we'll go to the post-test. Which of the following is not considered helpful in managing chronic time shift syndrome? Considering caffeine and other substances which suppress melatonin, rotating work shifts, maintaining light exposure in waking hours, or rotating work shifts in a direction of time delay? And I realize this is a not question and we're sorry about that in advance, but which one would it be? Caffeine use. Yep. Caffeine use is not known to actually keep anybody awake in a way that's reliable and reproducible. All the other things that are mentioned there, slow shift rotation, forward shift rotation, and light exposure during waking hours, all will help keep people on the straight and narrow. Okay. I'm not going to read the whole table to you, but it has the following audiometry. And so this is a little bit more complex, but so we're talking about standard threshold shifts here. And first question, this is a review, first for OSHA testing, what frequencies do we care about? Two, three, and four thousand. Exactly. Two, three, and four for OSHA. And so is there an STS present here on either ear? Standard threshold shift. Right ear, yes. Left ear, no. Oops. I agree. And the easy way, you have to look at each of the frequencies, but it's an average, so you can add them together as well. So you can just say, and then the difference would have to be more than 30. So if I do the right ear, the baseline is 10, 10, and 10, so that's 30. And the current is 25 or 20. I'm sorry, let me try it again. 25, 20, and 25. So that adds together to be 60. So 60 minus 30 is more than the 10. It's more than 30, which you're allowed. So it would be considered STS, I believe. It's right at 10, but it would be considered STS. There's a lot of ways to do this math. What I encourage you to do is figure out the way you prefer to do the math, and then make sure you can do it reliably. I don't remember if the test allows a calculator or not. If it's computerized testing, my guess is there's probably a calculator built into the testing thing, but they'll tell you that. Make sure you can do it in a way, whether it's pen and pencil or whether it's with a calculator, that you're prepared to figure that out. The period of greatest fetal susceptibility to the effects of toxic in utero exposures is? Organogenesis. Organogenesis hasn't changed since the pretest. OSHA laws that govern the exposure of women of childbearing age are best summarized in which the following standards. I don't think we talked about this directly today, but it's actually in the lead standard. There is no maternal and fetal health standard, at least not in the U.S. It would be cool if there was, but not here. And childbearing age workers are of no interest to the government. Which of the following metals can be chelated with EDTA? And what I really want you to read this is, which of these metals would you ever chelate? I mean, they all have valence of plus two. Can it chelate all of them? Well, that's why chelation is hard. You're correct. And the problem is of the things that are listed there, which ones will kill you if you take them all away? That's why when you chelate somebody, I've done it a couple of times, but not super often. When you chelate somebody, the key thing is you've got to watch all the other plus two valence ions. If you take all the calcium away with your EDTA, the patient's heart will be super unhappy. So calcium, you need calcium. You need zinc. And cobalt is a, I'm just going to call it a potential micronutrient, but definitely zinc and cobalt are definitely micronutrients. And so you need those. And so lead would be the one you can chelate away. The key thing for chelation of lead is the first thing to do is see how high they really are. And if they're not symptomatic, maybe you just wait. But if you have to chelate them, you can chelate with EDTA. But this is inpatient. This is not the naturopath at the corner that's doing you know, chelation therapy for whoever wanders by to take away the evils of the world. This is actually admitting them to the hospital and doing real full-on chelation with careful monitoring of all their other metals so that you don't get them in trouble medically. Which of the following associated with a nasal septal perforation? I like the fact that some of my distractors are still here, but they changed the original answer. We did talk about this earlier. I mean, like an hour ago, in the last hour. I'll help you one. Dilithium crystals is not the problem. Only the Trekkies out there will get that one. It's not the flux capacitor either. Anyway, so aluminum, antimony, divalent cadmium, hexavalent chrome, or dilithium crystals. So that's the hex. It says here hexachrome, which is not wrong. I think it was chromic acid or chromates that get people in trouble with the perforation. We had a business where I was working that they had the great big chrome plating tank, which they did it as an industry. Never saw anybody from the plant, ever. And it was a tank big enough you could dunk a car in it if you wanted to. And what happened was that people would go there and learn about the process and then go home and set up their own home business. And I saw two different people who did that. The one guy built a bathtub of refractory brick in his garage and filled it with chromic acid and bought a welding machine to use as his power source and with no ventilation at all. And then got the chrome hole in his nose, got a chrome hole in his hip. And he'd wandered around the medical facility for quite some time before he was convinced he had syphilis. Because remember, it's a painless ulcer. That syphilis will prove it otherwise. And so that you will actually see that. And you can look in one side of his nose, look out the other side. And it wasn't cocaine, which is the other thing that'll do that. Okay. So when he first got to the hospital, they were convinced he's a cocaine user that had syphilis. That's where they started. Um, and it was none of the above. Um, which of the following is consistent with the restrictive pulmonary disorder? The last one, FEC less than, uh, uh, low limits are normal. And FEV1, uh, ratio with FEC less than LLN. So you're, you're half, you're, you're halfway there. So the F, the FEC less than normal, that's restrictive. But if it's just a straight ratio, normal ratio, yeah. So you don't, and you don't even care what the FEV1 is. It's irrelevant. So, um, so the FEC less than LLN and normal ratio. So that would be D I think. It could be, it could be D, it could be C or D because they're both, they're both, they're both the same, I think. All right. Am I missing something? No. So I, but I, what I care about is there, is the FEV, FEC versus the low limit of normal and the ratio versus low limit of normal. So, so either C or D would be the correct answer because I don't, the, what the FEV1 is, the FEV1 is by itself doesn't matter. Um, according to this regulation, hearing protection must be worn, uh, for what's the eight hour TWA for hearing is? 85 decibels. Any other bids? 90 decibels. And so I like the 90 decibels, the answer for when you must wear hearing protection, what happens at 85? Oh, you must initiate the hearing conservation programs. Exactly. You have to have a plan and you have to surveil your workers. Um, but then you must, uh, go to have hearing conservation when you get to 90. Keep in mind, it's a logarithmic scale. So I'm going to make the math a little bit simpler, but when you go from 84 to 90, that, the noise is six times louder. So it's a, is that right? No, two, yeah, two, it's eight times louder. So it's a, it is quite a gain over that five decibels or six decibels. Um, okay. Hold on a second. I go to the next question. Um, okay. The, the audiometry portion of the OSHA hearing conservation standard is what type of press of prevention, primary, secondary, tertiary, or quaternary. Primary. So this is, so just as a reminder, so the OSHA hearing conservation standard, we test people and people who have, who are starting to exhibit the disease in question, we give them more protection, right? That's what the, that's what, that's what the OSHA standard is about. If you have, if you have a threshold shift, the employer has to go back and look and make sure that either put you in hearing conservation and hearing protective equipment, or make sure you're using it correctly or get you a better kind that, you know, they've got to do something like that. So with that. Secondary. Yeah, it's secondary. What's primary? Primary, we would actually give them something to stop any type of hearing, give them a protection. No, no. Well, well, sort of. So primary, we decrease the exposure either by making the machine less noisy, right? Or by giving them hearing protection. That'd be primary. Secondary, we just talked about, what's tertiary? Hearing aids? Exactly. It's some, it's, I'm going to do something special so that they're less impaired, functionally impaired by whatever the medical problem is. So it could be hearing aids, could be teaching people sign language, you know, it's something where we're, we're going to make them less dysfunctional when they lose all their hearing. Which of the following workplace exposures is associated with an impaired spermatogenesis? DBCP. Yep, it's A, the DBCP, or as the way I tell people that my, I used to tell my residents to remember this, it's the Dow birth control pill. It's a way to remember it. And the only other thing that we know that really interferes with spermatogenesis is high heat workplaces. That's the other thing that will also cause problems in that regard. And I don't mean like I'm uncomfortable at my office desk, it's 80. I mean, the guys that are working like a foundry or an aluminum pot room or something where it's like 140 degrees and their gonads are just getting too warm to be functional. This question allows multiple correct answers. I thought that glyphosate also reduced spermatogenesis. I don't know that to be true. I'm not saying it's not, it's still, it's not, let me do it this way. It's not carbon dioxide and it's not radar. Although the carbon dioxide in beer might decrease other functional, but not directly spermatogenesis. I don't know whether, whether glyphosate does that or not. I actually don't know. Right now, unfortunately, most of the science around glyphosate is based around attorneys rather than science. So it's a little bit confusing. So I'm not saying it's not, it's wrong, but it would not be my first answer of the ones who are listed. Okay. According to OSHA's respirator standards, which of the following spirometry results is automatically disqualifying for respirator use? Anybody want to play? I think none. I mean, anybody can wear a PAPR, right? Well, anybody can wear a respirator is the short answer. So yeah, the answer is OSHA standard just says a qualified physician's opinion, which could be whatever you decide it is as far as testing goes. So there's actually, OSHA never says if they're below some cutoff, you can't, they can't be in a respirator. So you're completely correct. And the backup answer is anybody could use a PAPR if they're having problems with other kinds of respirators. Absolutely correct. Morphine is metabolized to which of the following? Odean. Odean, number A, exactly. Okay. So now we have some mix and match to go on. And so, so 13, PTSD goes with which of the following? Re-experiencing. The second one. I agree. Consistently experiencing. Depression. I think it's A. A. I agree. And the last one for chronobiology disorders. Shift work. D. I think it's D like in Delta for the shift work part. And hostile work environment. C. Is C. Yeah. If anybody wants and tells you all those things, you let me know. I want to meet that person. It's that, that's forward. So, okay. So we've got our, our, so for the people who are exposed, we have lung cancer and the calculation for here is how to do relative risk. You know, A over A plus B divided by C over C plus D. And we got a relative risk of 2.2. Does that math kind of make sense? I would encourage you as you're preparing for this test that you are prepared to create a two by two table and know how to do a relative risk and an odds ratio. And then the negative predictive value, positive predictive value of the test. If you can do those things, you're probably pretty well set. But it is, you need to know the two by two table and how to work that out. 18. In regulated drug testing, the MRO contacts the donor for positive sample two. Discover alternative medical explanations. Exactly. Number 19, federally regulated drug testing may be done. If it's federally regulated, the federal part of it has to be done in an accredited lab. There's no instant version of federal. Now, some employers do both, like they'll do the instant test for a pre-employment program that has nothing to do with federal, and then they'll do a sent off to lab for the federal. That's allowed. Here's the math for number 17. The recording didn't turn out very well for that, but you can see the answer here. And the answers for 18, 19, and 20.

chronic time shift syndrome

OSHA hearing conservation

pulmonary disorder indicators

chelation therapy EDTA

spermatogenesis factors