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COHN-S Exam with Complete Solutions
Tolulene - ANS-An isocyanate, is a respiratory sensitizer that can lead to occupational asthma Primary concern of a kerosene splash - ANS-Lung irritation Benzene - ANS-Adversely affects the hematopoietic system. Therefore, individuals with a history of thrombocytopenia would be at increased risk if exposed to Benzene SWOT - ANS-Strengths Weaknesses Opportunities Threats; way to asses an environment Jaundice is a common symptom of - ANS-Carbon tetrachloride poisoning OSHA PEL for airborne lead exposure - ANS-50ug/m Action level for lead blood levels - ANS-30ug/100g What unique contribution can the OHN make to workplace safety and health programs?
- ANS-Provide screening to specific exposures What are other problems that usually accompanies sleep apnea? - ANS-Diabetes and cardiovascular disease Doxycycline - ANS-And anti-malarial preventative. Take the drug daily one or two days before travel and for 28 days after a trip. The occupational health and safety OSHA's 18001 is described as? - ANS-An international consensus standard for occupational health and safety management systems What are the five classes of drugs tested for DOT purposes? - ANS-Cannabinoids, cocaine, amphetamines, opiates, PCP Primary prevention - ANS-Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse. For example immunizations secondary prevention - ANS--focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status
-examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail. Screenings tertiary prevention - ANS-Intervention for example chronic disease monitoring cardiac rehab physical rehab treatment Pre-placement Exam - ANS-Match the job with employee, and sure the compatibility of the person with the job demands, and serve as a baseline for future evaluations Nursing Process - ANS-ADPIE; ASSESSMENT, DIAGNOSIS, PLANNING, INTERVENTION, EVALUATION Nursing Diagnosis - ANS-describes a health problem that can be treated by nursing measures; a step in the nursing process Emergency triage categories - ANS-Level 1 - resuscitation CPR, Level 2- emergent based on clarity of mind acute distress Level 3- urgent need at least two resources 30 to 40% of ER visits Level 4- non-urgent require some hospital resource Level 5- requires little or no treatment Hazmat responses; three zones - ANS-Hot-Evacuation with ABCs, only enter with appropriate PPE Warm-Decontamination, ABCs, only enter with appropriate PPE Cool-Stabilization and treatment, non-contaminated area, PPE not required to treat the decontaminated evacuee. Primary Survey - ANS-an examination of the patient to determine the presence of any life-threatening emergencies; the initial assessment of airway, breathing, and circulation on a patient Suspect C-spine dislocation with high-voltage shock Supplement oxygen in all traumatic injuries Secondary Survey - ANS-a head-to-toe physical assessment; an additional assessment of a patient to determine the existence of any injuries other than those found in the primary survey Physical Assessment - ANS-IPPA; Inspect, Palpate, Percuss, Auscultate Abdominal exam order IAPP; Inspect, Auscultate, Percuss, Palpate Approximately 80 to 90% of all types of skin disease can be classified as? - ANS- Contact dermatitis Sensitizing agents - ANS-Response after single or multiple exposures and only and some individuals
heat cramps - ANS-muscle pain and spasm resulting from exposure to heat and inadequate fluid and salt intake Treatment: Fluids, electrolytes, cool area heat exhaustion - ANS-Skin cool, clammy and pale: Circulatory collapse from sodium depletion and ineffective circulating blood volume, the pulse will be weak and respiratory rapid and shallow Heat stroke - ANS-Altered mental state, unconscious, convulsions Temperature >106°F, skin hot and dry Dilated peoples, respirations deep to shallow Pulse rapid strong to week rapid Treatment for heat stroke and heat exhaustion - ANS-Cool quickly until temperature is 102 or below Strip clothes, turn on side, expose more skin 60° water spray, cold water lavage is necessary Maintain airway Cold stress - ANS-Excessive loss of heat that results in increased respirations and nonshivering thermogenesis to maintain core body temperature Warm core temperature until > 86° Engineering methods - ANS-Are procedures which may be used to reduce the stress of a hot environment. Examples include general ventilation, spot cooling, local exhaust, air conditioning, fan, etc Administrative work practice - ANS-Controls include acclimatize to heat, work-rest program, rotation of workers, education and training Critical incident technique - ANS-Is a method of identifying errors and unsafe conditions that contribute to both potential and actual injurious accidents within a given population by means of a stratified random sample of participants and observer selected from within this population Acetylene - ANS-Is a colorless gas with a slight garlic like older A job safety analysis is a technique to? - ANS-Identify hazards associated with each step of the job The analysis technique where individuals are interviewed about accidents, near misses, and hazardous conditions is known as which of the following? - ANS-Critical incident technique
Potentiation - ANS-A substance which does not have a toxic effect upon a system or organ, but when in combination with another chemical, makes the chemical much more toxic. Methylene chloride is a mild toxic and his primary metabolite is? - ANS-Carbon monoxide A person can lose his or her heat acclimatization in as little as? - ANS-3 days Performance standard - ANS-A performance standard sets the objective to be obtain but leaves the compliance details up to the company or organization. Noise dosimeters under OSHA's Hearing Conservation Standard accumulate noise exposure beginning at? - ANS-80dB Chemicals with a "C" notation with their TLVs: - ANS-Have ceiling TLV limits assigned to them Viton - ANS-The type of glove material that offers protection against chlorinated solvents Quantitative fit testing - ANS-Quantitative fit testing checks for leakage that results in the employee smelling or sensing the presence of the fit test material. Employees assigned to the hazardous waste site must receive a minimum of__________ Hours of offsite training prior to assignment. - ANS-40 hours The amount of a chemical that kills 50% of the organisms exposed to it in the air is the: - ANS-LC The nature, degree and extent of undesirable effects of a substance is known as? - ANS-Toxicity The most powerful epidemiological study design is: - ANS-Prospective cohort The study of the frequency and distribution of injury and disease in the human population is: - ANS-Epidemiology When establishing a bio monitoring program for workers exposed to benzene, one would love for the metabolite ____________in the urine? - ANS-Phenol Shaver's Disease - ANS-Caused by silica and aluminum dust and fumes A client comes in to your medical department complaining of wrist weakness, constipation, anemia, loss of appetite, and a peculiar linear discoloration of the gingival tissue, you would suspect: - ANS-Lead poisoning
Point of operation - ANS-the area where the equipment actually performs its intended task Exposure of blades - ANS-Periphery of fan less than 7 feet above the floor or working level must have guard openings of less than or equal to 1/2 inch Pinch point - ANS-Area of machine where body part can be caught during activation Case management - ANS-Case management is the process of coordinating and comprehensive healthcare services, following disease, illness or injury, to achieve optimum quality care delivered in a cost effective manner. Goals of Case Management - ANS-Quality of healthcare, decrease fragmentation of care, enhance workers quality of life, cost containment. Right treatment, right time, right outcome, right cost Office of vocational rehabilitation\Department of rehab - ANS-It's funded by the US Department of education and services provided enables individuals with disabilities to pursue meaningful careers, secure is gainful employment commensurate with their abilities and capabilities Transitional work assignment - ANS-It's Time bound, expected duration is eight weeks or less, no longer than 12 weeks/sunset factor, if longer reevaluate ANA defines the medical home or health home as - ANS-A mechanism to provide patients with a central primary care practice or provider who coordinates the patient's care across settings and providers First work comp law - ANS-Wisconsin 1911 Purpose of Worker's Compensation law - ANS-To provide income benefits to employees for lost wages caused by occupational injury or disease as well as benefits to survivors of fatal injuries to workers Temporary partial indemnity - ANS-Partially disabled. Able to do some work, but not all of job at for wages, for a temporary period of time Temporary total indemnity - ANS-Disabled. Unable to work for a temporary period of time Permanent partial indemnity - ANS-Reduce capacity to earn wages permanently Permanent total indemnity - ANS-Unable to return to any type of work permanently Biological Hazards - ANS-Viruses, bacteria, and other organisms in the environment that harm human health are classified as
Chemical Hazards - ANS-Various forms of chemicals that are potentially toxic or irritating to the body system, including medications, solutions, and gases Environmental Hazards - ANS-Factors in countered in the work environment that causes our potentiate accidents, injuries, strain, or discomfort (I.e. Poor equipment or lifting devices, slippery floors, deficient workstations) Physical hazards - ANS-Agents within the work environment such as radiation, electricity, extreme temperatures, and noise that can cause tissue trauma. Examples are vibration and noise Physiological hazards - ANS-Factors and situations in countered or associated with one's job or work environment that create or potentiate stress, emotional strain, and or interpersonal problems. 90% of what we are exposed to is? - ANS-Inhalation Gases - ANS-Chemicals gaseous at room temp vapors - ANS-gaseous state of any substance that normally exists as a liquid or solid fumes - ANS-Gas with solid particles in it produced by condensation of volatized solid or gaseous combustion product for example in welding or molten metal's Time Weighted Average (TWA) - ANS-an evaluation of exposures that are time- weighted over an established period. It allows the exposure levels to be averaged generally over an 8-hour time period Permissible Exposure Limit (PEL) - ANS-PEL; the maximum legal limits established by OSHA for regulated substances; these are based on employee exposure that are time- weighted over an 8 hour work shift; when these limits are exceeded, employers must take proper steps to reduce employee exposure; for formaldehyde, the PEL is .75 ppm NIOSH (National Institute for Occupational Safety and Health) - ANS-tests and certifies respiratory protective devices and air sampling detector tubes, recommends occupational exposure limits for various substances, and assists OSHA inoccupational safety and health investigations and research.Part of the department of health and human services under the CDC ACGIH: American conference of governmental industrial hygiene - ANS-Provides guidelines for protection against toxic chemicals. They establish threshold limit value TLV And industrial hygiene, does is best described as? - ANS-The single factor that determines the degree of harmfulness of a substance
What is the length of time before the OHN must be recertified in hearing conservation? - ANS-5 years Wagner Act (1935) - ANS-(National Labor Relations Act) gives workers the right to organize a union and bargain with management Five step grievance arbitration procedure - ANS-Grievant, union steward, chief steward, local union president, last step arbitration OSHA (Occupational Safety and Health Administration) - ANS-Establish and modify mandatory standards Falls under the department of labor restrictive lung disease - ANS-disease of the lung that causes a decrease in lung volumes The flow of air into the lungs is restricted Ability of the lungs to expand Decrease volume of air FEV1/FVC is high=95 to 100% FVC is lower = Decreased amount of total air Forced Vital Capacity (FVC) - ANS-The volume of air expired during a forced maximal expiration after a forced maximal inspiration. FEV1 - ANS-forced expiratory volume in 1 second pulmonary function testing ratio - ANS-The amount of air that can be forcibly excelled in the first second FEV1 compared to the total amount that is exhaled FVC FEV1/FVC% Normal PFT - ANS-Greater or equal to 80% of predicted value Number one route of entry of contaminant - ANS-Respiratory system Air Purifying Respirator - ANS-A respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air- purifying element. Atmosphere Supplying Respirators - ANS-Provide clean, breathable air from and uncontaminated source from outside the area Three resistance to filter degradation - ANS-N = not resistant to oil R = resistant to oil P = oil proof
Change Model Perspective - ANS-Four conditions are necessary for change to occur:
- Employees must understand the reasons for change and agree with those reasons
- Employee must have the skills needed to implement the change
- Employees must see that managers and other employees in powerful positions support the change
- Organizational structures, such as compensation and performance management systems, must support the change. Level 1 Awareness - ANS-Posters Pamphlet/Brochures Fax sheets Newsletters Health screening Health Promotion Model - ANS-Program assessment -Obtain management commitment -Conduct needs assessment -determine internal and external resources Program planning Program implementation Program evaluation Health coaching approach - ANS-Directive, client-centered coaching style For example motivational interviewing Health coaching - ANS-A process that helps patients identify their values related to health, set health goals, and take steps to meet their personal goals. motivational interviewing - ANS-Open ended questions Affirmation Reflective listening Summarize NIOSH (National Institute for Occupational Safety and Health) - ANS-Federal agency that is nonregulatory and provides national and worldwide leadership to prevent work- related illnesses and injuries. Developed criteria for the national standards Does not cite or give penalties DOT exam blood pressure qualification - ANS-Driver qualified if blood pressure is less than or equal to 140/
Safety data sheets Employee education Safety data sheets are updated within: - ANS-Three months of new hazard finding SDS information and training - ANS-Must take place on initial assignment and one new hazard is introduced FML a comes from - ANS-The department of labor Which two heavy metals present a rest to the breast-feeding infant? - ANS-Lead and mercury Carbon tetrachloride is a chemical that affects which of the following target organs? - ANS-Liver Metal fume fever is characteristic of excessive exposure to which heavy metal? - ANS- Cadmium Oral cavity disorders, tremor and psychological disturbances make up a triad of signs for excessive exposure to which heavy metal? - ANS-Mercury Dietary intake may contribute to the workers overall body burden in which of the heavy metals? - ANS-Lead, mercury, cadmium, and arsenic Modification of the process equipment of production, local area exhaust, ventilation and frequent equipment maintenance are examples of which type of control? - ANS- Engineering Levels of confidentiality - ANS-Level one information required by law Level two information to assist HR Level III this level is the most controlled and this is personal health information 29 CFR 1910.1020 - ANS-Access to employee exposure and medical records General Recording Criteria - ANS-Death Days away, restricted, or transferred Medical treatment beyond first aid Loss of consciousness Significant injury/illness diagnosed by a P/LHCP Determination of a new case - ANS-Reappearance of signs or symptoms from completely recovered injury or illness event related to work environment. Restricted work - ANS-Cannot perform one or more routine functions (Work activities the employee regularly performs at least once per week) Of his/her job; or
Cannot work a full workday, or A P/LHCP recommends either of the above first aid - ANS-Non-prescription medication at non-prescription strength Tetanus immunization's Cleaning, Flushing, soaking surface wounds When coverings, butterfly bandages, Steri-Strips Hot or cold therapy Nonrigid means of support Temporary immobilization device used to transport accident victims Drilling fingernail or toenail, draining fluid from blister Eyepatches Removing foreign bodies from the eye with only irrigation or cotton swab Removing splinters, foreign material from areas other than the eye by irritation, tweezers, cotton swabs or simple means. Finger guards Massages not PT Drinking fluids to relieve his stress Special recording criteria - ANS-Needle sticks Medical removal Hearing loss Tuberculosis MSD's Recording criteria for blood and body fluid exposure - ANS-Record all work related needlestick injuries and sharp object cuts contaminated with blood or other potentially infectious material. Record as injury on the OSHA 300 log without employees name Record blood or body fluids exposures if results in blood borne illness diagnosis Medical removal recording - ANS-Record all mandatory medical removal cases per status for example restricted duty etc. Record chemical exposure as poisoning Hearing loss recording - ANS-Record confirmed, work related STSF total hearing level is 25 dB or greater above audiometric zero, average at 2000, 3000, and 4000 Hz and same here as STS Work related tuberculosis recording - ANS-Record if occupationally exposed to known active case of TB resulting in positive skin test or P/LHCP diagnosis. Do not record is non-occupational exposure for example household contact, community exposure, previous exposure with skin test. Privacy concern cases - ANS-Cases that allow the substitution of a case number for an employee's name on the Occupational Safety and Health Administration (OSHA) 300
High voltage interrupts hearts electrical system resulting in rhythm disturbances usually? - ANS-Ventricular fibrillation Hydrofluoric acid - ANS-Use calcium gluconate gel and sq inject after iced Zephiran irrigation to stop the burning Delayed or type IV allergic contact dermatitis - ANS-Itchy, red, mildly swollen rash like poison ivy, appears only on areas touched by latex Symptoms develop 10 to 30 hours after contact irritant contact dermatitis is not a true latex allergy Immediate hypersensitivity or type I latex allergy - ANS-Hives, itchy welts, hayfever like symptoms, wheezing, coughing Symptoms occur within minutes of exposure Allergic reaction may involve parts of body not touch my latex May involve airway reaction and anaphylaxis Rocky Mountain Spotted Fever - ANS-Caused by Rickettsia rickettsii Sx: rash on palms and soles (migrating to wrists, ankles, then trunk), HA, fever. Endemic to East Coast (in spite of its name). Hypnozoite - ANS-Dormant liver stage parasites that may reactivate after symptom less intervals of 2 to 4 years Malaria - ANS-After 1 sporozoite ( parasite from female mosquito)- invades the liver cell Parasite grows in six days producing 30 to 40,000 daughter cells merozoites One merozoite invades a red blood cell, grows in 48 hours producing 8 to 24 daughter cells Most common antimalarial drugs - ANS-Chloroquine Quinine sulfate (qualaquin) Hydroxychloroquine (plaquinil) Check visual acuity - ANS-24 hours after patch/treatment or post injury Injuries can cause closed angle glaucoma the signs and symptoms are - ANS-Severe eye pain Rapid increase in intraocular pressure Halos around light Headache Nausea and vomiting Common alkalis - ANS-Lye Cement Lime
Ammonia Irrigate for 45 minutes Hyphema - ANS-blood in the anterior chamber of the eye Oral hygiene-swollen, puffy gums can be? - ANS-A vitamin C deficiency Koplik spots - ANS-Rubeola (measles)- Red measles White areas on Buechel Makossa opposite first and second molars inside the cheek Angle of Louis - ANS-Second intercostal space landmark Sternal angle, And junction between manubrium and tracheal bifurcation, aortic arch Mantoux test - ANS-intradermal test to determine recent or past exposure to tuberculosis (TB) Read in 48 to 72 hours += induration/wheal not redness QuantiFERON-TB Gold Test - ANS-definitive blood test to diagnose TB Must be processed within 8 to 16 hours Requires one visit and no error in reading skin reaction No false positives from prior BCG pneumoconiosis - ANS-any fibrosis of the lung tissues caused by dust in the lungs after prolonged environmental or occupational contact Silicosis Asbestosis Black lung disease mesothelioma - ANS-Rare malignant tumor arising in the pleura and associated with asbestos exposure. Silicosis - ANS-Caused by inhaled dust containing crystalline free silica Develops in 10 to 15 years of exposure PFT shows restrictive lung disease Asbestosis - ANS-the form of pneumoconiosis caused by asbestos particles in the lungs Interstitial fibrosis Smoking increases risk Signs and symptoms include shortness of breath, maybe clubbing of fingers Develops in 10 to 20 years Progresses to mesothelioma and G.I. cancers byssinosis - ANS-lung disease resulting from inhaling cotton, flax, or hemp, also known as brown lung disease
Hip pelvis fracture - ANS-Affected leg is shorter External rotation is normally seen Hip dislocation - ANS-Thigh rotates internally Low Back Pain (LBP) - ANS-a non-specific symptom that affects people for a number of reasons, including mechanical problems, excess body weight, injuries, and chronic diseases. Exercise is considered one of the cornerstones of both prevention and treatment. Oldest occupational health problem; leading cause of absenteeism Appendicitis - ANS-Peri-umbilical pain first to McBurney's point (Right lower quadrant) Hepatitis A - ANS-inflammation of the liver caused by the hepatitis A virus (HAV), usually transmitted orally through fecal contamination of food or water Hepatitis B virus - ANS-virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood Hepatitis C (HCV) - ANS-bloodborne viral disease that affects the liver; transmitted by blood exposure, sharing needles, or from infected mother to infant; rarely transmitted by sexual contact Chlamydia - ANS-A sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated. Treatment is not penicillin Doxycycline, TCN, azithromycin Erythromycin for pregnant women Secondary syphilis - ANS-Rash on palms and soles of feet Copper penny spots One week to six months later infectious up to 2 years non-ionizing radiation - ANS-Microwave telecommunications Microwave ovens Infrared lamps to keep food warm Radio waves broadcasting ionizing radiation - ANS-radiation w/enough energy to free electrons from atoms forming ions, may cause cancer (ex. gamma, X-rays, UV).
Ionization - ANS-the process of adding or removing electrons from an atom or molecule, which gives the atom or molecule a net charge Three main kinds of ionizing radiation - ANS-Alpha particles-two protons and two neutrons Beta particles-essentially electrons Gamma rays and x-rays-pure energy, photons, most dangerous Radio Active Iodine - ANS--Absorbed by thyroid cells and destroys the thyroid producing cells, given by oral route -High doses are used to treat: Hyperthyroidism Thyroid cancer -Radiation sickness- nausea, vomiting,epistaxis -Monitor CBC -Bone marrow suppression -Monitor for signs of hypothyroidism -Patient should not cough or expectorate Treatment potassium iodide Radiation sickness - ANS-a condition that results from a large dose of ionising radiation, causing significant cell death; symptoms include nausea, vomiting, fever, hair loss and diarrhoea Example; Hiroshima, Nagasaki, Chernobyl Prussian blue-1704-dye military uniforms - ANS-Traps cesium and thallium to excrete through intestines COPD (chronic obstructive pulmonary disease) - ANS-Airflow out of the lungs is obstructed/ decreased airflow Obstructive lung diseases - ANS-asthma, emphysema, chronic bronchitis FEV1 is low= Decrease speed of outflow, difficult getting out of lungs FVC is normal Hardiness theory (Know what the 3 C's of hardiness are) - ANS-Challenge-openness to change Commitment- involvement or alienation at work Control-Sense that one is influential or helpless maturational crisis - ANS-A normal state in growth and development in which a specific maturational task must be learned but old coping mechanisms are no longer adequate or acceptable. situational crisis - ANS-occurs when a patient faces an event or situation that causes a disruption in life
