Occupational Health

Question 1

High-risk work for occupational asthma

Answer 1

Baking

Farming

Hairdressing, cleaning

Veterinary/laboratory animal work

SPray painting

Welding, soldering (electronics), metalwork (lubricants), woodwork

PAST OR PRESENT OR HOBBIES

Question 2

Investigation of work-related asthma

Answer 2

Serial peak flow 4x daily for at least 3 weeks

Referral to specialist unit - challenge testing

Assess specific IgE levels

Question 3

Occupational MSK disease

Answer 3

Due to repetitive, forceful activities with poor ergonomics

Type 1: Clear pathology e.g. De Quarvain’s, lateral epicondylitis

Type 2: Diffuse, non-specific, but clear association w/ repetitive force

Question 4

Features suggesting occupational asthma

Answer 4

Adult new-onset OR exacerbation

Better away from work (at home, not on holiday!)

Sensitisation period (weeks)

At-risk profession

Rhinitis/conjunctivitis may precede asthma

Others affected at work

Question 5

Employer responsibilities for asthmagens

Answer 5

COSHH Act - must take reasonable steps to protect

RIDDOR - must report occupational asthma to HSE

Question 6

Features of extrinsic allergic alveolitis

Answer 6

Form interstitial lung disease

Hypersensitivity reaction to antigen e.g. spores

Esp common in farmer’s and bird keepers

Question 7

Acute symptoms of EAA

Answer 7

Cold-like: fever, chills, dyspnoea, myalgia

4-8h after exposure

Resolve within 12-24h

Question 8

Chronic symptoms of EAA

Answer 8

Increasing SOB

Weight loss

Malaise

Question 9

Chronic EAA Ix and signs

Answer 9

HRCT - diffuse changes

Inspiratory crackles, tachypnoea

Raised ESR, neutrophilia

Question 10

EAA treatment and prognosis

Answer 10

If allergen excluded - usually resolves

May lead to progressive fibrosis - steroids helpful

Question 11

What is pneumoconiosis?

Answer 11

ILD from mineral dust exposure

Latency >10y

Smoking worsens

Treatment supportive

Nodular CXR changes (esp in bases for asbestosis)

Question 12

Features of irritant dermatitis

Answer 12

Repeated exposure to irritants esp water, soap detergents

Cracked, red, dry hands esp in webs of fingers

Pre-existing eczema increases risk

Within 6w of starting

Question 13

Management of irritant dermatitis

Answer 13

Avoidance

Emollients

Steroids if necessary

Question 14

Features of IgE-mediated dermatitis

Answer 14

Immediate reaction - within minutes

Wheals, generalised rash (can spread beyond exposure), may cause anaphylaxis

Hx of atopy

Question 15

Investigation of immediate contact dermatitis

Answer 15

Specific IgE

Skin prick test

Question 16

Management of immediate contact dermatitis

Answer 16

Epipen if necessary + medalert bracelet

Antihistamines

Avoidance

Question 17

Features of T-cell mediated dermatitis

Answer 17

Red, itchy, cracked skin

Develops many hours after contact

Hx of sensitisation period

Contact-only distribution

Question 18

Treatment of delayed contact dermatitis

Answer 18

Avoidance

Topical steroid

Emollient

Retinoic acid if resistant

Question 19

Investigation of T-cell mediated contact dermatitis

Answer 19

Patch test

Question 20

Occupational history components

Answer 20

What do you do? How long for?

What does that involve - incl. hazards

Past jobes/hobbies with hazardous exposures

Question 21

What to check on return-to-work assessment

Answer 21

Functional impact of symptoms - at home?

Biopsychosocial obstacles to return to work - e.g. anxieties

Safety guidance - incl. signposting to DVLA or relevant authority

Rehab/adjustment - encourage contact with employer OH department

Highlight that fit note does not prevent dismissal