Exam

Question 1

Full Service EAP

Answer 1

Internal or external EAP covering a variety of services
Most likely to provide:
Crisis management and critical incident debriefing
Employee counseling in response to worksite changes (i.e. downsizing)
Innovators in developing new services such as HIV, legal, and financial counseling
Disability management
Elder and child care assistance
Risk management and prevention

Expensive to operate

Question 2

The Integrated Program (EAP)

Answer 2

Utilizes combination of in-program services and referrals
Focuses on behavioral health benefit management by merging managed behavioral health care and employee assistance services
Attempt to unify assessment, service, and benefit management
Reduce administrative overhead (cost) and improve efficiency
Most common with larger, self-insured companies and large internal union groups

Question 3

Wrap-Around EAP

Answer 3

Developed by smaller employers
Response to restrictions imposed by managed care on the use of mental health services
Smaller employers contract with EAP’s to provide access to outpatient behavioral health benefits

Question 4

Compliance EAP

Answer 4

Monitor and comply with conditions of Drug-free Workplace Act, DoT and various State regulations, etc.
Relatively few of these programs
Often used as the least expensive mechanism to comply with regulations (instead of offering substance abuse programs, etc.)
Central elements: Alcohol and drug testing, counseling services for detected abusers, medical review officer services.

Question 5

Peer-assistance programs

Answer 5

Operated by labor and professional groups to support their membership
Typically adopted to serve workers who are not provided with EAP coverage by their employers due to:
Small size of company or contract worker status
Mobility or geographical dispersion of employee group
Worker-employer relationship (i.e. contracted labor)
May also be implemented by workers who have a concern about confidentiality of EAP services
Typically rely on trained peer counselors and referral agents often with referral to self-help groups

Question 6

Which types of workplace violence are most common?

Answer 6

Types II and III are most common

Question 7

Type I Workplace Violence

Answer 7

no association with the workplace

Question 8

Type II Workplace Violence

Answer 8

customer or patient (customer/client)

Question 9

Type III Workplace Violence

Answer 9

current or former employee (worker-on-worker)

Question 10

Type IV Workplace Violence

Answer 10

personal relationship with employee only (not organization)

Question 11

mercury poisoning

Answer 11

used in production of felt when making hats led to the poisoning of some hat makers
At low-level exposures, nonspecific symptoms: weakness, fatigue, anorexia, weight loss, and gastrointestinal disturbance have been described
Higher exposure levels: mercurial tremor: fine muscle fasciculations punctuated every few minutes by coarse shaking
Erethism may also be observed: severe behavior and personality changes, emotional excitability, loss of memory, insomnia, depression, fatigue, and in severe cases delirium and hallucination

Question 12

“Phossy” jaw

Answer 12

Osteonecrosis secondary to phosphorous exposure often in match factories
described by dr. alice hamilton

Question 13

THE OCCUPATIONAL SAFETY AND HEALTH ACT

Answer 13

Established NIOSH and OSHA to carry out its mandate to ensure a workplaces free of recognized hazards.
1970

Question 14

Principles of Control of Workplace Hazards*

Answer 14

Identify
Evaluate
Control:
Eliminate
Substitute
Enclose/separate
PPE/vaccinate

Question 15

most common problem among food service and construction workers

Answer 15

Drug Abuse

Question 16

The National Labor Relations Act

Answer 16

federal statute governing collective bargaining, among other things, and applies to companies with union employees

Question 17

Americans With Disability Act

Answer 17

enacted to protect the rights of disabled individuals and their ability to perform a job despite a disability, includes language on drug testing

Question 18

opiates v opioids

Answer 18

opiates are natural: poppy seed, Codeine, Morphine, and Heroin
opioids: Hydromorphone/Oxycodone, Methadone, Propoxyphene

Question 19

Employee Assistance Programs (EAPs)

Answer 19

“EAPs are workplace-based programs designed to address substance use and other problems that negatively affect employees’ well-being or job performance”
Have evolved significantly over time in response to workplace and societal issue
Goal: to advance workplace environment and maximize employee performance through improved employee & family health

Question 20

PEP for HIV

Answer 20

Must be taken within 72hrs of exposure

2-3 anti-viral medications, taken for 28 days

Question 21

Preferred HIV PEP Regimen*

Answer 21

Raltegravir 
(Isentress; RAL) 400 mg PO twice daily
Plus
Truvada, 1 PO once daily
(Tenofovir DF [Viread; TDF] 300 mg, emtricitabine [Emtriva; FTC] 200 mg)

Question 22

PrEP Pre-Exposure Prophylaxis*

Answer 22

Daily oral PrEP with the fixed-dose combination of tenofovir disoproxil fumarate (TDF) 300 mg and emtricitabine (FTC) 200 mg has been shown to be safe and effective in reducing the risk of sexual HIV acquisition in adults

Question 23

amphibole asbestos can remain

Answer 23

can remain in the lungs for decades

particularly bio-persistent

Question 24

Burton line

Answer 24

blue line along the gums, with bluish black edging to the teeth
indication of chronic lead poisoning

Question 25

Lead poisoning

Answer 25

Brain – most sensitive – target organ Children – decreased IQ, cognitive deficits, reading disabilities, decreased motor skills Adults – neurobehavioral changes From time of exposure, lead stays in RBCs for 20 – 40 days Long term - 90% stored in the bones for 20 – 30 years**

Question 26

“Mad Hatter’s Disease”

Answer 26

mercury poisoning: nephrotoxic, neurotoxic paresthesias, vision, and hearing impairment, slurred speech, anxiety, hallucinations, irritability, depression, lack of coordination, tremors

Question 27

Mercury Poisoning

Answer 27

Acute Effect By ingestion – corrosive effects – nausea, vomiting, severe abdominal pain, chemical colitis, renal damage By inhalation – chemical pneumonitis, pulmonary edema Chronic Effect Classic symptoms – tremor, gingivitis, erethism (irritability, low self-confidence, depression, apathy, shyness and timidity, and in some extreme cases with prolonged exposure to mercury vapors, delirium, personality changes and memory loss occur as a result) Renal and CNS damage Minamata disease – neurological syndrome caused by severe mercury poisoning

Question 28

Major classes of pesticides

Answer 28

organophosphates and carbamates, pyrethroids, organochlorines and chlorophenoxy and nitroaromatic compounds

Question 29

Organophosphates and Carbamates poisoning

Answer 29

Act by inhibiting the enzyme acetylcholinesterase, which catalyzes breakdown of the neural transmitter acetylcholine*** Depending on dose - clinical presentation may include nausea and vomiting, diarrhea and cramping, chest tightness, increased tearing and salivation, blurred vision (due to miosis), urinary incontinence, profuse sweating, bradycardia, muscle twitching and weakness, anxiety, tremor, choreoform movements, and impaired cognition Seizures, lethargy and coma – common in children

Question 30

Organophosphate Toxidrome: Sludge*

Answer 30

``` SLUDGE Salivation Lacrimation Urinary incontinence GI distress Emesis ```

Question 31

Organophosphate Toxidrome: DUMBBELLS*

Answer 31

``` DUMBBELLS Diarrhea Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Lethargy Salivation and seizures ```

Question 32

Organophosphate Induced Delayed Polyneuropathy (OPIDP)

Answer 32

Characterized by flaccid paralysis of the lower limbs (although upper limbs may be affected in severe cases) Sensory peripheral nervous system is affected to a lesser degree

Question 33

Organophosphates Tx

Answer 33

Airway protection Atropine sulfate: Aim is to antagonize the effects of excessive concentrations of acetylcholine at end organs Glycopyrolate: alt to atropine

Question 34

Organochlorine Insecticides

Answer 34

Acute toxicity reflects influence on neuronal membrane stability (interacts with either sodium channels or GABA receptors) resulting in CNS hyperactivity S/S: Headache, nausea, dizziness, un-coordination, confusion, paresthesias, tremor, sudden seizures, cardiac toxicity

Question 35

Pyrethroid Pesticides

Answer 35

Some of the synthetic pyrethroids are toxic to the nervous system – permethrin, resmethrin and sumithrin Toxicity Is mediated through functional changes in sodium channels S/S: Salivation, nausea, vomiting, diarrhea, irritability, tremor, un-coordination, seizures Allergic: asthma, allergic rhinitis, contact dermatitis Treatment: non-specific and supportive

Question 36

Cyanide and carbon monoxide

Answer 36

interfere with cellular respiration and oxygen transport, respectively, and may be rapidly fatal at sufficient dose inorganic gas

Question 37

Ammonia and sulfur dioxide

Answer 37

rapidly absorbed because of high water solubility and exert an irritant effect in the upper respiratory tract inorganic gas

Question 38

phosgene and nitrogen oxide

Answer 38

profound and delayed effects in the lower respiratory tract, including bronchospasm, pneumonitis, and pulmonary edema low solubility inorganic gas

Question 39

methane and nitrogen

Answer 39

may dilute oxygen in an enclosed space but do not act as direct toxins

Question 40

Benzene can cause

Answer 40

aplastic anemia and acute myelogenous leukemia | solvent

Question 41

repeated exposures that cause temporary threshold shift of hearing causes

Answer 41

permanent loss

Question 42

what types of frequencies affect hearing first

Answer 42

higher frequencies

Question 43

threshold for hearing damage and pain

Answer 43

140 decibels

Question 44

Noise Measurement-OSHA Rules*

Answer 44

>=90 dB averaged over an 8 hour shift = maximum allowed Hearing protection required (either PPE or environmental) Earplugs MUST be used when noise is +90dB >=85 dB averaged over an 8 hour shift Requires enrollment into the company’s hearing conservation program Employee training Annual hearing tests & follow-up Noise above 140 dB is not permitted

Question 45

calculation of hearing loss (STS, change from baseline)

Answer 45

If change >= 10 decibels from baseline – a shift has occurred

Question 46

Reporting to OSHA - Criteria*

Answer 46

ALL of the following MUST be YES to be “reportable”: Is employee in Hearing Conservation Program? Is there a current average loss of >=25 dB? Is there a STS of >= 10 dB? Hearing loss is NOT caused by other medical problems/non-occupational noise exposure.

Question 47

Parenchymal (Interstitial) Disease

Answer 47

``` Small particles (< 5 µm in diameter) and fibers are deposited in terminal bronchioles, alveolar ducts, and alveoli. Penetration to the Interstitium results in fibrosis and the formation of granulomas EXAMPLE: Asbestosi ```

Question 48

most prevalent OLD

Answer 48

Occupational Asthma | reversible narrowing of the airways

Question 49

most helpful diagnostic study for OLD

Answer 49

CT

Question 50

Pneumoconiosis (3 main types)

Answer 50

Asbestosis Silicosis Coal workers pneumoconiosis group of interstitial lung diseases caused by the inhalation of certain dusts and the lungs tissue’s reaction to the dust.

Question 51

Asbestosis

Answer 51

chronic progressive disease of pulmonary fibrosis caused by inorganic fibers Causes scarring of the lung parenchyma risk of mesothelioma Pleural plaques and pleural thickening

Question 52

asbestosis on cxr

Answer 52

Later stages appear as ground glass opacities followed by honeycombing

Question 53

Earliest symptom of asbestosis

Answer 53

insidious onset of breathlessness with exertion.

Question 54

Silicosis is common amongst

Answer 54

metal miners, sandstone and granite cutters, foundry workers, masonry**, sandblasting and potters. construction industry ** often fatal

Question 55

silicosis has highest incidence of developing

Answer 55

active tuberculosis and other mycobacterial disease

Question 56

silicosis on CXR

Answer 56

Eggshell calcifications**: hilar node lymphadenopathy and calcification Rounded opacities in upper and middle lung zones

Question 57

Silica

Answer 57

human carcinogen that is especially associated with risk for lung ca independent of tobacco exposure

Question 58

Byssinosis

Answer 58

Brown Lung Disease Seen in people who work with cotton, flax, hemp, jute** textile workers

Question 59

when do you experience byssinosis Sx

Answer 59

usually on the first day of the work | dec fev1

Question 60

Tx for gas/chemical exposure

Answer 60

O2 mainstay | most recover completely

Question 61

Beryllium Disease

Answer 61

X-ray tubes, Computers, Dental alloys, Aerospace industry Differs from other OLD in that at low levels of exposure seen in people that are sensitive to beryllium – about 2% Immune mediated systemic disorder

Question 62

Cherry red skin

Answer 62

carbon monoxide poisoning, usu post-mortem

Question 63

serious sequelae from CO poisoning

Answer 63

MI common | delayed neuropsychiatric syndrome

Question 64

most common presenting Sx of CO

Answer 64

headache

Question 65

Allowable limit for Radon

Answer 65

<4 | number one cause of lung cancer among non-smokers

Question 66

Sick Building Syndrome

Answer 66

Inadequate ventilation Trend of making highly insulated airtight houses and office buildings, which lowers the amount of natural ventilation Biological contaminants Bacteria, molds, pollen, and viruses