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

Beryllium Toxicity
Posttest

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:

Accreditation Council for Continuing Medical Education (ACCME)

The Centers for Disease Control and Prevention (CDC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CDC designates this educational activity for a maximum of 1.5 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

This activity for 1.5 contact hours is provided by the Centers for Disease Control and Prevention, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

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

CDC is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. 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 1.5 Category I contact hours in health education, CDC provider number GA0082.

International Association for Continuing Education and Training (IACET)

The Centers for Disease Control and Prevention (CDC) has been reviewed and approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), Suite 800, McLean, VA 22102. CDC will award 0.15 of CEU's to participants who successfully complete this program.

Disclaimer

In compliance with continuing education requirements, all presenters must disclose any financial or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use.

CDC/ATSDR, our planners, and the presenters for this seminar do not have financial or other relationships with the manufacturers of commercial products, suppliers of commercial services or commercial supporters. This presentation does not involve the unlabeled use of a product or product under investigational use.

Online Instructions

To complete the Assessment and Posttest, go to www2.cdc.gov/atsdrce 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

Click on the correct answers. There may be more than one correct answer for each question.

1. The following are true regarding beryllium except
   1. Beryllium is one of the heaviest metals known.
   2. Pure beryllium is a naturally occurring hard, grayish material obtained from mineral rocks bertrandite and beryl.
   3. The major source of its emission into the environment is combustion of fossil fuels.
   4. Beryllium is relatively water insoluble and adsorbs tightly to soils.
2. Which of the following activities are potential sources of beryllium exposure?
   1. Fabricating aircraft/satellite structural components.
   2. Washing the clothes of a machinist.
   3. Applying fertilizers.
   4. Traveling in an airplane.
   5. Grinding dental prostheses.
3. A worker’s family members may be exposed to beryllium by
   1. Sharing utensils with the worker.
   2. Kissing the worker.
   3. Gathering and washing the workers dirty clothes.
   4. Living beneath high-voltage power lines.
4. It is a federal (OSHA) regulation that workers not be exposed to more than 2 µg/m3 of beryllium in air
   1. Averaged over an 8-hour workday.
   2. At any time during the day.
   3. If they have underlying lung disease.
   4. If they are not wearing a paper dust mask.
5. The EPA regulation for beryllium emissions in air is
   1. 10 micrograms in a 24-hour period.
   2. 10 grams in a 24-hour period.
   3. 10 grams averaged over an 8-hour workday.
   4. 10 micrograms averaged over an 8-hour workday.
6. Which of the following statements are true?
   1. Ingestion of beryllium is associated with high rates of chronic beryllium disease.
   2. Beryllium is classified by some agencies as a known carcinogen in humans.
   3. Some individuals have a genetic susceptibility to beryllium sensitization or disease.
   4. Skin contact with ultrafine beryllium particles may cause disease.
   5. People who have chronic beryllium disease should be considered infectious.
7. Which of the following are correct?
   1. In beryllium sensitization and chronic beryllium disease, a susceptible person develops a cell-mediated, delayed hypersensitivity reaction after beryllium exposure.
   2. Both individual susceptibility and exposure circumstances are important in developing chronic beryllium disease.
   3. The HLA-DPb1 genes with the supratypic marker Glu69 may lead to an increased risk for those exposed to beryllium.
   4. All of the above.
8. Possible chest radiograph findings associated with beryllium–related diseases may include
   1. Nodular diffuse infiltrates.
   2. Diffusely linear infiltrates.
   3. Hilar adenopathy
   4. All of the above.
9. Which of the following statements are true?
   1. Acute and chronic beryllium disease results from the same physiologic mechanism.
   2. Acute beryllium disease can progress to chronic beryllium disease.
   3. The distinguishing feature of acute beryllium disease is the presence of granulomas.
   4. Today, acute beryllium disease is a rare occurrence in the workplace.
   5. Chronic beryllium disease predominantly affects the lungs and skin.
10. Exposure to beryllium may result in which of the following conditions?
    1. Contact dermatitis.
    2. Ulcerative granulomas.
    3. Emphysema.
    4. Interstitial pneumonitis.
    5. Hypersensitivity.
11. Which of the following statements are true?
    1. The period between initial beryllium exposure and detectable disease can be less than one year.
    2. Sarcoidosis and chronic beryllium disease have certain manifestations that are similar.
    3. Pulmonary function tests and a chest radiograph can be used to distinguish a patient with sarcoidosis from one with chronic beryllium disease.
    4. Cutaneous granulomas result from beryllium inhalation only.
    5. Most patients with chronic beryllium disease require steroid therapy for less than one year.
12. Tests that may be used to distinguish beryllium sensitization from CBD include
    1. Pulmonary function tests.
    2. Chest radiography.
    3. Blood BeLPT.
    4. Diffusion capacity for carbon monoxide.
    5. Arterial-alveolar gradient at rest.
13. Tests that may be used to distinguish sarcoidosis from chronic beryllium disease include
    1. Pulmonary function tests.
    2. Blood BeLPT.
    3. Bronchoalveolar lavage BeLPT.
    4. Serum alpha fetoprotein level.
    5. None of the above.
14. Proper treatment and management of chronic beryllium disease might include
    1. Pneumococcal immunization.
    2. Influenza immunization.
    3. Corticosteroid therapy.
    4. Excision of beryllium-contaminated cutaneous sites.
15. Indications for CBD treatment include which of the following?
    1. Evidence of decline on resting pulmonary function tests.
    2. Worsening gas exchange abnormalities on exercise testing.
    3. Signs of pulmonary hypertension and cor pulmonale.
    4. All of the above.
16. What are possible sequelae or complications of CBD?
    1. Right ventricular heart failure.
    2. Pulmonary fibrosis.
    3. Pneumothorax.
    4. All of the above.

Relevant Content

To review content relevant to the posttest questions, see:

Where is beryllium found?

• Describe beryllium properties

How are people exposed to beryllium?

• Describe how people are exposed to beryllium

Who is at risk of exposure to beryllium?

• Identify the populations most heavily exposed to beryllium

Who is at risk of exposure to beryllium?

• Identify who is at risk of exposure to beryllium in the home

What are standards and regulations for beryllium exposure?

• Describe the OSHA permissible exposure limit (PEL) for Beryllium

What are standards and regulations for beryllium exposure?

• Describe the EPA regulation for Beryllium emissions in air

Who is susceptible to beryllium exposure?

• Name a marker of genetic susceptibility to beryllium exposure

How does beryllium induce pathogenic changes?

• Describe health conditions associated with beryllium exposure

Who is susceptible to beryllium exposure

• Name a marker of genetic susceptibility to beryllium exposure

How does beryllium induce pathogenic changes?

• Describe two mechanisms of injury resulting from beryllium exposure

Clinical assessment

• Describe chest radiograph findings associated with beryllium-related diseases

How does beryllium induce pathogenic changes?

• Describe two mechanisms of injury resulting from beryllium exposure
• Describe health conditions associated with beryllium exposure

How does beryllium induce pathogenic changes?

• Describe health conditions associated with beryllium exposure

Clinical assessment

• Describe pulmonary function test findings associated with beryllium-related diseases
• Describe chest radiograph findings associated with beryllium–related diseases

Clinical assessment

• Describe pulmonary function test findings associated with beryllium-related diseases
• Describe chest radiograph findings associated with beryllium–related diseases

Clinical assessment – other diagnostic tests

• Identify other tests that can assist with diagnosis of beryllium-related diseases

Clinical assessment – other diagnostic tests

• Identify other tests that can assist with diagnosis of beryllium related diseases

How should patients exposed to beryllium be treated and managed?

• Identify the primary drug for treatment of chronic beryllium disease (CBD)

How should patients exposed to beryllium be treated and managed?

• Identify what patients should be treated

How should patients exposed to beryllium be treated and managed?

• List possible sequelae of chronic beryllium disease