Agency for Toxic Substances and Disease Registry 
Case Studies in Environmental Medicine (CSEM) 
Toxicity of Polycyclic Aromatic Hydrocarbons (PAHs)
Assessment and Posttest Instructions

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)

CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this educational activity for a maximum of 2 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

CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 2 contact hours.

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

CHES: 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 2 Category I contact hours in health education, CDC provider number GA0082.

International Association for Continuing Education and Training (IACET)

CEU: The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer 0.2 IACET CEU's for this program.

Disclaimer

CDC, our planners, and our presenters wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use. There was no commercial support received for this activity.

Online Instructions

To complete the Assessment and Posttest, go to Training and Continuing Education Online 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

1. Other names for PAHs include which of the following?
   1. Polynuclear aromatics (PNAs).
   2. Polynuclear hydrocarbons.
   3. Polynuclear aromatic hydrocarbons.
   4. Polycyclic organic matter (POM).
2. Which of the following statements regarding PAHs is (are) true?
   1. Heavier PAHs (more than 4 rings) tend to adsorb to particulate matter.
   2. Lighter PAHs (less than 4 rings) tend to remain gaseous until removed via precipitation.
   3. PAH concentration in water tends to be low (around 100 ng/l) due to their weak solubility.
   4. PAHs can be absorbed by plants.
   5. PAHs mostly accumulate in soil.
3. Potential sources of PAH exposure include
   1. Passive inhalation of cigarette smoke.
   2. Motor vehicle exhaust.
   3. Alcoholic beverages.
   4. Inhalation of paint vapors in poorly ventilated area.
   5. Wood stoves for home heating.
4. Which of the following statements regarding PAHs are false?
   1. PAHs are found only in a small number of industrial settings.
   2. PAHs mostly accumulate in soils.
   3. Benzo[a]pyrene is generally used as an environmental indicator for PAHs.
   4. Most PAHs in ambient air are the result of man-made processes.
5. In non-occupational settings, the majority of PAH exposure in a nonsmoking individual comes from which of the following?
   1. Foodstuff ingestion.
   2. Inhalation route.
   3. Dermal route.
   4. Water.
6. Persons with potentially increased PAH exposure include
   1. Hunters.
   2. Coke oven workers.
   3. Roofing asphalt applicators.
   4. Chimney sweeps.
   5. Breastfeeding mothers.
7. Which of the following statements are true about PAHs?
   1. Exposure is most often determined based on patient history.
   2. Direct assays in the body are not clinically useful.
   3. Exposure can cause pancreatitis.
   4. Acute exposure can cause convulsions or unexplained loss of consciousness.
   5. The prognosis for most acutely exposed patients is poor.
8. Which of the following statements regarding OSHA’s standards for PAHs is/are false?
   1. OSHA requires workers who are exposed to PAH above the PEL to be under medical surveillance.
   2. OSHA requires all workers to be trained in proper use of appropriate personal protective equipment and safety.
   3. Purchase of personal protective equipment is the responsibility of individual employees.
   4. The OSHA PEL is a legally enforceable standard.
9. Which of the following statements regarding PAHs in water is/are true?
   1. The EPA maximum contaminant level is a legally enforceable standard.
   2. The maximum contaminant level is an 8-hour time-weighted average.
   3. EPA has set maximum contaminant levels for PAHs in foodstuffs.
   4. EPA developed ambient water quality criteria to protect human health from the carcinogenic effects of PAH exposure.
10. Which of the following regarding the biologic fate of PAHs in the body are true?
    1. PAHs are metabolized in a number of organs and excreted in bile and urine.
    2. Information on the absorption, distribution, and elimination of PAHs in the human body is derived primarily from animal studies.
    3. Generally, PAHs bound to airborne particulate matter are not absorbed as well in the lungs as the same dose of PAHs that are unbound to particulate matter.
    4. The liver P-450 mixed-function oxidase system is the predominant mechanism of PAH metabolism.
    5. 1-Hydroxypryrene is a commonly measured urine metabolite for PAH exposure.
11. The following signs and symptoms can be found in patients chronically exposed to PAHs
    1. Chloracne.
    2. Bronchitis.
    3. Vertigo.
    4. Exotropia.
    5. Cutaneous photosensitization.
12. The mechanism of PAH-induced carcinogenesis is believed to be which of the following?
    1. Covalent binding of PAH metabolites to DNA.
    2. Generation of active oxygen species.
    3. Cell-mediated inflammatory mechanisms.
    4. All of the above.
13. Reported health effects associated with chronic exposure to coal tar and its by-products (e.g., PAH) include
    1. Warts on sun-exposed areas of the skin, with progression to cancer.
    2. Irritation of the eyes.
    3. Bronchogenic cancer.
    4. Leukoplakia.
    5. Lymphoma.
14. In the treatment of patients with PAH exposure, which of the following is/are true?
    1. Education and future avoidance of exposure are important.
    2. Continued use of tobacco products should be discouraged.
    3. Treatment of acute exposure is largely symptomatic.
    4. The specific PAH should be determined so that an antidote can be prescribed.
    5. A fat biopsy is integral to medical surveillance of PAH-exposed patients.
15. Which of the following should be included in the differential diagnosis of a patient suffering from the chronic effects of PAH exposure?
    1. Pancytopenia.
    2. Hepatic angiosarcoma.
    3. Pancreatitis.
    4. Tuberculosis.
    5. Lung abscess.
16. Regarding PAH distribution, metabolism, and excretion, which are true?
    1. The liver and kidney are both involved in metabolism.
    2. Binding of PAH metabolites to DNA is believed to be the mechanism of PAH-induced carcinogenesis.
    3. Metabolized PAHs cannot be eliminated by hepatobiliary excretion.
    4. Excretion is through bile and urine.
    5. Calcium EDTA chelation enhances PAH excretion.
17. Which of the following statements is (are) true?
    1. Management of a worker exposed to PAHs includes bone marrow aspiration.
    2. PAH metabolites can cross the placental barrier.
    3. Acutely exposed skin should be decontaminated by gently scrubbing with a 10% iodine solution.
    4. Hair analysis can reveal past PAH exposure.
    5. The bay region theory attempts to explain why PAHs are found in bay waters.
18. What steps can patients take to reduce the risk of overexposure to PAHs?
    1. Minimize hobby and recreational PAH exposures.
    2. Avoid exposure to all forms of smoke.
    3. Stop smoking.
    4. Minimize dietary PAH exposure.
    5. All of the above.

Relevant Content

To review content relevant to the posttest questions, see:

What are PAHs?

What are PAHs?
Where are PAHs found?

Where are PAHs found?

Where are PAHs found?

What are routes of exposure for PAHs?

Who is at risk of PAH exposure?

Clinical Assessment

What are standards and regulations for PAH exposure?

What are standards and regulations for PAH exposure?

What is the biologic fate of PAHs in the body?

Clinical assessment

How do PAHs induce pathogenic changes?

What health effects are associated with PAH exposure?

How should patients exposed to PAHs be treated and managed?

Clinical assessment

What is the biologic fate of PAHs?
How do PAHs induce pathogenic changes?

What are routes of exposure for PAHs?

What instructions should be given to patients exposed to PAHs?