LATEST OCCUPATIONAL MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PREVENTIVE MEDICINE
| COMPLETE EXAM Q&A WITH RATIONALES
1. A 45-year-old male construction worker presents
with a 2-year history of progressive dyspnea and
cough. Chest X-ray shows bilateral upper lobe
nodular opacities with eggshell calcification of hilar
lymph nodes. Which is the most likely diagnosis?
A) Silicosis
B) Asbestosis
C) Coal workers' pneumoconiosis
D) Hypersensitivity pneumonitis
Correct answer: A
Rationale: Eggshell calcification of hilar nodes is
pathognomonic for silicosis. Upper lobe nodular
opacities are typical of chronic silicosis.
2. A 55-year-old female shipyard worker with a 30-
year history of asbestos exposure presents with
dyspnea and bilateral basilar crackles. Pulmonary
function tests show restrictive pattern with reduced
DLCO. Which is the most likely diagnosis?
,A) Silicosis
B) Asbestosis
C) Pleural plaques
D) Malignant mesothelioma
Correct answer: B
Rationale: Asbestosis presents with progressive
dyspnea, basilar crackles (Velcro), restrictive PFTs,
and reduced DLCO. Latency is 20-40 years.
3. A worker at a battery recycling plant presents with
abdominal pain, constipation, and a blue line on the
gingiva. Blood lead level is 70 mcg/dL. Which is the
most appropriate next step?
A) Chelation therapy with EDTA
B) Remove from exposure and repeat level
C) Succimer (DMSA) orally
D) Calcium disodium EDTA plus dimercaprol (BAL)
Correct answer: D
Rationale: Symptomatic lead poisoning with blood
lead >70 mcg/dL requires hospitalization and
chelation with BAL + CaNa2EDTA due to risk of
encephalopathy.
,4. A 35-year-old male painter presents with
confusion, ataxia, and tremor. He has a history of
using paint stripper in a confined space without
respiratory protection. Which solvent is most likely
responsible?
A) Toluene
B) Methyl ethyl ketone (MEK)
C) Methylene chloride (dichloromethane)
D) n-Hexane
Correct answer: C
Rationale: Methylene chloride (dichloromethane) is
metabolized to carbon monoxide, causing headache,
confusion, ataxia, and potential death from
carboxyhemoglobin formation.
5. A 50-year-old female electronics worker reports
fatigue, arthralgias, and a rash on sun-exposed
areas. She has a history of working with soldering
materials. Which metal is most likely responsible?
A) Lead
B) Mercury
C) Cadmium
D) Beryllium
Correct answer: D
, Rationale: Chronic beryllium disease (CBD) presents
with dyspnea, fatigue, arthralgias, and skin rash
(cutaneous granulomas). It mimics sarcoidosis.
6. A 40-year-old male welder reports dyspnea and
cough. Chest X-ray shows diffuse nodular opacities.
He has a 20-year history of welding stainless steel.
Which fume is most likely responsible?
A) Aluminum oxide
B) Zinc oxide (metal fume fever)
C) Hexavalent chromium
D) Manganese
Correct answer: C
Rationale: Stainless steel welding generates
hexavalent chromium fumes, which cause lung
fibrosis, asthma, and lung cancer.
7. A worker at a polyvinyl chloride (PVC)
manufacturing plant presents with Raynaud's
phenomenon (fingers turn white, blue, red) and
sclerodactyly. Which is the most likely diagnosis?
A) Vinyl chloride disease (acroosteolysis)
B) Systemic sclerosis
C) Vibration white finger
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PREVENTIVE MEDICINE
| COMPLETE EXAM Q&A WITH RATIONALES
1. A 45-year-old male construction worker presents
with a 2-year history of progressive dyspnea and
cough. Chest X-ray shows bilateral upper lobe
nodular opacities with eggshell calcification of hilar
lymph nodes. Which is the most likely diagnosis?
A) Silicosis
B) Asbestosis
C) Coal workers' pneumoconiosis
D) Hypersensitivity pneumonitis
Correct answer: A
Rationale: Eggshell calcification of hilar nodes is
pathognomonic for silicosis. Upper lobe nodular
opacities are typical of chronic silicosis.
2. A 55-year-old female shipyard worker with a 30-
year history of asbestos exposure presents with
dyspnea and bilateral basilar crackles. Pulmonary
function tests show restrictive pattern with reduced
DLCO. Which is the most likely diagnosis?
,A) Silicosis
B) Asbestosis
C) Pleural plaques
D) Malignant mesothelioma
Correct answer: B
Rationale: Asbestosis presents with progressive
dyspnea, basilar crackles (Velcro), restrictive PFTs,
and reduced DLCO. Latency is 20-40 years.
3. A worker at a battery recycling plant presents with
abdominal pain, constipation, and a blue line on the
gingiva. Blood lead level is 70 mcg/dL. Which is the
most appropriate next step?
A) Chelation therapy with EDTA
B) Remove from exposure and repeat level
C) Succimer (DMSA) orally
D) Calcium disodium EDTA plus dimercaprol (BAL)
Correct answer: D
Rationale: Symptomatic lead poisoning with blood
lead >70 mcg/dL requires hospitalization and
chelation with BAL + CaNa2EDTA due to risk of
encephalopathy.
,4. A 35-year-old male painter presents with
confusion, ataxia, and tremor. He has a history of
using paint stripper in a confined space without
respiratory protection. Which solvent is most likely
responsible?
A) Toluene
B) Methyl ethyl ketone (MEK)
C) Methylene chloride (dichloromethane)
D) n-Hexane
Correct answer: C
Rationale: Methylene chloride (dichloromethane) is
metabolized to carbon monoxide, causing headache,
confusion, ataxia, and potential death from
carboxyhemoglobin formation.
5. A 50-year-old female electronics worker reports
fatigue, arthralgias, and a rash on sun-exposed
areas. She has a history of working with soldering
materials. Which metal is most likely responsible?
A) Lead
B) Mercury
C) Cadmium
D) Beryllium
Correct answer: D
, Rationale: Chronic beryllium disease (CBD) presents
with dyspnea, fatigue, arthralgias, and skin rash
(cutaneous granulomas). It mimics sarcoidosis.
6. A 40-year-old male welder reports dyspnea and
cough. Chest X-ray shows diffuse nodular opacities.
He has a 20-year history of welding stainless steel.
Which fume is most likely responsible?
A) Aluminum oxide
B) Zinc oxide (metal fume fever)
C) Hexavalent chromium
D) Manganese
Correct answer: C
Rationale: Stainless steel welding generates
hexavalent chromium fumes, which cause lung
fibrosis, asthma, and lung cancer.
7. A worker at a polyvinyl chloride (PVC)
manufacturing plant presents with Raynaud's
phenomenon (fingers turn white, blue, red) and
sclerodactyly. Which is the most likely diagnosis?
A) Vinyl chloride disease (acroosteolysis)
B) Systemic sclerosis
C) Vibration white finger
