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OEM Midterm > Intro to Occ Med > Flashcards

Intro to Occ Med Flashcards

1
Q

What does a sewage system backup with a “rotten egg smell” indicate?

A

Hydrogen sulfide fumes

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2
Q

What would happen if a construction worker entered a manhole with H2S fumes?

A

Overcome by fumes and became unconscious

no air supply

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3
Q

What toxic gas was responsible for the incident involving the construction workers in Florida?

Miami

A

Hydrogen sulfide fumes, confined space, no SCBA

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4
Q

Who is considered the first physician to teach that diseases are the result of physical causes?

A

Hippocrates

Born in 460 B.C. on the Greek island of Kos.

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5
Q

What components of the environment did Hippocrates consider?

A

Dwellings
Climate
Water quality
Diet/Exercise
Socioeconomic factors

Air, water, places… way of life

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6
Q

What question did Bernardino Ramazzini add to the inquiry about health?

A

What is your occupation?

Should be able to work without sickness. Pulm tox, ergonomics.

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7
Q

Who was the pioneer of American Industrial Medicine?

A

Alice Hamilton

She was the first woman Harvard Professor in 1919. Industrial Poisons, The Dangerious Trades.

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8
Q

What conditions did Alice Hamilton investigate related to occupational hazards?

A
  • Lead poisoning among bathtub enamelers
  • Phossy jaw in matchmakers
  • Mercury poisoning among hatters
  • Vibration dead fingers syndrome in jackhammer operators
  • Anemia in workers exposed to benzene

These conditions highlight the dangers of occupational exposures. LFMVAb

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9
Q

What disaster highlighted occupational hazards as a public health problem and galvanized legislation in the U.S.?

A

Gauley Bridge-Hawks Nest Tunnel Disaster

3-mile tunnel, 1930s, West Virgnia

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10
Q

Where/when did the Gauley Bridge-Hawks Nest Tunnel Disaster occur?

A

1930s
West Virginia

3-mile tunnel, unemployed men, many African Americans (3/4)

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11
Q

What was the main occupational exposure in the Hawks Nest Tunnel Disaster? How many became ill/died?

A

silica dust, dry drilling
high quartz sandstone content in mountain
50% developed silicosis (764 died, 1500+ disabled)

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12
Q

What did medical researcher Irving Selikoff’s studies link asbestos exposure to?

A
  • Fibrosis (asbestosis)
  • Lung cancer
  • Mesothelioma
  • Other cancers

multiplicative effect of cigarette smoking on lung CA; Mt. Sinai Medical School

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13
Q

What organization was formed in 1916 related to occupational medicine?

A

American Association of Industrial Physicians and Surgeons

This organization laid the groundwork for the field of occupational medicine.

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14
Q

What was the exposure in the Hawks Nest Tunnel Diasaster?

A

High quartz content in mountain
Dry drilling techniques, silica dust (90-95%)

476 (764) deaths and 1500 disabled, congressional hearing

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15
Q

When did the American Board of Preventive
Medicine add occupational medicine?

A

1955

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16
Q

When did ACOM add the “E” to become ACOEM?

A

Environmental, 1990s

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17
Q

Which medical researcher found multiplicative effect of cigarette smoking on lung cancer (with asbestos)?

A

Irving Selikoff

Mt. Sinai Medical School (1920-1992)

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18
Q

What is the role of the OEM practioner?

A
  • Individuals (illness, injury, PPE, accomodations, FFD, RTW eval, IME)
  • Hazards (exposures, job tasks, environmental conditions; walk thrus)
  • Populations (illness cluster, cohort health, group risk assessment)
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19
Q

What is it called when workers are at work/present but not well?

A

Presenteeism

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20
Q

Which employees generate the most healthcare costs?

A

Employees with chronic conditions

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21
Q

What is the primary diagnostic tool in Occupational and Environmental Medicine?

A

A careful history

Possible relations to work, home, or other activities. Previous jobs.

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22
Q

When did the American Board of Preventive Medicine add occ med?

A

1955

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23
Q

What should be documented first when assessing a specific exposure?

A
  • Relevant historical data
  • Labels from chemicals; lists
  • Material Safety Data Sheets (MSDS)
  • Prior OSHA reports
  • Medical records, prior medical evals

This documentation helps in understanding potential exposures.

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24
Q

When did ACOM become ACOEM?

A

1990’s

E for environmental

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25
What is UN 1790?
Hydrofluoric acid
26
What effects does hydrofluoric acid have?
Systemic electrolyte disturbances: hypocalcemia, hyperK+ (QT prolongation, Torsades) Swelling, blanching, pain OOP Coagulation necrosis, fingertips, subungual ## Footnote F- highly lipophilic, deep tissue penetration
27
Important components of the exposure HPI?
Potential and known exposures Probable routes Rate (dose x duration)
28
Caveats of temporal relationships?
Allergic diseases require latency, reactions sometimes delayed If symptoms chronic and disease progresses, may not experience relief away from inciting environment ## Footnote Cancer, asbestosis (15-30 year latency)
29
What are common symptoms of sudden cardiac death in a work-related context?
* Significant respiratory distress * Pallor and clamminess * Strenuous exposure (physical altercation) * increased HR, BP, flight or flight response (epinephrine, norepinephrine, cortisol) ## Footnote These symptoms can indicate severe stress or exposure to hazardous situations.
30
Roles of the OEM practitioner? ## Footnote vs. evaluate and treat individual sick patients
* Individuals (illness, injury, PPE, RTW eval, accomodations, IME) * Hazards (exposures, job tasks, environmental conditions) * Populations (illness clusters, ongoing cohort helath, risk assessment for groups) ## Footnote IME = impairment and etiology
31
What are the major toxic components of cigarette smoke?
* Nicotine * Catechols * N'-Nitrosonor-nicotine * Phenol * Polynuclear aromatic hydrocarbons * β-Napthylamine * Nickel (Carbonyl) * Cadmium * Arsenic * Polonium-210 * Carbon monoxide * Acetylaldehyde * Nitrogen oxides * Hydrogen cyanide * Acrolein * Ammonia * Formaldehyde * Urethane * Hydrazine * Nitrosamines ## Footnote These components pose various health risks, including cancer and respiratory issues.
32
What type of effects can combined occupational exposures have?
Synergistic/multiplicative effects ## Footnote This means that the combined effect of exposures can be greater than the sum of their individual effects.
33
Cigarette smoking and occupational and environmental exposures?
Vehicle for exposure (e.g. lead dust) Transformation into a more harmful form (e.g. teflon and polymer fume fever) Additive exposures (e.g. CO) Synergistic/multiplicative effects (e.g. Lung Ca) Additive impairment (e.g. COPD & asbestosis) Fire and non-fire related accidents increased
34
What components of a patient's home surroundings should you consider?
* Neighborhood external pollution: nearby industry, demo, dump; water supply; work clothes; acute disaster (e.g., wildfires) * Internal household pollutants: chemicals, pets, hobbies (bird fancier's lung), accidents
35
What should be included in a complete physical examination for occupational health?
* Skin * HEENT * Chest * GI * Musculoskeletal * Neurological ## Footnote DOCUMENT THE PATHOLOGY
36
What lab tests should you obtain?
* Biomarkers - specific toxin, metabolite of (e.g., BLL) * effect marker (CBC, UA, biopsy, x-rays, SMAC = CMP + amylase, CK, GGT, LDH, lactic acid, lipids, Mg, phosphate, uric acid
37
What are tests of functionality?
Audiogram, PFTs, neuropsychological testing, exercise testing, respiratory challenge testing
38
What is a significant finding in a case of a 26-year-old male with persistent headaches? With possible exacerbation by fumes at workplace?
COHb 21% ## Footnote exogenous carbon monoxide exposure, >9% (vs. less than 2% in non-smokers, less than 5% in smokers)
39
What should be done at the work site when making the diagnosis?
Consider conducting a 'walk through' or Industrial Hygiene consult ## Footnote Obtain results of previous environmental testing, if available.
40
What is methylene chloride?
MeCl2: Methylene chloride is transformed to carbon monoxide (CO) in the body, increased carboxyhemoglobin (COHb) concentrations
41
What is the first step in the diagnosis process regarding exposure?
Assess temporal relationship between the exposure and subsequent development of the problem ## Footnote MAKE THE DX
42
What is evaluated after temporality in the diagnosis process?
Dose of toxic exposure adequate or patient particularly sensistive to effects of exposure
43
What does the final step of the diagnosis process involve?
Rule out other diseases that could cause the same outcome. Decide whether it's an exacerbation of a pre-existing disease.
44
What's the plan/disposition?
Continue/return to work, any modifications or restrictions
45
What are the 3 steps?
Document the exposure Document the pathology Make the diagnosis
46
What is the purpose of primary prevention?
To decrease/eliminate exposures: * pre-market testing * elimination/subsitution * engineering controls ## Footnote vs. just PPE
47
What type of monitoring involves assessing ambient exposure?
Exposure Assessment ## Footnote Potential exposures, ambient exposure & biological monitoring; estimate probable routes, rate (dose x duration)
48
What are two methods of environmental monitoring?
* area sampling * personal dosimetry
49
What does biological monitoring measure?
biomarkers: measure the chemical or metabolite levels in biological samples
50
What is an example of a biomarker in biological monitoring?
CO in exhaled breath or COHb in blood, BLL, 24-hour urine Hg or As
51
What are effect markers?
Biological monitoring, measure response in an end organ: * LFT, renal function, CBC * spirometry/PFT * CXR * audiometry
52
Fill in the blank: Screening aims for *presumptive* identification of *unrecognized* disease in apparently _______.
well persons ## Footnote ideally, detects disease at a reversible/treatable stage
53
What is the ideal characteristic of a screening program regarding the population?
Population is at risk
54
What are the ideal characteristics of a screening program regarding the condition?
Condition is * of significant concern * amenable to an intervention
55
What characteristic should the ideal screening test have regarding invasiveness?
Simple, Non-invasive & Rapid
56
True or False: High specificity is a desired characteristic of a screening test.
True ## Footnote Also high sensitivity and predictive values (+ & -)
57
What happens with positive or suspicious screening tests?
Refer for follow-up, definitive diagnostic test
58
What does 'yield' refer to in screening?
Number or proportion of unrecognized cases detected in a population
59
What does reliability refer to in screening?
Reproducibility or consistency of results (precision?)
60
What does validity refer to in screening?
Extent that test actually determines what it is supposed to measure (accuracy?)
61
What is the primary medical cause of excessive daytime sleepiness (EDS)?
Obstructive Sleep Apnea (OSA)
62
What was the impact of untreated OSA on crash risk according to the systematic review?
Increases the risk of crash by 1.2 to 5 fold ## Footnote risk decreased with CPAP
63
What is an example of medical monitoring/surveillance?
bio monitoring, screening tests, OSHA-mandated exams, baseline/periodic exams, drug testing ## Footnote individuals/groups w/ common exposures/hazards
64
What does hazard surveillance monitor?
Exposure to chemicals or other hazards ## Footnote EPA monitors air pollution; data from facilities
65
What are some public health surveillance examples?
Cancer registries, lead toxin registries, slips/falls? ## Footnote monitor health events in a population
66
What percentage of their time do adults spend at work?
~1/3
67
What is estimated to contribute to 50-70,000 deaths/year in the US?
Work exposures ## Footnote +350,000 new illness cases
68
What is the estimated number of traumatic occupational injuries/year in the US? Fatalities?
10 million 10,000
69
What are the environmental impacts on health?
Air, Water and Food Pollution, Housing Conditions, Socioeconomic, Lifestyle (diet, exercise), Climate
70

OEM Midterm (2 decks)

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