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

Cadmium 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 1.75 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 1.75 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)

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 http://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

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

1. The following clinical sequelae may result from chronic exposures to cadmium
   1. Sensory neuropathy in hands and feet.
   2. Renal damage.
   3. Impaired lung function.
   4. Loss of hearing at high frequencies.
   5. Bone fractures.
2. Which of the following statements are true?
   1. Municipal waste incinerators can be a source of airborne cadmium.
   2. Cadmium accumulates in the food chain.
   3. Cigarette smoke is a source of cadmium.
   4. Iron deficiency may decrease a person’s risk of cadmium toxicity.
   5. Like lead, cadmium accumulates mostly in bones and teeth.
3. Clues to the diagnosis of chronic cadmium poisoning may include
   1. Hepatomegaly.
   2. Frank wrist drop.
   3. Hyperthyroidism.
   4. Yellow tooth discoloration.
   5. Increased excretion of β2-microglobulin.
4. The effect of cadmium on the kidney
   1. Can lead to increased urinary excretion of β2-microglobulin.
   2. Can be associated with both renal tubular damage and decreased GFR.
   3. May be worse in cigarette smokers.
   4. Is treatable by chelation.
   5. Leads to increased density of the renal shadow on flat plate of the abdomen.
5. Treatment for acute cadmium poisoning by inhalation may include
   1. Oxygen.
   2. Fluid replacement.
   3. Hemodialysis.
   4. Peritoneal dialysis.
   5. Urinary acidification.
6. The body systems or organs affected by chronic cadmium exposure may include
   1. Olfactory epithelium.
   2. Kidneys.
   3. Adrenals.
   4. Reproductive.
   5. Skeletal.
7. Cadmium toxicity might be suspected in
   1. Rubber workers.
   2. Solderers.
   3. Battery makers.
   4. Jewelry fabricators.
   5. Tree sprayers.
8. Cadmium is a natural element that is classified as a transition metal. Its chemical properties include which of the following?
   1. Is a lustrous blue-tinted solid.
   2. Produced in association with zinc production.
   3. Commonly occurs in a +2 oxidation state.
   4. All of the above.
9. Which of the following statements regarding the biologic fate of cadmium in the body are true
   1. Cadmium is transported in the blood bound to metallothionein.
   2. The greatest cadmium concentrations are found in the kidneys and the liver.
   3. Urinary cadmium excretion is slow; however, it constitutes the major mechanism of elimination.
   4. Due to slow excretion, cadmium accumulates in the body over a lifetime and its biologic half-life may be up to 38 years.
   5. All of the above.
10. Certain factors can increase the absorption or body burden of cadmium.
    1. Younger age.
    2. Non-smoking.
    3. Pregnancy.
    4. All of the above.
    5. None of the above.
11. During the exposure history, the key to including chronic cadmium intoxication in the differential diagnosis is
    1. A history or smoking tobacco.
    2. A history of febrile illnesses.
    3. Recent physical exercise.
    4. The use of nephrotoxic medications.
    5. Detailed questioning regarding occupations and hobbies.
12. Workers in certain industries are generally exposed to higher levels of cadmium than the general populations since
    1. Cadmium air levels can be thousands of times higher in the workplace than in the community.
    2. Workers have lower levels of smoking than the general population.
    3. Ingestion is the main route of exposure in the workplace.
    4. None of the above.
13. The workup for a patient with an acute inhalation exposure to cadmium includes
    1. An exposure history.
    2. Physical exam with emphasis on the respiratory system.
    3. Chest X-ray.
    4. Pulse oximetry.
14. In order to detect renal disease from higher than average chronic exposures to cadmium, one should:
    1. Look for yellow discoloration of teeth.
    2. Order a thorough panel of renal tests including electrolytes, BUN, serum and urinary creatinine, and urinary proteins such as β₂-microglobulin and RBP.
    3. Order a set of skeletal X-rays.
    4. Order a chest X-ray.
15. Advice the physician can give the patient in order to prevent further exposures to cadmium include
    1. Avoid eating, drinking, and smoking in the workplace.
    2. Eat large amounts of cereal grains and sweetmeats.
    3. Exercise.
    4. None of the above.

Relevant Content

To review content relevant to the posttest questions, see:

What diseases are associated with chronic exposure to cadmium?

Where is cadmium found?
What are routes of exposure for cadmium?

What diseases are associated with chronic exposure to cadmium?

What diseases are associated with chronic exposure to cadmium?

How should patients exposed to cadmium be treated and managed?

What diseases are associated with chronic exposure to cadmium?

Who is at risk of cadmium exposure?

What is cadmium?

What is the biologic fate of cadmium in the body?

What factors increase the risk of developing disease from exposure to cadmium?

Clinical assessment – History and physical examination

What are the routes of exposure for cadmium?

Clinical assessment – History and physical examination
Clinical assessment – Laboratory tests

Clinical assessment – Laboratory tests

What instructions should be given to patients exposed to cadmium?