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Chromium Toxicity
Assessment and Posttest Instructions

Course: WB 1466
CE Original Date: December 18, 2008
CE Renewal Date: December 18, 2011
CE Expiration Date: December 18, 2013
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Introduction

ATSDR seeks feedback on this course so we can assess 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)

CME: 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 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC), Commission on Accreditation

CNE: 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 2.0 contact hours.

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

CHES: 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 Certified Health Education Specialist (CHES) to receive 2.0 Category I contact hours in health education, CDC provider number GA0082.

International Association for Continuing Education and Training (IACET)

CEU: 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.

Online 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.

Posttest

Please select the best correct answer

  1. Which of the following statements is NOT true?
    1. Chromium is excreted in urine and bile as Cr(III).
    2. Cr(III) is generally more toxic than Cr(IV).
    3. Cr(VI) is absorbed more quickly than Cr(III).
    4. Cr(VI) is carcinogenic when inhaled.
  2. Which of the following statements is correct?
    1. Naturally occurring chromium is usually present as hexavalent Cr(VI).
    2. Cr(III) and Cr(VI) are released to the environment primarily from stationary point sources resulting from human activities.
    3. Cr(VI) in the air does not undergo any reaction.
    4. Tobacco smoke is a source of chromium intake.
  3. Which of the following statements is incorrect?
    1. Due to the actions of gastric acid and other components within the gastrointestinal tract, most of ingested Cr(VI) dosage is converted to Cr(III)
    2. Cr(VI) is reduced to Cr(III) in the lower respiratory tract.
    3. Absorption of Cr(VI) compounds can not occur through intact skin.
    4. The general population is exposed most often by ingestion through chromium content in soil, food, and water.
  4. EPA's MCL for chromium in drinking water is which of the following?
    1. 50 g/L.
    2. 100 g/L.
    3. 500 g/L.
    4. None of the above.
  5. Which of the following is NOT true?
    1. Chromium deficiency may result in glucose intolerance.
    2. Cr(VI) compounds are irritating and corrosive.
    3. Cr(III) readily passes through cell membranes.
    4. Chromium compounds may be skin and pulmonary sensitizers.
  6. Significant chromium uptake occurs in all of the following EXCEPT
    1. Lung.
    2. Kidneys.
    3. Muscle.
    4. Liver.
  7. Dermal signs of chromium exposure may include all of the following EXCEPT
    1. Penetrating, painless, and persistent ulcers.
    2. Papule-like lesions.
    3. Dermatitis with eczema and edema.
    4. Erythema nodosum.
  8. Effects of chronic chromium exposure may include all of the following EXCEPT
    1. Pancreatitis.
    2. Nasal mucosal irritation.
    3. Chromium-induced asthma.
    4. Lung cancer.
  9. Because Cr(VI) is a powerful oxidizing agent, it does all of the following EXCEPT
    1. Causes gastrointestinal hemorrhage as a result of ingestion.
    2. Causes skin necrosis on dermal contact.
    3. Appears to be much more toxic systemically than Cr(III) compounds, given similar amounts and solubilities.
    4. Is eliminated in the urine.
  10. Which of the following tests is of little use in evaluating a chromium-exposed individual?
    1. Urinary â2-microglobulins level.
    2. Urinary chromium level.
    3. Chromium level in the hair.
    4. Chest x-ray.
  11. Treatment recommendations for patients with chronic chromium poisoning may include all of the following EXCEPT
    1. Prolonged chelation therapy with dimercaprol.
    2. Cessation of further exposure.
    3. Surveillance for lung cancer.
    4. Topical ascorbic acid treatment for chrome ulcers.
  12. Patients who have been exposed to chromium should contact their physician if they develop all of the following EXCEPT
    1. Respiratory problems.
    2. Yellowing of teeth.
    3. Altered sense of smell.
    4. Difficulty sleeping.

Relevant Content

To review content relevant to the posttest questions, see:

1

What is chromium?

2

Where is chromium found?

3

What are the routes of exposure to chromium?

4

What are the standards and regulations for chromium exposure?

5

What is the biologic fate of chromium in the body?

6

What is the biologic fate of chromium in the body?

7

What are the physiologic effects of chromium?

8

What are the physiologic effects of chromium?

9

Clinical assessment - history, signs and symptoms

10

Clinical assessment - laboratory tests

11

How should patients exposed to chromium be treated and managed?

12

What instructions should be given to patients?

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