Case

A 57-year-old man presents to his physician for a routine health maintenance visit. He believes that he is in good health. His review of systems reveals that he has a 3-year history of cough. Over the last 6 months, the cough has been productive of small amounts of green or brownish material. He has a 40+ pack-year history of smoking. When asked about his work history, he indicates that he has been employed in a uranium milling plant for approximately 15 years and has been told that his occupational exposure to uranium may be harmful. There is no evidence of renal impairment.

Initial Check Questions

1. What information should be obtained during the examination?
2. What additional tests should be conducted to assist with diagnosis and evaluation of exposure?
3. Which diseases are linked to dusts or specifically uranium exposure?
4. What risk factors may make the patient more likely to develop a uranium-related illness?

Initial Check Answers

1. What information should be obtained during the examination?

   The physician should take a full exposure and work history, including

   • job duties,
   • potential exposures at the work site,
   • frequency, source, and duration of exposure,
   • use of personal protective equipment at the work site,
   • other potential sources of exposure, including residential exposures (drinking water source, hobbies, etc.) and exposures to other hazardous materials in this and prior jobs, and
   • a history of tobacco use.

   More information for this answer can be found in the “Clinical Assessment” section.

2. What additional tests should be conducted to assist with diagnosis and evaluation of exposure?
   • Renal function studies.
   • Pulmonary function studies.
   • Chest X-ray.

   More information for this answer can be found in the “Clinical Assessment” section.

3. Which diseases are linked specifically to uranium exposure?

   Uranium exposure in the occupational setting has been associated with relatively few medical problems. Renal disease is related to over-exposure to uranium, but it s not specific to uranium. Pulmonary disease is related to dust exposure and is also not specific to uranium. These problems are also not related to exposure to radiation; such problems would not be expected unless the individual were handling highly enriched uranium.

   More information for this answer can be found in the “What Are the Physiologic Effects of Uranium Exposure?” section.

4. What risk factors may make the patient more likely to develop a uranium-related illness?
   • Smoking status.
   • Prior renal disease.
   • Intensity, frequency, and duration of exposure.

   More information for this answer can be found in the “Clinical Assessment” section.