Patient Case: E.G.

University of Maryland - School of Medicine
Baltimore, Maryland

Instructor(s): Keogh, James P.; Gordon, Janie
Subject area: Health / Medicine
Department: Occupational and Environmental Medicine
Level: Undergraduate Medical
Learning objective: Develop Group Skills, Develop Individual Skills, Provide Information
Teaching style: Group Activity, In-class Activity

Please note that the copyright for this course project is retained by the instructor.

This case is presented to medical students at the University of Maryland School of Medicine. Developed by the University of Maryland's Occupational Health Project, this case focuses on health effects and exposures to lead in children and adult lead poisoning due to occupational exposures. It teaches students to:
- Describe how exposures at home, in the community and at work influence health.
- Derive the elements of an occupational and environmental history.
- Develop an approach to assessing the work relatedness of an illness.
- Identify chemical exposures and find existing toxicological information.
- Learn how to gather more information from employers, co workers, and unions.
- Learn the capabilities and limitations of existing public health and regulatory agencies.
- Practice problem solving skills needed in caring for patients with environmental illnesses.

This case is also included in the video The Doctor Never Asked Me. This 15 minute video produced at the University of Maryland School of Medicine documents the cases of five patients with occupational illnesses or injuries.

E.G. Patient History

E.G. is a 12 month old who presents to your office for a routine well child visit. He has generally been doing well. Weight and height are both in the 75 percentile. He had an upper respiratory infection and suspected otitis a month ago for which he received Amoxicillin. He has not had any other serious health problems. Vaccinations are up-to-date. Blood work shows a normal hemoglobin and hematocrit. A screening blood lead level was drawn and this shows a blood lead level of 26 mcg/dl. CDC guidelines suggest that a blood lead level over 1Omcg/dcl is " of concern. "

Script for F. G. - Mother of patient E.G.

You have not had any recent concern about your son. He seems to be in good health. You were very concerned about the ear infection at the time which it occurred, but he responded within 48 hours to the antibiotics and stopped pulling and tugging his ear. His health has generally been good. You were concerned that he was somewhat slow to crawl, but now he scoots around quite readily and is able to pull himself up on furniture and seems to be ready to take some tentative steps.

He says "dada," "mamas" and "all gone" quite clearly as well as several other words which you think you can understand, but no one else seems to.

Home Environment: E.G. is your first child. You live in an apartment in a garden apartment building in Essex. You were working as a medical assistant in an obstetrician's office, but have not been back to work since your son was born. Neither you nor your husband smoke. There has been no recent painting in your apartment. You did put up a wallpaper border along the top of the baby's room using self adhesive wallpaper. There is no peeling paint that you are aware of. The windows are sliders and you believe they are made of vinyl clad aluminum. Heat is from a heat pump which also provides cooling in the summer. You are on city water and sewerage.

Occupation: Your husband, R.G., is a painter. He has been working as a painter for about 10 years. Prior to that he was a maintenance worker on a natural gas pipeline. He was painting at the Martin Marietta Plant, and then later he worked for a period of time in the shipyard at Bethlehem Steel as a painter. For the last three years he has worked for a painting contractor mostly doing large commercial jobs, not houses. He usually changes out of his work clothes promptly after he returns home and you wash these separately from the rest of the family's clothes because they are sometimes quite dirty, although usually just paint stains.

You have had more concerns about your husband's health recently because he has been having abdominal pain. The doctor he saw most recently wanted him to get some x-ray tests, but he hasn't been willing to take the time off work to do these. He has had several episodes of abdominal pain that have kept him from sleeping at night and has complained to you about constipation. You wish that he would follow through with what the doctor recommends.

Script for Patient R.G.

You are a 34 year old painter and the father of E.G.

Medical History: During the past two months you have begun to have stomach pains which at times are quite intense. You saw a doctor at a walk-in clinic near your home and he prescribed Ranitidine which you took twice a day for about a week, but this seemed to have no effect on your symptoms so you discontinued it. The pains can last for up to several hours at a time and sometimes are really quite severe and leave you doubled over. You can also go several days without any discomfort.

Your bowel movements have been less frequent. You used to have one bowel movement every morning and now you are going 2-3 days without a bowel movement. When you do have a bowel movement it does not have much effect on the severity of the pain. You saw your family doctor last week who examined you and suggested that you needed some x-rays taken. You saw him in the evening, but the x-rays he recommended could only be done in the day time and you have not had a chance to schedule them yet.

Home Environment: E.G. is your first child. You live in an apartment in a garden apartment building in Essex. Neither you nor your wife smoke. There has been no recent painting in your apartment. There is no peeling paint that you are aware of. The windows are sliding and you believe they are made of vinyl clad aluminum. Heat is from a heat pump which also provides cooling in the summer. You are on city water and sewerage.

Occupational Environment: You began working at a natural gas pipeline at age 22 as a maintenance worker. You then worked for Martin Marietta as a painter of fabricated steel structures for about five years. Most of this painting took place in a spray paint booth and involved minimal exposures to solvent. You then worked briefly for a contract painter and then moved to the Sparrows Point shipyard where you worked as a painter painting steel fabricated structures.

In 1989 you took a job with your current employer, Baltimore Painting, and have worked for them continuously since. You have done a variety of different kinds of painting, mostly in industrial settings. Most of your job involves spray painting or roller painting of large steel structures. Occasionally, you have to grind off some old paint. You recall using grinding wheels to remove paint at a city owned compost facility in south Baltimore last year. You also have done some abrasive blasting at the Vista Chemical Plant.

Four months ago you began working at a job on an older government building in Washington, D.C. doing paint removal and painting on cornices and window trim. On this job there is a containment structure made out of tarpaulins around the scaffolding so as to catch dust and loose material. Paint was removed with abrasive blasting and on some areas hand held needle guns were used.

The area where you are working is quite dusty. You have used a disposable respirator for dust when the job seemed most dusty to you. You have eaten your lunch on the roof of the building adjacent to the work area. Washing facilities are not available on the job. You have not been using protective coveralls on this job because very little painting has been done. You have worn your work clothes home, these are somewhat dusty by the end of the day's work. You have shared a truck with three other workers from Baltimore when you drive home.

This document was last modified on 06/14/2000 03:07:57 PM

This resource was acquired by CEEM (Consortium for Environmental Education in Medicine), a program of Second Nature, under the auspices of a NIEHS grant to gather and disseminate environmental health educational resources over the internet in order to help medical and allied health sciences faculty identify, locate and use resources for incorporating environment and health perspectives into their curricula. CEEM has authorized the use of these materials on this website for archival purposes. Please note that the copyright for this material is retained by the instructor and/or contributing institution.