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Environmental Medicine: Integrating a Missing Element into Medical Education (1995)

Chapter: C: Case Studies in Environmental Medicine

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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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C Case Studies in Environmental Medicine

This appendix contains 55 case studies from peer reviewed literature, including journal articles and educational material developed by the Agency for Toxic Substances and Disease Registry (ATSDR). They were selected for their clinical interest with respect to environmental factors and health, relevance to particular courses and clerkships in medical school, and illustrative potential for teaching medical school students about the impact of the environment on health.

Four indexes are included in this appendix to help guide the reader in the use of the case studies. Index 1 lists the case studies according to agent or condition (in alphabetical order). Index 2 presents the case studies in terms of the most common medical school courses and clerkships where they might be used. Creative teachers and students, however, may find these case studies helpful in other educational settings and courses/clerkships as well. Index 3 presents the case studies in terms of sentinel pathophysiological conditions, and Index 4 presents the case studies according to common clinical signs, symptoms, and presenting complaints. Taken together, these indexes should help the reader recognize the many opportunities for enhancing knowledge, skills, and abilities in environmental medicine, and integrating an enhancement of environmental medicine in medical education.

The ATSDR case studies included in this appendix are part of a series of self-instructional publications designed to increase the primary provider’s knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. Original copies of the ATSDR cases contained in this appendix and others in the series can be obtained from: Continuing Education Coordinator, ATSDR, Division of Health Education (E33), 1600 Clifton Road, N.E., Atlanta, GA 30333.

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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INDEX 1: Case Studies Related to Chemical Agents and Conditions

Agent

Case Study Title

Case Study No.

Arsenic

Arsenic Toxicity

1

 

Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood

2

Asbestos

Asbestos Toxicity

3

Benzene

Benzene Toxicity

4

Beryllium

Beryllium Toxicity

5

Cadmium

Cadmium Toxicity

6

Carbon Monoxide

Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning

7

Carbon Tetrachloride

Carbon Tetrachloride Toxicity

8

Chlordane

Chlordane Toxicity

9

Chlorine Gas

Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient

10

Chromium

Chromium Toxicity

11

Cyanide

Cyanide Toxicity

12

Dioxin

Dioxin Toxicity

13

Ethylene/Propylene Glycol

Ethylene/Propylene Glycol Toxicity

14

Formalin

Formalin Asthma in Hospital Staff

15

Gasoline

Gasoline Toxicity

16

Hantavirus

Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease

17

Lead

Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis

18

 

Lead Toxicity

19

Legionella

Legionnaires’ Disease: Description of an Epidemic of Pneumonia

20

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Agent

Case Study Title

Case Study No.

Mercury

Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penicillamine

21

 

Mercury Toxicity

22

Methanol

Methanol Toxicity

23

Methylene Chloride

Methylene Chloride Toxicity

24

 

Paint Remover Hazard

25

Nitrates/Nitrites

Fatal Outcome of Methemoglobinemia in an Infant

26

 

Nitrate/Nitrite Toxicity

27

Nitrogen Dioxide

An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players

28

Pentachlorophenol

Pentachlorophenol Toxicity

29

Pesticides

Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy

30

 

Cholinesterase-Inhibiting Pesticide Toxicity

31

 

Infertility in Male Pesticide Workers

32

 

Pesticide Food Poisoning from Contaminated Watermelons in California, 1985

33

 

Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides

34

Polynuclear Aromatic Hydrocarbon (PAH)

Polynuclear Aromatic Hydrocarbon (PAH) Toxicity

35

Polychlorinated Biphenyl (PCB)

Polychlorinated Biphenyl (PCB) Toxicity

36

Radiation

Ionizing Radiation

37

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Agent

Case Study Title

Case Study No.

Radon

Radon Toxicity

38

Radon

Residential Radon Exposure and Lung Cancer in Sweden

39

Soybean Dust

Community Outbreaks of Asthma Associated with Inhalation of Soybean Dust

40

Tetrachloroethylene

Tetrachloroethylene Toxicity

41

Toluene

Toluene Toxicity

42

Toluene Diisocyanate

Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers

43

1,1,1-Trichloroethane

1,1,1-Trichloroethane

44

Trimethyltin

Trimethyltin Encephalopathy

45

Trichloroethylene

Trichloroethylene Toxicity

46

Vinyl Chloride

Vinyl Chloride Toxicity

47

Condition

Case Study Title

Case Study No.

Carpel Tunnel Syndrome

Work-Related Disorders of the Neck and Upper Extremity

48

Dermatitis

Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement

49

 

Skin Lesions and Environmental Exposures: Rash Decisions

50

Hearing Loss

Acoustic Trauma Caused by the Telephone: A Report of Two Cases

51

 

Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss

52

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Condition

Case Study Title

Case Study No.

Reproductive and Developmental Effects

Reproductive and Developmental Hazards

53

 

See also Lead, Pesticides, and Radiation

18, 19, 32, 37

Respiratory Conditions

Childhood Asthma and Indoor Environmental Risk Factors

54

 

Populations at Risk From Particulate Air Pollution—United States, 1992

55

 

See also Chlorine Gas, Formalin, Hantavirus, Legionella, Soybean Dust, and Toluene Diisocyanate

10, 15, 17, 20, 40, 43

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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INDEX 2: Selected Case Studies Related to Common Medical School Courses and Clerkships/Clinical Rotations

Selected Courses

Selected Case Studies

Biochemistry and Physiology

7, 12, 18, 19, 24, 25, 26, 27, 29, 35, 36

Community Medicine/Public Health

17, 20, 30, 31, 32, 33, 34, 38, 39, 40, 54, 55

Epidemiology and Biostatistics

17, 20, 31, 32, 33, 38, 39, 40, 54, 55

Genetics

29, 37, 38

Introduction to Clinical Medicine

See Appendix A

Microbiology

17, 20

Neuroscience

1, 2, 8, 9, 18, 19, 21, 22, 23, 24, 30, 31, 33, 34, 41, 42, 45, 48

Nutrition

2, 6, 18, 33

Pathology

3, 4, 8, 37, 38

Pharmacology

4, 7, 8, 12, 16, 18, 19, 26, 27, 28, 30, 31, 33, 34

Selected Clerkships/Clinical Rotations

Selected Case Studies

Cardiovascular Medicine

7, 12, 19, 23, 24, 25, 26, 27, 29, 30, 31, 33, 34

Dermatology

1, 2, 11, 13, 21, 22, 29, 36, 49, 50

Emergency Medicine

2, 7, 10, 12, 30, 31, 33, 34

Endocrinology

18, 32

Family Medicine

1, 2, 3, 4, 5, 8, 11, 13, 14, 15, 17, 18, 19, 20, 21, 22, 24, 26, 27, 28, 30, 31, 32, 33, 34, 42, 43, 48, 54

Gastrointestinal Disease

8, 11, 18, 27, 30, 31, 33, 34, 36, 47

Hematology/Oncology

3, 4, 11, 13, 18, 19, 26, 35, 37, 38, 39, 46, 47

Infectious Disease

17, 20

Internal Medicinea

1, 2, 4, 8, 11, 14, 15, 17, 18, 20, 24, 30, 31, 32, 33, 34, 42, 43, 48

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
×

Selected Clerkships/Clinical Rotations

Selected Case Studies

Nephrology

1, 2, 6, 8, 14, 18, 19, 21, 22, 23

Neurology

1, 2, 8, 9, 18, 19, 21, 22, 23, 24, 30, 31, 33, 34, 41, 42, 45, 48

Obstetrics-Gynecologya

7, 9, 18, 19, 30, 31, 33, 34, 37, 44, 53

Orthopedics

6, 48

Otolaryngology

11, 19, 40, 51, 52, 54

Pediatricsa,b

2, 3, 5, 13, 14, 17, 18, 19, 21, 22, 26, 27, 28, 34, 54

Pulmonary Medicinec

3, 5, 10, 11, 12, 14, 15, 17, 20, 26, 27, 28, 30, 31, 33, 34, 40, 42, 43, 54, 55

Psychiatrya

8, 21, 22, 41, 42, 45, 46

Appendix A

Radiology

3, 5, 11, 35, 38, 39

aRequired clerkships/clinical rotations in all U.S. medical schools.

bAdditional information on curriculum content in pediatrics can be found in the Children’s Environmental Health Network manual entitled Kids and the Environment: Toxic Hazards—A Course on Pediatric Environmental Health. For more information, contact the California Public Health Foundation, Rod Armstrong, The Children’s Environmental Health Network, 5900 Hollis Street, Suite E, Emeryville, CA 94608, Telephone (510) 540–3657, Fax (510) 540–2673.

cAdditional information on curriculum development in pulmonology can be found in the reports:

Preventive Pulmonary Academic Award Program. 1993. Guidelines for Curriculum Development for Undergraduate Medical Education in the Prevention of Pulmonary Diseases. Bethesda, MD: Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, November.

Preventive Pulmonary Academic Award Program. 1994. Knowledge Bases and Sample Curricula. Bethesda, MD: Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, March.

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
×

INDEX 3: Selected Case Studies Related to Sentinel Pathophysiological Conditions for Environmental/Occupational Evaluation

Sentinel Pathophysiological Conditions

Agent or Exposure Discussed

Selected Case Studies

CARDIOVASCULAR

Bradycardia

Pesticide

30, 33

Chest Pain

Methylene Chloride

24, 25

DERMATOLOGIC

Acne

Dioxin

13

Acne

Polychlorinated Biphenyl (PCB)

36

Acrodynia

Mercury

22

Contact Dermatitis

Chromium

11

Contact Dermatitis

Methylmethacrylate

49

Hyperkeratosis

Arsenic

1, 2

ENDOCRINOLOGIC

Thyrotoxicosis

Lead

18

GASTROINTESTINAL

Abdominal Pain

Lead

18

Abdominal Pain, Nausea, and Vomiting

Carbon Tetrachloride

8

Diarrhea

Nitrates

27

Diarrhea

Pesticides

30, 31, 33, 34

Vomiting

Pesticides

30, 31, 33, 34

HEMATOLOGIC/ ONCOLOGIC

Hypochronic Anemia

Lead

19

Leukemia

Benzene

4

Liver Cancer

Vinyl Chloride

47

Lung Cancer

Asbestos

3

Lung Cancer

Polynuclear Aromatic Hydrocarbon (PAH)

35

Lung Cancer

Radon

39

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Sentinel Pathophysiological Conditions

Agent or Exposure Discussed

Selected Case Studies

HEMATOLOGIC/ ONCOLOGIC

Methemoglobinemia

Nitrate

26

HEPATIC

Cancer

Vinyl Chloride

47

Hepatitis

Carbon Tetrachloride

8

Hepatitis

Polychlorinated Biphenyl (PCB)

36

INFECTIOUS

Respiratory

Hantavirus

17

Respiratory

Legionella

20

NEUROLOGIC

Ataxia

Mercury

21

Carpel Tunnel Syndrome (CTS)

Repetitive Motion

48

Dysarthria

Mercury

21

Encephalopathy

Trimethyltin

45

Headache

Carbon Tetrachloride

8

Headache

Methanol

23

Headache

Methylene Chloride

24

Headache

Tetrachloroethylene

41

Headache

Toluene

42

Hearing Loss

Lead

19

Hyperactive

Lead

19

Peripheral Neuropathy

Arsenic

1, 2

Tremor

Mercury

21

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Sentinel Pathophysiological Conditions

Agent or Exposure Discussed

Selected Case Studies

OBSTETRIC/GYNECOLOGIC

Miscarriage and Fetal Death

Carbon Monoxide

7

ORTHOPEDIC

Carpel Tunnel Syndrome (CTS)

Repetitive Motion

48

Osteomalacia Syndrome (CTS)

Cadmium

6

RENAL

Acute Renal Failure

Carbon Tetrachloride

8

Acute Renal Failure

Ethylene/Propylene Glycol

14

Acute Renal Failure

Methanol

23

Chronic Renal Failure

Cadmium

6

Chronic Renal Failure

Mercury

21, 22

Chronic Renal Failure

Lead

18, 19

REPRODUCTIVE AND DEVELOPMENTAL

Birth Defects

Various

53

Birth Defects

Mercury

22

Birth Defects

Radiation

37

Developmental Defects

Polychlorinated Biphenyl (PCB)

36

Developmental Defects

Lead

18, 19

Infertility

1,2-Dibromo-3-Chloropropane (DBCP)

32

RESPIRATORY

Asthma

Formalin

15

Asthma

Indoor Environment

54

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Sentinel Pathophysiological Conditions

Agent or Exposure Discussed

Selected Case Studies

RESPIRATORY

Chronic Upper Airway

Chromium

11

Cyanosis

Nitrate

27

Interstitial Fibrosis

Beryllium

5

Irritation Symptoms

Chromium

11

 

SOURCE: Kipen, HM and Craner, J. 1992. Sentinel pathophysiologic conditions: An adjunct to teaching occupational and environmental disease recognition and history-taking. Environmental Research 59:93–100.

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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INDEX 4: Selected Case Studies Related to Clinical Signs, Symptoms, and Presenting Complaints

Clinical Signs, Symptoms, and Presenting Complaints

Agent or Exposure Discussed

Selected Case Studies

ABDOMINAL PAIN

Carbon Tetrachloride

8

Lead

18, 19

Pesticides

30, 31, 33, 34

ABORTIONS, SPONTANEOUS

Chlordane

9

1,1,1-Trichloroethane

44

Various

53

ACNE

Polychlorinated Biphenyl (PCB)

36

ALOPECIA

Arsenic

2

ALTERED MENTAL STATUS WITH UNCONSCIOUSNESS

Arsenic

2

Carbon Monoxide

7

Cyanide

12

Pesticides

30, 31, 33, 34

ANOREXIA

Chlordane

9

Chromium

11

Pentachlorophenol

29

Vinyl Chloride

47

ATAXIA

Mercury

21

Methanol

23

BIRTH DEFECTS

Reproductive and Developmental Hazards

53

1,1,1-Trichloroethane

44

BRADYCARDIA

Pesticides

30, 31, 33, 34

CHEST PAIN

Asbestos

3

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Conditions

Agent or Exposure Discussed

Selected Case Studies

CHEST PAIN

Methylene Chloride

24, 25

Nitrogen Dioxide

28

Toluene Diisocyanate (TDI)

43

CONFUSION

Carbon Tetrachloride

8

Gasoline

16

Lead

18, 19

Methylene Chloride

24

Pesticides

30, 31, 33, 34

COUGH

Beryllium

5

Hantavirus

17

Indoor Environment

54

Legionella

20

Nitrogen Dioxide

28

Radon

39

Toluene

42

CYANOSIS

Nitrates

27

DELIRIUM

Arsenic

1, 2

Chromium

11

Dioxin

13

Gasoline

16

Mercury

21, 22

Methylmethacrylate

49

Trimethyltin

45

DIFFICULTY CONCENTRATING

Lead

18

Tetrachloroethylene (TCE)

41

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Conditions

Agent or Exposure Discussed

Selected Case Studies

DIAPHORESIS

Mercury

21, 22

Pentachlorophenol

29

Pesticides

30, 31, 33, 34

DIARRHEA

Carbon Tetrachloride

8

Hantavirus

17

Nitrates

26, 27

Pesticides

30, 31, 33, 34

DYSARTHRIA

Mercury

21

DYSPNEA

Asbestos

3

Beryllium

5

Hantavirus

17

Indoor Environment

54

Nitrogen Dioxide

28

Pentachlorophenol

29

Pesticides

30, 31, 33, 34

Polynuclear Aromatic Hydrocarbon (PAH)

35

Toluene

42

Toluene Diisocyanate (TDI)

43

EPISTAXIS, ECCHYMOSES, and PETECHIA

Arsenic

2

Benzene

4

Chromium

11

FATIGUE

Arsenic

2

Benzene

4

Lead

18

Methylene Chloride

24

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Conditions

Agent or Exposure Discussed

Selected Case Studies

FATIGUE

Pesticides

30, 31, 33, 34

Vinyl Chloride

47

FEVER

Hantavirus

17

Legionella

20

Pentachlorophenol

29

HEADACHE

Arsenic

2

Carbon Tetrachloride

8

Chlordane

9

Gasoline

16

Methanol

23

Methylene Chloride

24

Nitrogen Dioxide

28

Pesticides

30, 31, 33, 34

Tetrachloroethylene (TCE)

41

Toluene

42

HEARING LOSS

Lead

19

Occupational Noise

51, 52

HEMOPTYSIS

Nitrogen Dioxide

28

HEPATITIS

Carbon Tetrachloride

8

Chromium

11

Polychlorinated Biphenyl (PCB)

36

HEPATOMEGALY

Vinyl Chloride

47

HYPERTENSION

Lead

19

HYPOTENSION

Cyanide

12

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Complaints

Agent or Exposure Discussed

Selected Case Studies

HYPOTENSION

Pesticides

30, 31, 33, 34

INCONTINENCE

Pesticides

30, 31, 33, 34

INFERTILITY

1,2-Dibromo-3-Chloropropane (DBCP)

32

Various

53

IRRITABILITY

Gasoline

16

Mercury

22

Methylene Chloride

24

Nitrates

26, 27

Tetrachloroethylene (TCE)

41

LACRIMATION

Pesticides

30, 31, 33, 34

LOW BACK PAIN

Cadmium

6

MUSCLE TWITCHING

Arsenic

2

Pesticides

30, 31, 33, 34

MYALGIA

Cadmium

6

Lead

18

NASAL IRRITATION WITH RHINORRHEA

Chromium

11

NAUSEA

Carbon Tetrachloride

8

Chlordane

9

Methanol

23

Pesticides

30, 31, 33, 34

PERIPHERAL NEUROPATHY

Arsenic

1, 2

Repetitive Motion

48

PROTEINURIA

Cadmium

6

Carbon Tetrachloride

8

Chromium

11

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Complaints

Agent or Exposure Discussed

Selected Case Studies

RALES

Asbestos

3

Pesticides

30, 31, 33, 34

RASH

Arsenic

1, 2

Chromium

11

Dioxin

13

Environmental Exposures (i.e., allergens, irritants)

50

Mercury

21, 22

Methylmethacrylate

49

Pentachlorophenol

29

Polychlorinated Biphenyl (PCB)

36

SEIZURES

Arsenic

2

Pesticides

30, 31, 33, 34

Trimethyltin

45

TACHYCARDIA

Cyanide

12

Hantavirus

17

Methanol

23

Methylene Chloride

24

Nitrates

26, 27

Pentachlorophenol

29

TACHYPNEA

Cyanide

12

Ethylene/Propylene Glycol

14

Hantavirus

17

Nitrates

26, 27

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Clinical Signs, Symptoms, and Presenting Complaints

Agent or Exposure Discussed

Selected Case Studies

TACHYPNEA

Pentachlorophenol

29

TINNITUS

Methanol

23

VISUAL DISTURBANCE

Methanol

23

VOMITING

Carbon Tetrachloride

8

Ethylene/Propylene Glycol

14

Hantavirus

17

Nitrates

26, 27

Pesticides

30, 31, 33, 34

WEAKNESS

Pesticides

30, 31, 33, 34

Polynuclear Aromatic Hydrocarbon (PAH)

35

Repetitive Motion

48

WEIGHT LOSS

Benzene

4

Chromium

11

Pentachlorophenol

29

Polynuclear Aromatic Hydrocarbon (PAH)

35

Radon

38, 39

Vinyl Chloride

47

WHEEZING

Formalin

15

Indoor Environment

54

Pesticides

30, 31, 33, 34

Soybean Dust

40

Toluene Diisocyanate (TDI)

43

Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Page 136
Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Page 137
Suggested Citation:"C: Case Studies in Environmental Medicine." Institute of Medicine. 1995. Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press. doi: 10.17226/4795.
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Page 138
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People are increasingly concerned about potential environmental health hazards and often ask their physicians questions such as: "Is the tap water safe to drink?" "Is it safe to live near power lines?" Unfortunately, physicians often lack the information and training related to environmental health risks needed to answer such questions. This book discusses six competency based learning objectives for all medical school students, discusses the relevance of environmental health to specific courses and clerkships, and demonstrates how to integrate environmental health into the curriculum through published case studies, some of which are included in one of the book's three appendices. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins.

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