Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Lead Toxicity
Posttest Instructions

Posttest

1. Lead is a
   1. soft, heavy, blue-gray metal
   2. naturally occurring substance
   3. commercially used substance
   4. All of the above.
2. Which statement is true of organic lead?
   1. It is more commonly found in home environments today than is inorganic lead.
   2. It was the most available source of exposure through natural processes.
   3. It was a  common source of lead exposure in the U.S. when leaded gasoline was used.
   4. It cannot enter the body through dermal exposure.
3. Of the following, the U.S. population most at risk from exposure to lead today is
   1. people who work in lead mining and smelting
   2. household contacts of workers engaged in the manufacture of lead-containing products
   3. children living in pre-1978 buildings with deteriorated paint
   4. construction workers
4. In older urban areas, most of the lead in the environment today comes from
   1. contaminated drinking water
   2. lead-contaminated dust, soil, and deteriorated lead-based paint
   3. imported food, home remedies, and cosmetics
   4. commercial products containing lead
5. Which of the following is not considered a potential source of lead exposure?
   1. jewelry
   2. treated lumber
   3. imported cosmetics and home remedies
   4. glazed ceramics
6. What is the Center for Disease Control’s blood lead action level for children?
   1. 5 µg/dL
   2. 10 µg/dL
   3. 25 µg/dL
   4. 40 µg/dL
7. The most important route of exposure to lead by children is
   1. ingestion
   2. inhalation
   3. dermal contact
   4. All are equally important.
8. Which of the following signs or symptoms is not consistent with childhood lead poisoning?
   1. recurrent headaches
   2. attention Deficit Hyperactivity Disorder
   3. decreased hearing and speech abilities
   4. difficulty learning
9. In caring for an adult patient with a blood lead level of 40 µ/dL, it is most important to
   1. continue to monitor with monthly capillary blood tests
   2. take steps to avoid further exposure to lead
   3. immediately start chelation therapy
   4. encourage a diet high in calcium
10. As part of the exposure history, you should explore
    1. possible lead exposure at work or during hobbies
    2. hobbies that might involve lead
    3. use of imported home remedies and cosmetics
    4. All of the above.
11. OSHA requires written notification and a medical examination for workers with blood lead levels of
    1. 10 µg/dL
    2. 25 µg/dL
    3. 40 µg/dL
    4. 70 µg/dL
12. At a 24 month well-child check up, under what circumstances should you order a venous blood lead level?
    1. If the 12-month blood test showed a prior elevation over 10 ug/dL or no prior blood lead level is available.
    2. If child is living or spending significant time in pre-1978 housing.
    3. If a household member works in a job involving lead.
    4. All of the above.
13. Why would a patient’s BLL drop only gradually, even with complete removal from the source of exposure?
    1. Lead’s half-life in the blood is almost one year.
    2. Everyone is exposed to high background levels of lead.
    3. Lead stored in the bones and soft tissues may be released over time.
    4. None of the above.
14. Chronic lead exposure is not believed to contribute to which of the following conditions
    1. hypertension
    2. kidney disease
    3. diabetes
    4. low sperm count
15. You should tell patients who are concerned about lead in their drinking water that
    1. As long as they don’t have well water, their water is safe.
    2. Until they can get their water tested, boil their drinking water.
    3. Drinking water is non-acidic and will not leach lead out of old pipes, fixtures, or solder
    4. Until they can get their water tested, run cold water for one to two minutes before use.
16. Which of the following statements about sources of lead in the environment is true?
    1. Lead dust can raise children’s blood lead levels above the level of concern.
    2. Lead is heavy, so it does not travel far in the air from smelters or industries.
    3. Lead is only a problem in urban areas with pre-1978 housing.
    4. Children who eat paint chips make up the majority of those with blood lead levels above 10 µg/dL.

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