Suspecting Occupational or Environmental Disease

Question 1

All of the following factors contribute to the under recognition of work-related health conditions by medical practitioners except?

Answer 1

The rare nature of occupational illness and injury in the United States

Question 2

What is least important when taking a brief survey of the patient’s O/E history?

Answer 2

The pay level awarded in all prior jobs

Question 3

Triggers in the O/E history brief survey that may prompt further inquiry include?

Answer 3

E. All of the above

Question 4

Exposure to O/E substances can also aggravate underlying medical conditions. T or F?

Answer 4

True

Question 5

What is a sentinel health event-occupational?

Answer 5

A disease, disability or untimely death that is occupationally related

Question 6

What is NOT a necessary element of a brief O/E survey?

Answer 6

A directory of the names and addresses of coworkers

Question 7

Possible sources of hazards in the home environment include?

Answer 7

A. Household chemicals and pesticides
B. Hobbies
C. A faulty heating system

Question 8

Which of the following are true regarding biologic monitoring?

Answer 8

D. None of the above

Question 9

In obtaining the occupational history, which of the following items of information is generally least helpful?

Answer 9

Direct communication with the patient’s attorney

Question 10

What resource is most accurately paired with the type of information available form the resource?

Answer 10

Agency for Toxic Substances and Disease registry (ATSDR) Case Series in Environmental Medicine/Description of a case followed by overview of key considerations

Question 11

You are evaluating a young man complaining about inability to conceive a child with his wife. The workup reveals a low sperm count. Occupational factors most likely to contribute to this condition would be?

Answer 11

Exposure to the nematocide dibromochloropropane

Question 12

Each of the following could be presented as a case report in the field of occupational medicine except?

Answer 12

Description of the biochemical pathways of a chemical substance

Question 13

Reasons that occupational and environmental disease is often not suspected (barriers)?

Answer 13

Most O&E diseases manifest as common medical problems and/or have nonspecific symptoms
- Env. factors rarely enter into the clinician’s differential diagnosis

Question 14

Why is it difficult to estimate the full extent of occupational illness/injury in the United States?

Answer 14

• Underreporting
• Insufficient awareness and education
• Long latency
• Lack of unique clinical manifestation

Question 15

What are the SHE-E categories?

Answer 15

• Category 1. Clearly Identifiable, environmentally (e.g. poisonings)
• Category 2. Potential signs of population exposure to environmental contaminants: increased pop. frequencies (e.g. miscarriages)
• Category 3. Indicators of Body Burdens Potentially Due to Environmental Exposures: heavy metals (e.g. hair, blood, nails)

Question 16

Bradford Hill criteria of causation?

Answer 16

Analogy
Consistency
Coherence
Experimental evidence
Strength
Specificity
Temporal sequence
Biologic plausibility
Dose response

Question 17

Strength of Association?

Answer 17

Greater relative risk suggests (but does not prove) causation

Question 18

Framework and questions for the occupational and environmental survey (history)? (As outlined by Dr. Rose Goldman)

Answer 18

 Step 1: Occupational and Environmental health history of all patients
 Step 2: Defining and describing potential sources of exposure in Workplace, Home, and Surroundings
 Step 3: Quantifying exposures
 Step 4 – Further follow up, consultation, and resolution of problem