ENVIRONMENTAL MEDICINE -- Copyright -- Acknowledgments -- Preface -- Contents -- Executive Summary -- 1 Introduction -- DEFINITION AND SCOPE OF ENVIRONMENTAL MEDICINE -- ROLE OF THE PHYSICIAN -- Recent History -- A Continuum of Roles -- ORIGIN AND ORGANIZATION OF THE REPORT -- 2 Curriculum Content -- COMPONENTS OF A CURRICULUM -- COMPETENCY-BASED LEARNING OBJECTIVES -- CONCLUSIONS AND RECOMMENDATIONS -- 3 Implementation Strategies -- CURRICULUM ACCESS POINTS AND TEACHING STRATEGIES -- Competencies 1 and 2 -- Basic Science Courses -- Introduction to Clinical Medicine Courses -- Competency 3 -- Introduction to Clinical Medicine/Medical Interviewing and Problem-Solving Courses -- Clinical Clerkships -- Competency 4 -- Written Information -- Community Placements -- Problem-Based Learning, Clinical Precepting -- Competency 5 -- Communication Skills and Interviewing Courses -- Epidemiology and Preventive Medicine Courses -- Basic Science Courses or Problems -- Clinical Clerkships -- Competency 6 -- Ethics Courses -- Community and Preventive Medicine and Public Health Courses -- Clinical Clerkships -- Conferences -- Standardized Patients -- ENHANCING FACULTY AWARENESS -- Some Long-Term Strategies -- Some Short-Term Strategies -- CONCLUSIONS AND RECOMMENDATIONS -- Integrating the Curriculum -- Developing Faculty -- Continuing Education -- Evaluating Progress -- 4 Changing Medical Education -- CALLS FOR REFORM IN MEDICAL EDUCATION -- BARRIERS AND OPPORTUNITIES -- Barriers -- Opportunities -- Prevention and Future Health Care -- The Knowledge Base -- Funding and Availability of Environmental Medicine Programs -- CONCLUSIONS AND RECOMMENDATIONS -- 5 Concluding Remarks -- References -- Appendixes -- A Taking an Exposure History -- 26 Taking an Exposure History -- Case Study -- Introduction -- Organ Systems Affected by Toxic Exposure.

Toxicants in the Home/Environment -- Indoor Air Pollution -- Tobacco Smoke -- Wood Stoves/Gas Ranges -- Building Materials -- Asbestos -- Radon -- Common Household Products -- Pesticides and Lawn Care Products -- Lead Products and Waste -- Recreational Hazards -- Water Supply -- Soil Contamination -- Using the Exposure History Form -- Part 1. Exposure Survey -- Part 2. Work History -- Part 3. Environmental History -- Identifying Hazardous Agents -- Material Safety Data Sheet -- Additional Toxicologic Information -- Summary and Follow-up -- Consultation -- Referral Resources -- Suggested Reading List -- Sources of Information -- Answers to Pretest -- B Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine -- MEDICAL SCHOOL COURSES -- Biochemistry and Physiology -- Community Medicine/Public Health -- Epidemiology and Biostatistics -- Genetics -- Introduction to Clinical Medicine -- Microbiology -- Neuroscience -- Nutrition -- Pathology -- Pharmacology -- CLERKSHIPS/CLINICAL ROTATIONS -- Cardiovascular Medicine -- Dermatology -- Emergency Medicine -- Endocrinology -- Family Medicine -- Gastrointestinal Disease -- Hematology/Oncology -- Infectious Disease -- Internal Medicine -- Nephrology -- Neurology -- Obstetrics and Gynecology -- Orthopedics -- Otolaryngology -- Pediatrics -- Pulmonary Medicine -- Psychiatry -- Radiology -- C Case Studies in Environmental Medicine -- 5 Arsenic Toxicity -- Case Study -- Exposure Pathways -- Who's At Risk -- Biologic Fate -- Physiologic Effects -- Gastrointestinal, Hepatic, and Renal Effects -- Cardiovascular Effects -- Neurologic Effects -- Dermal Effects -- Respiratory Effects -- Hematopoietic Effects -- Carcinogenic Effects -- Skin Cancer -- Lung Cancer -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute Exposure -- Chronic Exposure.

Laboratory Tests -- Direct Biologic Indicators -- Indirect Biologic Indicators -- Treatment and Management -- Acute Exposure -- Chronic Exposure -- Standards and Regulations -- Workplace -- Air -- Environment -- Air -- Drinking Water -- Food -- Pesticides -- Suggested Reading List -- Answers to Pretest and Challenge Questions -- Sources of Information -- Seasonal Arsenic Exposure From Burning Chromium-Copper-Arsenate-Treated Wood -- History -- Physical Examination of the Family -- Home Visit -- Comment -- References -- 8 Asbestos Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Respiratory Effects -- Asbestosis -- Mesothelioma -- Lung Cancer -- Other Carcinogenic Effects -- Cardiovascular Effects -- Immunologic Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Asbestosis -- Lung Cancer -- Mesothelioma -- Laboratory Tests and Special Procedures -- Radiographic Techniques -- Computerized Tomography -- Pulmonary Function Testing -- Sputum Studies -- Other Tests -- Treatment and Management -- Asbestosis -- Cancer -- Mesothelioma -- Lung Cancer -- Standards and Regulations -- Workplace -- Environment -- Suggested Reading List -- Answers to Pretest and Challenge Questions -- Pretest -- Challenge Answers -- Sources of Information -- 11 Benzene Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Central Nervous System Effects -- Hematologic Effects -- Anemia -- Leukemia -- Other Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute Exposure -- Chronic Exposure -- Laboratory Evaluation -- Direct Biologic Indicators -- Indirect Biologic Indicators -- Treatment and Management -- Acute Exposure -- Chronic Exposure -- Standards and Regulations -- Workplace -- Air.

Environment -- Air -- Water -- Food -- Suggested Reading List -- Sources of Information -- Answers to Pretest and Challenge Questions -- 19 Beryllium Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Respiratory Effects -- Dermal Effects -- Carcinogenic Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute -- Chronic -- Differential Diagnosis -- Laboratory Evaluation -- Treatment and Management -- Standards and Regulations -- Workplace -- Air -- Environment -- Air -- Water -- Suggested Reading List -- Answers to Pretest and Challenge Questions -- Pretest -- Challenge Answers -- Sources of Information -- 10 Cadmium Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Renal Effects -- Skeletal Effects -- Respiratory Effects -- Carcinogenic Effects -- Developmental Effects -- Other Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute Exposure -- Chronic Exposure -- Laboratory Evaluation -- Direct Biologic Indicators -- Indirect Biologic Indicators -- Treatment and Management -- Acute Exposure -- Chronic Exposure -- Standards and Regulations -- Workplace -- Air -- Environment -- Air -- Water -- Food -- Soil -- Suggested Reading List -- Answers to Pretest and Challenge Questions -- CASE REPORT -- Case Report -- Discussion -- Addendum -- Acknowledgment -- References -- 18 Carbon Tetrachloride Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Neurologic Effects -- Hepatic and Renal Effects -- Carcinogenic Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Laboratory Tests -- Direct Biologic Indicators -- Indirect Biologic Indicators -- Treatment and Management.

Standards and Regulations -- Workplace -- Air -- Environment -- Air -- Water -- Other -- Suggested Reading List -- Sources of Information -- Answers to Pretest and Challenge Questions -- Pretest -- Challenge -- 25 Chlordane Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Neurologic Effects -- Hepatic Effects -- Gastrointestinal Effects -- Carcinogenicity -- Other Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute Exposure -- Chronic Exposure -- Laboratory Tests -- Treatment and Management -- Acute Exposure -- Chronic Exposure -- Standards and Regulations -- Workplace -- Environment -- Air -- Water -- Food -- Suggested Reading List -- ANSWERS TO PRETEST AND CHALLENGE QUESTIONS -- Pretest -- Challenge -- Sources of Information -- Chlordane Environmental Fact Sheet -- Chronic Reactive Airway Disease following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient -- CASE REPORT -- DISCUSSION -- REFERENCES -- 4 Chromium Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Skin Effects -- Respiratory Tract Effects -- Renal Effects -- Hepatic Effects -- Carcinogenic Effects -- Reproductive and Developmental Effects -- Clinical Evaluation -- History and Physical Examination -- Signs and Symptoms -- Acute Exposure -- Chronic Exposure -- Laboratory Tests -- Direct Biologic Indicators -- Treatment and Management -- Acute Exposure -- Chronic Exposure -- Standards and Regulations -- The Workplace -- Air -- Environment -- Air -- Drinking Water -- Suggested Reading List -- Answers to Pretest and Challenge Questions -- Pretest -- Challenge -- 15 Cyanide Toxicity -- Case Study -- Exposure Pathways -- Who's at Risk -- Biologic Fate -- Physiologic Effects -- Acute Exposure -- Chronic Exposure.

Central Nervous System.