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B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine
Pages 97-120

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From page 97...
... In an effort to illustrate this integrative approach, this appendix provides brief examples of how courses and clerkships/cI~n~cal rotations can be used as access points for introducing or emphasizing the environmental medicine competencies outlined in the report. These courses and clerkships/clinical rotations (e.g., pharmacology, pathology, pulmonology, hematology, pediatrics, obstetrics/gynecology)
From page 98...
... MEDICAL' SCHOOL COURSES Instruction in the basic sciences during the first year in medical school includes diverse courses encompassing a variety of the biological sciences. Several of these disciplines include the basic sciences that form the backbone of environmental medicine.
From page 99...
... Title 7 Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning 12 Cyanide Toxicity IS Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis 19 Lead Toxicity 24 Methylene Chloride Toxicity 25 Paint-Remover Hazard 26 Fatal Outcome of MethemogIobinemia in an Infant 27 Nitrate/Nitrite Toxicity 29 Pentachiorophenol Toxicity 35 Polynuciear Aromatic Hydrocarbon (PAM) Toxicity 36 Polychiorinated Bipheny]
From page 100...
... These courses contain the central scientific framework that distinguishes the population-based approach of environmental and occupational medicine and other public health disciplines from much of coccal medicine. Especially important for environmental and occupational medicine are the approaches used to measure or estimate exposure to potential harmful agents.
From page 101...
... While the literature does now include many putative examples of gene-environment interactions pertinent to medicine, they remain speculative enough that their inclusion in a course should be elective, perhaps complementing discussions of the Human Genome initiative and its medical relevance for practicing physicians. Selected Case Studies From Appendix C Case No.
From page 102...
... Patients' homes should be described in terms of their heating system, air conditioning, type of building materials, water supply, and presence of problems with agents such as radon; lead paint; wood, kerosene, or other smoke; unvented appliances; water-damaged carpets or structural materials; proximity to known hazardous waste sites; and pesticide use. Enforcing this requirement needs attention, because most preceptors cannot be expected to give it high priority, as they will not feel completely competent themselves.
From page 103...
... r it -- - ~ Case No. Title 17 Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease 20 Legionnaires' Disease: Description of an Epidemic of Pneumonia Neuroscience Environmental causes of nervous system disease are surprisingly common and the environmental and occupational causes of both peripheral and central nervous system diseases are well described.
From page 104...
... Some environmental toxicants act by competition with micronutrients, such the role of goitragens in blocking iodine uptake and metabolism. Finally, evidence is accumulating that the biological effects of toxicants may be modified by dietary behaviors, such as recent evidence suggesting a chemopreventive effect of various antioxidants.
From page 105...
... For a well-known minority of conditions, especially pneumoconioses, pathologic examination can provide both a tissue and an etiologic diagnosis. More commonly, specific etiologic diagnoses will require information from a patient's medical history to supplement the tissue diagnosis, as in the case of hypersensitivity pneumonitis, toxic neuropathy, hepatotoxicity, and malignancy.
From page 106...
... . A Case Report with Prolonged Cholinesterase Anton and Improvement After Pralidox~me Therapy Cholinesterase-Inhibiting Pesticide Toxicity Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides CLERKSHIPS/CLINICAL ROTATIONS In the clinical or clerkship years of medical school, students receive instruction in several areas, such as pediatrics, psychiatry, and general internal medicine.
From page 107...
... Title 7 Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning 12 Cyanide Toxicity 19 Lead Toxicity 23 Methanol Toxicity 24 Methylene Chloride Toxicity 25 Paint-Remover Hazard 26 Fatal Outcome of Methemogiobinemia in an Infant 27 Nitrate/Nitrite Toxicity 29 PentachIoropheno] Toxicity 30 Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidox~me Therapy 31 Cholinesterase-Inhibiting Pesticide Toxicity 33 Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 34 Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides Dermatology Any abnormality or inflammation of the skin that is either directly or indirectly attributable to exposures or actions at work constitutes an occupational skin disorder.
From page 108...
... Selected Case Studies From Appendix C Case No. Title 2 7 10 12 30 31 33 34 Seasonal Arsenic Exposure from Burning Chromium-Copper-ArsenateTreated Wood Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient Cyanide Toxicity Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy Cholinesterase-Inhibiting Pesticide Toxicity Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticide
From page 109...
... Selected Case Studies From Appendix C Case No. Title 2 3 4 5 8 1 1 13 14 15 17 18 19 Arsenic Toxicity Seasonal Arsenic Exposure from Burning Chromium-Copper-ArsenateTreated Wood Asbestos Toxicity Benzene Toxicity Beryllium Toxicity Carbon TetrachIoride Toxicity Chromium Toxicity Dioxin Toxicity Ethylene/Propylene Glyco} Toxicity Forrnalin Asthma in Hospital Staff Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis Ideas Toxicity
From page 110...
... We urge that courses include a discussion of environmental sources of hepatotox~c compounds including alcohol and other hepatotoxins such as polychIorinated biphenyls (PCBs) , viny!
From page 111...
... Title 3 4 11 13 18 19 26 35 37 38 39 46 47 Asbestos Toxicity Benzene Toxicity Chromium Toxicity Dioxin Toxicity Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis Lead Toxicity Fatal Outcome of Methemogiobinemia in an Infant Polynuclear Aromatic Hydrocarbon (PAM) Toxicity Ionizing Radiation Radon Toxicity Residential Radon Exposure and Lung Cancer in Sweden Trichloroethylene Toxicity Viny!
From page 112...
... Selected Case Studies From Appendix C Case No. Title Arsenic Toxicity Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate Treated Wood Benzene Toxicity Carbon Tetrachloride Toxicity Chromium Toxicity Ethylene/Propylene Glycol Toxicity Formalin Asthma in Hospital Staff Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis Legionnaires' Disease: Description of an Epidemic of Pneumonia Methylene Chloride Toxicity AIdicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy Cholinesterase-Inhibiting Pesticide Toxicity Infertility in Male Pesticide Workers 1 2 4 8 11 14 15 17 18 20 24 30 31 32
From page 113...
... Toxicity Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis Lead Toxicity Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-AcetyI-D, L-PenicilIamine Mercury Toxicity Methanol Toxicity Neurology The neurologic approach, much like the internal medicine approach, focuses on the etiologic evaluation of certain complaints and pathophysiologic states. Selected Case Studies From Appendix C Case No.
From page 114...
... There is a defined, and likely incomplete, list of environmental and occupational agents with reproductive and developmental effects. Selected Case Studies From Appendix C 7 9 18 19 30 31 Title Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning Chlordane Toxicity Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis Lead Toxicity Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy Cholinesterase-Tnhibiting Pesticide Toxicity
From page 115...
... In addition, the upper respiratory tract is frequently the target of environmental and occupational irritants and allergens. Selected Case Studies From Appendix C Case No.
From page 116...
... Their smaller size, developing organ systems, higher respiratory rates, and differing metabolism rates make children particularly susceptible to some agents, including pesticides. In addition, recurrent upper or lower respiratory symptoms in children may signify recurrent or chronic exposure to allergens or irritants such as environmental tobacco smoke, nitrogen oxides from gas stoves, combustion products from inadequately vented wood stoves or space heaters, or agents resulting from home renovation projects.
From page 117...
... Title 3 5 10 11 12 14 15 17 20 26 27 28 30 31 33 34 Asbestos Toxicity Beryllium Toxicity Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient Chromium Toxicity Cyanide Toxicity Ethylene/Propylene Glycol Toxicity Formalin Asthma in Hospital Staff Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease Legionnaires' Disease: Description of an Epidemic of Pneumonia Fatal Outcome of MethemogIobinemia in an Infant Nitrate/Nitrite Toxicity An Outbreak of Nitrogen Dioxide-Induced Respiratory Iliness Among Ice Hockey Players Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy Cholinesterase-Inhibiting Pesticide Toxicity Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides
From page 118...
... 8 21 22 41 42 45 46 Appendix A Title Carbon Tetrachloride Toxicity Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penicillamine Mercury Toxicity TetrachIoroethylene Toxicity Toluene Toxicity Trunethy Tin Enc ephal op athy Trichioroethylene Toxicity Taking an Exposure History Radiology The lung is the portal of entry for many occupational and environmental toxicants that may affect the lung directly. Various radiographic patterns may be pathognomonic or highly suggestive of specific exposures, while other patterns should at least raise the possibility of an environmental exposure.
From page 119...
... Case No. Title 11 33 ~0 ~0 39 119 Asbcs10s To~lciV Befalls Toxicity Chomp Toxicity Poly~~ear Aromatic Hydrocarbon (PAL)


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