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LFOM Written practice questions

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Question 1Occupational medicine core clinical practice

Which piece of legislation forms the primary legal framework for workplace health and safety in the United Kingdom, placing general duties on employers to ensure, so far as is reasonably practicable, the health, safety and welfare of employees?

  1. The Control of Substances Hazardous to Health Regulations 2002
  2. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
  3. The Health and Safety at Work etc. Act 1974 Correct answer.
  4. The Management of Health and Safety at Work Regulations 1999

Explanation

The Health and Safety at Work etc. Act 1974 is the foundational statute setting the general duty on employers to protect the health, safety and welfare of employees so far as is reasonably practicable. The other instruments are subordinate regulations made under it that address specific hazards or management duties.

Question 2Occupational medicine core clinical practice

In occupational health, the term 'sentinel health event' is best described as which of the following?

  1. A single case of disease or injury that signals a workplace hazard requiring investigation Correct answer.
  2. A statutory report submitted annually to a regulator
  3. A clinical presentation that mandates immediate hospital admission
  4. A scheduled screening test performed at fixed intervals for all workers

Explanation

A sentinel health event is an individual case (such as an unusual cancer or a specific occupational disease) that serves as a warning signal of an underlying workplace exposure needing investigation. It contrasts with routine surveillance and reporting processes.

Question 3Occupational medicine core clinical practice

A worker in a battery factory has a blood lead concentration of 55 micrograms/dL. Which action is most appropriate according to UK occupational lead surveillance practice?

  1. Remove the worker from further lead exposure and investigate the workplace controls Correct answer.
  2. Continue routine monitoring with no change because the level is acceptable
  3. Repeat the test in twelve months as part of annual screening
  4. Advise the worker to increase dietary calcium and continue working normally

Explanation

Under UK lead regulations, blood lead levels above the action level (for example 50 micrograms/dL in many general workers) require removal from further exposure and review of controls. This protects the worker and triggers investigation of the exposure source.

Question 4Occupational medicine core clinical practice

Which occupational exposure is most strongly associated with the development of malignant mesothelioma?

  1. Asbestos Correct answer.
  2. Coal dust
  3. Silica
  4. Wood dust

Explanation

Asbestos exposure is the principal recognised cause of malignant mesothelioma of the pleura and peritoneum. The other dusts cause different patterns of disease, such as coal workers' pneumoconiosis, silicosis and sino-nasal cancer respectively.

Question 5Occupational medicine core clinical practice

A 45-year-old factory worker reports gradual hearing loss and tinnitus. Audiometry shows a notch at 4 kHz with recovery at higher frequencies. Which feature most supports a diagnosis of occupational noise-induced hearing loss rather than age-related hearing loss?

  1. A characteristic dip at 3-6 kHz on the audiogram with a history of significant noise exposure Correct answer.
  2. Unilateral loss with a strong family history of deafness
  3. Conductive loss with a normal bone conduction threshold
  4. Symmetric loss greatest at 8 kHz with no noise exposure history

Explanation

Noise-induced hearing loss classically produces a notch centred around 3-6 kHz, especially 4 kHz, and requires a credible history of hazardous noise exposure. Age-related loss tends to be more symmetric and affects higher frequencies without a discrete notch.

Question 6Occupational medicine core clinical practice

Which measurement is used to characterise whole-body vibration exposure for the purpose of comparing with the daily exposure action value?

  1. Personal dust concentration in mg/m3
  2. Peak sound pressure level in dB
  3. Hand-arm vibration magnitude in m/s2
  4. A(8) expressed in m/s2 Correct answer.

Explanation

Whole-body vibration is assessed using the daily exposure A(8) in metres per second squared, compared against action and limit values. Hand-arm vibration uses a separate metric and the other options relate to noise and dust.

Question 7Occupational medicine core clinical practice

A nurse develops itchy, erythematous dermatitis on the hands and forearms after starting work with latex gloves. Which is the most appropriate initial occupational health action?

  1. Advise the worker to change to a different clinical specialty
  2. Continue using the same gloves with barrier cream
  3. Prescribe a course of oral corticosteroids and continue exposure
  4. Substitute low-protein or non-latex gloves and assess for latex sensitisation Correct answer.

Explanation

The priority in occupational contact dermatitis is to remove or reduce exposure at source, so glove substitution is the key first step, alongside assessment for type I latex allergy. Continuing exposure risks progression and sensitisation.

Question 8Occupational medicine core clinical practice

Which clinical finding is most characteristic of hand-arm vibration syndrome?

  1. Painless swelling of the metacarpophalangeal joints
  2. Episodic finger blanching triggered by cold Correct answer.
  3. Bilateral thenar wasting with sensory loss in a glove distribution
  4. Persistent wrist drop

Explanation

Hand-arm vibration syndrome classically presents with vascular symptoms, namely cold-induced finger blanching (vibration white finger), often with sensory symptoms. The other findings suggest neurological or musculoskeletal conditions unrelated to the classic vascular presentation.

Question 9Occupational medicine core clinical practice

A worker presents with fever, breathlessness and myalgia days after cleaning a contaminated air-conditioning system. Which condition should be considered?

  1. Silicosis
  2. Occupational asthma
  3. Extrinsic allergic alveolitis
  4. Legionnaires' disease Correct answer.

Explanation

Legionnaires' disease is caused by Legionella bacteria, often aerosolised from contaminated water systems such as air-conditioning, and presents with systemic and respiratory features. The incubation and systemic symptoms fit this diagnosis.

Question 10Occupational medicine core clinical practice

In the assessment of a worker with suspected occupational asthma, which investigation is the reference standard for confirming the relationship between symptoms and workplace exposure?

  1. A single resting spirometry reading
  2. Serial peak expiratory flow measurements at and away from work Correct answer.
  3. Measurement of serum total IgE
  4. A chest radiograph

Explanation

Serial peak expiratory flow records taken over periods at work and away from work demonstrate the temporal relationship between exposure and airflow obstruction and are central to confirming occupational asthma. Single spirometry and IgE are supportive but not confirmatory.

Question 11Occupational medicine core clinical practice

Which of the following best describes the purpose of health surveillance in occupational health?

  1. Diagnosis of non-occupational diseases for the employer
  2. Assessment of an individual's fitness for promotion
  3. Determination of an employee's entitlement to sick pay
  4. Early detection of adverse health effects related to work so that action can be taken Correct answer.

Explanation

Health surveillance aims to detect early signs of work-related ill health so that corrective action can protect the worker and others. It is not a diagnostic service for unrelated conditions nor a tool for employment decisions.

Question 12Occupational medicine core clinical practice

A laboratory technician is exposed to a chemical that is a known sensitiser. Which control measure should be prioritised according to the hierarchy of control?

  1. Elimination or substitution of the hazardous substance Correct answer.
  2. Training in safe handling procedures
  3. Health surveillance for exposed workers
  4. Provision of personal protective equipment

Explanation

The hierarchy of control places elimination and substitution at the top because removing or replacing the hazard protects all workers without relying on individual behaviour. PPE, training and surveillance are lower-order measures used when higher controls cannot fully remove the risk.

Question 13Occupational medicine core clinical practice

A construction worker is found to have a positive tuberculin skin test with no symptoms and a normal chest radiograph after contact with a colleague with active pulmonary tuberculosis. What does this most likely represent?

  1. Active pulmonary tuberculosis
  2. A false-positive result requiring no further action
  3. Previous BCG vaccination only, with no infection
  4. Latent tuberculosis infection Correct answer.

Explanation

A positive test with no symptoms and a normal chest radiograph indicates latent tuberculosis infection, which requires assessment for preventive treatment. Active disease would typically show symptoms and radiographic changes.

Question 14Occupational medicine core clinical practice

Which of the following is the most appropriate first step when a worker reports a sharps injury from a contaminated needle?

  1. Wait for symptoms to develop before seeking advice
  2. Apply a tight tourniquet above the injury site
  3. Encourage bleeding, wash the wound and assess the source and need for post-exposure prophylaxis Correct answer.
  4. Immediately suture the wound to prevent infection

Explanation

Immediate first aid for a sharps injury involves encouraging bleeding, washing with soap and water, and promptly assessing the source and the need for post-exposure prophylaxis. Delaying assessment increases the risk from blood-borne viruses.

Question 15Occupational medicine core clinical practice

Which statutory requirement applies to the reporting of a specified occupational disease, such as carpal tunnel syndrome attributed to work, under UK RIDDOR?

  1. The general practitioner must report it to the police
  2. The responsible person must report the diagnosis to the enforcing authority Correct answer.
  3. The affected worker must personally notify the local council
  4. No report is required because it is not an injury

Explanation

RIDDOR requires the responsible person, usually the employer, to report specified occupational diseases diagnosed in workers to the relevant enforcing authority. Reporting is a duty of the duty holder rather than the worker or clinician.

Question 16Occupational medicine core clinical practice

A night-shift worker reports persistent fatigue and sleep disturbance. Which advice is most consistent with good occupational health practice?

  1. Suggest stopping all shift work immediately as the only option
  2. Recommend permanent night shifts to stabilise the body clock
  3. Advise the worker to increase caffeine intake throughout the shift
  4. Review shift scheduling and provide advice on sleep hygiene and recovery Correct answer.

Explanation

Managing shift-work-related fatigue involves reviewing rosters to limit consecutive nights and allow recovery, together with sleep hygiene advice. Permanent nights and heavy caffeine use do not address circadian disruption.

Question 17Occupational medicine core clinical practice

Which of the following best defines the term 'reasonably practicable' in UK health and safety law?

  1. Weighing the risk against the cost and effort of controlling it, unless grossly disproportionate Correct answer.
  2. Taking only the cheapest available control measure
  3. Doing whatever is technically possible regardless of cost
  4. Following only written procedures agreed with employees

Explanation

Reasonably practicable requires balancing the magnitude of risk against the time, trouble and cost of control measures, so that disproportionate measures need not be taken. It is not an absolute or purely cost-driven standard.

Question 18Occupational medicine core clinical practice

A worker with well-controlled epilepsy wishes to operate a forklift. Which approach best reflects sound occupational health practice?

  1. Perform an individual risk assessment considering seizure history, treatment and job demands Correct answer.
  2. Refer the decision solely to the employer's line manager
  3. Allow the task without any assessment if the worker feels well
  4. Exclude the worker automatically because of the diagnosis

Explanation

Fitness decisions should be based on an individual risk assessment weighing the likelihood of harm, the worker's seizure history and the specific demands of the task. Blanket exclusion by diagnosis is discriminatory and not evidence-based.

Question 19Occupational medicine core clinical practice

Which of the following is the primary purpose of pre-placement health assessment?

  1. To rank candidates for promotion
  2. To establish a baseline for future litigation
  3. To determine whether the individual can perform the job safely and to identify any needed adjustments Correct answer.
  4. To screen out applicants with any chronic illness

Explanation

Pre-placement assessment aims to ensure the individual is fit for the specific job demands and to identify reasonable adjustments, with the job offer usually made conditional. It is not a means of excluding applicants with chronic conditions.

Question 20Occupational medicine core clinical practice

A worker exposed to ionising radiation is subject to dose monitoring. Which principle underpins the system of radiological protection for occupational exposure?

  1. Justification, optimisation and dose limitation Correct answer.
  2. Routine exclusion of all workers of childbearing age
  3. Reliance solely on personal protective equipment
  4. Maximising exposure to build tolerance

Explanation

Radiological protection rests on the principles of justification, optimisation (as low as reasonably achievable) and dose limitation. These guide both the design of work and individual dose constraints.

Question 21Occupational medicine core clinical practice

Which of the following best describes the role of the occupational health nurse in relation to sickness absence management?

  1. Supporting rehabilitation and advising on adjustments to facilitate return to work Correct answer.
  2. Approving annual leave requests
  3. Deciding disciplinary action for absent employees
  4. Certifying the medical reason for every absence

Explanation

Occupational health supports return to work through rehabilitation planning and advice on workplace adjustments, working with the employee and employer. Certification and disciplinary decisions lie outside this role.

Question 22Occupational medicine core clinical practice

A worker reports that a colleague has developed similar respiratory symptoms after working in the same enclosed area with solvent vapours. Which action best reflects an occupational health response?

  1. Advise both workers to take annual leave
  2. Treat each worker individually without considering the workplace
  3. Investigate the shared exposure and recommend review of ventilation and controls Correct answer.
  4. Refer both workers to a respiratory clinic without workplace assessment

Explanation

Clustering of similar symptoms among workers sharing an exposure suggests a workplace hazard, so the occupational health response is to investigate exposure and recommend control measures such as improved ventilation. Treating individuals in isolation misses the opportunity to prevent further cases.

Question 23Occupational medicine core clinical practice

Which factor is most important in determining whether a chemical exposure is likely to cause systemic toxicity after skin contact?

  1. The ambient noise level in the workplace
  2. The substance's ability to penetrate intact skin and its systemic toxic potency Correct answer.
  3. The worker's shoe size
  4. The colour of the substance

Explanation

Dermal absorption depends on the substance's capacity to penetrate skin and its inherent systemic toxicity, which together determine risk. Physical characteristics such as colour or unrelated workplace factors do not determine absorption.

Question 24Occupational medicine core clinical practice

A worker with a known allergy to a metal develops dermatitis on skin contacting a component. Which control approach best follows the principles of prevention?

  1. Rely on the worker wearing gloves only when symptoms appear
  2. Substitute the allergenic component or introduce engineering controls to prevent skin contact Correct answer.
  3. Reassign the worker to the same task in a different building
  4. Continue exposure and treat flare-ups with topical steroids

Explanation

Where a sensitiser is identified, the preferred approach is to eliminate or substitute it or to use engineering controls that prevent contact, consistent with the hierarchy of control. Reactive measures such as treating flare-ups do not prevent sensitisation or recurrence.

Question 25Occupational medicine core clinical practice

Which of the following is a recognised feature distinguishing extrinsic allergic alveolitis from occupational asthma?

  1. A normal chest radiograph in all cases
  2. Reversible airflow obstruction within minutes of exposure
  3. A restrictive pattern with reduced gas transfer and systemic features after heavy exposure Correct answer.
  4. Raised total IgE with immediate wheeze

Explanation

Extrinsic allergic alveolitis (hypersensitivity pneumonitis) typically produces a restrictive defect with impaired gas transfer and systemic features such as fever and malaise after heavy exposure. Occupational asthma more often shows reversible obstruction and immediate or late bronchoconstriction.

Question 26Occupational medicine core clinical practice

Which airborne particle fraction is most relevant when assessing the risk of pneumoconiosis from an inhaled dust?

  1. The thoracic fraction
  2. The inhalable fraction
  3. The respirable fraction Correct answer.
  4. The total suspended fraction

Explanation

Pneumoconioses arise from dust deposited in the alveolar region, which is reached by the respirable fraction (roughly particles below 5 micrometres). The inhalable fraction describes material entering the nose and mouth, not the dose to the deep lung.

Question 27Occupational medicine core clinical practice

A worker is referred with a suspected occupational skin problem. Which feature most strongly suggests an allergic rather than an irritant contact dermatitis?

  1. Sharp demarcation limited to the area of direct contact
  2. Improvement over the working week
  3. Immediate burning on first exposure to the substance
  4. Spread beyond the area of contact with a delayed onset Correct answer.

Explanation

Allergic contact dermatitis is a type IV hypersensitivity reaction, so it develops after sensitisation and can spread beyond the contact site. Irritant dermatitis is usually confined to the exposed area and occurs on first exposure.

Question 28Occupational medicine core clinical practice

Which measure best quantifies a worker's cumulative exposure to lead over recent months?

  1. Urinary lead concentration
  2. Serum zinc protoporphyrin
  3. Blood lead concentration Correct answer.
  4. Hand-wipe sampling

Explanation

Blood lead reflects recent absorption over weeks to a few months and is the standard biological monitoring measure for lead exposure. Urinary lead varies with recent intake and renal function, and zinc protoporphyrin is a downstream effect marker.

Question 29Occupational medicine core clinical practice

A worker who uses a solvent-based adhesive in a small unventilated room reports headache, dizziness and nausea that improve at weekends. Which exposure route is most likely responsible?

  1. Ocular absorption
  2. Inhalation of vapour Correct answer.
  3. Ingestion from contaminated food
  4. Dermal absorption

Explanation

Volatile solvents in a confined space generate vapour that is inhaled, producing acute central nervous system symptoms that resolve away from work. Dermal and ocular routes contribute far less to systemic dose for most solvents.

Question 30Occupational medicine core clinical practice

Which finding is most consistent with a diagnosis of occupational asthma confirmed by serial peak flow records?

  1. Progressive fall in peak flow across each working week with recovery on days off Correct answer.
  2. Peak flow lowest immediately after waking on every day
  3. Lower peak flow on rest days than on work days
  4. Stable peak flow throughout the week with occasional random dips

Explanation

Occupational asthma typically shows a diurnal pattern of deterioration during periods at work and improvement during periods away from work. Serial peak flow analysis looks for this work-related rhythm.

Question 31Occupational medicine core clinical practice

Which principle underlies the setting of occupational exposure limits for airborne substances?

  1. Limits aim to control exposure to a level that protects most workers over a working lifetime Correct answer.
  2. Limits apply only to substances that are carcinogenic
  3. Limits are thresholds below which no health effect can occur
  4. Limits are set at the level achievable by the best available technology

Explanation

Occupational exposure limits are health-based benchmarks intended to protect the great majority of workers from adverse effects over a working lifetime. They are not absolute thresholds of safety and do not apply only to carcinogens.

Question 32Occupational medicine core clinical practice

A worker is diagnosed with noise-induced hearing loss. Which audiometric pattern is most characteristic?

  1. A flat sensorineural loss across all frequencies
  2. A conductive loss greatest at low frequencies
  3. A unilateral loss with no relation to noise exposure
  4. A sensorineural notch centred near 4 kHz Correct answer.

Explanation

Noise-induced hearing loss classically produces a sensorineural dip at around 3 to 6 kHz, often near 4 kHz, before spreading to other frequencies with continued exposure. Conductive patterns and unilateral losses suggest other causes.

Question 33Occupational medicine core clinical practice

Which action is most appropriate when a worker is found to be non-immune to hepatitis B and has occupational exposure to blood?

  1. Reassure the worker that gloves provide complete protection
  2. Advise the worker to avoid all patient contact
  3. Offer hepatitis B vaccination and check response where indicated Correct answer.
  4. Arrange immediate post-exposure prophylaxis regardless of exposure

Explanation

Non-immune workers with blood exposure risk should be offered hepatitis B immunisation and have their response assessed so that protection is confirmed. Post-exposure prophylaxis is only relevant after an actual exposure event.

Question 34Occupational medicine core clinical practice

Which feature best distinguishes asbestosis from benign pleural disease caused by asbestos?

  1. Localised pleural thickening at the lung bases
  2. Presence of pleural plaques on imaging
  3. Presence of asbestos bodies in sputum
  4. Diffuse interstitial fibrosis with reduced gas transfer Correct answer.

Explanation

Asbestosis is diffuse interstitial pulmonary fibrosis associated with reduced transfer factor and restrictive physiology. Pleural plaques and thickening are pleural manifestations and do not by themselves indicate parenchymal fibrosis.

Question 35Occupational medicine core clinical practice

Which factor most strongly determines the severity of acute toxicity from a single dermal exposure to an industrial chemical?

  1. The rate of skin absorption and the intrinsic toxicity of the substance Correct answer.
  2. The colour of the substance
  3. The odour threshold of the substance
  4. The viscosity of the substance

Explanation

Systemic toxicity after skin contact depends on how readily the substance crosses the skin barrier and on its inherent toxicity. Odour, colour and viscosity are not reliable predictors of absorbed dose.

Question 36Occupational medicine core clinical practice

A worker with chronic obstructive pulmonary disease wishes to continue in a dusty job. Which assessment approach best reflects good occupational health practice?

  1. Assess the workplace exposure and the worker's functional capacity, then consider reasonable adjustments Correct answer.
  2. Rely on the worker's own judgement without further assessment
  3. Declare the worker permanently unfit for all work
  4. Transfer the worker to any other role regardless of fitness

Explanation

Occupational health assessment weighs the demands of the job against the individual's capacity and seeks adjustments to reduce risk while preserving employment. Blanket exclusion or unplanned redeployment is not person-centred.

Question 37Occupational medicine core clinical practice

Which statement best describes the purpose of statutory health surveillance for workers exposed to a hazardous substance?

  1. To certify that the workplace is free of all risk
  2. To provide a general medical check unrelated to workplace hazards
  3. To detect early signs of work-related ill health so that action can be taken Correct answer.
  4. To replace engineering controls with medical monitoring

Explanation

Health surveillance is a systematic programme to detect early adverse effects related to exposure, allowing intervention before harm progresses. It complements, but never replaces, exposure controls.

Question 38Occupational medicine core clinical practice

A worker presents with sudden onset of fever, cough and breathlessness after using a metalworking fluid aerosol in a poorly maintained machine. Which condition should be considered?

  1. Tension headache
  2. Extrinsic allergic alveolitis Correct answer.
  3. Simple pneumothorax
  4. Pulmonary embolism

Explanation

Inhalation of contaminated aerosols, including metalworking fluids and humidifier water, can cause hypersensitivity pneumonitis (extrinsic allergic alveolitis) with fever, cough and breathlessness. The temporal link to exposure supports this diagnosis.

Question 39Occupational medicine core clinical practice

Which legal duty most directly requires an employer to assess and control risks to workers' health and safety?

  1. A duty to insure against all possible losses
  2. A duty to provide a staff canteen
  3. A duty to publish an annual accounts statement
  4. A duty to carry out suitable and sufficient risk assessments Correct answer.

Explanation

Health and safety law places a general duty on employers to assess risks and put in place suitable controls. Risk assessment is the foundation on which control measures and surveillance are built.

Question 40Occupational medicine core clinical practice

A worker who drives for a living reports excessive daytime sleepiness and loud snoring. Which action is most appropriate?

  1. Advise the worker to continue driving until symptoms worsen
  2. Recommend only a change of shift pattern
  3. Refer for assessment of possible obstructive sleep apnoea and advise on fitness to drive Correct answer.
  4. Record the symptoms without further action

Explanation

Excessive daytime sleepiness in a vocational driver raises concern about obstructive sleep apnoea and the risk of falling asleep at the wheel. Referral for diagnosis and advice on fitness to drive are required.

Question 41Occupational medicine core clinical practice

Which vaccine-preventable infection is of particular concern for workers exposed to sewage?

  1. Varicella
  2. Rubella
  3. Measles
  4. Tetanus Correct answer.

Explanation

Sewage and soil exposure carries a risk of tetanus through contaminated wounds, so tetanus immunisation status should be checked. The other infections are not specifically associated with sewage work.

Question 42Occupational medicine core clinical practice

A worker develops a persistent dry cough and breathlessness after several years of handling isocyanate paints. Which diagnosis should be considered first?

  1. Pulmonary fibrosis from silica
  2. Occupational asthma Correct answer.
  3. Pneumonia
  4. Chronic bronchitis from smoking

Explanation

Isocyanates are potent respiratory sensitisers, and new respiratory symptoms in an exposed worker should prompt assessment for occupational asthma. Diagnosis requires evidence of work-relatedness such as serial peak flow or specific challenge.

Question 43Occupational medicine core clinical practice

Which feature most strongly suggests that a case of dermatitis is work-related?

  1. Presence of atopic eczema in childhood
  2. Involvement of the face only
  3. Onset before starting the job
  4. Symptoms improve when away from work and recur on return Correct answer.

Explanation

Temporal association with work, with improvement during absence and recurrence on return, is a key indicator of occupational causation. Pre-existing or constitutional skin disease does not exclude occupational dermatitis but does not itself establish it.

Question 44Occupational medicine core clinical practice

Which control measure sits highest in the hierarchy of control for reducing exposure to a hazardous fume?

  1. Providing respiratory protective equipment
  2. Posting warning signs
  3. Eliminating the process that generates the fume Correct answer.
  4. Rotating workers between tasks

Explanation

The hierarchy of control places elimination of the hazard at the top, followed by substitution and engineering controls. Personal protective equipment and administrative measures come lower because they depend on human behaviour and maintenance.

Question 45Occupational medicine core clinical practice

A worker has been exposed to a splash of blood to the eye. Which immediate action is most appropriate?

  1. Wait to see whether symptoms develop before acting
  2. Take oral antibiotics immediately
  3. Irrigate the eye thoroughly and seek urgent assessment for post-exposure management Correct answer.
  4. Apply a dressing and continue working

Explanation

Mucous membrane exposure to blood requires immediate irrigation and urgent assessment for post-exposure prophylaxis against bloodborne viruses. Delay increases risk and is not acceptable practice.

Question 46Occupational medicine core clinical practice

Which physiological effect is most associated with chronic whole-body vibration exposure in drivers of heavy vehicles?

  1. Chronic obstructive pulmonary disease
  2. Low back pain and degenerative spinal changes Correct answer.
  3. Peripheral neuropathy of the hands
  4. Sensorineural hearing loss

Explanation

Prolonged whole-body vibration, particularly in seated drivers, is associated with low back pain and spinal degeneration. Hearing loss, hand neuropathy and airways disease are linked to other hazards such as noise, hand-arm vibration and dust.

Question 47Occupational medicine core clinical practice

Which statement best describes the role of biological monitoring in occupational health?

  1. It measures the amount of a substance or its metabolite in the body to assess absorbed dose Correct answer.
  2. It records the worker's self-reported symptoms
  3. It assesses the effectiveness of personal protective equipment
  4. It measures airborne concentration at the workplace

Explanation

Biological monitoring measures the substance or its metabolites in biological samples such as blood or urine, reflecting the dose absorbed by all routes. Air monitoring measures external concentration, which may differ from internal dose.

Question 48Occupational medicine core clinical practice

A pregnant worker is concerned about continuing in a role involving night shifts and heavy lifting. Which approach best reflects good occupational health practice?

  1. Advise immediate resignation
  2. Reassure her that pregnancy poses no workplace risks
  3. Refer her to occupational health only after problems arise
  4. Conduct an individual risk assessment and consider temporary adjustments Correct answer.

Explanation

Pregnancy requires an individual risk assessment because the hazards and the worker's capacity change over time. Temporary adjustments to shift work and manual handling can usually be made to protect both mother and fetus.

Question 49Occupational medicine core clinical practice

Which feature is most characteristic of hand-arm vibration syndrome?

  1. Persistent wrist swelling
  2. Nocturnal cough
  3. Episodic finger blanching triggered by cold Correct answer.
  4. Unilateral hearing loss

Explanation

Hand-arm vibration syndrome includes vascular symptoms, classically episodic blanching of the fingers provoked by cold, together with sensory and musculoskeletal components. The other findings are unrelated to vibration exposure.

Question 50Occupational medicine core clinical practice

A worker is found to have a raised blood lead level on biological monitoring. Which action is most appropriate?

  1. Investigate the source, review controls and consider removal from further exposure according to guidance Correct answer.
  2. Reassure the worker that lead has no health effects
  3. Continue monitoring without any change to work practices
  4. Recommend only increased fluid intake

Explanation

A raised blood lead level requires investigation of the exposure source, review of control measures and, where levels are high enough, removal from further exposure under the relevant regulations. Simply continuing or reassuring is unsafe.