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Lead Toxicity
Posttest

Course: WB2832
CE Original Date: June 12, 2017
CE Renewal Date: June 12, 2019
CE Expiration Date: June 12, 2021
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Posttest

Please select the one best answer choice.

  1. Lead is a
    • Soft, heavy, blue-gray metal
    • Naturally occurring substance
    • Commercially used substance
    • All of the above.
  2. Which of the following is true about organic lead in the United States?
    • It is more commonly found in home environments today than is inorganic lead.
    • It is the most available source of exposure through natural processes.
    • It was a common source of lead exposure in the United States when leaded gasoline was used in "on road" vehicles.
    • Cannot enter the body through dermal exposure.
  3. In the U.S., the majority of children exposed to lead are exposed from
    • Contaminated drinking water.
    • Lead-contaminated dust, soil, and deteriorated lead-based paint.
    • Imported food, home remedies, and cosmetics.
    • Commercial products containing lead.
  4. Which of the following is NOT considered a potential source of lead exposure?
    • Jewelry.
    • Unfinished treated lumber.
    • Imported cosmetics and home remedies.
    • Glazed ceramics.
  5. Which of the following statements about sources of lead in the environment is true?
    • Lead dust exposure can raise children's BLLs above the reference value.
    • Lead is heavy, so it does not travel far in the air from smelters or industries.
    • Lead is only a problem in urban areas with pre-1978 housing.
    • Children who eat paint chips make up the majority of those with BLLs above 5 µg/dL.
  6. The most common route of exposure to lead in U.S. children is?
    • Ingestion.
    • Inhalation.
    • Dermal contact.
    • All are equally common.
  7. Of the following, the U.S. population most at risk for exposure to lead today is
    • People who work in lead mining and smelting.
    • Adult household contacts of workers engaged in the manufacture of lead-containing products who remove contaminated clothing and take showers before going home.
    • Children living in pre-1978 buildings with deteriorated paint.
    • Construction workers.
  8. CDC's upper reference level value of 97.5% based on 2012-2015 population distributions of children's blood lead is which of the following?
    • 3 µg/dL.
    • 5 µg/dL.
    • 10 µg/dL.
    • 25 µg/dL.
  9. What does the CDC's reference value for children's blood lead indicate?
    • The BLL below which no effects have been found.
    • The level OSHA uses as a level of concern in workers.
    • An advisory level for environmental and educational intervention.
    • A regulatory level at which children must be immediately removed from any pre-1978 residences.
  10. What are the OSHA standards for Lead Levels?
    • Permissible exposure limit (PEL) of lead in the workplace.
    • The frequency and extent of medical monitoring triggered by the action level.
    • Other responsibilities of the employer.
    • All of the above.
  11. What is the U.S. EPA drinking water action level for lead?
    • 15 ppb in more than 10% of customer taps sampled.
    • The frequency and extent of medical monitoring for a BLL of 10 µg/dL.
    • 5 ppm in tap water.
    • All of the above.
  12. What is the CPSC regulatory limit value for lead in paint?
    • 5 ppb.
    • 5 µg/L.
    • 10 µg/L.
    • 15 µg/L.
    • 90 ppm (0.009%).
  13. What is the percentage of ingested inorganic lead a child will absorb after a meal and on an empty stomach?
    • 10 and 40%.
    • 25 and 60%.
    • 40 and 80%.
    • 50 and 100%.
  14. Which of the following answer choices best describes where lead is distributed once it enters the body?
    • Blood, sweat and tears.
    • Stomach, liver and bones.
    • Blood, mineralizing tissues and soft tissue.
    • Blood, cerebrospinal fluid and brain.
  15. What is the approximate half-life of lead in the blood of an adult?
    • Seven days.
    • Twenty-eight days.
    • Three to six months.
    • One year.
  16. Why would a patient's BLL drop only gradually, even with complete removal from the source of exposure?
    • Lead's half-life in the blood is almost one year.
    • Everyone is exposed to high background levels of lead.
    • Lead stored in the bones and soft tissues may be released over time.
    • None of the above.
  17. The most commonly reported adverse health effects in children at BLLs <5µg/dL include all of the following EXCEPT
    • Endocrine effects.
    • Attention-related behavioral problems.
    • Decreased IQ and cognitive performance.
    • Greater incidence of problem behaviors.
  18. Some researchers have suggested that lead exposure in the U.S. continues to contribute significantly to
    • Socio-behavioral problems such as juvenile delinquency and violent crime.
    • Kidney disease.
    • Decreased IQ and cognitive performance.
    • All of the above.
  19. What is the most sensitive organ system for lead exposure in children?
    • Endocrine system.
    • Nervous system.
    • Immunologic system.
    • Renal system.
  20. What is the identified threshold or safe level of lead in blood for children?
    • 5 µg/dL.
    • 10 µg/dL
    • 15 µg/dL.
    • There is no identified threshold or safe level of lead in blood.
  21. Which of the following statement(s) about taking screening exposure histories for children is/are true?
    • It is necessary to ask all the screening questions at every visit.
    • The physician should perform age-appropriate risk-based screening for lead poisoning during an initial well-child visit.
    • There is no need to ask age-specific screening questions because all children are exposed equally.
    • All of the above.
  22. As part of the exposure history, you should explore
    • Possible lead exposure at parent's work.
    • Household members' hobbies that might involve lead.
    • Household use of imported home remedies and cosmetics.
    • All of the above.
  23. Which of the following statements regarding the clinical assessment of a lead exposed patient is/are true?
    • Carefully evaluate the nervous system for subtle changes, including behavioral changes.
    • Check blood pressure to evaluate whether the patient is hypertensive and pay special attention to the renal system in those who are hypertensive.
    • Hearing, speech, and other developmental milestones must be carefully evaluated and documented.
    • Assess the nutritional status, diet, and dietary behaviors of young children.
    • All of the above.
  24. Which of the following statements is true regarding the signs and symptoms of lead toxicity?
    • Signs and symptoms will always be more noticeable with increasing BLLs.
    • All children with low dose level exposure, will be asymptomatic.
    • Symptoms of lead exposure and their onset may vary.
    • Categorizing the signs and symptoms by BLL from lowest to highest is very accurate.
  25. What is the best screening and confirmatory diagnostic test for evaluating recent or ongoing lead exposure in a child?
    • EP/ZPP.
    • Capillary BLL (fingerstick).
    • Venous BLL.
    • Abdominal radiograph.
  26. Blood lead level (BLL) testing is recommended for all of the following at risk groups EXCEPT
    • Neonates and infants of women with BLLs ≥5µg/dL.
    • Children ≤72 months that missed recommended screening at a younger age.
    • All immigrant, refugee, and internationally-adopted children when they arrive in the U.S.
    • All children when they start school.
  27. What imaging and other clinical modalities may assist in the diagnosis of current or past lead exposed patients?
    • Abdominal radiographs.
    • Long bone radiographs.
    • Hair assay.
    • All of the above.
    • None of the above.
  28. Management strategies for children whose blood levels are equal to or greater than the reference value include of the following:
    • Nutritional education and intervention.
    • Educational intervention and ongoing monitoring.
    • Coordination with other organizations.
    • All of the above.
  29. When is ongoing monitoring of BLLs indicated?
    • When a child is identified with BLL results greater than or equal to the CDC reference value (≥5 µg/dL).
    • When a child has a venous BLL <5 µg/dL.
    • When any child presents with hypertension and neurological symptoms.
    • When there is more than one child living in a pre-1978 home.
  30. BLLs that increase after interventions to mitigate lead exposure may indicate which of the following?
    • An unrecognized source of exposure.
    • Inappropriate abatement activities and failure to mitigate the identified hazard.
    • The redistribution of lead stores within the child's body post-chelation.
    • All of the above.
  31. What should you tell patients who are concerned about lead in their drinking water, but there is no confirmation of lead contamination from the Department of Health?
    • As long as they don't have well water, their water is safe.
    • Until they can get their water tested, boil their drinking water.
    • Drinking water is non-acidic and will not leach lead out of old pipes, fixtures, or solder.
    • Until they can get their water tested, they can drink bottled water, or run cold water for 1 to 2 minutes before use. They can contact their water provider for recent lead level test results (large water suppliers).
  32. When explaining patients or parents that domestic exposure to lead can come from a variety of sources, it is important to advise to:
    • Eliminate source(s) of lead exposure.
    • Flush standing water from the lines and faucet for several minutes before use, and use cold water for drinking (if they have older homes with galvanized lead or lead soldered pipes and/or lead service lines).
    • Maintain a low-fat diet high in calcium, zinc, vitamin C and iron.
    • Continue to monitor BLLs (if applicable).
    • All of the above.
  33. What effective doctor/patient communication strategies can you use?
    • Offer simple information about the meaning of elevated BLL test results, and relevant, culturally-sensitive messages about their impact.
    • Allow interactions with affected families performed in a culturally-sensitive, same-language, and streamlined manner.
    • Define specialized terms such as "detectable level" or "elevated BLL".
    • All of the above.

Relevant Content

Question Location of Relevant Content
1. What Is Lead?
  • Explain what lead is.
2 Where is Lead Found?
  • Describe potential sources of lead exposure in the United States today.
3 Where Is Lead Found?
  • Describe potential sources of lead exposure in the United States today.
4 Where Is Lead Found?
  • Describe potential sources of lead exposure in the United States today.
5 Where Is Lead Found?
  • Describe potential sources of lead exposure in the United States today.
6 Where Is Lead Found?
  • Identify the most common routes of exposure to lead in the United States today.
7 Who Is At Risk of Lead Exposure?
  • Identify the populations most heavily exposed to lead.
8 What Are U.S. Standards for Lead Levels?
  • Describe the Centers for Disease Control and Prevention's (CDC) reference value for lead in children's blood.
9 What Are U.S. Standards for Lead Levels?
  • Describe the Centers for Disease Control and Prevention's (CDC) reference value for lead in children's blood.
10 What Are the U.S. Standards for Lead Levels?
  • Describe the U.S. Occupational Safety and Health Administration's (OSHA) Permissible Exposure Limit (PEL) for lead in workplace air.
11 What Are U.S. Standards for Lead Levels?
  • Describe the U.S. Environmental Protection Agency's (EPA) drinking water regulation for lead.
12 What Are U.S. Standards for Lead Levels?
  • Describe the Consumer Product Safety Commission's (CPSC) regulatory limit value for lead in paint.
13 What Is the Biological Fate of Lead in the Body?
  • Describe how lead is absorbed.
14 What Is the Biological Fate of Lead in the Body?
  • Describe how lead is distributed in the body.
15 What Is the Biological Fate of Lead in the Body?
  • Identify the half-life of lead in the blood.
16 What Is the Biological Fate of Lead in the Body?
  • Describe how lead is distributed in the body.
17 What are Possible Health Effects from Lead Exposure?
  • Describe how lead affects adults and children.
18 What are Possible Health Effects from Lead Exposure?
  • Describe how lead affects adults and children.
19 What Are Possible Health Effects from Lead Exposure?
  • Describe what is the most sensitive organ system for lead exposure in children.
20 What Are Possible Health Effects from Lead Exposure?
  • Specify that there is no identified threshold or safe level of lead in blood.
21 Clinical Assessment - Exposure History
  • Describe how to take a screening exposure history for lead exposure.
22 Clinical Assessment - Exposure History
  • Identify lead exposure-related questions to ask during a child visit.
23 Clinical Assessment - Signs and Symptoms
  • Name typical signs and symptoms consistent with lead toxicity.
24 Clinical Assessment - Signs and Symptoms
  • Describe key features of the physical examination for patients exposed to lead.
25 Clinical Assessment - Diagnostic Tests and Imaging
  • Describe guidelines for blood lead screening and confirmatory diagnostic testing on patients at risk of recent or ongoing lead exposure.
26 Clinical Assessment - Diagnostic Tests and Imaging
  • Describe guidelines for blood lead screening and confirmatory diagnostic testing on patients at risk of recent or ongoing lead exposure.
27 Clinical Assessment - Diagnostic Tests and Imaging
  • Describe imaging and other clinical modalities that may assist in the diagnosis of current or past lead exposed patients.
28 How Should Patients Exposed to Lead be Treated and Managed?
  • Describe a management strategy for children whose blood lead levels are equal to or greater than the current CDC reference value of 5 μg/dL.
29 How Should Patients Exposed to Lead be Treated and Managed?
  • Describe a management strategy for children whose blood lead levels are equal to or greater than the current CDC reference value of 5 μg/dL.
30 How Should Patients Exposed to Lead be Treated and Managed?
  • Describe a management strategy for children whose blood lead levels are equal to or greater than the current CDC reference value of 5 μg/dL.
31 What Instructions Should be Given to Patients?
  • Describe instructions to parents and patients to prevent or reduce lead exposure.
32 What Instructions Should be Given to Patients?
  • Describe instructions for patients exposed to lead
33 What Instructions Should be Given to Patients?
  • Describe communication strategies that health care providers can use to best deliver clinical information to their lead exposed or potentially exposed patients.

Table of Tables and Figures

Table of Tables and Figures
Table of Tables
Number Title Page
1 Where Is Lead Found? Lead Source and Contaminated Media 34
2 Populations at Risk of Exposure to Lead in the Workplace 49
3 Risk Factors for Lead Exposure in Pregnant and Lactating Women 50
4 Standards and Regulations for Lead 61
5 Screening Questions for Children's Lead Exposure History 97
6 Continuum of Signs and Symptoms of Ongoing Lead Exposure 103
7 Recommended Schedule for Obtaining a Confirmatory Venous Sample 116
8 ACCLPP Recommended Actions Based on BLL 123
9 Clinical Recommendations Based on Blood Lead Levels (BLLs) 126
10 Ongoing Monitoring for Lead-Exposed Children 132
Table of Figures
Number Title; Page
1 Sources of Contribution of Lead Exposure to Children's Blood Lead Concentrations 44
2 Lowering of BLLs Considered Elevated by CDC Over Time 53
3 Sex Influences Brain Volume Loss Associated with Lead Exposure 80
4 Lead lines on gingiva 107
5 Basophilic stippling 117
6 Microcytic hypochromic anemia associated with lead poisoning 118
7 Long Bone Radiograph of Hands; 119
8 Long Bone Radiograph of Knees 119
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