Occ Med Flashcards
1
Q
Asbestos related plural plaques are associated with which type of PFT pattern
A
Normal
2
Q
Asbestos fibrotic disease is usually associated with what type of asbestos?
A
Amphibole
3
Q
Asbestos related pleural effusions usually occur within how many years?
A
10
4
Q
Metal fume fever is caused by ___ and the time course is ___?
A
Welding fumes
Tachyphalaxis within ~48 hours
5
Q
What joint is most commonly affected with decompression sickness?
A
Shoulder
MSK pain most common symptom of compression sickness
6
Q
Chrome salts are skin/respiratory sensitizer/irritant? (Choose all that apply)
A
Skin sensitizer and irritant
7
Q
A rare form of occupational asthma caused by inhaling hemp, flax, or cotton particles
A
Byssinosis
In the United States, byssinosis occurs almost exclusively in people who work with unprocessed cotton.
8
Q
What is Caplan syndrome?
A
Aka Rheumatoid pneumoconiosis
Pulmonary rheumatoid nodules in pts w/ rheumatoid arthritis who’ve breathed in coal, asbestos or silica
9
Q
Osseous complication of decompression illness
A
Dysbaric osteonecrosis
10
Q
Risk factors (3) for dysbaric osteonecrosis
A
Obesity, alcohol, steroid use
11
Q
Wood dust is a type I (known) carcinogen of … (3)
A
Nasopharynx, nasal cavity and paranasal sinuses
12
Q
What is the causative agent of silo filler’s dz?
A
Gaseous oxides of nitrogen from organic material
13
Q
Arsenic is a type I (known) carcinogen of … (3)
A
Lung, skin and bladder cancer
14
Q
Pain on thumb side of wrist from repetitive motion
A
De Quervains tenosynovitis
Also called: radial styloid tenosynovitis
15
Q
Thickening of the palmar fascia most commonly affecting the 4th and 5th digits
A
Dupuytren’s contracture
16
Q
____ syndrome of hand caused by trauma to ____ artery.
A
Hypothenar hammer syndrome
Ulnar artery
17
Q
Specific gravity of toxic heavy metals
A
5 g/cm3 or heavier
18
Q
Carbon monoxide poisoning causes the ___ curve to shift to the ___
A
Oxyhemoglobin curve
Left shift
19
Q
Allergic contact urticaria is diagnosed with…
A
Skin prick test
20
Q
Aluminum is a known carcinogen for (2) …
A
Bladder and lung cancer
21
Q
High blood levels of aluminum are associated with…
A
Poor cognitive function
22
Q
Systemic sclerosis is associated with what environmental exposures (2)
A
Silica
Organic solvents
23
Q
Types of UV spectrum radiation from welding
A
All… UVA, UVB and UVC
24
Q
___ skin discoloration from exposure to silver is called ___
A
Blue-grey
Argyria
25
Frequency range of human hearing
20 Hz to 200 kHz
26
Sign/symptoms associated w following Lead blood Levels
1) 30 mcg/dL
2) 50 mcg/dL
3) 100 mcg/dL
1) HAs & poor concentration
2) anemia and abd pain
3) encephalopathy
27
Treatment of de Quervain’s tenosynovitis
Thumb spica splint
28
Test for de Quervain’s tenosynovitis
Finklestein’s test
| Ulnar deviation w thumb flexed
29
Sudden death from overwork
Karoshi
30
First line treatment of Achilles tendinopathy
PT: eccentric exercises
31
Physiology of noise induced hearing loss
Sensorineural HL due to loss of cilia and hair cells in cochlear
32
Nighttime sign of carpal tunnel syndrome
Flick sign
Symptomatic relief when waking at night and shaking out their hand.
93% sensitive &
96% specific for CTS.
33
treatment for methemoglobinemia
methylene blue (reduces methemoglobin hemoglobin)
34
in cases of ___ d/t chlorate exposure do not treat with methylene blue d/t risk of more toxic __ production
methemoglobinemia
| hypochlorite
35
medications that cause methemoglobinemia (3)
dapsone (and other ABX)
benzocaine (& other -caines)
nitrites
36
Where does cyanide bind (2)
To Fe3+ in
1) methemoglobin
2) cytochrome C reductace in e- transport chain (irreversible)
(Prevents reduction back to Fe2+)
37
Most common cause of cyanide poisoning in US
Fires/fire fighting
38
Cyanide is removed from methemoglobin by the enzyme ___
and ___
is excreted in the ___
Liver rhodanase
Thiocyanate
Urine
(Na thiosulfate is consumed)
39
In cyanide poisoning
is PaO2 low/ normal / high?
is PvO2 low/ normal / high?
PaO2 is normal.
PvO2 is high.
They are ~ equal because O2 does offload to the tissue.
Normally O2 would diffuse to cytochrome oxidase in mitochondria, but cyanide fixes Fe3+ oxidase in the oxidized form.
40
2 foods that contain cyanide
Almonds (cyanide poisoning associated w “bitter almond” breath)
Apricots
41
Cherry red skin is associated with what type of poisoning
Carbine monoxide poisoning (rarely 2-3%)
{Another source aside Cyanide 2/2
Tissue unable to offload O2 so there is a high venous concentration of O2 - high PvO2 }
42
Cyanide poisoning antidote (3)
Na thiosulfate
Na nitrite
Hydroxycobalamine (vit B12)
43
Cyanide poisoning antidote that directly binds cyanide
Hydroxycobalamine
| Cyanocobalamine excreted in urine
44
This cyanide antidote induces methemoglobin formation
Na nitrite
| Fe3+ in Methemoglobin has affinity for CN
45
This cyanide antidote is utilized by liver rhodinase to remove CN from cyanomethemoglobin
Na thiosulfate
| Thiocyanate excreted in urine
46
Q fever bacteria
Coxiella Burnetti
47
Q fever treatment
Doxycycline
48
Carbon disulphide
Acute exposure -> ?
Chronic exposure -> ?
Neurotoxicity
| CAD
49
Poisons that inhibit cytochrome C oxidase in e transport chain (complex IV)
Cyanide
Carbon monoxide
Hydrogen sulfide (H2S)
50
Lyme disease is caused by...
Borrelia burgdorferi
51
Lyme disease single dose ABX prophylaxis
200mg doxycycline
52
Group 1 (known) carcinogen for melanoma
Polychlorinated biphenyls
53
Most dangerous type of UV radiation
UVB
| UVC does not reach surface of earth
54
Occupational voice loss risk factors (4)
low humidity
high background noise
increased vocal load
poor upper body posture
55
Toluene diisocyante is a skin/respiratory sensitizer/irritant? (Choose all that apply)
respiratory sensitizer
It causes occupational Asthma in ~1% of people when exposure > 5ppb
56
Size at which fibers are respirable
less than 3 microns
57
type of mercury poisoning associated with intestinal necrosis and bloody diarrhea
ingestion of inorganic mercury salts
58
mechanism of Pb poisoning
Replaces elements such a Ca in many biological pathways
59
treatment of Itai-itai disease
cadmium chelators
60
PFT pattern for hypersensitivity pneumonitis
restrictive pattern
61
Bacteria in Legionnaire's disease
Legionella pneumophila causes 90% of Legionnaire's
The other 10% of cases caused by other Legionella serotypes.
62
Audiometry threshold shift is considered permanent if it last greater than ...
4 weeks
63
form of ionizing radiation with highest weighting factor
alpha particles
weighting factor = 20
64
radiation equivalent dose (HT) formula
```
Absorbed dose (DT)
x
radiation weighting factor (WR)
=
equivalent dose (HT)
```
65
Light flickering in what range (Hz) can cause seizures
5 to 30 Hz
66
Illumination (lux) required for perception of detail in workplace
500 lux
67
Resting metabolic rate
65 W/m2
68
For 10m of seawater depth, pressure increases by how much? (ATA?, kPa?)
1 ATA
| 100 kPa
69
Hypothermia is body temperature less than (C?, F?)
35 C
| 95 F
70
In hypothermia, shivering may stop when body temp is less than ...
32 C
| ~ 90 F
71
Frequency of tuning fork used for Webber's and Rinne's tests
512 Hz
72
How is Webber's rest performed?
Place the fork in the midline high on the patient’s forehead.
Ask the patient: “Do you hear the sound louder in one ear than the other?”
73
How is Rinne's rest performed?
Place the fork at the pt’s mastoid process for ~2-3 secs, then 1 cm from meatus for ~2 secs.
Ask which is louder
74
Rinne's test has a high ___ for ___ hearing loss.
sensitivity (0.84)
| conductive
75
Rinne’s test can only detect a ____ hearing loss of at least ____
conductive
| 30dB
76
Describe a false negative Rinne's test
In total unilateral *sensorineural* hearing loss, when testing the "dead" ear, pt will hear bone conduction (conducted to the good ear) better than when the fork is EAC meatus.
77
Describe a positive Rinne's test (and significance)
A positive Rinne's test is *normal*
Air louder than bone
78
Describe a negative Rinne's test (and significance)
A negative Rinne's test is abnormal and c/w conductive hearing loss of at least 30 db
Bone louder than air
79
With Weber's test, in which ear would you the sound in *conductive* hearing loss?
Bad ear
80
With Weber's test, in which ear would you the sound in *sensorineural* hearing loss?
Good ear
81
What dose of ionizing radiation is 50% lethal at 60 days (LD50/60) without treatment?
3.5-4 Gy
82
How is the Bradford Factor (score) calculated?
B = S × S × D
where:
B is the Bradford Factor
S is the total number of spells (instances) of absence of an individual over a set period
D is the total number of days of absence of that individual over the same set period
83
Hepatitis Viruses
Enveloped? / DNA or RNA?
```
HAV
HBV
HCV
HDV
HEV
```
```
Hepatitis Viruses
A: unenveloped RNA
B: enveloped DNA
C: enveloped RNA
D: enveloped RNA
E: unenveloped RNA
```
84
Hepatitis E virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
HEV
nonenveloped
positive-sense
single-stranded
RNA
85
Hepatitis Viruses Families
```
HAV
HBV
HCV
HDV
HEV
```
```
A: Picornaviridae
B: Hepadnaviridae
C: Flavividae
D: Deltavirus
E: Hepeviridae
```
86
Hepatitis Virus with zoonotic hosts (and what are the hosts)
HEV (genotypes 3 and 4) - swine & deer
87
Which hepatitis virus is a satellite (subviral agent) and what other hepatitis virus does it propagate with?
HDV (propagates with HBV)
HDV is an RNA virus, HBV is a DNA virus
88
Hepatitis D virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
HDV
enveloped
negative-sense
single-stranded
RNA
89
Fatality rate of HBV and HDV coinfection
20%
| highest of all hepatitis virus infection
90
% of people who when exposed to HCV do NOT get chronic infection
~ 20% of infected clear the virus and do not progress to chronic infection
91
Hepatitis C virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
HCV
enveloped
positive-sense
single-stranded
RNA
92
Hepatitis B virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
HBV
enveloped
circular double-stranded
DNA
93
HCV transmission
IVDU (#1 in USA, >60%)
Sexual contact
Unsafe medical procedure / transfusions (#1 in developing world)
94
Medical treatments for HBV (4)
Tenofovir
Entecavir
Lamivudine
INF-alpha
95
medication that can treat both HIV and HBV
Lamivudine
96
entecavir black box warnings (3)
lactic acidosis with severe hepatomegally w/ steasosis
HIV resistance
acute HBV exacerbation upon d/c
97
Hepatitis A virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
HAV
unenveloped
single-stranded
positive-sense
RNA
98
What is the RNA/DNA sense of the the Hepatitis Viruses (A - E)
```
HAV: +
HBV: N/A, dsDNA
HCV: +
HDV: -
HEV: +
```
99
Isocyanates are skin/respiratory sensitizer/irritant? (Choose all that apply)
Both skin and respiratory sensitizer and irritant.
100
Difference between Decompression Sickness (DCS) and Decompression Illness (DCI)
DCI encompasses both DCS and arterial gas embolism (AGE).
101
DCS type I involves which systems
skin
MSK
lymphatic
102
DCS type II involves which systems
neurologic,
audiovestibular or
cardiorespiratory
(in addition to skin, MSK, lymphatic of type I)
103
In DCS, what % of patients have experienced symptoms by 8 and 24 hours?
83% and 98%, respectively
104
In Decompression Illness, what is the time course of onset of Arterial Gas Emboli
Immediate
105
___ is the oxidized form of iron
ferric
106
___ is the reduced form of iron
ferrous
107
Boyle's law
P1V1 = P2V2
108
Most important occupational risk factor for carpal tunnel syndrome
Forceful hand exertion
109
Most toxic form of chromium
hexavalent chromium
| highly water soluble
110
Influenza virus characteristics
| ? envelope, # of strands, sense?, RNA/DNA
enveloped
negative sense
single stranded
RNA
111
```
Coronavirus characteristics
(? envelope, # of strands, sense?, RNA/DNA )
```
enveloped
positive sense
single stranded
RNA
112
PFT pattern in Caplan's syndrom
restrictive (or mixed)
Rheumatoid pneumoconiosis in people with rheumatoid arthritis who have breathed in dust (ie coal, silica)
113
Vinyl chloride is a type I carcninogen of (1) ...
hepatic cancer (including angiosarcoma of liver)
114
Sedentary work expends how much energy ...
1.5 METs
115
Which heavy metal exposure is know to cause nasal perforation?
chromium
| chrome ulcers
116
visual complication from recompression therapy
reversible myopia
117
occupational acoustic trauma
vs
noise induced hearing loss
OAT: Sudden loud noise imulse
NIH: Hearing loss from prolonged steady state noise exposure.
Both are sensorineural type hearing loss
118
Noise level that causes occupational acoustic trauma
> 130 dB
119
Henry's law
The amount of a gas that dissolves in a liquid is directly proportional to the partial pressure of that gas.
120
Medical reasons pilots must inform licensing authority (4)
deterioration in medical fitness > 20 days
illness requiring hospitalization
illness that renders unsafe to fly
pregnancy
121
1 Gy =
1 J /kg
122
units of rate of transformation of radioactive material
becquerels
123
When does vibration with finger present
usually on exposure to cold (not necessarily during the vibration exposure)
124
ABX used as supplemental treatment of tetanus
metronidazol
125
bacterial that causes tetanus
Clostridium tetani
126
Besides supportive care, treatment for tetanus
1) Benzos
2) neuromuscular blockers
3) tetanus immune globulin (TIG)
4) ABX (metronidazol)
5) immunization
127
Anthrax bacteria
Bacillus anthracis
128
Most common for of *occupational* anthrax
cutaneous
| GI & respiratory also possible
129
What is the healthy worker effect?
A bias in occupational epidemiology studies that is typically characterized by lower relative M&M rates in an occupational cohort, possibly masking an increased risk of the disease under study
130
Environmental asthma due to exposure to mouldy sugar cane
Bagassosis
131
Heavy metal exposure that leads to renal tubular dysfunction
Cadmium
132
Most common bacteria causing otitis external in saturation divers
Pseudomonas aerginosa
133
treatment for streptococcus suis
PCN
134
By what units is hand transmitted vibration monitored?
m/s^2 (acceleration)
135
Allergic contact *dermatitis* is diagnosed with...
patch test
136
Carbon monoxide binds to hemoglobin at ___ times the strength of O2.
200 times
137
% carboxyhemogblogin in blood that indicates severe exposure
30%
138
'slate bronze skin' is associated with what type of poisoning
arsine gas
| d/t a hemolytic jaundice
139
diesel exhaust is a group 1 carcinogen for ...
lung cancer
140
Potential preventive treatments s/p needle stick exposure
HBV vaccine
HBV immunoglobulin
HIV prophylaxis
141
medication for HIV post-exposure PEP
zidovudine AND
lamivudine AND
dolutegravir OR raltegravir
142
time course for HIV post-exposure PEP
start within 72 hours
| continue for 28 days
143
Benign pneumoconioses (4)
Siderosis
Stannosis
Baritosis
Fuller’s earth pneumoconiosis
144
Mechanism of organophosphate poisonings
Inhibition of acetylcholinesterase at neural junction
145
Bacteria genuses (4) that cause human brucellosis
Brucella genuses
```
B melitensis (sheep/goats)
B aborted (cattle)
B suis (pigs)
B canid (dogs)
```
146
Initial sign of noise induced hearing loss
Loss at 3000 to 6000 Hz
147
How long should patient wait before flying for
1)
Pneumothorax
2) uncomplicated MI
1) 6 weeks
| 2) 10 days
148
Laryngeal cancer group 1 carcinogens (3)
Cigarettes
Asbestos
Inorganic acid mists
