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COHNS EXAM HIGHLIGHTS WITH
COMPLETE SOLUTIONS
of newly occurring cases per person-time unit - ANSWER-Incident rate
Identification or reporting of a group of cases; not a true epi study - ANSWER-Case studies (series) Survey to determine PREVALENCE of disease or exposure at the same point in time; SELECTION BIAS IF ILL INDIV ARE GONE. Another shortcoming is that it can only show association between exposure and disease: did the disease precede exposure or vice versa? Health status of those who left work? - ANSWER-Cross sectional study Recommended gloves mask eye protection - ANSWER-Amputation PPE Reduce likelihood of exposure by altering the manner in which a task is performed (not to be associated with engineering controls) - ANSWER-Work practice control definition
- ANSWER-Compute range of sample distribution Exposed and nonexposed groups followed over time to determine who develops the disease; MOST direct eval of health and disease patterns; MEASURES RISKS AND EXPENSIVE - ANSWER-Cohort study (longitudinal or follow up study) Comparison of exposure among individuals with disease (cases) and others without disease (controls); retrospect or case referent eval done to determine who was ir wasnt exposed; LESS EXPENSIVE AND RECALL BIAS FOR THOSE EXPOSED - ANSWER- Case control study Ex: Pb, Cd Accumulate in subsoil Toxic accumulation in veggies, fruits, pica activity, leaching into drinking water - ANSWER-Environmental effects of heavy metal contaminants Lead induced porphyria (skin and nervous system), aplastic anemia (bone marrow toxicity) neuro (lowered IQ and attention deficit) - ANSWER-Body burdens of Pb and Cd AGIH, OSHA: permissible work place exposures
DOT, EPA, OSHA and state agencies: enable statutes and regs to establish workplaces to be free of potentially hazardous exposures to toxic substances - ANSWER- Regulatory principles for limiting potential health threatening exposures Highest permissible level in 8hr work day - ANSWER-OSHA PEL Maximal avg encountered value that can be safely experienced in 8hr day; usually SAME OR LOWER THAN PEL - ANSWER-NIOSH TLV Max permissible exposure in a 15min time period (short term) - ANSWER-OSHA STEL Exposure level in humans not expected to produce adverse effects; extrapolated safety factor of 10 from animal data - ANSWER-NOEL (no observable effect level) Immediate danger to life or health - ANSWER-IDLH Lowest level of exposure capable of producing a detectable effect - ANSWER-LOEL (lowest observable effect level) Exposure level pegged to conditions necessary to ensure the maintenance of well-being
- ANSWER-HBEL (health based exposure level) 1869-1970, pioneering physician who first delved into the problems of Occ disease in 1908 when IL governor asked her to investigate industrial disease (phosphorus in matches, decreased lead, mercury, benzene, CO, CO2) - ANSWER-Alice Hamilton Congress set standards for airborne emissions and air pollutants and industrial effluents and drinking water - ANSWER-Clean Air Act 1970 & Clean water Act 1972 "Superfund Act", 2 main federal laws that deal with land disposal practices and clean up. - ANSWER-Resource Conservation and Recovery Act (RCRA 1976) & Comprehensive environmental response, Compensation liability act (CERCLA 1980) Came from CERCLA, to prevent and mitigate adverse human health effects from environmental hazards. NIOSH and ATSDR take active roles in educational efforts for medical and public health professionals - ANSWER-ATSDR (agency for toxic substances and disease registry) Organic compounds that are effective in dissolving other substances. Exists as liquid and gas (i.e. gas, pain thinner). Many are ORGANIC HYDROCARBONS which are LIPOPHILIC. As a result, the most common s/s of toxicity involve the SKIN, LIVER and PNS/CNS. Local mechanical ventilation is a highly effective method of controlling solvent vapors. - ANSWER-Solvents
Routes of exposure: inhalation and ingestion. Once absorbed, lead is found in all tissues and accumulated into bone. Excreted: primarily urine with small amounts via feces, sweat, hair and nails - ANSWER-Lead absorption and secretion Single best diagnostic test: BLL (not reliable for prior or cumulative exposure or total body burden). Indirect measures of lead: Erythrocyte protoporphyrin (EP) or zinc protoporphyrin (ZPP) - ANSWER-Evaluating lead exposure (thimerosol) metal that naturally exists in different forms to include elemental, inorganic and organic. An estimated 3mg avg daily intake of mercury! Can be found in nasal sprays, vaccines, eye ointments, eye drops, food/fish, paper mills, disinfectants, latex paints and adhesives, fungicides - ANSWER-Mercury GI, Skin and Respiratory tract and effects: CNS/kidneys - ANSWER-Mercury absorption Most common use: electroplating of iron and steel, pigments for paints and plastics. Cadmium is NOT mined, but is a byproduct of the smelting of other metals such as zinc, copper and lead. - ANSWER-Occupations involving cadmium exposure INHALATION exposure to fumes (associated with welding or using silver solder). Initial symptoms: fever, chills, metallic taste. Severe: cadmium pneumonitis. - ANSWER-Acute effects of cadmium exposure KIDNEYS; absorbed cadmium is transported in the blood to kidneys, liver and muscle. - ANSWER-Critical target organ of CHRONIC cadmium exposure Most common use: high-strength steel and permanent magnets, it is the binder in cemented carbides in the manufacture of machine tools/saw blades and drill tips. Cobalt compounds are used in pigments in glass and ceramic industry, additive in animal feeds and as foam stabilizers. Cobalt is an essential nutrient for humans and vitamin B contains cobalt. - ANSWER-Occupations involving cobalt exposure Target organs: skin & lungs. Granulomatous lung disease aka chronic beryllium disease, nasopharyngitis, contact dermititis, beryllium skin ulcers, pneumonitis. Latency of disease as short as a few weeks to span up to several decades. - ANSWER-Disease associated with beryllium "noncombustible", naturally occurring fibrous, hydrated silicates present everywhere in the soil. 6 types: chrysotile, croicdolite, amosite, anthophyllite, actinolite and tremolite. 2 feber types: serpentine and amphibole. **USED IN CONSTRUCTION MATERIALS FOR ITS HEAT RESISTANCE, FLEXIBILITY, ACID/ALKALI RESISTANCE AND TENSILE STRENGTH. - ANSWER-Define asbestos the only serpentine asbestos fiber that accounts for 95% of all asbestos used commercially worldwide. - ANSWER-Chrystolite
typically occurs during the degradation of asbestos-containing materials in existing buildings. PEL=0.1 fiber/ml per OSHA - ANSWER-Current exposure to asbestos Route: inhalation. Nonmalignant diseases: asbestosis, pleural plaques, benign pleural effusions, diffuse pleural thickening, rounded atelectasis, benign lung nodules. Malignant diseases: lung cancer and mesothelioma - ANSWER-Asbestos exposure diseases Pleural effusions have the shortest latency at 10-20yrs. Asbestosis develops over 20- 30yrs. Lung cancer latency is 20-40yrs. Mesotheliomas occur 30-40 yrs after exposure. (*all are "on average") - ANSWER-Asbestos latency periods Describes ONLY the bilateral interstitial fibrosis of the lung parenchyma caused by inhalation of asbestos fibers - ANSWER-Define asbestosis The International Labor Organization (ILO) designed a system of classifying chest radiographs of persons with pneumoconiosis to standardize for epidemiological use. This classification was based on the posteroanterior chest radiograph with associated terms and 22 standard radiographs that illustrate the pleural and parenchymal changes of pneumoconioses. NIOSH and ACR offer ILO classifications to become a "NIOSH certified B reader" - ANSWER-What is a chest radiograph B-reading? Fibrotic lung disease caused by inhalation of crystalline silicone dioxide (SiCO2). - ANSWER-Silicosis Miners, foundry workers, sandblasters, manufacturers of glass and ceramics - ANSWER-Occupations at risk for silicosis Chronic, accelerated and acute. Chronic is most common and is evident more than 20yrs after exposure to SiCO2. Accelerated develops 15-20yrs, acute within 2yrs - ANSWER-Clinical presentations of silicosis Spectrum of respiratory symptoms and functional impairment in workers exposed to dust from cotton, flax, soft hemp and sisal. "Monday feeling" - ANSWER-Byssinosis Cotton mill workers, weavers, mattress makers, yarn/rope makers. Latency of about 10yrs - ANSWER-Occupations at risk for byssinosis Carbon monoxide - ANSWER-Leading cause of fatal poisonings in the US Headache, nausea, dizziness, muscle weakness, chest pain, visual disturbances - ANSWER-S/s of acute CO poisoning Auto mechanics, parking garage and gas station attendants, warehouse workers, firefighters, cooks, maintenance workers, construction workers - ANSWER-Occupations at risk for CO exposure
Up to 50% of the population has an episode of LBP and 50-70% will experience in their lifetime - ANSWER-How common is LBP 0.15 or 150mL - ANSWER-For PFT matches how close do u need to be? FEV1/FVC - ANSWER-What is the best indication of airway obstruction on a PFT? Industrial workers - ANSWER-Who has the largest number of occupational ILLNESSES? WMSD and skin rashes - ANSWER-Most common occupational health illnesses? Type of accident (struck by, caught in, struck against, fall from elevation, fall from same level, MVA, repetitive trauma, other physical trauma) - ANSWER-How does ANSI classify work injuries? Pain at base of thumbs caused by excessive twisting, gripping (butchers packers seamstresses) - ANSWER-DeQuervains Difficulty moving index finger and snapping/jerking movements caused by repetitive use of finger (meat packers, carpenters, electronic assemblers) - ANSWER-Trigger finger Pain and swelling to hands and wrists caused by repetitive or forceful hand motions (meat packers, cake makers) - ANSWER-Tenosynovitis Numbness tingling ashen skin loss of feeling or control caused by vibration to hands (power tool operators) - ANSWER-Raynauds Tingling numbness severe pain loss of strength or sensation to index middle or half of the ring finger - ANSWER-Carpal tunnel Most effective way to reduce stress and strain caused by physical exertion (mechanical aids, environment layout, order of operations) - ANSWER-Engineering controls Length of shift, number of breaks, number of employees - ANSWER-Administrative controls PPE - ANSWER-What is the least effective hazard control strategy? Worksite analysis, engineering controls, administrative controls and training/education. Elimination or substitution isolation or containment, engineering administrative, work practice (dampen mouse poop) and admin controls (lick out tag out) and PPE - ANSWER-OSHA's 4 aspects of an ergo program Education - ANSWER-Most important tool for prevention of illness and injury
Dusts fumes mists vapors and gases - ANSWER-5 ANSI chemical classifications If it has the potential to cause harm to an organism. Toxicity cannot be altered. - ANSWER-When is a chemical toxic? Inhalation (Gases, Mists Airborne Particles and Vapors) LEAST likely is oral - ANSWER-Most common chemical route of expisure Heavy metals, organic solvents, antineoplastic agents, antiviral, estrogenic/antiestrogenic compounds, immunosuppressive agents, carcinogens and mutagens, WAG, sterilants/disinfectants, PCBs, pesticides - ANSWER-Chemicals with known effects on pregnancy If the potential is severe enough to result in poisoning. Hazards can be eliminated or controlled - ANSWER-When is a chemical a hazard? A chemical that produces illness or death when a person is exposed to only small amounts - ANSWER-Define poison It's bad!!! - ANSWER-Short latency 0.5 microns - ANSWER-What size must a fiber be to make it through our nasal passages to lungs It does have an effect - ANSWER-Gender and toxicity IN UTERO (female specific) - ANSWER-Teratogenesis Product name trade name end use (used for) who makes it and contact info, hazardous ingredients/ chemical composite, physical data, exposure limits, fire and explosion data, reactivity, toxicological properties, preventive measures, first aid measures, who prepared this info and their contact - ANSWER-Main items on SDS Exposure limits, legal requirements from OSHA and data gathered from worksite (WEA)
- ANSWER-Sources of info that dictate class of substance as a hazrad dose at which a noticeable effect is realized (max tolerable but is not guaranteed so workers should always use lowest). TLV-C (ceiling TLV!) - ANSWER-TLV Change in DNA - ANSWER-Mutagenesis Recommended exposure limit - ANSWER-REL Grab sampling, integrative sampling, active sampling - ANSWER-Types of sampling
Chloracne - ANSWER-PCB exposure Lung cancer - ANSWER-Chromium Skin, lungs, liver, granulamatous, NOT asthma, NOT cirrhosis - ANSWER-Beryllium Urinary, reprod, nervous - ANSWER-Lead Acute toxic encephalopathy, PNS abnormalities, nausea/vomiting, headaches, disorientation NOT hepatic dysfunction - ANSWER-Ethylene oxide Pungent solvent with high vapor pressure, causes narcosis, dermatitis and is capable of defeating the skin (cracking to skin) - ANSWER-MEK methlethylketone Potent kidney toxins that affect skin lungs bone marrow and lymphatics - ANSWER- Insolvable and solvable uranium Exposure to dusts is implicated in many respiratory conditions - ANSWER-Respiratory distress Bauxite pneumoconiosis associates with silica and alumni in dust/fume - ANSWER- Shavers Disease Urinary creatinine, pH and beta 2 microglobins, exposure may cause abnormal lung cz, renal disease, low protein weight in urine. Inhalation is primary route. Symptoms similar to metal fume fever as result from welding and soldering - ANSWER-Cadmium Pigmentation of the king die to iron oxide exposure. Sometimes no physical detriment although some may present with chronic bronchitis or dyspnea - ANSWER-Siderosis Medical surveillance includes UA for hippuric acid - ANSWER-Toluene GI Tract (can cause diarrhea) - ANSWER-Acute arsenic poisoning Smoke pneumococcus and staphylococcus - ANSWER-Etiological factors in chronic bronchitis Adenovirus - ANSWER-Etiological factors in respiratory conditions such as common cold rhinitis and atypical pneumonia Cell destruction - ANSWER-Danger of high level ionizing radiation Lung, larynx pancreas bladder esophagus oral cavity and kidney - ANSWER-Cancers assoc with cigarette smoke
OSHA! It is a required exposure limit - ANSWER-PEL BELONGS TO ACGIH! It is a recommendation! - ANSWER-TLV BELONGS TO 30 years - ANSWER-OSHA requires medical records and exposure records to be maintained for how long? It's a summary of work related injuries and illnesses, must be posted annually from 2/1- 4/30 - ANSWER-OSHA 300A form Tests to evaluate carcinogenic potential within a relatively short period of time (40wks or less). They are NOT applied as a battery like in vitro short term tests, but SELECTIVELY according to info available on the chemical. - ANSWER-Limited in vivo bioassays 15 working days after receipt of citation - ANSWER-Once employer is cited by OSHA, how much time does the employer have to contest the citation?
- ANSWER-Critical incident technique Health needs, resources, org goals, priorities, indirect and direct operating costs - ANSWER-Preparation of a budget for an Occ health facility requires info about: One of the most valuable resources in developing a manual for Occ health and is published by AAOHN! - ANSWER-Guide for preparation of a manual of policies and procedures for Occ health services Lead formaldehyde cadmium methylene chloride cadmium and benzene - ANSWER- OSHA medical removal AND job placement provision is provided for exposure to: Protocols! Assists with measurement of standards. - ANSWER-What defines the area of practice, the quality and standards of care? Blue-health : blUE blood White-PPE white condoms Orange-physical hazard : oranges are hazards Yellow-reactivity - ANSWER-NFPA 704 diamonds (hazardous response) Health (blue) (0-4 with 0 no risk and 4 is life threatening - ANSWER-HMIS (hazard material identification system) created by NFPA
