Occupational Disorders

Question 1

Which of the following is unlikely to be a noxious work place exposure?

a. Heat/Cold
b. Streptococcus pneumoniae
c. Chlorine gas
d. Dust
e. Animal dander

Answer 1

B- Strep pneumonia

Question 2

Which of the following would not be considered an occupational lung disease:

a. New onset asthma in a isocyanate exposed worker
b. Exacerbations of Asthma caused by cold air in a refrigeration worker at a meat packing plant.
c. New onset COPD in a heavily grain dust exposed agricultural worker with a 40 pack year history of tobacco smoke exposure.
d. Bronchiolitis caused by diacetyl exposure in a consumer of flavored microwave popcorn.
e. Hypersensitivity pneumonitis in a zoo keeper working with avian species.

Answer 2

B - exacerbation of asthma caused by cold air in refrigeration worker at a meat packing plant

(asthma was not CAUSED by occupation)

Question 3

Which of the following is not a required part of the work up needed to make the diagnosis of a disabling occupational lung disease

a. Medical History
b. Occupational and Exposure History
c. Lung function testing
d. Pulmonary pathology specimens
e. Chest imaging

Answer 3

D - pulmonary pathology specimens are only needed if medical history, occupational history, LFTs, and chest imaging are equivocal

Question 4

All of the following are important components of the occupational history except:

a. Chronology of jobs and job titles
b. Description of work place processes
c. Data on specific exposures – i.e. MSDS sheets
d. Names of managers at each workplace
e. Use of Personal Protective Equipment

Answer 4

D. names of managers at each workplace

Question 5

What is an example of multifactorial causation in emphysema?

Answer 5

it is caused by both smoking and coal mine dust

Question 6

What is a multifactorial explanation for occupational related asthma?

Answer 6

allergies and isocyanate exposure

Question 7

What percent of the US population has most likely been exposed to respirable silica? What is the lifetime risk of developing silicosis, even if a workplace was compliant with all previous and current exposure laws?

Answer 7

1% exposed, 0.4 to 11% risk even if within the limits

Question 8

How does race play into silicosis risk?

Answer 8

SENSOR data showed that there was a 7x increased risk of silicosis in african americans, a foundry worker study found 2x risk in AA v white employees

Question 9

What must you always rule out with silicosis?

Answer 9

superimposed infection

Question 10

A 45 year old man who works making artificial stone countertops comes in with mixed restrictive and obstructive PFT’s, cicatrical emphysema that is mostly symmetric but slightly emphasized on the right lobe, and who does not have any signs of infection. What is the most likely diagnosis?

Answer 10

silicosis

Question 11

What is the criteria for silicosis with progressive massive fibrosis?

Answer 11

nodules over > 1 cm in diameter

Question 12

A sandblaster comes in with acute respiratory failure and alveolar proteinosis, 2 years after starting his job. What occupational disorder must be ruled out?

Answer 12

acute silicosis/silicoproteinosis

Question 13

How are PPD tests different for workers in silica exposed fields?

Answer 13

the induration limit is lower due to increased risk

Question 14

which autoimmune and renal diseases are increased in workers exposed to silica?

Answer 14

SLE and scleroderma

Question 15

If a retired individual who worked in construction 20 years ago has progressive symptoms over a period of years and small opacities of pneumoconiosis with nodules less than 1 cm on CXR, what kind of silicosis does he or she have?

Answer 15

chronic simple silicosis

Question 16

What effect does silica have on smoking related health?

Answer 16

it potentiates the effects of smoking that lead to emphysema

Question 17

In patients with pneumoconiosis, what are the 2 important first steps in management?

Answer 17

smoking cessation and removal from exposure

Question 18

What kind of preventative health measures should all pneumoconiosis patients receive?

Answer 18

vaccination and vigilance/screening for mycobacterial infection and lung cancer

Question 19

Farmer’s lung, mushroom worker’s lung, bagassosis, and humidifier lung are all occupational examples of what disease?

Answer 19

bacterial hypersensitivity pneumonitis

humidifier lung is also an amoebic form

Question 20

Malt worker’s lung, suberosis, and cheese worker’s lung are all examples of what occupational disease?

Answer 20

fungal hypersensitivity pneumonitis

Question 21

What two aspects of the following are absolutely required for making the diagnosis of occupational lung disease?

1. history of exposure
2. CXR
3. LFT
4. immunology testing
5. lung pathology

Answer 21

history of exposure and documented abnormal CXR

Question 22

Is HRCT recommended for screening of occupational lung disorders?

Answer 22

no - cost and radiation prohibitive.

CXR is a better screening tool, HRCT should be used for confirmation

Question 23

What kind of bias is occupational lung disease pathology subject to ?

Answer 23

sampling bias

Question 24

What does a sentinel occupational health event mean?

Answer 24

it is an index case of disease, disability or death
it indicates a sick WORKPLACE as well as a sick worker

Diagnosis (i.e. the role of the doctor) is frequently the sentinel event - 1 diagnosis can lead to shared exposure prevention of many other people