AKT – Occupational and environmental medicine

Samuel Briggs, aged 45, presents with worsening shortness of breath and dry cough over the past 6 months. He has worked in a quarry for 20 years and reports no smoking history. Examination reveals fine bibasal crackles. Chest X-ray shows reticulonodular opacities predominantly in the upper zones.

What is the MOST likely diagnosis?

Denise Walker, aged 52, presents with hand numbness and night-time tingling in the first three fingers. She works as a typist and spends long hours on the computer. Phalen’s and Tinel’s signs are positive.

What is the MOST likely cause of her symptoms?

Jonathan Clarke, aged 39, is a farmer presenting with malaise, fever, and a dry cough for 3 days. He recently spent several hours cleaning out a mouldy hay shed. Examination reveals mild tachypnoea and scattered crackles. Chest X-ray shows diffuse ground-glass opacities.

What is the MOST likely diagnosis?

Natalie Ng, aged 29, works in a battery manufacturing plant. She presents with fatigue, abdominal discomfort, and irritability. Blood tests reveal normocytic anaemia and elevated serum lead levels.

What is the MOST appropriate management?

Gareth Powell, aged 34, presents with worsening rash and itching on his hands and forearms over the past month. He is an auto mechanic and frequently handles solvents and cleaning agents. Examination reveals erythematous, scaly patches with excoriations on both hands.

What is the MOST likely diagnosis?

Rebecca Lang, aged 47, presents with episodic wheezing, chest tightness, and shortness of breath that improves on weekends. She works in a bakery. There is no history of atopy. Spirometry shows reversible airflow obstruction.

What is the MOST likely diagnosis?

Luke Watson, aged 36, presents with hearing loss and persistent ringing in both ears. He works in construction and uses heavy machinery without hearing protection. Audiometry shows a bilateral high-frequency sensorineural hearing loss.

What is the MOST likely cause of his symptoms?

Sarah Foley, aged 58, presents with increasing breathlessness and chest tightness. She is a retired insulation installer. Examination reveals digital clubbing and bilateral end-inspiratory crackles. Chest X-ray shows diffuse lower lobe interstitial fibrosis and pleural plaques.

What is the MOST likely diagnosis?

Dominic Hill, aged 42, presents with nausea, vomiting, and dizziness after returning home from work on a building site. He had been using a petrol-powered generator in an enclosed space. Examination reveals a mild headache and normal chest auscultation. Pulse oximetry is 98%.

What is the MOST likely diagnosis?

Jessica Moran, aged 31, presents with eye irritation, sore throat, and coughing since starting a new job at a nail salon. Symptoms improve when she is away from work. Examination is unremarkable. No asthma history. Spirometry is normal.

What is the MOST appropriate initial management?

Anthony Deluca, aged 53, presents for assessment as part of a pre-employment medical for a forklift operator position. He has a history of well-controlled epilepsy, with no seizures in the past 4 years. He is currently on lamotrigine. His most recent specialist review was 6 months ago.

According to Austroads guidelines, is he fit to drive a commercial vehicle?

Maria Stojanovic, aged 38, is a healthcare worker who presents with persistent dry cough and fatigue. She recently returned from working in a remote Aboriginal community where a patient was diagnosed with active tuberculosis. Her chest X-ray is normal. Tuberculin skin test shows 15 mm induration.

What is the MOST appropriate next step?

Colin Shepherd, aged 62, presents with progressive numbness and tingling in both feet. He is a retired industrial worker with a history of heavy metal exposure. Blood tests reveal elevated arsenic levels.

What is the MOST appropriate management?

Sophie Lim, aged 25, is a hairdresser presenting with episodic wheezing and nasal congestion that has developed over the past year. She has no history of asthma. Symptoms are worse during work hours and improve on weekends and holidays.

What is the MOST appropriate next step?

Gavin McRae, aged 45, works as a firefighter and presents with fatigue, sleep disturbance, and mood irritability. He reports disturbed sleep after night shifts and trouble concentrating. There is no past psychiatric history or substance use.

What is the MOST likely diagnosis?

Patrick Hall, aged 50, presents with increasing shortness of breath and dry cough. He has worked in shipbuilding for 25 years. Chest X-ray reveals bilateral pleural plaques and CT shows interstitial fibrosis in the lower lobes. He is a non-smoker.

What is the MOST likely cause of his condition?

Natalie Forbes, aged 43, presents with frequent headaches and eye irritation at work. She works in a new office building and reports that several colleagues also have similar symptoms. Symptoms improve when she is on leave.

What is the MOST likely diagnosis?

Jasdeep Singh, aged 35, works as a welder and presents with a 2-month history of dry cough, chest tightness, and fatigue. He does not smoke. Chest imaging reveals metal fume pneumonitis. Spirometry shows a mild restrictive pattern.

What is the MOST appropriate advice?

Edward Miles, aged 60, presents with fatigue, nausea, and tremor. He has worked in a fluorescent light recycling facility for 15 years. Blood tests show elevated mercury levels.

What is the MOST appropriate initial management?

Louise Denby, aged 30, works as a barista and presents with dry cough, shortness of breath and fatigue. She reports that the café has poor ventilation and she frequently works with coffee roasting equipment. Chest imaging reveals signs of bronchiolitis obliterans.

What is the MOST likely occupational cause?

James Wu, aged 40, presents with progressive vision changes and difficulty with coordination. He works at a battery recycling facility. Blood tests reveal significantly elevated lead levels. He has a normocytic anaemia and a basophilic stippling on blood smear.

What is the MOST likely neurological complication of his exposure?

Peter Riley, aged 58, presents for a pre-employment medical for a job as a long-distance heavy vehicle driver. He has type 2 diabetes managed with insulin. He has not had a hypoglycaemic event in the past 3 years and monitors his glucose regularly. Visual acuity is normal and there is no retinopathy.

According to Austroads guidelines, is he fit to drive a commercial vehicle?

Karen Finch, aged 32, presents with burning eyes, sore throat, and dry cough after moving into a newly renovated office building. Symptoms worsen throughout the day and improve on weekends. Several colleagues report similar issues.

What is the MOST likely cause of her symptoms?

Melanie Zhang, aged 46, is a pathologist who accidentally sustained a needlestick injury while disposing of a used needle from a known hepatitis B positive patient. She completed a full HBV vaccination course 5 years ago, but her serology status is unknown.

What is the MOST appropriate next step?

Liam Carmody, aged 39, works in agriculture and presents with confusion, muscle twitching, and pinpoint pupils. He was spraying insecticide earlier that morning. Examination reveals bradycardia, salivation, and wheezing.

What is the MOST appropriate treatment?

Emily Foster, aged 29, works in a busy commercial kitchen and presents with persistent hoarseness and throat discomfort. She denies smoking or alcohol use. Her symptoms worsen during long shifts and improve when on holidays. Examination of the larynx shows mild erythema without lesions.

What is the MOST likely occupational cause?

Raymond Bell, aged 49, presents with dizziness, headache, and mild confusion. He works as a fumigator and had recently completed an extended shift using aluminium phosphide. Examination reveals hypotension and tachycardia. ABG shows metabolic acidosis.

What is the MOST likely cause of his symptoms?

Ashleigh Monroe, aged 35, works in a dry-cleaning business and presents with fatigue, mood swings, and memory difficulty over the past 3 months. She reports minimal ventilation in her workplace. Blood tests show mild hepatic enzyme elevation.

What is the MOST likely chemical exposure causing her symptoms?

George Tran, aged 27, is a welder who presents with metal fume fever. He asks how to prevent recurrence. He is otherwise healthy and compliant with workplace policies.

What is the MOST appropriate preventive measure?

Isabel Dawson, aged 41, presents with chronic hand dermatitis. She works in a laboratory and frequently uses latex gloves. Examination shows erythema, fissures, and scaling of the hands, particularly on the dorsum. Patch testing confirms latex sensitivity.

What is the MOST appropriate long-term management?

Thomas Faulkner, aged 55, presents with cough and breathlessness. He is a former stonemason with a 20-year history of exposure to engineered stone. HRCT of the chest shows diffuse nodular opacities and progressive massive fibrosis.

What is the MOST likely diagnosis?

Rebecca Nolan, aged 34, presents with new onset anxiety, insomnia, and palpitations. She works in a new office located above a dry-cleaning shop. Several coworkers also report similar symptoms. There is no personal history of mental illness.

What is the MOST likely environmental exposure?

Jessica Kwon, aged 29, is a veterinary nurse who presents with fever, fatigue, and dry cough. She recently treated a sick cockatoo. Chest X-ray reveals patchy consolidation. Serology confirms Chlamydophila psittaci.

What is the MOST appropriate treatment?

Daniela Petrakis, aged 48, presents with chronic fatigue and difficulty concentrating. She has worked for 15 years in a poorly ventilated print shop using solvent-based inks. No abnormalities are found on physical exam. Neuropsych testing shows mild cognitive impairment.

What is the MOST likely diagnosis?

Cameron Ellis, aged 61, presents with haematuria and weight loss. He retired from a career in aluminium smelting 5 years ago. Urinalysis shows microscopic haematuria. Imaging reveals a bladder mass.

What occupational exposure is MOST associated with his condition?

Michelle Reddy, aged 44, presents with sneezing, nasal congestion, and itchy eyes that worsen during spring and when she is working in the archives of a museum. Symptoms improve with holidays. Examination shows pale, swollen nasal turbinates.

What is the MOST likely diagnosis?

Wayne Burgess, aged 60, presents with exertional dyspnoea. He is a former boilermaker and smoked for 35 years. Spirometry shows FEV1/FVC ratio of 60%, FEV1 65% predicted, with minimal reversibility.

What is the MOST likely diagnosis?

Samantha Bui, aged 33, presents with fatigue, nausea, and dark urine. She works at a childcare centre and is otherwise well. Examination reveals mild jaundice. Blood tests show raised transaminases and positive hepatitis A IgM.

What is the MOST likely source of infection?

Leonard Moore, aged 58, presents with progressive memory loss and difficulty concentrating. He worked for decades in a lead smelting plant. Neurological exam shows mild cognitive decline and coarse tremor. Blood lead levels are within normal range, but bone lead scan is elevated.

What is the MOST likely diagnosis?

Kate Abraham, aged 26, presents with low-grade fever, malaise, and rash on her hands. She recently began working at a veterinary clinic. Examination reveals papulovesicular lesions on her fingers. She reports treating a young calf with oral ulcers last week.

What is the MOST likely diagnosis?

Anthony Woods, aged 37, works in landscaping and presents with dyspnoea, dry cough, and fatigue. He reports recent use of a high-powered leaf blower in a dusty environment. Chest X-ray shows diffuse alveolar infiltrates. BAL reveals eosinophilia.

What is the MOST likely diagnosis?

Grace De Luca, aged 42, presents with fatigue, nausea, and cognitive slowing. She works at a ceramics workshop where she glazes pottery. Serum tests reveal elevated inorganic lead levels. No anaemia is present.

What is the MOST likely source of her exposure?

Trevor Haynes, aged 49, works as a diesel mechanic and presents with persistent cough, chest tightness, and dark sputum. He reports symptoms worsen during work shifts. Chest X-ray is normal. Spirometry shows mild airflow obstruction without reversibility.

What is the MOST likely diagnosis?

Bianca Rowe, aged 36, works at a tropical aquarium and presents with nodular lesions on her right hand and forearm. She reports feeding fish and cleaning tanks without gloves. The lesions are non-tender and follow lymphatic channels. Biopsy reveals granulomatous inflammation.

What is the MOST likely diagnosis?

Darren McAlister, aged 61, presents with new onset hoarseness and difficulty swallowing. He is a retired smelter with a 30-year history of exposure to metal fumes and tobacco use. Laryngoscopy reveals a suspicious lesion on the left vocal cord.

What is the MOST likely diagnosis?

Angela Carter, aged 33, works in an industrial kitchen and presents with chronic dry skin and fissuring of her hands. She frequently washes her hands and uses hand sanitiser. Examination shows erythema and scaling on the dorsal hands and fingers.

What is the MOST likely diagnosis?

Jordan Lee, aged 46, works in pest control and presents with headache, nausea, and confusion. He had been working in an enclosed space fumigated with methyl bromide. Vital signs show bradycardia and hypotension. ECG is normal.

What is the MOST appropriate immediate management?

Elizabeth Parry, aged 57, presents with chronic cough and progressive shortness of breath. She worked in textile manufacturing for over 30 years. HRCT shows upper lobe fibrosis and bronchiectasis. Lung biopsy reveals birefringent fibres.

What is the MOST likely diagnosis?

Frank Young, aged 62, presents with unsteady gait and tremor. He worked in a battery factory for 35 years. Examination reveals a coarse intentional tremor, ataxia, and mood lability. Blood mercury levels are mildly elevated. MRI shows cerebellar atrophy.

What is the MOST likely diagnosis?

Lisa Ma, aged 40, is a nurse who sustains a needlestick injury from a known HIV-positive patient. The patient is virally suppressed and on antiretroviral therapy. Lisa is up to date with all immunisations and otherwise well.

What is the MOST appropriate next step?