Occ Med Spec Boards - Clinical Patient Care

The human ear can hear frequencies in the range of ___? A) 16 - 20,000 Hz B) 2,000 - 5,000 Hz C) 300 - 700 Hz D) 20 - 10,000 Hz

The correct answer is: A 16 - 20,000 Hz is a span of nearly nine octaves. Answer B, 2000 - 5000 Hz, is the range of greatest sensitivity. Answer C, 300 - 700 Hz, is the pitch of the human voice.

Which of the following statements regarding hydrofluoric acid (HF) is FALSE? A) HF is relatively harmless in concentrations of 10-15% B) HF often leads to soft tissue necrosis and bony decalcification C) Pain is delayed up to 24 hours after contact with D) Calcium gluconate gel (2.5%) can be used on all parts of the body as a sequestering agent

The correct answer is: A Exposure to HF in relatively dilute concentrations (10-20%) can actually be more dangerous than contact with higher concentrations. Symptoms can be delayed for several hours leading to delayed diagnosis and treatment. The fluoride ion of HF readily penetrates the skin, causing soft tissue necrosis and bony decalcification. Onset of pain is related to acid concentration; pain is immediate after skin contact with >50% HF; delayed up to 6 hours after contact with 20-50% HF, and up to 24 hours after contact with less than 20% HF. Calcium gluconate gel is acceptable for use on all body parts, whereas quaternary ammonium compounds should not be used on the face or near the eyes. Fatal hypocalcemia has been reported in the literature following a total body surface burn of 2.5%.

Which of the following statements about Meniere's Disease is NOT correct: A) Hearing loss is noted in high frequencies: 4000-8000 Hz, by both air and bone conduction B) Vertigo and tinnitus are initially self-limiting, then permanent C) Patients complain of aural fullness and a "tinny" character to spoken voice D) The classic syndrome consists of episodic vertigo, with tinnitus and hearing loss localized to the affected ear

The correct answer is: A Hearing loss associated with Meniere's disease is typically in the low frequency range between 250-2000 Hertz.

A chest x-ray showing tiny round opacities primarily in the upper lung fields and hilar adenopathy is MOST characteristic of which of the following lung disorders? A) Silicosis B) Asbestosis C) Hypersensitivity pneumonitis D) Metal fume fever

The correct answer is: A In silicosis, the chest x-ray shows rounded opacities, initially localized to the upper lung fields. Eggshell calcification of hilar lymph nodes occurs in roughly 20% of cases.

What is the major cause of morbidity and mortality in acute radiation exposure below 1000cGy? A) Infection/sepsis B) Circulatory collapse C) Respiratory failure D) Brain edema

The correct answer is: A Ionizing radiation may comprise high-energy electromagnetic waves (x-rays and gamma rays) and particles (alpha particles, beta particles, and neutrons) that can strip electrons from atoms (ionization). The adverse impact of radiation depends on several factors, including dose, dose rate, percent of the body exposed, and types of tissue exposed (various tissues have differing sensitivities to radiation). Doses of radiation in the low to midlethal range will lead to depression of bone-marrow function with cessation of blood-cell production and resultant pancytopenia. Changes within the peripheral blood profile may occur as early as 24 hours post-irradiation. The time of onset of the depression of cellular production in the marrow will vary considerably, and the concomitant clinical problems of a tendency toward uncontrolled hemorrhage, decreased resistance to infection, and anemia will likewise vary considerably from as early as 10 days to as much as 6 to 8 weeks after exposure. In general, the severity of the hematological depression will be dose dependent, and the more severe phases of bone-marrow depression will occur earlier. Risk of various infections is increased as a result of the neutropenia (most prominent at 2 to 4 wk) and decreased antibody production.

Self-contained breathing apparatus and totally-encapsulating chemical protective suit A) Level A B) Level B C) Level C D) Level D

The correct answer is: A Level A protection should be used when: (1) the hazardous substance has been identified and requires the highest level of protection for the skin, eyes, and the respiratory system based on either the measured (or potential for) high concentration of atmospheric vapors, gases, or particulates; or the site operations or work functions involve a high potential for splash, immersion, or exposure to unexpected vapors, gases, or particulates of materials that are harmful to skin or capable of being absorbed through the skin; (2) substances with a high degree of hazard to the skin are known or suspected to be present, and skin contact is possible; or (3) Operations are being conducted in confined, poorly ventilated areas, and the absence of conditions requiring Level A have not yet been determined.

Which of the following statements regarding reproductive effects secondary to occupational exposure to chemical and physical agents is NOT CORRECT: A) 15% or more of all pregnancies do not result in live births B) Strict adherence to OSHA standards for occupational exposures will prevent adverse work related reproductive effects C) Chromosomal abnormalities are much more frequent in spontaneous abortions than in live-born infants D) The etiology of over 60% of all birth defects is unknown

The correct answer is: B Adherence to most OSHA standards will not necessarily prevent adverse reproductive outcomes. There is an insufficient amount of human data in this area to serve as a basis for most of these standards.

All of the following agents are regulated in part for their reproductive effects EXCEPT: A) Benzene B) Lead C) Radiation D) Ethylene oxide

The correct answer is: A Most of the approximately 79,000 chemicals listed in the NIOSH Registry of Toxic Effects of Chemical Substances (RTECS) have not been thoroughly evaluated for their reproductive or developmental toxicity. In fact, only a handful of agents have been regulated in part for their reproductive effects. Even some of these regulations have not been adequately updated to reflect the current scientific and medical literature, and therefore may not be fully protective. Depending on the source of exposure and industry, the Nuclear Regulatory Commission, MSHA and OSHA all regulate ionizing radiation exposure to prevent reproductive harm to workers. Additionally, OSHA has specific standards for: lead dibromochloropropane ethylene oxide based in part on their reproductive effects. The Air Contaminants Standard sets limits on seven agents: acetonitrile acetylsalicylic acid captan cyclohexylamine hexafluoroacetone phenylphosphine vinylidene chloride based in part on reports of animal reproductive toxicity. Sadly, a number of other agents-including benzene, formaldehyde and vinyl chloride-are suspected reproductive toxicants, but are only regulated for other adverse health effects that may not be protective of the worker's reproductive system or the health of the developing fetus.

Which of the following is the best method to prevent occupational back injuries: A) Job design B) Screening low back x-rays C) Therapeutic exercises D) Pre-placement evaluation of the lumbar spine

The correct answer is: A Preplacement examinations and back x-rays have not been effective in screening for high risk employees. Education in lifting techniques and exercises are an adjunct to job redesign with attention to ergonomic factors.

Smoking cessation program I. Primary prevention II. Secondary prevention III. Tertiary prevention IV. Hazard evaluation A) I B) II C) III D) IV

The correct answer is: A Primary prevention is the reduction in the incidence of disease and injury largely through the elimination of risk factors or causes of such disease and injury. !!! Smoking cessation = eliminating risk for disease

Adequate spirometric testing includes the following: A) Two acceptable expiratory maneuvers with no more than 5% difference in FVC obtained from the two best curves B) Two acceptable expiratory maneuvers with no more than 20% difference in FEV1 obtained from the best two curves C) Use of a machine that is calibrated at least once every two years D) At least two reproducible tracings of a maximal expiration that have been sustained for five or more seconds

The correct answer is: A Quality spirometry requires that: * machines be calibrated and meet recommended standards * the test should be performed by an individual trained in its use * at least three tracings should be obtained that are sustained for at least six seconds with appropriate shape to the flow-volume curve and with no more than 5% difference in FVC obtained from the two best curves.

Which of the following laboratory tests is the test of choice for monitoring occupational organophosphate insecticide exposure? A) Red blood cell cholinesterase B) Urine cholinesterase C) Serum cholinesterase D) Plasma cholinesterase

The correct answer is: A Red cell cholinesterase is valuable in the diagnosis and medical surveillance of potentially exposed workers and is a more direct indicator of true acetylcholinesterase inhibition than the plasma level.

An employer asks you to institute a CTS screening program as part of the pre-placement exam for asymptomatic job applicants for clerical positions. Current medical opinion is that there is/are __________ for accurately predicting whether healthy workers are susceptible to carpal tunnel syndrome (CTS). A) No valid methods B) Valid methods which can be administered only by a clinician C) Numerous valid methods D) Valid methods which have nearly 100% predictive value only if the individual is exposed to repetitive motion on a sustained basis

The correct answer is: A Screening tests (Phalen's test, Tinel's test, nerve conduction latency) for carpal tunnel syndrome are not reliable even though some vendors of screening devices allege that they have products that do so. As with most screening tests, screening and diagnostic tests for CTS will have a certain rate of reported false positives and false negatives. Sensitivity (ratio of number of disease present subjects with positive test result to number who test positive + number who test negative), specificity (ratio of number of subjects who are disease free and with negative test results to number who are disease free with positive test result + number who are disease free and who test negative), and positive predictive value are not considered high enough to be used as a screening tool in asymptomatic workers. Nerve conduction testing is considered the gold standard, however, for diagnose of CTS in those patients who are symptomatic.

From Nachemson's research on intervertebral disc pressure between the 3rd and 4th lumbar vertebrae, which combination of postures represents the highest to lowest disc pressures? A) Sitting, standing, lying B) Standing, lying, sitting C) Lying, standing, sitting D) Sitting, lying, standing

The correct answer is: A Sitting = 140%, standing = 100%, laying = 24% From Nachemson and Morris, 1964, relative increase and decrease in intradisc pressure in different supine, standing, and sitting postures, compared to the pressure in upright standing (100%).

Temporary Threshold Shift is a physiological event that results in a depression of the hearing. The anatomic location of the change that results in the TTS is the: A) Organ of Corti B) Auditory canal C) Tympanic membrane D) Auditory nerve

The correct answer is: A The Organ of Corti is thought to be the location of the physiological change that results in the TTS. The change has been hypothesized to be a chemical change in the composition of the fluid or a metabolic change in the hair cells themselves.

Which of the following statements about hand-arm vibration syndrome is FALSE: A) The principal clinical presentation includes vasospasm, quantitative cutaneous sensory deficits, and nerve conduction abnormalities B) About 80% of symptomatic cases may have median nerve slowing at the wrist, which is indistinguishable from carpal tunnel syndrome C) The etiology is vibration, predominantly in the 30-500 Hz range D) Neurologic symptoms usually precede vascular complaints

The correct answer is: B 20% of symptomatic cases may have median nerve slowing at the wrist.

A temporary depression of hearing is called a: A) Noise Induced Hearing Reduction (NIHR) B) Temporary Threshold Shift (TTS) C) Permanent Threshold Shift (PTS) D) Temporary Auditory Depression (TAD)

The correct answer is: B A temporary depression of the hearing is called a Temporary Threshold Shift or TTS.

Acute whole body exposure to 100 rads of ionizing radiation will MOST likely result in: A) No effect B) Reduction in platelet and lymphocyte counts C) Intractable nausea, vomiting, and diarrhea with 50% chance of death in 30 days D) Death within 1 week

The correct answer is: B An acute whole body dose of 100 rads can produce mild prodromal symptoms of acute radiation syndrome, with a detectable reduction in the platelet and lymphocyte counts, and with full spontaneous recovery. The 50% mortality level is in the 400 rem range.

Which of the following has NOT been associated with cancer secondary to occupational exposure? A) Liver B) Breast C) Bladder D) Lung

The correct answer is: B Bladder cancer has been linked to leather dyes, B-napthylamine, and benzidine. Lung cancer is associated with exposure to asbestos, arsenic, chromium compounds, iron ore, mustard gas, nickel, and radiation. Leukemia has been linked to exposure to radiation and benzene. Liver cancer is associated with arsenic and vinyl chloride. Breast cancer has not been connected to any occupational exposure.

Which of the following agents has been linked to the development of atherosclerosis? A) Hydrogen disulfide B) Carbon disulfide C) Lead D) Fluorocarbons

The correct answer is: B Carbon disulfide has been associated with the development of atherosclerosis, in addition to causing neuropsychiatric effects. Hydrogen disulfide, lead, fluorocarbons, and carbon tetrachloride have not been associated with atherosclerosis.

All of the following are true of carpal tunnel syndrome EXCEPT: A) Most common in patients 30-60 years of age B) Male to female ratio of between 3 to 5: 1 C) 50 % are bilateral D) Earliest involvement of the abductor pollicis brevis muscle

The correct answer is: B Carpal tunnel results from impairment of motor and/or sensory function of the median nerve as it transgresses the carpal tunnel. Muscle atrophy and loss of function are late findings, although the abductor pollicis brevis muscle may show earlier involvement. Symptoms are precipitated by activities which require repeated flexion, pronation and supination of the wrist, for example, sewing, driving, and operating computers. Females are more commonly affected than males.

Finklestein's Test is a test for: A) Visual acuity B) De Quervain's Disease C) Phalen's Disease D) Derangement of the shoulder

The correct answer is: B De Quervain's disease is a stenosing tenosynovitis of the tendons on the radial side of the wrist and base of the thumb (Tunnel I). To perform Finklestein's test, the examiner instructs the patient to form a gentle fist around the thumb as the thumb is folded into the palm. Then gently deviate the wrist to the ulnar side. Discomfort and sharp pain during this process in the region of Tunnel I is a positive physical finding for De Quervain's disease.

Death due to whole-body radiation exposure above 10,000 rad is most likely attributable to which of the following causes? A) Hematopoietic syndrome B) Effects on the neurological system C) Gastrointestinal syndrome D) Cancer

The correct answer is: B Deaths caused by whole-body radiation exposure below 1,000 rad are primarily due to hematopoietic effects. Between 1,000 and 10,000 rad, death is usually attributable to gastrointestinal syndrome. Above 10,000 rad, death is most commonly due to central nervous system effects.

All of the following are true with respect to occupational asthma EXCEPT: A) It accounts for about 2-15% of new cases of adult asthma B) Workers with comparable exposures will be affected to the same degree C) Typical symptoms include cough, chest tightness, wheezing, and dyspnea D) Symptoms show improvement on weekends and vacations

The correct answer is: B Host factors, such as atopy and smoking, seem to play a role in predisposition of workers to occupational asthma. For affected individuals, job transfer to an area free of exposure to the offending agent is usually indicated.

According to IARC classification, an agent classified as Group 2B is: A) Carcinogenic to humans B) Possibly carcinogenic to humans C) Not classifiable as to its carcinogenicity D) Probably carcinogenic to humans

The correct answer is: B IARC classifies agents by the following groups: Group 1 Carcinogenic to humans (107 agents) Group 2A Probably carcinogenic to humans (63 agents) Group 2B Possibly carcinogenic to humans (271 agents) Group 3 Not classifiable as to its carcinogenicity to humans (509 agents) Group 4 Probably not carcinogenic to humans

All of the following are symptoms of organophosphate poisoning EXCEPT: A) Chest tightness B) Urinary retention C) Wheezing D) Bradycardia

The correct answer is: B Involuntary urination is a sign of severe organophosphate poisoning.

Self-contained breathing apparatus and hooded chemical-resistant splash protective chemical suit A) Level A B) Level B C) Level C D) Level D

The correct answer is: B Level B protection should be used when: (1) the type and atmospheric concentration of substances have been identified and require a high level of respiratory protection, but less skin protection; (2) the atmosphere contains less than 19.5% oxygen; or (3) the presence of incompletely identified vapors or gases is indicated by a direct-reading organic vapor detection instrument, but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through the skin.

Mr. Jones is a musician who complains of pain in the anterior forearm. He presents with numbness and tingling in the distribution of the median nerve in the thumb, index, and middle fingers, and the radial half of the ring finger. However, he denies nocturnal paresthesias. He also mentions that the forearm pain and paresthesias increase with progressive activity, but are relieved by rest. The most likely diagnosis is: A) Carpal Tunnel Syndrome (CTS) B) Pronator Teres Syndrome C) Cubital Tunnel Syndrome D) Degenerative Arthritis

The correct answer is: B Musicians are particularly prone to nerve entrapment syndromes of the upper extremities, including pronator teres syndrome, carpal tunnel syndrome (CTS), cubital tunnel syndrome, compression of the digital nerves, and thoracic outlet syndrome. Pronator teres syndrome is a nerve entrapment syndrome caused by compression of the median nerve as it passes between the two heads of the pronator teres, resulting in pain along the volar aspect of the proximal forearm. The history is frequently significant for numbness and tingling in the distribution of the median nerve in the thumb, index, and middle fingers, and the radial half of the ring finger. It can be distinguished from compression of the median nerve at the carpal tunnel in several ways. Pronator teres syndrome is characterized by complaints of maximal pain at the forearm rather than at the wrist as is more commonly seen with CTS. In addition, with pronator teres syndrome, the patient is likely to report increasing forearm pain and paresthesias with use and relief of symptoms with rest. In CTS, symptoms may increase during rest periods. Additionally, nocturnal paresthesias are rare in pronator teres syndrome, but common with CTS. Note, though, that the patient may demonstrate a positive Phalen's test with both conditions. Cubital tunnel syndrome is caused by entrapment of the ulnar nerve as it passes along the medial aspect of the elbow. Chief complaints include pain along the medial aspect of the elbow or the proximal aspect of the medial forearm and paresthesias into the ring and little fingers of the hand along the distribution of the ulnar nerve. Severe neuropathy may result in weakness of the ulnar innervated muscles of the hand, with resultant loss of grip strength and clawing of the ring and little fingers.

Which of the following statements regarding reproductive hazards is true? A) Compliance with OSHA standards pertaining to non-reproductive effects generally affords full protection against the agents' reproductive effects. B) NIOSH has ranked reproductive disorders as one of the ten leading categories of work-related injuries and illnesses. C) NIOSH has issued Recommended Exposure Limits (REL's) on over 79,000 chemicals in use today based in part on their reproductive toxicity. D) Reproductive hazards include only chemical or biological agents.

The correct answer is: B NIOSH has ranked disorders of the reproductive system among the ten leading categories of work-related injuries and illnesses. Chemical, biological and physical agents may pose a reproductive hazard to the male or female reproductive systems or to the developing fetus. (Answer C) Most of the approximately 79,000 chemicals listed in the NIOSH Registry of Toxic Effects of Chemical Substances (RTECS) have NOT been thoroughly evaluated for their reproductive or developmental toxicity. In fact, only a handful of agents have been regulated in part for their reproductive effects. (Answer A) Even some of these regulations have not been adequately updated to reflect the current scientific and medical literature, and therefore may not be fully protective. (Answer D) Depending on the source of exposure and industry, the Nuclear Regulatory Commission, MSHA and OSHA all regulate ionizing radiation exposure to prevent reproductive harm to workers. Additionally, OSHA has specific standards for lead, dibromochloropropane, and ethylene oxide based in part on their reproductive effects. The Air Contaminants Standard sets limits on seven agents (acetonitrile, acetylsalicylic acid, captan, cyclohexylamine, hexafluoroacetone, phenylphosphine and vinylidene chloride) based in part on reports of animal reproductive toxicity. Sadly, a number of other agents-including benzene, formaldehyde and vinyl chloride-are suspected reproductive toxicants, but are only regulated for other adverse health effects that may not be protective of the worker's reproductive system or the health of the developing fetus.

Patch testing is useful in establishing: A) The allergenicity of unidentified substances B) Contact allergy of known substances C) Contact irritant dermatitis D) Sensitization to unknown compounds in the workplace

The correct answer is: B Patch testing is most useful when testing for contact allergy of known substances. Placing a number of unknown chemicals from the worksite on the worker's back can lead to false positive reactions. Patch testing can also sensitize the worker to a number of substances to which sensitization did not previously exist.

"Benign" simple pneumoconiosis can be caused by all of the following EXCEPT: A) Amorphous silica B) Fiberglass C) Tin D) Iron

The correct answer is: B Pulmonary exposure to fiberglass particles causes chronic bronchitis; the remainder cause simple pneumoconiosis.

Blood pressure screening I. Primary prevention II. Secondary prevention III. Tertiary prevention IV. Hazard evaluation A) I B) II C) III D) IV

The correct answer is: B Secondary prevention is the early identification of abnormalities and health problems at an early stage, generally pre-clinically (i.e., before symptoms appear). At this stage, medical intervention or treatment can reverse or limit progression of the disorder. Primary care is an important component of secondary prevention.

Specific contact sensitization is responsible for what percentage of contact dermatitis? A) 10% B) 20% C) 50% D) 80%

The correct answer is: B Specific contact sensitization is responsible for 20% of contact dermatitis cases.

Hearing speech is related to hearing thresholds at: A) 250, 500, 1000 Hz B) 500, 1000, 2000 Hz C) 1000, 2000, 3000 Hz D) 2000, 3000, 4000 Hz

The correct answer is: B Speech is detected within the range of 500 to 2000 Hz.

Which of the following is the most reliable diagnostic tool for monitoring respiratory function in workers exposed to respiratory hazards? A) Chest x-ray B) Spirometry (FEV1, FVC) C) Peak flow rates D) FEF50

The correct answer is: B Spirometry is the most reliable diagnostic tool for monitoring respiratory function in workers exposed to respiratory hazards.

What is the recommended annual occupational exposure limit for a pregnant woman? A) 0.5 mSv B) 5 mSv C) 50 mSv D) 500 mSv

The correct answer is: B The EPA and NRC recommend an occupational limit of no more than 5 mSv (500 mrem)/year for a pregnant woman. Additionally, the NRC recommends that in any one gestational month the occupational exposure not exceed 0.5 mSv (50 mrem). (Recall that "rad" [1 Gy=100 rad] is the unit of absorbed dose. Seivert (1 Sv=100rem) is the dose equivalent that measures the biological effect of absorbed radiation taking into account the degree of damage that can be caused by different forms of radiation due to differing linear energy transfer or LET properties. For x-rays and gamma rays, an absorbed dose of one rad results in a dose equivalent of one rem.

Which of the following best describes the type of health hazard produced by noise? A) Hearing changes correctable by surgery B) Damage to the hair cells of inner ear C) Reversible damage to the ear drum D) Damage to the outer ear

The correct answer is: B The best answer is damage to the hair cells of the inner ear. Bald spots may be formed and hearing is impaired at the frequencies corresponding to the location of sensory hair cell damage.

At a given intensity, sound in which frequency is most likely to result in permanent hearing damage? A) 375-500 Hz B) 1000-4000 Hz C) 8000-16000 Hz D) 16000-32000 Hz

The correct answer is: B The ear is most susceptible to noise in the range in which it is most sensitive. The ear is most sensitive in the range 1000-4000 Hz.

At what frequency does noise induced hearing loss first show up on an audiogram? A) 250-1000 Hz B) 3000-6000 Hz C) 250-500 Hz D) 250-8000 Hz

The correct answer is: B The first sign of noise induced hearing loss usually is seen in the higher frequencies, i.e., 3k-6k Hz.

Which of the following is INCORRECT regarding hypersensitivity pneumonitis: A) The illness is due to an immunologic response to small deeply inhaled antigens B) It is an IgE mediated disease C) Collagen deposition may occur with recurrent attacks leading to chronic irreversible fibrosis D) Spirometry reveals a chronic restrictive pattern

The correct answer is: B The presence of IgG precipitins to causal agents suggests a Type III (immune complex) response.

Conjunctivitis may result from a welding arc due to: A) Intense visible light radiation B) UV radiation C) IR radiation D) Soft x-ray radiation

The correct answer is: B The wavelengths responsible for conjunctivitis are 270-280 nm in the ultraviolet area of the electromagnetic spectrum.

_______ is an inflammation of the tendons and their sheath and is commonly associated with the "clothes wringing" motion. A) Tendonitis B) Tenosynovitis C) Epicondylitis D) Trigger finger

The correct answer is: B Washer Woman's Sprain is an older name for De Quervain's disease, also called stenosing tenosynovitis of the first dorsal compartment. It is caused by inflammation of the abductor pollicis longus and the extensor pollicis brevis tendons which lie in the first dorsal compartment.

At high levels of illumination, the rods and cones both function (photopic vision) and the eye is most sensitive to light wavelengths around ____nm (green). A) 450 B) 500 C) 550 D) 600

The correct answer is: C 550 nanometers (nm)

An obstructive pattern on pulmonary function testing is best characterized by: A) Decrease in Total Lung Capacity (TLC) B) Increased FEV1/FVC ratio C) Decreased flow rates and FEV1 D) All of the above

The correct answer is: C A decreased FEV1 with a normal FVC, and decreased FEV1/FVC ratio suggest obstructive lung disease.

A standard threshold shift is a change in hearing threshold relative to the baseline audiogram at an average of: A) 10dB or more at 500, 1000, and 2000 Hz B) 20dB or more at 500, 1000, and 2000 Hz C) 10dB or more at 2000, 3000, and 4000 Hz D) 20dB or more at 2000, 3000, and 4000 Hz

The correct answer is: C A standard threshold shift is a change in hearing threshold relative to the baseline audiogram at an average of 10dB or more at 2000, 3000, and 4000 Hz in either ear.

Acroosteolysis has been described in workers with exposure to: A) Beryllium B) Platinum C) Vinyl chloride D) Zinc

The correct answer is: C Acroosteolysis, a syndrome consisting of resorption of bone from the terminal phalanges of fingers and toes, has been described in workers exposed to vinyl chloride.

Wool handlers are most likely to be exposed to which of the following biologic hazards: A) Psittacosis B) Candidiasis C) Anthrax D) Sporotrichosis

The correct answer is: C Anthrax is a bacillary infection causing skin ulceration that affects handlers of hides, wool, and goat hair. Psittacosis is a chlamydial infection transmitted by infected birds and is commonly seen in bird fanciers. Brucellosis is found in veterinarians, slaughterhouse workers, and farmers. Sporotrichosis is typically found in horticulturalists, whereas candidiasis is seen in workers whose hands are frequently wet and prone to maceration, such as dishwashers.

Which of the following agents has NOT been associated with peripheral neuropathies? A) N-hexane B) Arsenic C) Toluene diisocyanate (TDI) D) Lead

The correct answer is: C Arsenic, n-hexane, lead, and triorthocresylphosphate (TOCP) have all been associated with exposure related peripheral neuropathies.

The most likely acute effect from a whole-body radiation dose of 100-200 rem is: A) Death within two hours B) Hemorrhage C) Nausea D) Epilation

The correct answer is: C At 100-200 rad, the human experiences minimal symptoms, including nausea, fatigue, and potentially transient reductions in lymphocytes and neutrophils.

Caplan's syndrome is associated with: A) Byssinosis B) Lead exposure C) Coal Worker's Pneumoconiosis D) Inhalation of metal fumes

The correct answer is: C Caplan's syndrome (rheumatoid pneumoconiosis) is associated with Coal Worker's Pneumoconiosis.

A farmer presents to the ER after accidentally spraying himself with a carbamate pesticide. He is confused, diffusely weak, and dyspneic. He should receive all of the following modalities except: A) Decontamination B) Oxygen C) 2-PAM D) Atropine

The correct answer is: C Carbamate pesticides do not form stable bonds with the cholinesterase enzyme like the organophosphates, and 2-PAM has no effect in carbamate poisoning as its action is specific to the phosphorylated enzyme.

As an occupational health professional you may need to appraise a noise hazard. You must consider that: A) Damage always occurs slowly and loss of hearing can be stopped B) Loss of hearing can be prevented if you control the hazard once pain is felt C) Damage can occur slowly and without pain being noticed D) A small hearing loss is obvious to the employee

The correct answer is: C Hearing loss is an occupational disease. However, there are no warning signs, and it can occur without the employee's awareness.

For which of the following agents is reproductive toxicity least conclusive? A) Anesthetic gases B) Styrene C) Hair dyes D) Mercury

The correct answer is: C Known or suspected reproductive effects of anesthetic gases include spontaneous abortion, stillbirths and birth defects. Known or suspected reproductive effects of styrene include menstrual irregularities and decreased fertility. Known or suspected reproductive effects of mercury include menstrual irregularities, spontaneous abortion, breast milk contamination, and in animal studies decreased fertility, birth defects, damage to the fetus and stillbirth. With respect to hair dyes, there is a dearth of human data in the medical and scientific literature, particularly in the occupational setting. As of this time, there is no direct evidence that at least the personal use of hair dyes is harmful during pregnancy.

Full-face or half-mask air-purifying respirator with hooded chemical-resistant splash protective chemical suit A) Level A B) Level B C) Level C D) Level D

The correct answer is: C Level C protection should be used when: (1) the atmospheric contaminants, liquid splashes, or other direct contact will not adversely affect or be absorbed through any exposed skin; (2) the types of air contaminants have been identified, concentrations measured, and an air-purifying respirator is available that can remove the contaminants; and (3) all criteria for use of air-purifying respirators are met.

Regarding occupational asthma, all of the following are true EXCEPT: A) Typical symptoms are cough, chest tightness, and dyspnea B) Symptoms begin after a long period of exposure C) Most patients have either a personal or family history of atopy D) Bronchial hyperreactivity may persist after permanent removal from exposure

The correct answer is: C Most patients with occupational asthma have no personal or family history of atopy.

The following is the effect of bodily posture on the pressure inside the disc between the third and fourth lumbar vertebrae: A) Standing erect disc pressure = 100 % B) Sitting trunk erect disc pressure = 140 % C) Sitting, bent forward disc pressure = 190 % D) All of the above

The correct answer is: D From Nachemson and Morris, 1964. Relative increases and decreases in intradiscal pressures were observed in different supine, standing, and sitting postures, compared to the pressure in upright standing (100%).

Occupational asthma is typically characterized by all of the following EXCEPT: A) Positive methacholine challenge test B) Decreased peak expiratory flow rates associated with exposure C) Irreversible bronchoconstriction D) A decrease in FEV1 of >10-20% on pre- and post-shift spirometry testing

The correct answer is: C Occupational asthma is characterized by reversible bronchospasm. Examples of agents associated with occupational asthma include: metal fumes and salts (e.g., nickel, chromium, cobalt, and platinum salts), organic chemicals (e.g.,isocyanates, formaldehyde), cotton dust, wood dusts, grain dusts, etc.

The correct term for hearing loss that can be induced by occupational exposure to noise is: A) Presbycusis B) Sociocusis C) Sensorineural D) Conductive

The correct answer is: C Presbycusis is hearing loss due to age. Sociocusis is loss due to background noise. Conductive loss is a loss between the outer ear and the cochlea. Flat hearing loss represents significant damage across the range of frequencies.

As one ages there is a vascular and neural degeneration of the inner ear. This results in a decrease in hearing ability. This condition is called: A) Temporary Threshold Shift (TTS) B) Permanent Threshold Shift (PTS) C) Presbycusis D) Auditory Threshold Reduction (ATR)

The correct answer is: C Presbycusis is the decrease in hearing that is associated with aging.

Restrictive lung disease is characterized by: A) Decreased FEV1/FVC ratio B) Reduction in flow rates with normal FVC C) Reduction in lung volume and FVC D) Response to methacholine challenge

The correct answer is: C Restrictive lung disease is suggested by reduced vital capacity and normal FEV1/FVC ratio on spirometry. Both FEV1 and FVC are decreased.

Compressive forces on the lumbar disc are greatest when __________. A) Standing B) Bending C) Sitting D) Lying supine

The correct answer is: C Sitting in a slouched position creates the greatest compressive forces on the lumbar disc because the natural "S" curve of the back is disrupted (facet joints unhinge) and forces are not evenly distributed.

Physical therapy for an amputee I. Primary prevention II. Secondary prevention III. Tertiary prevention IV. Hazard evaluation A) I B) II C) III D) IV

The correct answer is: C Tertiary prevention is the clinical management of injured or diseased workers and the provision of necessary rehabilitation to restore workers to the highest level of health possible and to limit disability.

Suturing a laceration I. Primary prevention II. Secondary prevention III. Tertiary prevention IV. Hazard evaluation A) I B) II C) III D) IV

The correct answer is: C Tertiary prevention is the clinical management of injured or diseased workers and the provision of necessary rehabilitation to restore workers to the highest level of health possible and to limit disability.

A health care worker fails to return to have her PPD read until 5 days after it was planted. At this point, the PPD is negative. You should: A) Return the employee to work with no further action B) Re-test the employee in one year if TB is prevalent in the community C) Invalidate the PPD and plant a new PPD at this time D) Invalidate the PPD and plant a new PPD in one week

The correct answer is: C The PPD test should be read within 48-72 hours. When there is a delay in the interpretation of the skin test, a new PPD may be planted immediately.

When a sound enters the ear, it is amplified before it reaches the inner ear. Where does most of this amplification take place? A) Eustachian tube B) Outer ear C) The stapes-oval window interface D) Auditory canal

The correct answer is: C The area of the tympanic membrane is 25 times that of the oval window. Energy is transferred from the tympanic membrane to the oval window via the ossicular chain: the malleus, incus and stapes.

Ms. Smith presents with paresthesias of the thumb and index finger and demonstrates a positive Spurling's sign. You observe ulnar deviation upon wrist extension. Brachioradialis reflex is diminished. The most likely diagnosis is: A) De Quervain's Disease B) C5 Radiculopathy C) C6 Radiculopathy D) C7 Radiculopathy

The correct answer is: C The biceps is innervated by both C5 and C6. The wrist extensor group has partial innervation by both C6 and C7. C6 supplies sensation to the lateral forearm, the thumb, index finger and one half of the middle finger. C6 radiculopathy is characterized by paresthesias of the thumb and index finger. Because the radial wrist extensors are innervated by C6, and C7 innervates the extensor carpi ulnaris, patients may demonstrate ulnar deviation upon wrist extension when C6 innervation is absent and C7 is spared. Brachioradialis reflex testing is the preferred test to determine integrity at the C6 level because the brachioradialis is innervated by the radial nerve at the C6 neurological level. Spurling's test detects localized or referred pain emanating from the cervical facet joint or radicular pain due to nerve root irritation. The maneuver is performed by applying axial compression to the cervical spine in the neutral position followed by neck extension and with rotation to both the left and the right. De Quervain's disease (stenosing tenosynovitis) is caused by entrapment of the abductor pollicis longus and extensor pollicis brevis as they pass through the first extensor compartment at the radial styloid process. Chief complaints include tenderness of the radial aspect of the wrist over the radial styloid process. Patients may demonstrate a positive Finkelstein's test (with the thumb tucked under the other fingers and ulnar deviation of the wrist, the patient reports sharp pain over the styloid process).

Which of the following is NOT an acceptable therapeutic intervention for welder's flash? A) Cold compresses B) Systemic analgesics C) Long-acting topical anesthetics D) Eye patching

The correct answer is: C Topical anesthetics should be used for temporary anesthesia to allow for examination of the eyes after a flash burn; they should not be used for prolonged periods as they delay corneal healing and can lead to corneal perforation.

Solvent encephalopathy is often associated with the following symptoms EXCEPT: A) Slowness in response time B) Diminished concentration ability C) Visual and auditory hallucinations D) Irritability

The correct answer is: C Visual and auditory hallucinations are classically found in manganese neurotoxicity. Slowness in response time, diminished concentration ability, short-term memory loss, and irritability are neurobehavioral disturbances seen in solvent encephalopathy.

Finkelstein's test is typically associated with which of the following? A) Straight leg raise B) C-spine flexion C) Radial devation of the wrist D) Ulnar deviation of the wrist

The correct answer is: D A positive Finkelstein's test is associated with De Quervain's disease (stenosing tenosynovitis), which is caused by entrapment of the abductor pollicis longus and extensor pollicis brevis as they pass through the first extensor compartment at the radial styloid process. Chief complaints include tenderness of the radial aspect of the wrist over the radial styloid process. A positive Finkelstein's test occurs with ulnar deviation of the wrist while the thumb is tucked under the other fingers, resulting in reported sharp pain over the styloid process.

The pathognomonic feature of lead-induced renal disease found on biopsy is: A) Glomerulosclerosis B) Interstitial fibrosis with tubular atrophy C) Intranuclear inclusion bodies in the glomeruli D) None of the above

The correct answer is: D Although chronic lead nephropathy is characterized by interstitial fibrosis with atrophy and dilation of the tubules and relative sparing of the glomeruli, there is no true pathognomonic feature. This picture may be indistinguishable from that due to changes of chronic hypertension, which is usually coexistent.

NIOSH estimates that over 7 million Americans are occupationally exposed to whole body vibration (WBV). Biological effects of occupational exposure to WBV include: A) Skeletal system effects, such as degeneration of bone and cartilage, and reduction in the height of and calcification of intervertebral discs B) Abnormal motor responses, such as involuntary muscle contractions, suppression of reflex responses, decreases in tracking performance, and impairment of speech quality C) Cardiovascular effects, such as increased heart rate, blood pressure, and ventilation D) All of the above

The correct answer is: D Although researchers have not fully determined the relationship between WBV and these adverse effects, a number of studies have shown an increased incidence of musculoskeletal, neurologic, cardiovascular, and digestive system disorders in occupationally (especially long-term) exposed workers.

Irritant dermatitis is often related to the pH of the agent to which the worker is exposed. Which of the following levels is MOST likely to result in dermatitis? A) pH 4 B) pH 6 C) pH 8 D) pH 12

The correct answer is: D An alkaline pH of 11 or greater usually implies a high risk of skin damage, whereas acidic agents are better tolerated.

Non-specific low back pain resolves itself in what percent of cases: A) 20 B) 30 C) 50 D) Over 90

The correct answer is: D Approximately 40% of patients recover in one week, 80% within three weeks, and 90% within six weeks, regardless of treatment.

With repeated exposure to noise of sufficient intensity, a permanent threshold shift (PTS) will gradually appear first at ________Hz. A) 200 Hz B) 1500 Hz C) 3000 Hz D) 4000 Hz

The correct answer is: D As the number of years of noise exposure increases, the hearing loss between 3000Hz and 6000 Hz becomes more pronounced.

Which of the following is the EARLIEST effect of chronic cadmium poisoning? A) Dermatitis B) Anosmia C) Central nervous system depression D) Proteinuria

The correct answer is: D Cadmium is an extremely toxic metal commonly found in industrial workplaces, particularly where any ore is being processed or smelted. Due to its low permissible exposure limit (PEL), overexposures may occur even in situations where trace quantities of cadmium are found in the parent ore or smelter dust. Cadmium hazards may be present in a number of seemingly unrelated operations and materials, such as paints, batteries, and phosphate fertilizers. Cadmium is used extensively in electroplating, although the nature of the operation does not generally lead to overexposures. Several deaths from acute exposure have occurred among welders who have unsuspectingly welded on cadmium-containing alloys or worked with silver solders. Cadmium is also found in some industrial paints and may represent a hazard when sprayed. Operations involving removal of cadmium paints by scraping or blasting may similarly pose a significant hazard. Cadmium is also present in the manufacture of some types of batteries. Cadmium emits a characteristic brown fume (CdO) upon heating, which is relatively non-irritating, and thus does not alarm the exposed individual. A variety of adverse health effects may result from acute exposure to cadmium compounds. The most widely recognized effects are seen in the respiratory system from the inhalation of cadmium fumes and dust. Acute pneumonitis occurs 10 to 24 hours after initial acute inhalation of high levels of cadmium fumes with symptoms such as fever, headache, chills, sweating and chest pain. In extreme exposure cases, pulmonary edema may develop and cause death several days after exposure. Such symptoms have been reported among workers exposed to high concentrations of cadmium. For example, after a day's exposure to cadmium fumes, workers developed severe weakness, dyspnea, coughing and tightness of the chest. Chest radiographs showed signs of pulmonary edema Although the most serious consequence of chronic cadmium poisoning is cancer (lung and prostate), the kidney is the principal organ targeted by chronic exposure to cadmium. And thus the first observed chronic effect is generally kidney damage, manifested by excretion of excessive (low molecular weight) protein in the urine. Cadmium nephrotoxicity may follow chronic inhalation or ingestion. Data from human studies suggest a latency period of approximately 10 years before clinical onset of renal damage, depending on intensity of exposure. However, subtle alterations of renal function have been described after acute exposure in animals, and there are rare reports of renal cortical necrosis after acute high-dose exposure in humans. Classically, chronic cadmium exposure is associated with progressive renal tubular dysfunction. The first sign of renal abnormalities occur at 2 µg/g creatinine and are microscopic tubular proteinuria - the biomarkers are 2-microglobulin, à1-microglobulin. At urinary cadmium levels of 4 µg/gCr, enzymes such as N-acetyl-B-glucosaminidase (NAG) are elevated in urine, and signs of glomerular damage including increased albumin in the urine and a decrease in glomerular filtration rate are seen. In the final stages of cadmium nephropathy, glycosuria, wasting of calcium and phosphate, and altered calcium metabolism with secondary effects on the skeleton of osteomalacia and osteoporosis are seen. Osteomalcia and osteoporosis have been observed in Japan ("itai-itai" disease) where residents were exposed to cadmium in rice crops irrigated with cadmium-contaminated water. Cadmium may also cause anemia, teeth discoloration (Cd forms CdS) and loss of smell (anosmia).

Chloracne is: A) A type of occupational acne that typically involves the nose B) A type of acne seen in workers whose clothes are contaminated with oily substances C) Readily treated by standard acne therapy D) A skin condition that develops after topical or systemic exposure to halogenated aromatic hydrocarbons

The correct answer is: D Chloracne may develop after exposure to halogenated aromatic hydrocarbons, including polychlorinated biphenyls (PCBs), dioxins, and organochlorine pesticides. It has a predilection for the lateral periorbital angles, earlobes, neck, shoulders, abdomen, genitalia, and legs. It is unresponsive to standard therapy and active lesions may persist for years.

Occupational asthma has been related to exposure to: A) Cobalt B) Nickel C) Chromium D) All of the above

The correct answer is: D Chromium, cobalt, and nickel fumes are routinely generated in chemical industries, metal refining, metal plating, and metal grinding. Isocyanates are used in the manufacture of plastics, adhesives, insecticides, surface coatings, and polyurethane foam; and toxicity is widely reported in spray painters in the automobile and aerospace industries.

Central nervous system dysfunction associated with organic mercury exposure includes all of the following EXCEPT: A) Dysarthria B) Tremor C) Parkinsonian syndrome D) Euphoria

The correct answer is: D Chronic exposure to organic mercury can produce tremor, paresthesias, dysarthria, ataxia, decreased visual fields, deafness, and mental disturbances.

Which of the following is MOST likely to cause "degreaser's flush" ? A) Methyl n-butyl ketone and hops B) Beer exotoxin and glycol ether C) Methyl chloroform and cobalt D) Trichloroethylene and ethanol

The correct answer is: D Degreasers' flush can occur in workers imbibing alcohol (ethanol) following industrial exposure to trichloroethylene (TCE) vapor. The subject shows the appearance of normal facial skin after exposure to trichloroethylene, and shortly after beginning to drink beer. Forty-four minutes later, the flush is very apparent. The dermal response of flush reaches maximum intensity 30 minutes after onset and fades within 60 minutes.

Which of the following has NOT been linked to reproductive system dysfunction in health care workers: A) Waste anesthetic gases B) Cytotoxic drugs C) Ethylene oxide D) Tuberculosis

The correct answer is: D Ethylene oxide is mutagenic in animals and is a suspected teratogen. Health care workers exposed to waste anesthetic gases have been found to have increased rates of spontaneous abortion. Health care workers handling cytotoxic drugs have been found to have increased numbers of spontaneous abortions and malformed infants. While tuberculosis can cause serious effects during pregnancy, it does not target the reproductive system. Ionizing radiation is both a male and female reproductive hazard with a wide range of effects.

Which of the following agents is most likely to cause angina pectoris? A) Chromate B) Methanol C) Arsine D) Methylene chloride

The correct answer is: D Exposure to methylene chloride vapors can cause elevated carboxyhemoglobin levels, which can in turn stress patients with underlying cardiac or pulmonary disease.

Evidence suggests that short term occupational exposure to vibration causes: A) Severe physiological effects on the body B) Moderate physiological effects on the body C) Increased risk of injury to the spine, the peripheral nervous system, the digestive system, and the reproductive system D) Only small physiological effects which are reversible

The correct answer is: D In most occupational settings, the damage from vibration is thought to occur from the micro-trauma induced by vibration exposure over a long period of time, usually years. In the initial stages, vibration injury is reversible if the worker is removed from the exposure or the exposure is eliminated from the job.

Inorganic lead affects the reproductive system in all of the following ways EXCEPT: A) Affects sperm production B) Increases infant mortality C) Decreases birth weight D) Causes phocomelia

The correct answer is: D Inorganic lead has been known to be an abortifacient; it crosses the placental barrier causing decreased birth weight and mental retardation. Lead is also associated with abnormal spermatogenesis. Lead does not cause phocomelia (shortening of the limbs); this deformity is attributed to maternal use of thalidomide.

Abnormally increased rearward curvature of the thoracic spine is known as: A) Lordosis B) Vertebral arching C) Spinal tilting D) Kyphosis

The correct answer is: D Kyphosis (also known as hunchback) is defined as excessive rearward curvature of the thoracic spine. Scoliosis refers to a lateral curvature of the spine. Lordosis (also called sway-back or saddleback) is an abnormally increased concavity or forward curvature of the lumbar spine. Note that lordosis may also refer to the normally occurring anterior concavity of the lumbar and cervical regions. In the normal spine, one finds a lordotic curve in the lumbar region, followed by a kyphotic curve in the mid-back (thoracic region) and a lordotic curve at the neck (cervical region).

Work uniform, not chemical resistant, affording minimal protection, used for nuisance contamination only; no respiratory protection A) Level A B) Level B C) Level C D) Level D

The correct answer is: D Level D protection should be used when: (1) the atmosphere contains no hazard; and (2) work functions preclude splashes, immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals.

Which of the following is most appropriate in the routine examination of a machinist? A) Exercise stress test B) Electromyogram (EMG) C) Allergy history D) Audiometric testing

The correct answer is: D Machinists are likely to be exposed to noise that may produce hearing loss. The best answer is audiometric testing.

Early hearing loss caused by noise: A) Seriously affects speech reception B) Makes a person's speech sound distorted C) Affects telephone usage D) Is not generally noticeable to the subject

The correct answer is: D Most people do not notice the hearing loss until there is significant detriment to their hearing.

The classic "cookie bite" notch in noise induced hearing loss peaks at: A) 500 Hz B) 1000 Hz C) 3000 Hz D) 4000 Hz

The correct answer is: D Noise induced hearing loss classically peaks at 4000 Hz.

Within the OSHA lead standard are recommendations that ___________ be removed from the workplace when blood lead levels exceed 30 µg/100g of blood. A) Only pregnant women B) Any woman contemplating pregnancy or currently pregnant C) Only male workers contemplating fathering offspring D) All of the above

The correct answer is: D OSHA recommends a 30 µg/100g of blood maximum permissible blood lead level in both males and females who wish to bear children. In addition, OSHA recommends that blood lead levels in the fetus and newborn should not exceed 30 µg/100g of blood. 29 CFR 1910.1025 (App.C) .

Raynaud's Syndrome is caused by: A) Repetitive motion stresses B) Improper lifting C) Improper posture D) Hand-arm vibration

The correct answer is: D Raynaud's Syndrome, also known as vibration white finger disease, is caused by repeated exposure to hand-arm vibration in the 500-1200 HZ range. Repetitive motion, improper lifting, pushing, pulling, and improper posture lead to other types of ergonomic disorders.

The probable mechanism of sudden death involving fluorocarbon exposure is: A) Massive hemolysis B) Fulminant pulmonary edema C) Respiratory arrest secondary to acetylcholinesterase inhibition D) Cardiac arrhythmias or simple asphyxiation

The correct answer is: D Sudden death after exposure to high levels of industrial solvents is well documented and the mechanism that is usually implicated is fatal cardiac arrhythmia. Solvents frequently involved include 1,1,1 trichloroethane in solvent abusers and freons in refrigerator mechanics.

The ILO classification scheme for pneumoconiosis is designed to: A) Award compensation B) Assist in diagnosis of specific pneumoconioses C) Classify disability and impairment after fibrogenic dust exposure D) Standardize classification for epidemiological and clinical purposes

The correct answer is: D The ILO classification system was adopted to allow for more reliable reporting of radiographic abnormalities. Chest x-rays are rated by shape, size, and profusion of shadows in each of six lung zones.

Which of the following agents is most likely to cause stomatitis, gingivitis, and tremor: A) Beryllium B) Zinc C) Arsenic D) Elemental mercury

The correct answer is: D The classic syndrome of elemental mercury toxicity includes stomatitis, gingivitis, tremor, and behavioral changes; AKA erethism in the "Mad Hatter Syndrome."

When a person is first exposed to hazardous levels of noise, the initial change usually observed is a loss of hearing at about____________ Hz. A) 500 Hz B) 1,000 Hz C) 2,000 Hz D) 4,000 Hz

The correct answer is: D The hearing loss normally occurs at about 4,000 Hz and appears on the audiogram as a dip or notch. After a rest period away from the noise, the hearing normally returns to its former level. Permanent damage, if exposure is not controlled, will normally occur at around 4,000 Hz.

The Stockholm Workshop HAVS Classification System used for Vibration-induced White Finger (VWF) uses the following symptoms: A) Vascular effects including blanching of fingers B) Sensorineural effects including tingling and numbness C) Pain of the fingers D) Vascular and sensorineural effects considered independently

The correct answer is: D The length of initial symptom-free period of vibration exposure is known as the latent period. As vibration exposure time increases, the number and severity of symptomatic episodes increase. Vascular and sensorineural symptoms are assessed separately in recognition that they may develop independently.

Findings in carpal tunnel syndrome include all of the following EXCEPT: A) Sensory loss on the palmar surface of the median side of the hand B) Positive Tinel's and Phalen's signs C) A history of nighttime and morning symptoms, symptoms with driving, and relief by shaking or movement D) Numbness, tingling, and burning in the 4th and 5th digits

The correct answer is: D The median nerve is affected in carpal tunnel syndrome; therefore, symptoms are noted in the first 3 1/2 digits.

Which of the following statements about asbestos exposure is FALSE? A) Chemical differences such as solubility and acid resistance and physical differences such as fiber length, brittleness, and texture are important in the severity of deliterious effects B) Benign pleural effusions are demonstrated in 3.1 to 7% of patients with heavy occupational exposures C) Benign pleural effusion are the most common abnormality seen within 10 years of the onset of asbestos exposure D) There is a direct causal relationship between benign pleural effusions and the subsequent development of malignant mesothelioma

The correct answer is: D There is NO direct causal relationship between benign pleural effusions and the subsequent development of malignant mesothelioma. The other statements are true of asbestos exposure.

Hypersensitivity pneumonitis is caused by exposure to: A) Oxides of heavy metals B) Irritant gases C) Plastic constituents D) Organic dust

The correct answer is: D Various organic dusts can cause hypersensitivity pneumonitis with acute symptoms of fever, cough, dyspnea, and malaise.

Regarding metal fume fever, which of the following statements is TRUE: A) Workers are more susceptible to symptoms of metal fume fever after repeated exposure B) Treatment consists of oxygen, IV fluids, and steroids C) Radiography reveals changes consistent with fulminant pneumonitis D) The condition is secondary to exposure to high concentrations of oxides of heavy metals

The correct answer is: D Workers are more susceptible to metal fume fever after they have been away from work for a few days; the disease is typically worse on a Monday. Treatment is supportive, and symptoms generally resolve within 2 days. Radiography is usually normal. Metal fume fever is due to exposure to oxides of heavy metals, especially zinc and copper.

Which shift rotation will result in faster adaptation of workers' internal clocks, resulting in more sleep? A) 21 days day shift 21 days night shift 21 days evening shift B) 21 days day shift 21 days evening shift 21 days night shift C) 3 days day shift 3 days night shift 3 days evening shift D) 3 days day shift 3 days evening shift 3 days night shift

The correct answer is: D [DataChem stated 'B' was correct, but explanation indicates 'D' is correct.] Adapting to rotating shifts can be affected by the speed or rotation and the direction of rotation. Evidence suggests that the body's internal clock adapts more easily to a forward rotating schedule. Moreover, rotating shifts every 2-3 days is the ideal schedule for workers because the body's internal clock has not yet adapted, and, therefore, the worker can quickly recover sleep loss. If a rotating shift every 2-3 days is not possible, then a slowly rotating shift over at least three weeks is preferred. Slow rotation of shifts improves adaptation of the internal body clock. However, weekly/biweekly rotating shift schedules are extremely disruptive to the internal body clock, requiring it to reset itself as the shift changes. Therefore, when fast rotation over 2-3 days is not feasible, a slowly rotating shift over at least three weeks is recommended.