Module 3: Toxicology - Section 5: An Approach To Managing Case Problems In Occupational Medicine

TOX 5.1: Overview

ACTIVITIES

We will do this as a group exercise in class.

EXERCISE:

1. Question 1: A worker from a nearby smelter presents to your clinic complaining of an itchy skin rash affecting his forearms and darkening of his skin around the eyelids and neck during the past 3 months. He also complains of red, itchy eyes and nose bleeds. He suspects that his symptoms are due to his work. What are some of the pointers in his history that may suggest a work-related problem?
   (Answer).

2. Question 2: What do you do next? (Answer).

3. Question 3: Assuming that his problem is work-related, what are the possible chemicals that could be responsible? (Answer).

4. Question 4: On further questioning he indicates that he works in the roasting plant where arsenic is collected and bagged. You send an end of work-week urine specimen of the worker to the laboratory. The results indicate that the urinary arsenic levels are 80 µg/g creatinine (normal = 50 µg/g creatinine). What are the main principles in your approach to managing this problem? (Answer).

REFERENCES:

1. Govender M, Ehrlich RI, Mohamed A. Notification of occupational diseases by general practitioners in the Western Cape. S Afr Med J 2000;90:1012-1014.
2. Jeebhay MF. Health and safety legislation and worker’s compensation for allergic diseases of occupational aetiology. Current Allergy and Clinical Immunology 2000;13(3),4-8.



 

Answer to Question 1:

WHEN TO SUSPECT A WORK RELATED DISEASE?

1. The worker denies having symptoms prior to working at the current workplace.

2. The worker complains of work-related symptoms that may or may not deteriorate over the working day or working week.

3. The symptoms improve when the worker is away from current work on weekends and holidays.

4. The worker develops the disease while doing high-risk work (current or previous jobs) and was sufficiently exposed to the hazardous agent as it appears in Schedule 3 of COIDA (in the first instance).

Note: Not all criteria need be present in each situation.

Answer to Question 2:

Do a clinical examination. On clinical examination you observe the following positive findings (The rest of the examination is normal):

Examination of the face:
Examination of the neck:
Examination of forearms:
Examination of hands:
Examination of Nose:

(Back to main text).

Answer to Question 3:

(Back to main text).

Answer to Question 4:

1. Remove from exposure (Discussion);
2. Institute appropriate treatment where possible (Discussion);
3. Submit a claim for worker's compensation (Discussion);
4. Notify the case to the Chief Inspector in the Department of Labour (Discussion);
5. Investigate and treat the workplace (Discussion);

(Back to main text).

 

 

 

 

 

 






Postgraduate Diploma in Occupational Health (DOH) - Modules 3: Occupational Medicine & Toxicology (Basic) by Profs Mohamed Jeebhay and Rodney Ehrlich, Health Sciences UCT is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License. Major contributors: Mohamed Jeebhay, Rodney Ehrlich, Jonny Myers, Leslie London, Sophie Kisting, Rajen Naidoo, Saloshni Naidoo. Source available from here. For any updates to the material, or more permissions beyond the scope of this license, please email healthoer@uct.ac.za or visit www.healthedu.uct.ac.za. Last updated Jan 2007.
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