Home Books CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e

Previous Chapter

Next Chapter

CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e

Section V: Program Management

Section V. Program Management

Listen

The hallmark of major depression is

a. the inability to get out of bed

b. diminished productivity

c. irritable mood

d. a severely depressed mood lasting at least 2 weeks

d. The hallmark of major depression is a severely depressed mood lasting at least 2 weeks.

Bipolar disorder is a cyclical mood disorder involving

a. at least one episode of abnormally elevated energy level and mood which usually alternate with one or more episodes of depression

b. at least one episode of depression followed by an episode of abnormally elevated energy level and mood

c. three or more episodes of mania

d. at least one episode of anxiety and one episode of major depression

a. Bipolar disorder is a cyclical mood disorder involving at least one episode of abnormally elevated energy level and mood which usually alternate with one or more episodes of depression.

The majority of individuals subject to shiftwork or jet travel–related time shifts in their sleep–wake schedules commonly report some degree of

a. anxiety

b. manic symptoms

c. depressive symptoms

d. job dissatisfaction

c. The majority of individuals subject to shiftwork or jet travel–related time shifts in their sleep-wake schedules commonly report some degree of depressive symptoms.

Extensive disruption in circadian function is known to occur among patients with

a. aerobic exercise regimens

b. bipolar disorder

c. high levels of productivity

d. chemical dependency withdrawal

b. Extensive disruption in circadian function is known to occur among patients with bipolar disorder.

Determining whether or not an employee may become violent

a. has less to do with a static profile of that person than a series of dynamic variables (behaviors)

b. is impossible

c. has less to do with personality than job satisfaction

d. requires training in violence assessment

a. Determining whether or not an employee may become violent has less to do with a static profile of that person than a series of dynamic variables (behaviors).

Substance use disorders

a. usually are accompanied by a decline in social and occupational functioning

b. are ignored in the workplace because there are clearly defined expectations on attendance, work performance, and behavior

c. always become apparent at home or in everyday social life before they are identified at work

d. are personal problems of little interest to company health and safety professionals

a. Substance use disorders usually are accompanied by a decline in social and occupational functioning, making the workplace a good place to observe this decline in an individual's functioning and to direct the worker to appropriate treatment.

A basic criterion for a substance use disorder diagnosis is

a. slurred speech and poor decision making

b. an unconscious drive to hurt oneself

c. depression and anxiety

d. compulsive use despite serious issues created by substance use

d. The basic criteria for a substance use disorder diagnosis include tolerance; withdrawal; craving or urge to use; failure to fulfill major obligations at work, school, and home; and compulsive use despite serious issues created by substance use.

Alcoholism

a. is a syndrome that does not include “heavy drinkers”

b. is by far the most serious chemical dependency problem encountered in the workplace

c. leads to delirium tremens in nearly all cases

d. presents cognitive and physiological symptoms of little diagnostic importance to occupational physicians

b. Alcoholism is by far the most serious chemical dependency problem encountered in the workplace.

The CAGE questionnaire

a. predicts the quantity of alcohol consumed on a daily basis

b. is difficult to administer in the workplace

c. is a highly effective tool in establishing a diagnosis of alcohol use disorder

d. can be used as a means of contraverting workers' compensation claims

c. The CAGE questionnaire is a highly effective tool in establishing a diagnosis of alcohol use disorder.

Tetrahydrocannabinol (THC)

a. is water soluble

b. creates a feeling of euphoria and excitement

c. causes impairment in judgment and motor coordination

d. seldom if ever creates a dangerous work environment

c. Tetrahydrocannabinol (THC), the active ingredient of cannabis, creates a feeling of euphoria and relaxation, but also causes impairment in judgment and motor coordination.

Cannabis

a. is the substance most commonly detected in workplace urine testing

b. is absorbed readily from the skin and the intestinal mucosa

c. rapidly decays in the body, leaving no evidence of use after 24 hours

d. does not appear in the urine even after chronic use

a. Cannabis is the substance most commonly detected in workplace urine testing.

Cocaine

a. intoxication increases energy, appetite, and the need for sleep

b. is used to overcome mania, panic attacks, paranoia, psychotic symptoms, and impulsive violent behavior

c. produces an intense adrenergic discharge, resulting in tachycardia, hypertension, and mydriasis

d. withdrawal symptoms typically include apathy, serenity, and loss of consciousness

c. Cocaine produces an intense adrenergic discharge, resulting in tachycardia, hypertension, and mydriasis.

Amphetamine

a. causes fewer signs of tachycardia, hyperemia, and mydriasis than cocaine

b. leads in most cases to severe toxic psychosis characterized by motor agitation, intense paranoia, and violence

c. withdrawal symptoms include dysphoria, irritability, extreme fatigue, psychomotor agitation, increased appetite, and vivid dreams

d. long-term use leads to stable weight control and personality development

c. Amphetamine withdrawal symptoms include dysphoria, irritability, extreme fatigue, psychomotor agitation, increased appetite, and vivid dreams.

Opioids

a. produce profound mental and psychomotor slowing that will interfere with almost any work task

b. are a risk for workers only in special environments that require the use of respirators or breathing apparatus

c. are excreted in the urine but are not readily detectable with urine drug testing

d. produce most false-positive tests on urine drug testing

a. Opioids produce profound mental and psychomotor slowing that will interfere with almost any work task.

Nerve agent

a. vapor exposure results in immediate effects on the eye, mucosa, and skin

b. ocular effects include miosis, lacrimation, conjunctival injection, pain, and blurred or dim vision

c. miosis resolves rapidly

d. effects on pulse and blood pressure are reliable indicators of exposure

b. Nerve agent ocular effects include miosis, lacrimation, conjunctival injection, pain, and blurred or dim vision.

Mustard

a. has a high volatility and is persistent

b. is a highly reactive molecule and acts as an alkylating agent to cause cellular tissue damage

c. has a pronounced cholinergic activity

d. is found in fluids such as blister fluids or other biological fluids

b. Mustard is a highly reactive molecule and acts as an alkylating agent to cause cellular tissue damage.

Anthrax

a. is an infectious disease that affects animals and humans

b. spores are hardy but do not persist in soil

c. infection begins when the spores are ingested by lymphocytes and become vegetative

d. clinical disease has the same characteristics regardless of the route of exposure

a. Anthrax is an infectious disease that affects animals and humans.

Inhalational anthrax

a. begins with nonspecific symptoms of malaise, fatigue, myalgia, and fever

b. invariably causes chest pain and a nonproductive cough

c. symptoms persist and steadily become more severe

d. leads to pneumonia in most patients

a. Inhalational anthrax begins with nonspecific symptoms of malaise, fatigue, myalgia, and fever.

Cutaneous anthrax

a. first appears as a small papule that progresses to a vesicle containing serosanguinous fluid

b. lesions are very painful

c. patients seldom have fever, malaise, and headache

d. always causes local lymphadenitis

a. Cutaneous anthrax first appears as a small papule that progresses to a vesicle containing serosanguinous fluid.

Gastrointestinal anthrax

a. is the most common form of infection

b. presents with nonspecific symptoms of nausea, vomiting, and fever

c. rarely causes severe abdominal pain, vomiting of blood, and bloody diarrhea

d. would very likely cause dysphagia

b. Gastrointestinal anthrax presents with nonspecific symptoms of nausea, vomiting, and fever.

Botulinum toxin

a. is considered a candidate for bioterror because of the potential for contamination of food or water supplies

b. is slowly absorbed after ingestion or inhalation

c. is readily absorbed through skin

d. attacks the presynaptic terminal of the peripheral nerves blocking the release of acetylcholine and inhibiting muscle contraction

d. Botulinum toxin attacks the presynaptic terminal of the peripheral nerves blocking the release of acetylcholine and inhibiting muscle contraction.

Ricin is

a. absorbed through the skin

b. unstable and is affected by extreme weather conditions

c. a cellular toxin that inhibits protein synthesis by binding to and catalytically modifying ribosomes.

d. less toxic after inhalation or injection than ingestion

c. Ricin is a cellular toxin that inhibits protein synthesis by binding to and catalytically modifying ribosomes.

After inhalation of ricin

a. symptoms occur immediately

b. the primary organ affected is the central nervous system

c. there are no systemic symptoms

d. hemoptysis and pulmonary edema may develop over the next 18–36 hours leading to respiratory failure and death

d. After inhalation of ricin, hemoptysis and pulmonary edema may develop over the next 18–36 hours leading to respiratory failure and death.

The highest professional designation recognized by the BCSP is

a. Site Safety Coordinator (SSC)

b. Associate Safety Professional (ASP)

c. Certified Safety Professional (CSP)

d. Occupational Safety and Health Technologist

c. Certified Safety Professional (CSP) is the highest professional designation recognized by the BCSP.

The safety and health management system

a. designates the company role in preventive health care

b. guides the organization to prevent work-related injuries and illnesses

c. establishes the insurer's role in health care

d. circumvents compliance costs

b. The safety and health management system guides the organization to (1) prevent work-related injuries and illnesses, (2) comply with applicable health and safety regulations, and (3) minimize injury/illness, regulatory, and related compliance costs and violations.

Injury and Illness Prevention (IIP) programs

a. reduce the number and severity of workplace injuries

b. alleviate the costs of preventive health care on workers

c. are required by law in all states

d. discourage worker participation and compliance

a. Injury and Illness Prevention (IIP) programs are universal interventions that can substantially reduce the number and severity of workplace injuries and alleviate the associated financial burdens on workplaces.

IIP programs should include

a. selection of insurance underwriters

b. bonus awards for loss prevention

c. hazard assessment

d. review of medical records

c. Hazard assessment procedures should be part of an effective IIP program.

A hazard

a. can cause harm or adverse effects to individuals

b. would be of no interest to the organization

c. is another word for accident

d. is the effect of weather on the workplace

a. A hazard can cause harm or adverse effects to individuals as health effects or to organizations as property or equipment losses.

Emergency action plan (EAP)

a. is required by OSHA in nearly all cases

b. requires outside consultants

c. centers on the availability of health care facilities

d. ignores prevention planning

a. OSHA and often other regulatory agencies require employers in nearly all cases to prepare and implement an EAP for emergency situations.

OSHA's Hazard Communication Standard (HCS)

a. requires chemical manufacturers to evaluate the hazards of all chemicals

b. requires employers with hazardous chemicals to train workers to handle the chemicals safely and appropriately

c. exempts companies from providing precautionary statements along with labels

d. no longer requires employers to provide safety data sheets

b. All employers with hazardous chemicals in their workplaces must have labels and safety data sheets for their exposed workers, and train them to handle the chemicals safely and appropriately.

OSHA mandates access to employee exposure and medical records

a. without legal and regulatory statute

b. after approval by the employer

c. except physician and employment questionnaires or histories, laboratory results, medical opinions, diagnoses, treatments, etc

d. including industrial hygiene monitoring data

d. Exposure records consist of safety and/or industrial hygiene air and exposure monitoring data, and biological monitoring data.

Hazard prevention and control

a. excepts equipment maintenance

b. ensures that hazard correction procedures are in place

c. allows employees to decide on which PPE they want to use

d. delegates to employees workplace hazards and exposures

b. Hazard prevention and control ensures that hazard correction procedures are in place.

Job safety analysis (JSA)

a. entails daily observation and weekly analysis

b. uncovers the inherent hazards in the work environment

c. can be performed only by trained professionals

d. develops an effective teaching tool for consultants

b. Job safety analysis (JSA) uncovers the inherent hazards in the work environment, a task or activity, and recommends control strategies.

The walk-through survey

a. is the most important technique used to recognize occupational health hazards

b. should begin with an analysis of work injuries and illnesses

c. is needlessly delayed by preparation of a simplified process flow diagram

d. should end at the loading dock, where materials entering the facility can be examined

a. The walk-through survey is the first and most important technique used to recognize occupational health hazards.

OSHA Workers Right-to-Know regulation

a. alerts workers to all materials to which they may be exposed

b. relies on the accuracy and comprehensiveness of substance data sheets

c. is satisfied by walk-through surveys

d. specifies that the employer may be subject to governmental investigation

d. The current OSHA Workers' Right-to-Know regulation makes explicit (and subject to governmental investigation) the commonsense duty of the employer to inform workers of the nature and hazards of materials to which they may be exposed.

Sampling and analysis of airborne contaminants

a. primarily discovers unsuspected contamination

b. is a definitive function of the industrial hygienist

c. is the sole responsibility of the physician to interpret the results

d. is unable to measure very low concentrations of hazardous materials

b. Sampling and analysis of airborne contaminants is a definitive function of the industrial hygienist.

Phase-contrast microscopy

a. is specified by NIOSH for the analysis of all inhaled fibers

b. is not as accurate as gravimetric methods

c. visualizes all asbestos fibers

d. gives an imperfect index of exposure to all asbestos fibers

d. Phase-contrast microscopy gives an imperfect index of exposure to all asbestos fibers.

Wipe sampling

a. would not be appropriate for a PCB spill

b. does not detect pesticide residue

c. is a useful measure of housekeeping measures

d. should be done on a daily basis

c. Wipe sampling may be a useful adjunct to programs used to evaluate the effectiveness of housekeeping measures, particularly in manufacturing facilities where separation of manufacturing areas from cafeterias, offices, or dressing rooms is important.

Sound-level meters

a. give a readout in decibels of hearing loss

b. evaluate exposures to components of the noise spectrum

c. have replaced the A-weighting network

d. give primacy to the nonspeech frequencies

b. Sound-level meters typically contain filtering circuits that permit evaluation of exposures to components of the noise spectrum weighted in accordance with their effects on hearing.

TLV, PEL, and REL

a. represent maximum allowable time-weighted exposure levels

b. fully protect workers in regulated industries

c. ensure a risk-free workplace environment

d. specify that the level of risk is acceptable

a. TLVs—or the OSHA PELs and the NIOSH RELs—represent maximum allowable time-weighted exposure levels.

Public health surveillance systems

a. seek to assess the burden and distribution of occupational diseases in the population

b. target specific groups of workers with known or possible exposures to specific risk factors

c. survey discrete groups of workers to identify patterns and trends within industries, occupations, and workplaces

d. are funded by federal, state, or local health authorities without statutory authority to monitor and follow up on work-related morbidity and mortality

a. Public health surveillance systems seek to assess the burden and distribution of occupational diseases in the population.

Death certificates

a. are the only source of information available to researchers for assessing cause(s) of death

b. provide uniformity related to occupation and industry coding on death certificates between states

c. make aggregated analyses possible between states

d. are undergoing standardization and routine recording of industry and occupation

d. To address the lack of uniformity in coding, a large collaborative initiative established a number of programs aimed at the standardization and routine recording of industry and occupation on death certificates.

The National Health and Nutrition Examination Survey

a. examines a nationally representative sample of about 1000 persons each year

b. is a program of studies of children and adults whose primary purpose is to assess the health and nutrition status of US residents

c. has no physical examination component

d. has found no increased prevalence of airway obstruction by industry

b. The National Health and Nutrition Examination Survey (NHANES) is a program of studies of children and adults whose primary purpose is to assess the health and nutrition status of US residents.

Cancer registries

a. accumulate data on a voluntary basis by working with hospitals

b. manage information on select cancer cases

c. exclude information on occupation and industry of the patient

d. exist in 45 states representing 96% of the US population

d. The CDC administers the National Program of Cancer Registries (NPCR), which supports central cancer registries in 45 states representing 96% of the US population.

The annual Survey of Occupational Injuries and Illnesses

a. is conducted by the Bureau of Labor Statistics at NIOSH

b. surveys private sector establishments only

c. directs workers to report injury and illness information directly to OSHA

d. substantially undercounts work-related events

d. Even for injuries, there is concern that the SOII substantially undercounts work-related events.

Medical surveillance

a. is the same as medical screening in the workplace

b. excludes medical screening and safety surveys

c. entails compiling and analyzing the health data from workers over a period of time

d. is confined by law to physicians and industrial hygienists

c. Medical surveillance entails compiling and analyzing the health data from workers over a period of time.

Medical surveillance

a. evaluates trends of biological monitoring laboratory tests on workers to assess the effectiveness of exposure controls

b. distinguishes between health effects from exposures and those from preexisting medical conditions or habits

c. is not required when exposures are below permissible levels

d. is the process of identifying, quantifying, and removing causative factors that increase the risk of occupational diseases or injuries

d. Medical surveillance is the process of identifying, quantifying, and removing causative factors that increase the risk of occupational diseases or injuries.

Primary prevention methods

a. are intended to minimize employee exposure to hazards and risk of injury or occupational disease

b. must reduce risk to the point where adverse health effects attributable to that agent do not occur

c. primarily minimize or avoid employee exposure to hazards through engineering

d. exclude worker training and risk information

a. Primary prevention methods are intended to minimize employee exposure to hazards and risk of injury or occupational disease.

Health-based regulations

a. are neither exposure driven nor performance based

b. are set by NIOSH and must be administered by both OSHA and MSHA in the United States

c. are derived from allowable exposure levels determined by current scientific knowledge about each toxicant

d. apply to hazardous substances such as lead, asbestos, and benzene

d. Health-based regulations apply to hazardous substances such as lead, asbestos, and benzene.

The company's compliance plan

a. requires each company or organization to test hazardous materials

b. is optional if workers do not complain of adverse health effects

c. must be reviewed and reevaluated at regular intervals at least annually

d. excludes outcomes measures

c. The compliance plan must be reviewed and reevaluated at regular intervals at least annually.

Action level (AL)

a. is determined by OSHA for employees whose exposure to a regulated substance exceeds the PEL

b. initiates medical surveillance

c. triggers removal of employees with adverse effects resulting from overexposure

d. ensures that employees will not experience any adverse effects associated with exposure to a toxicant

b. Action level (AL) initiates medical surveillance.

OSHA and MSHA requirements for medical surveillance

a. specify that the company determine the minimum requirements for the physician's level of training, expertise, or qualifications to conduct medical surveillance examinations

b. require federal review of physician credentials by NIOSH

c. require employers to be aware of the significance or complexity entailed in medical surveillance

d. are codified as regulations such that employers may assume that all doctors are trained and knowledgeable for any problem or service that they or their facility offers

d. OSHA health standards are codified as regulations such that employers may assume that all doctors are trained and knowledgeable for any problem or service that they or their facility offers.

Confidentiality of employees' health information by examining physicians

a. is not required for information obtained during examinations provided to workers at employers' expense

b. is waived by OSHA for purposes of risk reduction requiring company participation

c. prevents discussion of drug use, smoking, and alcohol consumption with the patient

d. usually is protected in a contractual agreement between the employer and the physician or medical practice

d. The physician has a duty to protect confidential information learned about the company and its processes and methods. Usually this information is protected in a contractual agreement between the employer and the physician or medical practice.

Most OSHA health standards

a. require employers to analyze temporal trends and associations between exposure and health data using statistical methods to assess the efficacy of exposure control methods

b. are updated at least every 5 years to reflect current scientific knowledge and technology

c. are efficiently managed using standard business tools and methods such as spreadsheets, checklists, and paper files and folders

d. require that physicians evaluate health effects and risks of employees on an individual basis, not as a group

d. OSHA health standards only require that physicians evaluate health effects and risks of employees on an individual basis, not as a group.

Temporary removal of an employee from an exposure by a physician

a. must first be approved by the company to ensure the employee's job and pay is safeguarded

b. is required only when the results of the employee's most recent biological monitoring or other test exceed the allowable regulatory threshold

c. can be based upon the physician's assessment of the employee's medical condition which places the employee at increased risk of adverse health effects resulting from exposure

d. is the most effective way for the company to prevent employees from being overexposed to hazardous workplace agents

c. Temporary removal of an employee from an exposure can be based upon the physician's assessment of the employee's medical condition which places the employee at increased risk of adverse health effects resulting from exposure.

Biologic markers are

a. distinct from biomarkers

b. indicators of biochemical, genetic, molecular, immunologic, or physiologic signals of events in biologic systems

c. reliably sensitive, specific, biologically relevant, practical, and inexpensive

d. of primary use in research

b. Biologic markers or biomarkers are indicators of biochemical, genetic, molecular, immunologic, or physiologic signals of events in biologic systems.

Measurements of chemicals in blood

a. are of marginal value with chemical metabolites

b. reflect chronic more than acute exposures

c. have unlimited applications for biomonitoring

d. can be a valuable matrix for measuring adducts of hemoglobin, albumin, or DNA

d. Blood can be a valuable matrix for measuring adducts of hemoglobin, albumin, or DNA.

Measurements of chemicals in exhaled air

a. are of no value for volatile organic compounds

b. entail an invasive procedure

c. may be used to assess airway inflammation

d. do not offer a direct comparison to measurements from air monitoring

c. Measurements of chemicals in exhaled air include the measurement of exhaled nitric oxide (NO), a well-known method to assess airway inflammation.

Health-based values

a. are chemical concentrations below which an individual does not develop adverse health effects

b. may not include proprietary industry studies

c. may incorporate safety factors

d. are inappropriate in occupational settings

c. Health-based values may incorporate safety factors.

Biological exposure indices (BEIs) are

a. available for over 100 substances

b. based on studies that address minimal or no adverse health effect levels in exposed workers and animals

c. levels that ensure healthy workers

d. indicative of concentrations below which adverse health effects do not occur

b. BEIs are based on a critical evaluation of the literature and studies submitted for review, with an emphasis on studies that address minimal or no adverse health effect levels in exposed workers and animals.

Biologic monitoring in the occupational setting

a. may be a voluntary or required component of routine medical surveillance

b. is required by OSHA standards for lead and chromium

c. makes it unnecessary to verify potential sources of exposure

d. ignores logistics and feasibility

a. Biologic monitoring in the occupational setting may be a voluntary or required component of routine medical surveillance as well as worker monitoring during and after emergency response.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

Section V: Program Management

Send Email

Citation

Jump to a Section

Section V. Program Management

Pop-up div Successfully Displayed