MFOM Written cheat sheet

Pre-placement assessment determines ability to do the job safely and identifies adjustments; it is not a general health screen and must comply with the Equality Act 2010.

Occupational history should record all jobs, specific agents, exposure intensity and duration, latency, control measures, PPE and non-occupational exposures.

Health surveillance is indicated where residual risk remains after controls, a valid detection method exists, and early detection benefits the worker.

Biological monitoring measures the substance or its metabolite in blood, urine or breath and reflects total uptake; biological effect monitoring measures an early reversible effect.

Post-bronchodilator FEV1/FVC below 0.70 supports airflow obstruction; a restrictive pattern requires lung volumes for confirmation.

Noise-induced hearing loss classically shows a 3–6 kHz notch on audiometry; presbycusis is bilateral, symmetrical and high-frequency.

Hand-arm vibration syndrome is classified using the Stockholm scale into vascular (white finger) and sensorineural (numbness, reduced dexterity) components.

Occupational asthma diagnosis uses serial peak flow or spirometry at and away from work; specific inhalation challenge is the reference test.

A fit note can state fit for work, may be fit with adjustments, or not fit; it should specify duration and be reviewed.

UK workplace exposure limits: the LTEL is an 8-hour time-weighted average; the STEL is a 15-minute reference period, normally not more than four times per day with at least 1 hour between.

Asbestos-related diseases have a latency of 15–40 years; mesothelioma risk has no safe threshold; licensed asbestos work requires HSE-licensed contractors.

Respirable crystalline silica causes silicosis, increases tuberculosis risk and is associated with autoimmune disease and lung cancer.

Organophosphates inhibit acetylcholinesterase, producing cholinergic toxicity; atropine reverses muscarinic effects and pralidoxime reactivates enzyme if given early.

Lead inhibits ALAD and ferrochelatase in haem synthesis; effects include anaemia, peripheral neuropathy, hypertension and neurodevelopmental harm.

Noise uses the equal-energy principle with a 3 dB exchange; UK lower EAV is 80 dB(A)/135 dB(C) peak, upper EAV 85 dB(A)/137 dB(C), ELV 87 dB(A)/140 dB(C).

Hand-arm vibration daily exposure A(8) action value is 2.5 m/s² and limit value is 5 m/s²; exposure points can combine tools and durations.

Carbon monoxide binds haemoglobin with high affinity forming carboxyhaemoglobin; treat suspected exposure with high-flow oxygen and measure COHb.

Sensitising agents such as isocyanates, latex and flour can cause occupational asthma; control exposure and use health surveillance.

HSWA 1974 section 2 imposes general duties on employers to ensure health, safety and welfare so far as reasonably practicable; section 7 requires employees to take reasonable care.

MHSWR 1999 require suitable and sufficient risk assessment, competent persons, emergency arrangements and health surveillance where the risk assessment identifies need.

COSHH 2002 requires risk assessment, prevention or adequate control, health surveillance and records; records for substances causing occupational disease are kept 40 years.

RIDDOR 2013 requires reporting deaths, specified injuries, over-seven-day injuries, occupational diseases and dangerous occurrences to the enforcing authority.

Equality Act 2010 defines disability as a substantial, long-term adverse effect on normal day-to-day activity; employers must make reasonable adjustments.

OH records are confidential special category data; disclosure to managers should be limited to fitness and adjustments unless consent or law permits otherwise.

Consent must be informed, voluntary and specific; workers may withdraw it, but OH may have an overriding duty in exceptional public-interest situations.

The OH physician owes duties to both employer and worker: provide impartial advice, avoid dual advocacy, and document the basis of fitness decisions.

Fitness for work balances job demands, worker capacity and risk; decisions should be evidence-based and recorded with review dates.

Job demand analysis identifies physical, cognitive, psychological and environmental requirements before fitness or rehabilitation planning.

Work is generally beneficial for health; prolonged sickness absence is harmful and early supported return to work improves outcomes.

Fit note options are fit, may be fit with adjustments, or not fit; adjustments can include altered hours, duties, equipment, supervision or workplace.

The WHO ICF model classifies impairment, activity limitation and participation restriction, with environmental and personal contextual factors.

Yellow flags such as fear avoidance, catastrophising and low work confidence, and blue flags in work organisation, predict long-term work disability.

Ill-health retirement requires permanent incapacity for the job after reasonable adjustments and rehabilitation; pension scheme rules and medical evidence apply.

Safety-critical roles require assessment against regulatory standards, such as DVLA standards for drivers, covering epilepsy, diabetes, vision and substance misuse.

Incidence equals new cases divided by population at risk over a period; prevalence equals all existing cases divided by population at a point or period.

Cohort studies measure incidence and relative risk; case-control studies estimate odds ratios and suit rare diseases; cross-sectional studies measure prevalence.

Confounding is a third factor associated with both exposure and outcome; address it by design (randomisation, restriction) or analysis (stratification, regression).

The healthy worker effect occurs because occupational cohorts are healthier than the general population, biasing mortality comparisons downward.

SMR equals observed deaths divided by expected deaths multiplied by 100; standardised rates allow comparison after adjusting for age and sex.

Attributable fraction among exposed equals (RR − 1)/RR; population attributable fraction equals Pe(RR − 1)/(1 + Pe(RR − 1)).

Bradford Hill criteria include strength, consistency, specificity, temporality, biological gradient, plausibility, coherence and experiment.

Screening requires a valid test, acceptable sensitivity and specificity, early detectable disease and effective treatment; Wilson–Jungner criteria apply.

Outbreak investigation: verify diagnosis, define cases, describe time, place and person, generate hypotheses, test with analytical studies and control.