Health Effects and Medical Surveillance
Health-effects and medical-surveillance questions test whether you can connect exposure, disease, and the OSHA/MIOSHA surveillance triggers.
Health effects
- Asbestosis is diffuse interstitial fibrosis from cumulative dose; it typically appears after 15–20 years.
- Lung cancer risk rises with dose and is multiplied by cigarette smoking; the effect is more than additive.
- Mesothelioma is a rare pleural or peritoneal cancer with a long latency, often 20–40 years, and can follow relatively low exposures.
- Pleural plaques and thickening are common markers of past exposure but are not necessarily disabling.
Medical surveillance triggers
Under 29 CFR 1926.1101(m), surveillance is required for employees exposed at or above the PEL for 30 or more days per year, or who wear a negative-pressure respirator. It includes a pre-placement examination, annual examinations, and an exit examination. Components typically include medical and occupational history, chest X-ray read by a B-reader, and pulmonary function testing.
Worked example
A worker is assigned to a six-week Class I pipe-removal project and must wear a half-mask respirator. Even if air sampling later shows exposures below 0.1 f/cc, the respirator requirement alone triggers medical evaluation before fit testing and use; the examination is repeated annually while the assignment continues.
Traps
- Thinking surveillance is required only after a diagnosis.
- Missing the respirator-use trigger.
- Assuming a smoking history excuses surveillance.
- Confusing medical clearance with fit testing.