<s>[INST] context: Clinical features of chronic lead poisoning/ plumbism/saturism:

 Facial pallor especially around mouth is the earliest and most consistent sign
 Polycythemia with polychromatophilia followed by anemia with punctate basophilia (basophilic stippling), reticulocytosis, poikilocytosis, nucleated RBC(sideroblasts), increased neutrophils & decreased platelets are seen in early stages.
 Stippled blue line known as Burtonian or lead line is seen on gums, only near carious teeth in upper jaw as an early sign.

It is bluish black epithelial deposition of lead sulphide granules on gums. Similar blue line may also be seen in mercury; copper, silver, bismuth & iron poisoning.

 Colic & constipation is a late manifestation
 Paralysis, encephalopathy, cardiovascular, renal & reproductive system manifestations are late manifestations,
 Tremors, numbness, hyperesthesia & cramps preceding actual muscle paralysis more commonly involve muscle groups prone to fatigue .
 Paralysis is associated with muscle atrophy Sc nerve degeneration due to interference with resynthesis of phosphocreatinine.
 Encephalopathy is present in every case but is more common in children Sc in poisoning by tetra ethyl lead salt.
 Menstrual derangements (amenorrhoea, dysmenorrhoea, menorrhagia), abortion (between 3-6 months), dead fetus & sterility in both sexes.
 Vascular constriction due to lead results in hypertension & interstitial nephritis. [/INST] question: Burtonian lines on gums is seen in poisoning with | options: A: Lead B: Mercury C: Arsenic D: Zinc | answer: A </s>