenic found?

  • Describe arsenic
  • Identify where arsenic is found in the United States today.

2

Where is arsenic found?

  • Identify where arsenic is found in the United States today.

3

What are routes of exposure for arsenic?

  • Identify the major routes of exposure to arsenic.

4

Who is at risk of arsenic overexposure?

  • Identify the populations most heavily exposed to arsenic.

5

What are standards and regulations for arsenic?

  • Describe standards for arsenic exposure.

6

What is the biological fate of arsenic in the body?

  • Describe what happens when arsenic enters the body.

7

How does arsenic induce pathogenic change?

  • Describe the ways arsenic induces illness.

8, 9, 11

What are the physiologic effects of arsenic exposure?

  • Describe the health effects associated with arsenic exposure.

10, 12, 13, and 14

Clinical assessment

  • Identify the primary focuses of the exposure and medical history.
  • Describe the most typical findings on physical exam
  • Describe the tests you would order for patients exposed to arsenic.

15

How should patients exposed to arsenic be treated and managed?

  • Identify primary strategies for treating and managing arsenic associated diseases.

16

What instructions should be given to patients exposed to arsenic?

  • Describe instructions for patient self care.
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