Excess of the following in water causes skin pigmentation, mellanoids and excessive keratosis of skin

UPPSC 2017

Community Health Nursing

Easy

Appeared in: UPPSC 2017

Explanation

Chronic exposure to arsenic, most commonly through contaminated drinking water, is the primary cause of the symptoms described.
This condition, known as arsenicosis, has classic dermatological manifestations due to arsenic's effect on skin cells.
The key signs are hyperpigmentation (melanosis), which can appear as diffuse darkening or a 'raindrop' pattern, and hyperkeratosis, a thickening of the skin, particularly on the palms and soles.

Option A: Excess fluorine causes fluorosis, which affects teeth (dental mottling) and bones (skeletal fluorosis), not the skin manifestations of pigmentation and keratosis.
Option B: Excess calcium in water contributes to water hardness and is not associated with toxic effects like skin pigmentation or keratosis.
Option D: Imbalances in iodine primarily affect the thyroid gland, leading to conditions like goiter or hypothyroidism. While skin can be affected (e.g., dry skin in hypothyroidism), it does not cause the specific combination of melanosis and keratosis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Environmental Toxicology: Heavy Metal Poisoning as background academic context rather than a clinical decision trigger.
Nurses, particularly in public health and community settings, must be vigilant for signs of environmental toxicity. Recognizing the unique skin changes of arsenicosis can lead to early identification of contaminated water sources.
Patient education is a key nursing role. This includes teaching communities about safe water practices and the importance of reporting unusual clusters of health problems to local health authorities.
What if? If the exposure to arsenic was acute (a single large dose) instead of chronic, the primary symptoms would be severe gastrointestinal distress (nausea, vomiting, 'rice-water' diarrhea), hypotension, and shock, rather than the slow-developing skin lesions.

How to Approach the Question

First, identify the key clinical signs presented in the question stem: 'skin pigmentation' (melanosis) and 'excessive keratosis' (skin thickening).
Recognize that these are specific dermatological findings linked to a chronic toxic exposure.
Systematically evaluate each option based on its known toxicological profile.
Eliminate Fluorine by recalling its effects on teeth and bones (fluorosis).
Eliminate Calcium as it's not associated with this type of skin toxicity from water.
Eliminate Iodine by linking it primarily to thyroid disorders.

Concept Tested & Keywords

Concept Tested: Environmental Toxicology: Heavy Metal Poisoning
Stem keywords: excess in water, skin pigmentation, mellanoids, excessive keratosis
Lead-in keywords: causes

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