Heavy metal intoxication and chelators

1. Gingivitis, discolored gums and loose teeth are common symptoms of chronic exposure to this
agent.
a. Arsine
b. Iron
c. Mercury
d. None of these

2. What agent is used in the treatment of Wilson’s disease and has been reported to cause lupus
erythematosus and hemolytic anemia?
a. Deferoxamine
b. Penicillamine
c. Succimer
d. Dimercaprol

3. What toxic compound can be produced in seawater by the action of bacteria and algae. It is also
synthesized chemically for commercial use as a fungicide?
a. Mercury vapor
b. Tetraethyl lead
c. Trivalent arsenic
d. Methylmercury

4. What agent causes shock if given by rapid intravenous infusion?

a. Unithiol
b. Penicillamine
c. Deferoxamine
d. Succimer

5. Which of the following agent is co-administered with Dimercaprol in severe chronic lead
poisoning?
a. EDTA
b. Succimer
c. Penicillamine
d. Dimercaprol

6. What agent should not be used in cases of chronic inorganic mercury poisoning because it may
redistribute mercury to the CNS?
a. Succimer
b. Unithiol
c. Dimercaprol
d. None of these
 7. Which of the following may cause hyperkeratosis and raindrop hyperpigmentation?
a. Arsenic
b. Arsine
c. Mercury
d. Lead

8. The following statements are true regarding unithiol, except:

a. It chelates arsenic and mercury that are excreted in the feces
b. It is used in lead poisoning
c. It may cause dermatologic reactions
d. None of the above

9. Which of the following is known to be a carcinogen?

a. Arsine
b. Arsenic
c. Lead
d. Mercury

10. Which of the following is usually contained in anti-knock gasoline additives?

a. Inorganic lead
b. Organic lead
c. Organic mercury
d. Arsenic

Dora, a toddler, was brought to a hospital due to severe abdominal colic. On further history taking, she
was seen ingesting a painted toy few hours prior to consult. At the wards, the patient was referred to
you due to changes in sensorium.

11. What is your assessment for this case?

a. Chronic inorganic lead poisoning
b. Acute inorganic lead poisoning
c. Organic mercury poisoning
d. Iron poisoning

12. What treatment should be instituted immediately?

a. Succimer
b. Acetlycysteine
c. EDTA
d. Penicillamine

A young woman working as a dentist came to your clinic because of hair loss. On examination, you
noted perforation of nasal septum, transverse bands in nails and with milk and roses complexion.

13. Which of the following results from vasodilation and anemia?

a. Mee’s lines
b. Gray pallor
 c. Milk and roses complexion
d. Hair loss

14. What treatment should be given for this patient?

a. Dimercaprol
b. Deferoxamine
c. EDTA
d. Succimer

Mr. X came to your clinic for consult regarding his chronic headache accompanied with fatigue and
anorexia. On examination, you noted weakness of the extensor muscles in the upper extremities.
Diagnostics tests done revealed: emoglobin 12g/L, urinary coproporphyrin > 80mcg/100mg creatinine
and urinary aminolevulinic acid >2mg/100mg creatinine.

15. Based on the data presented, what is your initial impression?

a. Arsenic poisoning
b. Inorganic lead poisoning
c. Iron poisoning
d. Mercuric chloride poisoning

16. What will be your preferred treatment if patient was admitted?

a. Low dietary calcium
b. Succimer
c. EDTA
d. All of the above

Mr. Y, an engineer in a cobalt and gold smelting company was brought to the Emergency Room due to
severe gastrointestinal discomfort, rice watery stools and sweet garlicky breath.

17. What is your initial management?

a. Hydration and replacement of electrolytes
b. Give Hyoscine-N-Butylbromide for relief of pain
c. Insert NGT for gastric lavage
d. All of the above

18. What is the chelation therapy of choice?

a. Deferoxamine
b. Dimercaprol
c. EDTA
d. Penicillamine

A young man working in semiconductors manufacturing had an accident inside their plant. After 1 day
patient had nausea and vomiting. Blood pressure was 140/90mmHg and with episodes of shivering.
Laboratory tests done showed hemoglobinuria and plasma free hemoglobin level greater than 1.4g/dl.

19. This young man was probably exposed to what agent?

a. Arsine
 b. Inorganic Arsenic
c. Mercury vapor
d. Methylmercury
20. What is the mainstay treatment if patient is on acute renal failure already?
a. Vigorous hydration
b. Exchange transfusion
c. Chelators
d. Hemodialysis

Prepared by:

Patrick Dycoco, M.D.