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A 36-year-old man who works at an explosives factory comes to the clinic for an annual check-up. He is concerned about long-term exposure to industrial chemicals. He reports that although he is in excellent health otherwise, he experiences headaches, dizziness, and palpitations every Monday. Laboratory tests show:
Na+: 137 mEq/L
K+: 3.4 mEq/L
Cl–: 102 mEq/L
HCO3–: 24 mEq/L
Blood urea nitrogen: 12 mg/dL Creatinine: 1.0 mg/dL
WBC count: 8000/mm3 Platelet count: 310,000/mm3 Hematocrit: 46% Hemoglobin: 15 g/dL
An ECG shows normal sinus rhythm with no Q wave changes. Which of the following is the most likely serious complication that can occur as a result of his exposure?
(A) Anemia
(B) Atherosclerosis
(C) Cardiac arrest
(D) Congestive heart failure (E) Dementia
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1 Answer

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The correct answer is C. This patient’s symptoms suggest that he is experiencing nitroglycerine withdrawal. Nitroglycerine is a vasodilator. Chronic industrial exposure leads to tolerance for vasodilatation on work days and a compensatory vasoconstriction on weekends when the exposure is removed, thus resulting in the “Monday disease.” The most severe consequence is when the compensatory vasoconstriction is un- opposed in critical areas such as the coronary vessels, leading to non-atherosclerotic-related ischemia.


Answer A is incorrect. Anemia can be a result of lead or other heavy metal poisoning, but not nitroglycerine.

Answer B is incorrect. Atherosclerosis is formed by fatty streak deposition, which along with endothelial damage results in plaque formation over time. It is not linked to nitroglycerine exposure.

Answer D is incorrect. Congestive heart failure can be a complication of long-term coronary artery disease or a myocardial infarction, but not of nitroglycerine exposure.

Answer E is incorrect. Dementia can be a result of neurotoxin exposures (eg., mercury). Nitroglycerine exposure does not cause dementia.