Occupational diseases

A woman, aged 45, has been working for 20 years at the chemistpharmaceutical

plant. She complains of asthma attacks, which occur

against a background of “full health”. Noisy, stridulous breathing, which

is heard at a distance. Herewith a patient takes a forced sitting position.

On examination the thorax is extended. The lips, nails’ loges, skin are

cyanotic. On percussion of the lungs — a band-box sound. Breathing is

difficult, with prolonged exhalation, a big amount of diffuse dry rales on

inhalation and exhalation are heard.

Make a probable diagnosis:

A 32-year-old man has been working on the elevator for 10 years,

complains of constant cough for 2 years. Cough is dry, sometimes with

the small quantity of sputum. Heavy physical load causes dyspnea. Auscultation:

harsh breathing, single dry rales. 1–2 times a year the patient

notes exacerbation. X-ray revealed no changes. Signs of cardiac insufficiency

are absent. A diagnosis was: dust bronchitis.

Define a degree of severity:

A woman, aged 35, has been working at the flax-spinning production

for over 5 years. During the preventive physical examination she complained

of strong pertussoid cough, which was terminated by the discharge

of a little amount of the viscous sputum, deterioration of condition during

a week and during each day, attacks of asphyxia at the end of the

week. Objectively: expiratory dyspnea, dry rales in the thorax on auscultation,

reduction of FVCL, power of the exhalation,VCL, MVL.

What is the most probable cause of this condition?

A 35-year old man applied to the physician with complaints of the

constant cough, dyspnea, separation of a swampy mucous sputum, seasonly

appeared attacks of asphyxia last 6 months. In anamnesis — 10-

year experience of work at the lacquer-paint plant. He noticed that attacks

appear under overflowing of paints.

Objective: on the part of the respiratory system at the percussion — a

band-box sound on the base of the lungs; dry diffused rales are auscultated.

Laboratory data: moderate eosinophilia. X-ray — a reinforcement of

a lung pattern and expansion of lungs’ roots.

What is the most possible reason of this condition?

A woman, aged 50, has been working during 20 years at the chemical

plant. She complains of attacks of asthma, appeared at work, noisy,

stridulous breathing, which is heard at a distance, dyspnea. At the examination

— the thorax is extended. The lips, nails’ loges, skin are cyanotic.

At the percussion — a band-box sound. Breathing is harsh, with the prolonged

expiration, a big amount of diffuse dry rales on the inhalation and

exhalation are auscultated.

What a pathology has this patient?

A patient Y., 48 years old, has been working at the iron ore concentration

factory during 20 years. At the medical examination he presented

the following complaints: extended pains in the thorax in the manner of

pricking, dyspnea during insignificant physical load, cough (mainly on mornings)

with discharge of a small quantity of sputum. These complaints have

been observed during 5 months. Objective: a band-box sound in the lower

parts of the lungs, vague dry rale, at the interscapular space — a harsh breathing. Excursion of the lower pulmonary margin on the middle axillar line

— 3 cm. X-ray investigation: in the lower parts of the lungs on the right

and on the left the pulmonary tissue is emphysematously changed, the

lung pattern is intensificated, deformed, roots are extended, compacted

and deformed. In the lower parts on the right and on the left there is a

greater amount of small (< 0.5 cm) nodular shadows.

Preliminary diagnosis:

In the course of routine medical examination, which was conducted

among mining workers, it was chosen one of them, complained of dyspnea

under the small physical load, pain in the thorax, dry cough. He has

worked for 14 years. Objective: a band-box sound at percussion on the lower

side areas of the lungs, reduction of the mobility of lower margins of the

lungs. Auscultation: a harsh breathing, pleura friction noise. Factors of functions

of the external respiration: reduction of vital capacity of the lungs

and minute volume of the lungs, increase of residual volume of the lungs.

Data of the roentgenologic examination: reinforcement and deformation of

a lung pattern, node shades by the size 3–5 mm. The roots of the lungs are

extended, compacted, of “cut” type. The pleura is slaked and deformed.

Probable diagnosis:

A man, 40 years old, during 10 years has been working in the building

material production and has a contact with oxides of silicon.

What disease is it necessary to exclude during the periodic medical

examination?

A man, 42 years old, applied to the therapeutical department with

complaints of pricking pains in scapulas’ area, compression in the chest,

dyspnea at the physical load, sometimes cough with separation of a small

amount of the sputum. From anamnesis — during 10 years he has worked in coal mining, has been ill for about 6 years; when these complaints appeared

for the first time, there wasn’t any therapy. Objective: at the percussion

— a band-box sound in the lower parts. Auscultation: a harsh

breathing. No heart pathology was revealed.

Possible diagnosis:

A man, 43 years old, has worked in coal industry over 10 years,

complains of the loss of the working capacity, dyspnea, strong cough with

a hard spitting sputum. Cough usually appears at the sharp changing of

the body position, under the physical load, breathing in a cool air and is

accompanied by asphyxia. Objective: auscultation — pleural dry and moist

rales; barrel chest, limited respiratory excursion of the lungs; at percussion

a band-box sound is defined. X-ray: an increase of transparency of

the lung pattern, plaining of the cupula of diaphragm, expansion of intercostal

spaces.

What is the most probable diagnosis?

A patient, 46 years old, is applied with complaints of dyspnea under

insignificant physical load and sometimes at rest, appearance of cough, first

dry, afterwards with the plantiful sputum discharge, pains in the thorax,

which are vastly intensified during cough. During the examination: asthenic

habitus, dirty grey colour of the skin, with cyanotic colour of the face

and lips. There are distant rales in the lungs, the auxiliary musculature takes

part in the act of breathing, intercostal spaces are extended. From anamnesis:

he has worked for 17 years at the Odessa Cement Plant as a packedman.

Beginning with the age of 28 the patient has been on the dispensary

account in connection with the bronchial asthma, infectious-allergic form.

Establish diagnosis:

A patient, 35 years old, an agriculturer, complains of a sharp sensation

in the eyes, lacrimation, dryness and burning sensation in the nose at

cleaning, hoarseness of the voice, sensation of compression and stethalgia,

dry cough; nasal bleeding, headache. It’s nessasary to prescribe for

the treatment:

A patient C., was delivered to CDH with the complaints of headache,

syncope, nausea, vomiting, abdominal pain. It was fixed that two

hours before hospitalization he processed a field by methylmercaptophos.

Objective: narrowing of the pupils, hyperhidrosis of the skin, bronchorrhea,

bradycardia, fibrillation of separate muscles. What organs and systems

suffer most of all as a result of this acute poisoning?

A patient A., 25 years old, works at the poultry factory during 5

years, complains of dry cough, dyspnea at the period of the working shift,

temperature above 39°C. Objective: percussion sound with a band-box

tone, weak vesicular breath, crepitation and fine bubbling rale on separate areas of lungs. The type of the function of external breathing is restrictive.

Blood test: Hb — 130,0 g/l; L — 90·109/l; ESR — 30 mm/h.

On X-Ray — diffuse enhancement and deformation of a lung pattern.

Establish diagnosis:

A man works in casting of nonferrous metals and alloys for 12

years. In the air of working area there was registered high content of heavy

metals, carbon monoxide, and nitrogen. During periodic health examination the

patient presents with asthenovegetative syndrome, sharp pains in the stomach,

constipations, pain in the hepatic area. In urine: aminolevulinic acid and

coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level.

Such intoxication is caused by:

During assessment of work conditions at the mercury

thermometer manufacture, content of mercury vapors in the air of working area

is revealed to exceed maximum concentration limit. Specify the main way of

mercury penetration into the body:

During health assessment of car drivers and police officers on

point duty, the physicians detected carboxyhemoglobinin the blood of the

patients, weakened reflex responses, disturbed activity of a number of enzymes.

Revealed professional health disorders are most likely to be associated with the

effect of:

A 47-year-old man is employed at the weaving workshop, has

15-year-long record of service at this factory; his work conditions are

associated with high-frequency and high-intensity noise. During periodical

examination he was diagnosed with occupational deafness. What are the

grounds for making such a diagnosis?

A 37-year-old man working as a typesetter in a print shop

complains of rapid fatigability, paroxysmal attacks of stomachache, weak

drooping hands. Examination of neurological status revealed hypotrophy of the

forearm muscles. Carporadial reflexes are sharply weakened. Sensitivity is not

disturbed. Gums present with dark blue border. What neurological pathology is

it?

During the periodic medical examination an assembly fitter

(works on soldering details) didn’t report any health problems. Closer examination

revealed signs of asthenic vegetative syndrome. Blood included red blood cells

with basophilic aggregations and a somewhat higher number of reticulocytes,

urine had a high concentration of delta-aminolevulinic acid. The complex of

symptoms indicates the initial stage of chronic intoxication with: