LFOM Written cheat sheet

Occupational asthma: serial peak expiratory flow records showing work-related diurnal variation support diagnosis; confirm with specific inhalation challenge when feasible.

Occupational contact dermatitis is the most common occupational skin disease; irritant (about 80%) exceeds allergic; patch testing identifies type IV allergens.

Hand-arm vibration syndrome: Stockholm scale grades vascular (vibration white finger) and sensorineural components separately; latency typically years of exposure.

Noise-induced hearing loss: characteristic 3, 4, or 6 kHz notch on audiogram; bilateral and symmetric after prolonged exposure; unlike presbycusis, does not spare high frequencies.

Lead exposure: biological exposure index for blood lead is 200 µg/L (30 µg/dL); elevated zinc protoporphyrin and microcytic anemia accompany chronic toxicity.

Carpal tunnel syndrome: median nerve distribution symptoms; Phalen and Tinel signs; electrodiagnostic testing confirms; forceful repetitive wrist work is a recognized risk factor.

Pneumoconioses: silicosis shows upper-lobe nodular opacities and eggshell calcification of hilar nodes; asbestosis shows lower-lobe reticular opacities and pleural plaques.

Biological monitoring measures internal dose (blood, urine, exhaled air); biological effect monitoring measures early reversible change (e.g., cholinesterase, zinc protoporphyrin).

Hierarchy of controls: elimination, substitution, engineering controls, administrative controls, personal protective equipment; PPE is the least reliable single measure.

Health surveillance is required where a residual risk of identifiable work-related ill health remains after controls; it is distinct from pre-placement fitness assessment.

Spirometry for surveillance should follow ATS/ERS standards; record FEV1, FVC, and FEV1/FVC ratio; interpret with predicted values by age, sex, height, and ethnicity.

Occupational health service delivery models include in-house, outsourced/contract, and hybrid; the service should report to senior management while maintaining clinical independence from line management.

Audiometry surveillance: baseline audiogram, then periodic testing; significant threshold shift is typically ≥10 dB at two consecutive frequencies or ≥15 dB at one frequency in either ear.

Risk assessment is a five-step process: identify hazards, decide who may be harmed and how, evaluate risks and controls, record findings, and review and update.

Sickness absence management: fit notes certify fitness for some work, not just incapacity; early occupational health referral supports return-to-work planning.

Immunization for occupational exposure (e.g., hepatitis B for healthcare workers) should be offered where risk assessment identifies exposure-prone tasks.

Occupational health clinicians owe a duty of care to the worker; consent is required before disclosing personal health information to an employer except where statutory or public-interest exceptions apply.

Medical confidentiality: disclose only the minimum information necessary for workplace decisions (fitness, restrictions, adjustments), not diagnoses, unless the worker consents.

Fitness-for-work decisions distinguish between 'fit', 'fit with restrictions', and 'unfit'; the certificate should state functional capacity, not clinical detail.

Statutory sick pay and fit note frameworks: a fit note may certify fitness for amended duties, phased return, or workplace adaptations.

Disability discrimination: reasonable adjustments are required where a worker meets the definition of disability; occupational health should advise on adjustments, not make the legal determination.

Reporting requirements: RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) requires reporting specified occupational diseases and dangerous occurrences to the enforcing authority.

Data protection: health data are special category data; processing requires a lawful basis and, in the UK, an appropriate condition under data protection legislation.

Ethical duties: beneficence, non-maleficence, autonomy, and justice; conflicts between employer and worker interests should be managed transparently with the worker informed.