Occupational Medicine 1 And 2

Front 1

Chest tightness on Mondaymorning, better as week progresses

Back 1

Byssinosis (cotton, flax, hemp, or sisal or other fiberous material)

Front 2

angina symptomdeveloped after withdrawal (over weekends)– “Monday Morning death”

Back 2

Nitroglycerin workers/explosive workers:

Also increased risk of CHD, even when exposure removed; increased risk of sudden death

Front 3

OSHA 300 LOG

Back 3

Employers must record all new cases of workrelated fatalities, injuries and illnesses if theyinvolve:– Death– Days away from work– Medical treatment beyond first aid– Loss of consciousness, or– A significant injury or illness diagnosed by aphysician or other licensed health careprofessional

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Which labor sector has the highest injury/illness rate?

Back 4

Goods-Producingsector– Manufacturing highest within goodsproducingsector

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the Service sector, which has the highest injury/illness rate?

Back 5

Transportation & public utilities highestin Service sector

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“Normal” FEV-1 & FVC

Back 6

usually both ≥ 80%of predicted value

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“Normal” FEV-1/FVC ratio

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≥ 70% predicted

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Back 8

Spirometry chart

Front 9

Most common occupational lung disease

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silicosis

Associated with lung cancer

Front 10

progression through increasinglysevere disease stages– small rounded opacities → confluentopacities → progressive massive fibrosis• Spirometry shows restrictive pattern• Carcinogenic

Back 10

silicosis

These pts are at risk of TB (+PPD >10mm)

Front 11

Spirometry is primarily obstructive initially,restrictive in later phases

Back 11

Coal Workers’Pneumoconiosis

Associate with Kaplans syndrome and other rheumatic diseases

Front 12

Most common type of asbestos?

Back 12

chrysotile (serpentine)

Front 13

protein coated fiberwhich contains iron (ferruginous body)

Back 13

Asbestos body

Front 14

True or false? Smoking + asbestos = increased risk for mesothelioma

Back 14

False. Increased risk of bronchogenic carcinoma.

Note that mesothelioma develops after lung cancer~25 years. From earliest to latest: benign pleural effusion->plaque-> asbestos-> Meso

Front 15

High single irritant exposures may cause

Back 15

Reactive Airways Dysfunction Syndrome(RADS)

http://www.medscape.com/viewarticle/722307_1

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Spirometry features for occupational asthma:

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Obstructive

Reduced FEV1 , Normal FVCReduced mid-flow volumes & PEFRReversibility

Front 17

“Monday morning fever”

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Exposure to freshly generated metal fumes- primarily zinc in galvanized steel.

Front 18

Byssinosis-Obstructive or restrictive

Back 18

Restrictive

Front 19

True or false water soluble chemical settle in lower airways?

Back 19

False-upper airways

Water insoluble settle in lower are ways.

Upper: S02, HCL, H2SO4, ammonia, chlorine

Lower: No2 (silo filler's disease), phosgene, ozone

Front 20

Determinates of pulmonary toxicity

Back 20

particle size

solubility

Agent

Front 21

Examples of water soluble pulmonary toxins?

Back 21

– Ammonia, chlorine, formaldehyde– Sulfur dioxide

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Examples of water insoluble pulmonary toxins?

Back 22

– Nitrogen oxides (Silo-filler’s disease)– Phosgene (COCl2 ) - hydrolyzes in lung toHCl

Front 23

When should imaging be done for low back pain?

Back 23

Avoid imaging unless red flags, or notimproved in 4-6 weeks

Front 24

True or false. Most people with carpal tunnel syndrome have motor weakness?

Back 24

False. The median nerve is 90% sensory. Motor weakness is a late sign

Front 25

At risk groups for carpal tunnel syndrome?

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– Meat, fish, poultry workers– Garment workers– Assemblers, electricians

Front 26

Most common occupational skindisease

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70-80% exposure to irritants

20-30% from exposure to allergens

Irritant contact derm= type I hypersen rx

Allergic=type 4

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Back 27

Irritant contact dermatis in a cement worker

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What type of rxn is allergic contact dermatitis?

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Cell-mediated immune response –Type IV delayed cellular immunity (like PPD reaction

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Hives after direct contact•Immediate reaction – often seconds to minutes•Immunologic: IgE-mediated Type I allergy–or non-immunologic (Histamine release)•Other Type I sx may accompany (rhinitis, asthma)•Anaphylaxis is possible

Back 29

Contact Urticaria

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Allergic contact dermatis

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Front 31

Examples of occupational agents causing Increased melanin production

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Coal tar pitch• Psoralens• Heavy metals (Arsenic)• Ionizing and nonionizing radiation

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Occupations at risk for stap/strep skin infections

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Barbers, beauticians, butchers

Front 33

Lead inhibits which enzyme?

Back 33

–Delta-aminolevulinic dehydratase (ALA-D)

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OSHA standard for blood lead levels

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< 40 ug/dl

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Back 35

Chromium toxicity

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Consequences of Chromium exposure.

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Painless skin ulcers (chrome holes) •Lung cancer•Pulmonary irritant•Renal tubular acidosis•Hepatic necrosis

Front 37

Sources of cadium exposure

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industry, hobbies( use of colored pigments), cigarette smoking

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target organ(s) for cadium

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Kidney and liver

*causes: HTN, prostate, bladder Cancer; osteoporosis from CA+ waisting (Ouch, ouch disease)

Front 39

Metals causing lung cancer

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Arsenic

Cadium

Chromium

Beryllium

Nickel

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occupational sources of phosphorus.

Back 40

Munitions, flares, match production

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Sources of occupation phosphorus exposure

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Munitions, flares, match production

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Consequences of phosphorus exposure

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Phossy jaw–Bone necrosis

Front 43

Nuclear industries, metal reclamation•Used in alloys – risk to dental technicians•Risk to household contacts of workers•Exposure by inhalation

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Beryllium

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Beryllium toxicity

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•Acute – conjunctivitis, pneumonitis•Chronic – )–Lung and skin granulomas–Cough and exertional dyspnea–Interstitial abnormalities on chest X-ray

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90 dBA 8 hour TWA –

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OSHA PEL for hearing conservation

Front 46

Cancer of the paranasal sinuses and lungs

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Nickel

*Also#1 cause of contact dermatis

* can cause occupational asthma

Front 47

Central nervous system toxicants

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•Carbon disulfide•Chlorinated hydrocarbons•Carbon monoxide (CO)•Metals – arsenic, lead (epilepsy), manganese (Parkinsons), mercury•Solvents – benzene, halothane, methylene chloride, perchloroethylene (PERC), styrene, toluene, trichloroethylene (TCE)

Front 48

N-hexane & methyl n-butylketone cause...?

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peripheral neuropathy; generally lower first, sensory before motor

Front 49

Toulene causes...?

Back 49

encephalopathy

Front 50

Cobalt & manganese affect...?

Back 50

basal ganglia

Front 51

Causes of Parkinsonism from occupational exposure?

Back 51

Carbon disulfide•Carbon monoxide•Manganese•N-methyl-4-phenyltetrahydropyridine (MPTP)

Front 52

N-hexane & methyl n-butylketone cause...?

Back 52

peripheral neuropathy

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Toulene causes...?

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renal tubular necrosis

Front 54

Carbon tetrachloride causes?

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Myocardial sensitization

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Methyl bromide (used by model building hobbyists for joining plastic components together) causes...?

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seizures

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“Painter’s Syndrome” =

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headaches, dizziness, asthenia, mood and personality change, inattentiveness, forgetfulness, and depression

Front 57

OSHA action level for hearing conversation

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Integrated, continuous, or intermittent noise levels of 85 dBA or greater

Front 58

What is the OSHA Hazard communication Standard?

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Employees must be made aware of possible occupational hazards. Employers must post a material data safety sheet.

Front 59

What are some key differences b/t irritant contact dermatitis and allergic contact dermatits?

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1) ICD requires a high exposure to the agent and affects most people; ACD only requires a small amount of exposure and affects few people.

2. ACD rash may be pruritis and a sysmetrical

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Usually enters through the skin. Used as a wood preservative. Interferes with cellular respiration. Causes anorexia and respiratormtooms. In high doses, coma a nd death

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Pentachlorophenol

Front 61

Absorbed readily through the lungs. Damages kidney and liver

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Carbon tetraflouride

Front 62

Enters the body through the lungs and stimulates the respiratory system. When concentrations reach 3%, causes rapid breathing

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carbon dioxide

Front 63

Enters the nody via the lungs or GI tract. Is a chemical asphyxiant. Causes headaches, parid breathing, and frequently death

Back 63

Hydrogen cyanide

Front 64

Absorbed through the lungs and skin. Used to make plastics. Causes sclerodematous skin lesions, Raynaud phenomenon, bone lesion is the had, and liver damage. Can cause hemangoscarcomia of the liver.

Back 64

Vinyl chloride

Front 65

Common causes and occupations associated with Irritant Dermatitis

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*Fiberglass - construction

* Oil - machining

* Solvent - painting, cleaning

* Detergent -housekeeping, cosmetology

* Cement- Construction

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Common causes and occupations associated withcontact Dermatitis

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* Latex or rubber - lab and health workers

* Nickel - electroplating

* Colophony

*Epoxy resin painting

* Hair dye -cosmetology

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Occupational asthma agents and associated industries

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*Isocynates - wood industry

* Wood dust - wood work

* Wheat flour

* Cutting oils - machining

Front 68

1) Is the evidence based on a testable theory or technique?

2) Has the theory or technique been per reviewed?

3) In the case of a particular technique, does it have a known error rate and standards controlling his technique's?

4) Is the underlying science generally accepted?

Back 68

Daubert criteria

Front 69

How many times greater is the radiation from exposure from a chest x Ray than from the normal yearly background radiation

Back 69

20x

Front 70

In 2010, how many workers sustained a work related injury or illness?

Back 70

3.5%

Front 71

Please select the best match.a. OSHA; RELb. NIOSH; PELc. REL; STELd. ACGIH; BEI

Back 71

Correct answer: D. OSHA=Permissible exposure limits (PEL)

NIOSH=Recommended exposure limits (REL)

ACGIH=Biological exposure index (BEI) and short-term exposure limits (STEL)

Front 72

Who are these exposures measured? Lead, organophasates, benzene, arsenic?

Back 72

Organophosphates- inhibition of RBC and plasma cholinesterase

*Benzene: urine metabolite

* Arsenic: urine

*lead: blood

Front 73

Low back pain: disc pathology

Back 73

L4: numbness mostly above knee, weakness on quad ext., decread knee jerk

L5: -week dorsiflexion of great big toe and foot

21: lat foot and toe numbness, dec ankle jerk

Front 74

Imagining guidelines for low back pain

Back 74

Unless red flags, no imaging for <1 month; MIR 4-6 weaks for sub-acute or radicular pain. Most people have asymptomatic disc pathology. Thus, not great corelation between disease and discs

Front 75

Causes of carpel tunnel syndrome?

Back 75

Occupations, DM, obesity, RA, pregnancy. Keyboarding is contraversal

Front 76

Please select the best match.a. OSHA; RELb. NIOSH; PELc. REL; STELd. ACGIH; BEI

Back 76

Correct answer: D. OSHA=Permissible exposure limits (PEL)

NIOSH=Recommended exposure limits (REL)

ACGIH=Biological exposure index (BEI) and short-term exposure limits (STEL)

Front 77

Who are these exposures measured? Lead, organophasates, benzene, arsenic?

Back 77

Organophosphates- inhibition of RBC and plasma cholinesterase

*Benzene: urine metabolite

* Arsenic: urine

*lead: blood

Front 78

Low back pain: disc pathology

Back 78

L4: numbness mostly above knee, weakness on quad ext., decread knee jerk

L5: -week dorsiflexion of great big toe and foot

S1: lat foot and toe numbness, dec ankle jerk

Front 79

Imagining guidelines for low back pain

Back 79

Unless red flags, no imaging for <1 month; MIR 4-6 weaks for sub-acute or radicular pain. Most people have asymptomatic disc pathology. Thus, not great corelation between disease and discs

Front 80

Causes of carpel tunnel syndrome?

Back 80

Occupations, DM, obesity, RA, pregnancy. Keyboarding is contraversal

Front 81

Risk factors for carpal tunnel syndrome

Back 81

occupations, DM, obesity, RA, pregnancy. Keyboarding is controversal.

Front 82

Arsenic sources?

Back 82

Sources: pesticides, lumbar, mining, smelting, glass, pharma, mines, electroplating

Front 83

Effects of chronic arsenic exposure?

Back 83

Hyperpigmentation, neuropathy (sen>motor), megablastic anemia, sking, lung, bladder CA

* EPA standard <10 mcg/L

Front 84

True or false? perpheral Neuropath in lead poisoning is more motor than sensory

Back 84

True

Front 85

Sx of organophosphate poisoning? Atropine

Back 85

"DUMBBELLS"

Diarrhoea

Urination

Miosis

Bradycardia

Bronchorrhea

Emnesis

Lacrymation

Salivation

Front 86

How long to a PPD becomes positive?

Back 86

2-10 weeks

Front 87

Given a positive ppd, what is the risk of developing active tb?

Back 87

5-15%

But 30% if HIV positive

Front 88

Which occupation setting has a higher risk of having a positive ppd? Nursing home or prison

Back 88

Nursing homes (10-40% have positive ppd).

Front 89

Is a prior BCG vaccination a contraindication to occupation PPD testing?

Back 89

No

Front 90

Can a health worker with latent TB continue to work?

Back 90

Yes, even without treatment, as long as no evidence of active TB. They pose no risk.

Front 91

What are PCB?

Back 91

Use: coolants and insulating fluids (transformer oil) for transformers and capacitors, such as those used in old fluorescent light ballasts.[13] PCBs were also used as plasticizers in paints and cements, stabilizing additives in flexible PVC coatings of electrical wiring and electronic components, pesticide extenders, cutting oils, reactive flame retardants, lubricating oils, hydraulic fluids, and sealants

Exposure: air, food, breast milk, skin

Acute high dose: chlorachne

Children: low IQ, dec immunity

Crash dieter at increased risk because concentrate PCPs

Cancer: rare liver CA, and also melanoma

Control: incineration, irradiation, others

Banned since 1970

Front 92

Dose response assessment

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2nd step in risk assessment: quantitative relationship between exposure and toxic effect

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quantitative estimate of population and individual exposure to a chemical under expected exposure situations

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Step 3: exposure assessment

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- integration of the toxic effect, dose-response, and exposure assessment information in order to estimate the risk associated with particular exposures

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Risk characterization, last step in hazard evaluation

Front 95

What are Polycyclic Aromatic Hydrocarbons?

Back 95

Source: incomplete combustion of carbon-containing fuels such as wood, coal, diesel, fat, tobacco, and incense.

+Cancer: lung, skin, bladder, kidney, GI, liver CA

Front 96

Screening for Hep B among workers?

Back 96

Don't check titer EXCEPT in HCWs. Check titers in 1-6 mo (1-2 mo ideal)

Front 97

What is the risk of Hep B after a needle stick?

Back 97

2-40%

Front 98

Hep B post-exposure ppx from high risk/positive source?

Back 98

1) Determine vaccination status

2) Check titers in previously vaccinated: < 10 consider additional HB vac; > no rx, immune

3) No vac: 1 dose HBIG and start vac

Front 99

What is the risk of acquiring Hep C after a needle stick?

Back 99

Seroconversion rates after needlestick injury 1.8% (range 0 - 7%

Front 100

What is the post-exposure prophylasix for HCV?

Back 100

There is no effective PEP. Test and follow.

Front 101

What are the main differences between FIFRA and TSCA?

Back 101

FIFRA: Labeling, registration, and setting tolerance standards

TSCA: prevent new hazardous chemicals from entering the market; producer must study environmental impact. Does NOT regulate pesticides

Front 102

Maxium contaminant levels set at zero under EPA safe drinking water act?

Back 102

Short list: crypto, giardia, legionella, enteric viruses; Arsenic, lead,benzene, dioxin, PCB, PAH.

Mercury=0.002

Front 103

determination of the health effects or toxicological endpoints that result from exposure to a chemical

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1st step in risk assessment: Hazard identification

Front 104

What dose response relationships hold true for carcinogenesis?

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Back (Definition)

Front 105

Front (Term)

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Chemical warfair agents

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Front (Term)

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Hypothermia

Front 107

Anthropogenic natural disasters

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Man made natural disasters

Front 108

What is the post exposure prophylaxis for anthrax?

Back 108

Cipro/doxycycline for 60 days: rx is 400 mg Cipro IV q12 hr

Front 109

PEP for tularemia!

Back 109

Same as anthrax. Rx is streptomycin or gentamicin

Front 110

Category A terrorism agents transmitted by droplets?

Back 110

1) small pox

2) plague

3) botulism( not contagious but could be aerosolized

Ebola is NOT airborne ( transmitted through bodily fluids, semen, blood)

Front 111

Which toxins producing organism have an association with cancer: fusarium, aflatoxin, claviceps purpua ( weight alkaloids)

Back 111

fusarium-esophagus

aflatoxin-liver

Front 112

Carb oxyhemoglobin levels digestive of poising ?

Back 112

10%

O2 sat unreliable. ABGs for monitoring respiratory status and oxygenation of perperal tissues

Front 113

What businesses are exempt from OSHA duty cause?

Back 113

1) family farms

2) self employed

3) public employees (except federal ) unless they have adopted OHSA standard

Front 114

Carpal tunnel syndrome is characterized by which of the following?

A)

Hypothenar muscle atrophy in severe or longstanding cases

Correct answerB)

Nocturnal paresthesias

C)

Numbness in the 4th and 5th fingers

D)

Reduced sensory latency in the median and ipsilateral ulnar nerves

Back 114

Answer: B. Carpal tunnel syndrome (CTS) results from compression of the median nerve at the wrist. Symptoms include burning or tingling in the palm of the hand and fingers, often occurring at night because many people sleep with flexed wrists. Classic symptoms are usually described in the thumb-3rd fingers, the areas innervated by the median nerve. Muscular innervation of the median nerve encompasses the thenar muscles, particularly the abductor pollicis brevis, but not the hypothenar muscles (supplied by the ulnar nerve). Guyon’s canal, through which the ulnar nerve passes at the wrist, is relatively spacious, therefore the ulnar nerve is usually unaffected by pressure in the carpal tunnel, and has normal conduction velocity and latency in CTS cases.

Front 115

Chronic exposure to cadium can cause this

Back 115

Fanconi syndrome: a disease of the proximal renal tubules[1] of the kidney in which glucose, amino acids, uric acid, phosphate and bicarbonate are passed into the urine, instead of being reabsorbed. Fanconi syndrome affects the proximal tubule, which is the first part of the tubule to process fluid after it is filtered through the glomerulus. It may be inherited, or caused by drugs or heavy metals.

Back 116

Back (Definition)