TOXIC INHALANTS QUIZ
Kent R. Olson, MD
California Poison Control System – SF Division
1) The U.S. Occupational Safety & Health Administration (OSHA) regulates exposures to toxic
gases, vapors and dusts in the workplace. Which of the following acronyms refers to the
OSHA exposure limit for an 8-hour time-weighted average exposure?
a)
b)
c)
d)
The Threshold Limit Value (TLV-TWA)
The Permissible Exposure Limit (PEL)
The Ceiling (C)
The Short-term Exposure Limit (STEL)
2) The air level considered “Immediately Dangerous to Life or Health” (IDLH) is:
a) The level sufficient to kill 50% of a test group of worker bees
b) Based originally on a 1-minute escape scenario
c) Used by OSHA to determine the need for respiratory protection (eg, self-contained
breathing apparatus [SCBA])
d) Not a real term
3) A 14 year old boy collapses 5 minutes after inhaling from a plastic bag filled with Freon. The
most likely pathophysiology involved is:
a) Acute CNS depression from the pharmacological effects of the chlorofluorocarbon vapor
b) Acute cardiac dysrhythmia resulting from sensitization of the myocardium to the effects
of epinephrine
c) Simple hypoxia
d) Prolonged QT interval leading to torsades-type ventricular tachycardia
4) Which of the following gases or vapors is most likely to cause a delayed-onset of chemical
pneumonitis (eg, more than 12-24 hours after the exposure)?
a)
b)
c)
d)
Sulfur dioxide
Chlorine
Phosgene
Ammonia
5) Five factory workers get a large breath of toluene di-isocyanate when a valve malfunctions.
They are standing outside when paramedics arrive, coughing and wheezing. What type of
decontamination procedure should they undergo before being medically treated and
transported to the hospital?
a) If their clothing and exposed skin are not wet or irritated, no decontamination is needed
b) Remove all clothing and thoroughly wash the skin with soapy water
c) Spray with a dilute bleach solution
d) Call the regional poison control center for advice
6) Several firefighters battling a blaze at a warehouse develop shortness of breath, dizziness and
palpitations. In the emergency department patient #1 is tachypneic, tachycardic (HR
120/min) and appears cyanotic (pulse oximetry 89%). His color fails to improve with highflow oxygen. Chest x-ray reveals no infiltrates, and he has no wheezing. He is most likely
suffering from:
a)
b)
c)
d)
Cyanide poisoning
Carbon monoxide poisoning
Methemoglobinemia
Hydrogen sulfide poisoning
7) Firefighter #2 was in another area of the warehouse. He was found by paramedics at the
scene with dyspnea, confusion and headache. Oximetry is 100%. Assuming the following
antidotes are all available to paramedics at the scene (I know that’s unlikely, but hey this is a
quiz, not the real world), which would you recommend?
a)
b)
c)
d)
Oxygen and hydroxocobalamin
Oxygen, sodium nitrite and sodium thiosulfate
Oxygen and methylene blue
Oxygen alone
8) Firefighter #3 was not at the warehouse. He had skipped duty to take his girlfriend to lunch.
In the storage room at her office, they accidentally knocked over a gas cylinder, and a brief
“whoosh” of garlicky-fishy smelling gas escaped. He spent a few minutes getting it under
control. Several hours later, he developed nausea, vomiting and flank pain, and went to the
emergency department, where he was found to have grossly dark brown urine and a
hematocrit of 21%. What was the most likely gas in the cylinder?
a)
b)
c)
d)
Arsine
Methylene chloride
Phosgene
Nitrous oxide
9) Which of the following characteristics of a volatile liquid would be likely to contribute to the
hazard of a spill in a low-lying, partly enclosed tunnel?
a)
b)
c)
d)
Vapor pressure
Vapor density
LC50
All of the above