Evaluating suspected work-related XXXX (clinical diagnosis).

@entity1 @entity137 @entity16 @entity4968 @entity2359
The clinical diagnosis of work-related @entity16 is essentially one of exclusion because symptoms and signs are often nonspecific. The clinical reasoning requires a three-step approach: (1) establish the characteristics of the presenting disease; (2) ascertain that observed clinical features are consistent with those caused by the suspected agent(s); and (3) assess occupational exposures. A detailed history is of paramount importance in evaluating @entity1 with suspected work-related @entity16 as it is in other clinical contexts, especially because in some circumstances it may represent the only criterion to establish causality. Thus, besides characterization of @entity16 , including their location, quality, timecourse, and possible other associated symptoms, the work environment of the @entity1 should be understood in full detail. In this respect, when a neurotoxin is suspected, then the history collection can be guided by the knowledge of the likely syndromes it produces. Similarly, physical examination should be directed to the target of @entity137 /entrapment based on information from the work history. Although specific sites and elements of the nervous system may be affected depending on the offending agent, most @entity2359 are characterized by generalized rather than focal @entity16 . Laboratory toxicologic tests have limited application for the etiologic diagnosis of @entity2359 , except in cases of acute @entity4968 and in @entity1 exposed to @entity2359 chemicals with prolonged half-life. In most cases examination takes place after the end of exposure, when the offending chemical is no longer detectable in body fluids. Electrophysiologic studies, in particular evoked potentials, electromyography, and conduction velocities, are important to confirm the organic basis of symptoms, particularly to detect subclinical or early neurologic involvement and to reduce the number of disorders to be considered in the differential diagnoses. In general, imaging studies with computed tomography and magnetic resonance are of limited utility in the evaluation of suspected @entity2359 , except for helping to exclude other causes of the @entity1 's clinical state. Improved conditions and safer practices in the workplace have led to a gradual shift in application of neuropsychologic evaluation from the assessment of severe @entity2359 to the evaluation of mild subclinical disturbances, and these tests are nowadays extensively used in screening workers exposed to neurotoxicants. Tools used in the screening of large groups of workers exposed to neurotoxicants may differ from those used in the clinic. Whereas some are obviously impractical, such as physical examination, others, such as, for instance, toxicologic tests, are used for biologic monitoring of exposure to ascertain compliance with occupational exposure limits.
