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

Introduction

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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.

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Online Instructions

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Posttest

1. Which of the following statements is NOT true?
   1. Chromium is excreted in urine and bile as Cr(III).
   2. Cr(III) is generally more toxic than Cr(IV).
   3. Cr(VI) is absorbed more quickly than Cr(III).
   4. Cr(VI) is carcinogenic when inhaled.
2. Which of the following statements is correct?
   1. Naturally occurring chromium is usually present as hexavalent Cr(VI).
   2. Cr(III) and Cr(VI) are released to the environment primarily from stationary point sources resulting from human activities.
   3. Cr(VI) in the air does not undergo any reaction.
   4. Tobacco smoke is a source of chromium intake.
3. Which of the following statements is incorrect?
   1. Due to the actions of gastric acid and other components within the gastrointestinal tract, most of ingested Cr(VI) dosage is converted to Cr(III)
   2. Cr(VI) is reduced to Cr(III) in the lower respiratory tract.
   3. Absorption of Cr(VI) compounds can not occur through intact skin.
   4. The general population is exposed most often by ingestion through chromium content in soil, food, and water.
4. EPA's MCL for chromium in drinking water is which of the following?
   1. 50 g/L.
   2. 100 g/L.
   3. 500 g/L.
   4. None of the above.
5. Which of the following is NOT true?
   1. Chromium deficiency may result in glucose intolerance.
   2. Cr(VI) compounds are irritating and corrosive.
   3. Cr(III) readily passes through cell membranes.
   4. Chromium compounds may be skin and pulmonary sensitizers.
6. Significant chromium uptake occurs in all of the following EXCEPT
   1. Lung.
   2. Kidneys.
   3. Muscle.
   4. Liver.
7. Dermal signs of chromium exposure may include all of the following EXCEPT
   1. Penetrating, painless, and persistent ulcers.
   2. Papule-like lesions.
   3. Dermatitis with eczema and edema.
   4. Erythema nodosum.
8. Effects of chronic chromium exposure may include all of the following EXCEPT
   1. Pancreatitis.
   2. Nasal mucosal irritation.
   3. Chromium-induced asthma.
   4. Lung cancer.
9. Because Cr(VI) is a powerful oxidizing agent, it does all of the following EXCEPT
   1. Causes gastrointestinal hemorrhage as a result of ingestion.
   2. Causes skin necrosis on dermal contact.
   3. Appears to be much more toxic systemically than Cr(III) compounds, given similar amounts and solubilities.
   4. Is eliminated in the urine.
10. Which of the following tests is of little use in evaluating a chromium-exposed individual?
    1. Urinary β2-microglobulins level.
    2. Urinary chromium level.
    3. Chromium level in the hair.
    4. Chest x-ray.
11. Treatment recommendations for patients with chronic chromium poisoning may include all of the following EXCEPT
    1. Prolonged chelation therapy with dimercaprol.
    2. Cessation of further exposure.
    3. Surveillance for lung cancer.
    4. Topical ascorbic acid treatment for chrome ulcers.
12. Patients who have been exposed to chromium should contact their physician if they develop all of the following EXCEPT
    1. Respiratory problems.
    2. Yellowing of teeth.
    3. Altered sense of smell.
    4. Difficulty sleeping.

Relevant Content

To review content relevant to the posttest questions, see:

What is chromium?

Where is chromium found?

What are the routes of exposure to chromium?

What are the standards and regulations for chromium exposure?

What is the biologic fate of chromium in the body?

What is the biologic fate of chromium in the body?

What are the physiologic effects of chromium?

What are the physiologic effects of chromium?

Clinical assessment - history, signs and symptoms

Clinical assessment - laboratory tests

How should patients exposed to chromium be treated and managed?

What instructions should be given to patients?