So, no harm, no foul. I will share that in the live course, we do take questions that, you know, it's, I'm not sure which is more intimidating, to ask them in front of a hundred of your closest friends, or to ask them on a Zoom call, but, you know, Dr. Meyer and I are here. I will be doing another one of these on Thursday evening, same time, seven to nine, for special topics in occupational medicine. And there is a reproductive toxicology that is tucked into one of the other clinical occupational medicine sections that will also be available to review those questions and any other issues around reproductive toxicology. We've designed this course so that there's a lot of repetition. And we really believe that, you know, doing things like talking about organic mercury in the Neurotox lecture, talking about it again in Repro, when Dr. Meyers, you know, I told you, he and I have some similar slides. He will show you, or has shown in his presentation, the slide of degreaser's flush. He shows it in the skin conditions. You know, we both show, I have a slide about hand-arm vibration syndrome and occupational rhinos that he also shows. So we're hoping that a lot of this repetition, talking about toxicants like lead and carbon disulfide that affect many, many body systems so that they become friends to you. There was a question before about how do we put this all together? And some of the way to put it all together maybe is to realize how connected a lot of these things are. We've artificially just divided into body systems, texts like Ladoo do that as well. But then you'll see these same toxicants in multiple lectures. And again, hopefully realizing that that's the same carbon disulfide we were talking about before, but now we're talking about its effects on a different body system. And then one other thing we've tried to do is to pull out characteristics of the different exposures that are unique, because unique things make great test questions. So talking about opsoclonos, talking about toxicants that will produce one type of body health effect, like the ... I'm having a senior moment. There are a couple of things that only ... aminopropionitrile, I'm forgetting all of its initials. But we have these chemicals that do one thing. And so we've been highlighting those in our review slides, thinking about Parkinsonism, where we have many, many exposures that produce a tremor and ataxia, like the heavy metal manganese, but also the artificial drug MPTP, and also carbon monoxide. So again, we've tried to kind of collect things together to help you remember. But again, we are here for questions. This is a challenge. It's certainly a challenge taking a course that was live and translating it into something that you're doing on your own. You should know that when we do teach the live course, you get the slides in advance. So people are expected to come to the actual course having prepared. And then it's more of a discussion of the material during the course. So the audio for the course you're taking does mirror nearly exactly the audio that you would get in a room. You have the extra added advantage of being able to replay it to make sure that you've actually grasped the concepts. And you can certainly go back and revisit it over the time that the course is live to ensure that you've got the information that you need. So Berenice, did I forget anything? No, I think that was pretty much, you covered the basics on that, yes. Okay. Again, I'm here. So I see a hand up. Yeah, it's Fernando. You see my amateur radio call sign there on my name. Yeah, I see Fer. Yeah, and my nickname. So in regard to exposure to polyaromatic hydrocarbons and lung cancer, could you talk about the risks that firefighters have regarding lung cancer? So I get that you're an attendee in this course, but I have to ask, are you an attorney? Because if you Google me, you'll find out that I do a bit of testimony for the firefighters. Well, I have done. I'm not an attorney. So I am involved with independent medical exams and I have done some IMEs on cancer. And the one I did that I recall was regarding non-Hodgkin's lymphoma in a firefighter, but not lung cancer. But anyway, what's your, can you comment on that? And is that likely to be a board question? Right. So I guess let's answer that question first. So the board does not, they don't deal in controversy, okay? We do talk about obstructive sleep apnea, but this is not the NRCME course for examiners for commercial driver's licenses. So things that are, like one example of a controversy would be the relationship between overhead power lines and childhood cancers, which is still a research question. The question about reproductive hazards around different occupational exposures, a lot of that is still research questions. For example, exposure to solvents. We know some things about some solvents, but things that are not classified by the IARC are not things that make good board questions. So although it's outside the scope of a board review, I will share that Dr. Tivoli-Dotti and others, in addition to the NIOSH studies that are out there, the most recent ones in 2013 and 2014, looking at big studies of firefighters and cancer are a good resource in general. The other thing to think about is there's only so many questions they can ask you on the boards, right? So if you're taking part one, you're going to take the core, which is all your PrevMed and vaccinations and environmental health and laws. And then really, the afternoon, you don't have that much time or question real estate, if you will, to ask very specific questions. And again, they're not necessarily these first level questions, which is, tell me the answer. They're questions that advise you or ask you to evaluate an exposure scenario or a clinical disorder, and then match that with the most likely occupational exposure. So the question, which is rather narrow, of what's the relationship between PAHs and lung cancer in firefighters, I can tell you PAHs are a category of combustion products. So it's not one specific thing, but it's a descriptor for products of combustion, usually of combustion of fuel, although it can be combustion of something like lumber. And these are collectively IARC level one or grade one, class one carcinogens, which means that they are confirmed human carcinogens. They have many organ systems that are related in terms of the IARC ratings. IARC has as well rated firefighting as an occupation at risk of occupational cancers. So I think that's the type of information that you would need to know, and not specifically, given this firefighter's history, is he or she more likely than not having a cancer due to occupational exposure. Again, it is, as you said, an interesting independent medical exam question. It's an interesting opinion question for testimony. But that type of stuff is beyond the science exam purpose of the boards, which is really to make sure that physicians who are beginning their careers in occupational medicine have a level set about the knowledge base that they're responsible for. And then moving on to the recertification exam, which is only a hundred questions, that people practicing in what is a very broad field of occupational medicine still maintain a basic level of competency across a broad range of knowledge. So I know that's not an exact answer to your question, but again, the causality question is beyond the scope of this. I'd recommend having a general knowledge of what PAHs are, what types of occupations, which would include firefighters, as well as other folks who work with diesel that would be exposed to products of combustion. So any other questions? I'm sorry. Yeah. Thanks for your answer. I do have another question. Sure. So in regard to preparation, I have the second edition for the McKinney text, the Practical Approaches to Occupational and Environmental Medicine, and the Occupational and Environmental Medicine Self-Assessment Review that goes with that. You did, I think you mentioned that earlier and you said it's a bit dated. Should I, I mean, would it be helpful to still go through that or would you? So, you know, again, going back to what do you study, right? You know, Data Chem is another resource, right? It's a way that you can buy a CD that has a lot of questions on it. Data Chem is also dated, but I bring it up because resources like the Occupational Medicine Self-Assessment Review, you know, Data Chem, the Ratelli book, honestly, the tool that Dr. Meyer and I created, which is going to need updating periodically, sometimes the fact that they are out of date can be a helpful study aid because the point is that you recognize that. So if you're looking at something and you notice what year it was published in, and you know that, for example, the Occupational Medicine Self-Assessment and Review, I can't remember what year it was published, but I'm pretty sure that the Americans with Disabilities Act as amended of 2008 came out after that. So, again, it's just, Ratelli's book doesn't have hepatitis C. It still calls it non-A, non-B hepatitis. So that's pretty outdated. So I think recognizing where things have become outdated can be a study tool if you recognize it. You know, I wouldn't go using something that is, you know, over 20 years old because so much has changed. You know, if you get a version of Ladue, you want the current version because you want the IARC tables to be updated. Much of occupational medicine hasn't changed. The health effects of solvents, for example, on the body have not changed. But things like IARC classifications, things like laws, these are things that have changed. While we're talking about this, the exam was written in January of this year. That's when the year's exam gets written. So there's no COVID on this exam. The new vaccination recommendations that come out in January or February of every year will not be on that year's board exam because they didn't exist yet. So generally, if you're taking the whole boards, if you're taking them for the first time, you need to be familiar, certainly, with vaccination recommendations for your practice. But just keep in mind that certain things might be a year old. We haven't really had a lot of very significant changes. I'll bring up one specific one. Human papillomavirus, that recommendation is board eligible now, so to speak. That's fair game. It's been out there for a while. If you're taking part in one of the boards, you should know when to give that vaccine to children. The level of concern in environmental health for lead exposure for children of five, you should know that by now. That's been out since 2012. But, you know, in 2012 and 2013, that was new. So it is important to know what is current, but also to be aware that generally the boards were, the questions were written in the fall of the year before. There's a meeting in January. I teach board reviews, so I don't go to that meeting. But people who are writing and choosing the questions for the exam will have that set in January. So knowing that you're taking the exam in the fall, just be mindful that things that are late-breaking or controversial won't be on the board exam. So, again, I hope that's a good answer for your question. There's always an opportunity to create study materials. And I think, you know, as you study, you can certainly think about what you would ask as a question. You know, sort of in mad scientist mode. How could I ask this question? And that might be a way also to cement the information. So any other questions? Anybody's hand up? Oh, I hear DRD WISC, or is it Dr. WISC? Yep. One question. Where on the ACOM website do we find your book? Ah, that is an excellent question. Yeah, and I can help with that question. Okay. So the OEM self-assessment tool is an online assessment. So you can go to, if you're at ACOM.org, you would hover over to online learning, and you would find it there listed as actually the first item, because I added an underscore before the title, so it would pop up first. But I'm happy to also send everyone a link to where you can find it in our store as well. And as Dr. Litow mentioned, I believe it's 240-some questions. It's broken down by the various topic areas. As soon as you purchase it, you would have access to it right away. You could go ahead and start the assessment. You would go through it, answer all your questions, and at the end, it would generate a PDF, which would have the question, the answer, if it was different than your answer, an explanation. You can take it as many times as you'd like. You can claim up to 35 credits, CME, and we'll see credits for it. You can only claim credit once, but you can take the assessment as many times as you need to. Okay, yeah, that'd be great to send us the link. I will. I will do that. And second question, what, you know, there's a lot of resources, but are there any books, flashcards for the toxicology? For toxicology, you said? Yeah. So, I haven't looked in a bit. There might be some, say, in a bookstore, you know, for people in pharmacy school, you know, might have toxicology flashcards. I'm not aware of any that you can buy. I'm a flashcard person, so when I was studying for the boards, I made some for myself. But things that help to populate flashcards are the tables in Ladoo. And Ladoo, now the most recent Ladoo has different tables than other versions. So you can certainly, you know, if you don't have the very most recent, you might have different tables in there that authors and the editors seem to change them about. But particularly for things like the carcinogens, they're useful. The other thing that is useful, and I think Dr. Meyer mentions it, but let me give it a plug here. And I think he put the link in, but maybe Bernice that would be something else to send out. The ATSDR, which, you know, I'd have to Google to remember what exactly that stands for. So I'm going to do it just so I, it's the Agency for Toxic Substances and Disease Registry. So the ATSDR has these things called CSIMs or Clinical Studies in Environmental Medicine. And they are study tools. You can actually get CME for some of them. Some of them are out of date with respect to the CME, but they are still posted. And they are case-based modules that you can use to study. So I know there's one on asbestos there for most of the heavy metals, they have them. So that might be something that, again, if you're looking for review questions based on clinical scenarios, that is something that you could use. Another person had asked earlier and something just came to mind, the JAMA and the New England Journal of Medicine sometimes have like stumped the professor clinical cases. And the American Thoracic Society on their website has pulmonary clinical cases. Now, John's given you or Dr. Meyer's given you a lot in his lecture on occupational lung disease. But if you're looking for more radiographs to look at, more X-rays to look at, the American Thoracic Society site has those on there and those are free. So, and then NIOSH, we've mentioned a couple of times, the National Institute of Occupational Safety and Health, which is part of the CDC, has a dermatology, occupational dermatology library. It's no longer being added to, but it still exists. And most of the skin slides that we show have come from that library. So those are other places where you can use images for review and clinical situations for review. I think the bottom line is I'm looking to populate the PowerPoint flashcard function and you can build your flashcards on PowerPoint and just the most concise and rapid way to put information into those. That's, I mean, we can certainly do cases and the cases are helpful, but it has to start with a basic foundation, the nuances. And so the flashcards will be helpful if we can, I think we'll do is the answer to that. It sounds like. Yeah, and I think, again, you bring up an important point and that's that you definitely need, what I heard you say and I agree with is you need to have some amount of memorization. You can't just remember by chance all of what someone who works with solvents looks like. Again, we just don't have that clinical experience that we're getting in clinics right now. So yes, and a lot of this is rote. And a lot of the stuff that you study, you might not practice that part of occupational medicine in the future, but it's certainly important to know it for this exam. For those of you who might be preparing for the recertification exam, I have taken it once so far. I'm getting ready to take it again. That exam is one that just went to a computer option. It traditionally was offered paper and pencil, but it is targeted again to maintain competency. So you do certainly need to go back and learn your toxicology. But again, the goal of that exam is to confirm competency. And I think Dr. Meyer has it in his slides. If not, he will say it and I'll say it as well. And that's it. We haven't heard of anybody failed the MOC exam. The ABPM, the board is not sharing the pass rates, but based on that, our assumption is they're quite high because we've been teaching this course together since 2012. And he's been teaching it for a lot of years before that. And certainly if people don't do well on the exam, we hear about it. Sorry, there's a cat here again. Because people will come to us and say, hey, I need help. And we haven't had anybody come and say, I didn't pass the recert exam. So hopefully that in the absence of statistics from the board will give you a lift of your spirits if you are trying to study for the recert exam. Okay, that's helpful. I think the future of this is, your point about rote and clinical practice. Look, I did ER before I did occupational. And in ER, you have resources that you look at. In occupational, you may not have it because you don't have the same volume. So I think the future is clinical decision support. And so you're gonna get a lot of those things when you come up with symptoms and it's gonna suggest things to you. But for the board, it's clear that you have to have the pathways, the chemicals that break down in terms of the pharmacokinetics. And so I just wanna populate slides that give you those scenarios with the best information. It sounds like LADU is that. Yeah, and again, I think LADU is one of the great resources. I would recommend everyone go and look in that slide set, which again is the introductory slide set. So we really not made a point to review it. Knowing Dr. Meyer, I would strongly recommend if you can signing in tomorrow from eight to 9 p.m. for his first session as well. That will be recorded because I think that he will probably spend some time on general study topics. Because that is normally a, that is the first lecture. That's the first half hour of the live course. In addition, if you are studying for the whole boards, in other words, you're taking it for the first time, please contact Dr. Meyer. He is very gracious with his slides. He has slides and resources for the core, although it is not part of this course. Again, he is very gracious and generous and he will send you those resources. We don't include them as part of this course because this course as approved is just for the specialty section of the exam. Okay, and that would be useful if he can volunteer that to people who are part of this course because I think the core material, anything that we can get additionally for that would be great so we can do the repetition. Yep, and again, the way he does that is just email him. His email is listed several times in the course and he'll make sure that you get those resources. Perfect, thank you so much. You're welcome. Do you feel three months is enough to study for this exam? So, awesome question. I will give you what is sort of the recipe. I think Dr. Meyer would give you a different version of it, but sort of the party line, if you will, has been, and I should disclose, I used to be the residency co-director at Hopkins, so I am very used to giving this advice directly to my residents. You know, you're graduating in the spring. Generally, this course ran in May, so we're running it slightly later in June, but between this course and the boards, which generally run in mid-October, that is the study time. When I was a resident, there used to be a one-year waiting period before you were even allowed to take the boards. They removed that requirement. It's not unreasonable to take more time to study, but there was a lot of demand for people to get boards certified quicker than a one-year waiting period, so the one-year waiting period went away in 2000, and since then, you've been able to take the boards as soon as you finish residency training in the fall cycle. So, I guess my best advice for you would be to see if you feel ready or not, knowing the importance of this exam. I think that starting studying in the spring and preparing for an October exam was what from May to October could be four to five months of studying is adequate for most people, but it certainly matters what you've been doing the rest of the time. If you have not picked up a book and you've not done an occupational medicine residency, three months or four months is probably not enough time to sufficiently prepare for that exam. So, that's my best answer. So, any other questions? Yeah, I'm just looking to see if anybody has their hand up. I don't see Bernice. Do you see anybody with their hand up? No, I do not. I've been trying to pay attention. Again, this is the first evening that we're doing this, so kind of knowing how it goes and knowing that we're going to have different people attending, it's a little bit of a challenge, but it's a lot of fun and it's a lot of fun to do it. So, I think that's my best advice for you. So, thank you. Thank you. Thank you. Thank you. So, we're going to have different people attending. The sessions will be recorded. Although we've artificially broken them up into different topics, you can certainly feel free to ask questions if they come up, you know, sign on another night and say, hey, I really want to revisit this. But again, we've made these hours available to fill in the gap of not having us standing right in front of you and knowing that, you know, there are questions that come up after you've taken a look at the material. And after the course, we don't evaporate. You know, our contact information is in the syllabus. We do respond to email. I mentioned Dr. Meyer is very generous with providing additional resources if you're taking the full boards, if you're taking them for the first time. So, fear not. If you haven't asked a question, you have the week and then you have time after that as you prepare. And that is completely normal to come up with questions as you prepare. I am going to make one comment. Sure. First of all, I like the format. For the next time you're on, you're extremely knowledgeable and your explanations are incredibly perspicacious. You're very kind. So, I think in the future, it's helpful to have those questions broken down at the beginning because the explanations are much more nuanced than just reading the question and getting the answer. So, number one, I think it's good to start with the questions and answers. Number two, it would be helpful as I've gone through the lectures for you to highlight the issues in the lecture that you think should be highlighted and more advantageous for us to do a deep dive on for the goals. So, if you can cherry pick some of the slides and some of the topics in your lectures and then spend some of the time after the Q&A of the questions that they are hearing, that would be helpful. Okay, those are good. And I guess, so we've still got some time. So, I am certainly happy to do that for, I would say it's probably more important for the clinical occupational medicine. And although we did our voiceovers, I will share that one of the themes that I stress in addition to the fact that we're gonna be repeating a lot of stuff is that, and just so you know, the order that we put the course in is the order we teach the course in. So, that means that you get a whole lot of me on the first day and it can be daunting. And one of the things that I do try to stress, and we've got this in one of the early slides, is the theme songs of neurological toxicology. That it's the whole body exposed so that the health effects are symmetrical. I think later on, and I don't wanna steal my own thunder, but I think somewhere later on, we give you a review question, something like, hey, you know, somebody was having trouble and it's a clinical scenario of upper extremity musculoskeletal disorder. But we try to kind of confuse the issue by saying, well, you know, could this be solvents or are you supposed to think that maybe it's carpal tunnel? And the mission behind that question, if you will, is to say that we need to think about solvents, it affects the whole body. So, if somebody is exposed to solvents, but what they're presenting with is carpal tunnel on one side or a brachial plexopathy on one side, that's not solvents. Those two things are both true. They might be a painter, they might be furniture stripping, but what we're really talking about is that upper extremity musculoskeletal disorder. And I think it's actually Dr. Meyer, not to steal his thunder, but I think he's got one question where it's clearly a cervical nerve, it's like C5-6 or C7-8 on the one side. And that's repetitive motion, or it's a disc problem in the person's cervical spine. It's not due to their solvent exposure. So I think, you know, those are the kind of themes that we try to draw out. I think the other one I've touched on a little bit, and some of you have asked questions about it, is this idea of being able to go both ways. You need to be able to think about an exposure and think about what health effects would be related to that exposure. So, you know, carbon disulfide, the kitchen sink of health effects, lead, huge number of organ systems can be affected. Then you need to be able to go the other way and, you know, say, okay, Parkinsonism. Well, that's the clinical syndrome, but what causes it? Now, for some things it's gonna be really narrow, right? So, you know, fifth cranial nerve neuropathy, that's trichloroethylene. So sometimes one clinical clue is gonna guide you to one specific agent. And again, we do try to draw those out so that those become that automatic knowledge that you have. Carbon disulfide and accelerated atherosclerotic disease, that's kind of unique. So whenever we have these things that are like, wow, that's really unusual that that causes that very unique health effect, we've tried to highlight it in the slides. I, you know, I hear your comment and it's an important comment about, you know, perhaps even more than the slides highlighting what is important. And I guess the snarky professor in me wants to say, it's all important, but really what we've attempted to do is distill a huge body of knowledge, really down to teaching to the test. So although it seems like we're giving you a lot of material, probably all the slides would be highlighted if we were gonna try and highlight something, because what we've taken is all the stories and a lot of noise, if you will, around how you get to an understanding of a concept and put them as bullet points on slides. So I think we really have kind of curated, and one of the cartoons that are in that introductory slide set, it's of rats that are in a lab. I'm actually in the syllabus, cause I'm really hoping that it's still in there. I think sometimes we don't put all our cartoons in because it's really not part of the CME. But let's see, I'm looking at the slides. So if you see what I'm that I'm not looking at you is because I'm looking at the slides. Yeah, so he didn't put it in there. But, you know, one of the things is, you know, teaching to the test, right? So his his cartoon that he has is actually a rat going through a maze. And the comment is, you know, well, they didn't teach to the test. Well, here we're teaching to the test. So you might have heard me say before that, you know, the firefighters and cancer and IMEs is super interesting. That's beyond the test. And, you know, there's the 10 commandments, and then there's the 613 commandments in in the Torah, the Talmud. So we're kind of sticking to the, you know, the top hits, so to speak. Well, and that, you know, that kind of thing. Sorry, I meant, that's okay. And that's really great answer. And I'm going to actually ask you to drill down beyond that. That's this. Well, I give you, I'll give you a hypothetical. You know, are we going to get second level questions that are clinical cases, like we see in practice all the time? And are we going to ask to answer towards guidelines or to what we actually do in this? So the guideline makes a great question. Yeah, I'll give you a hypothetical. So someone comes in, they do repetitive motion, they lift above their shoulder. They're 55 years old, male, and they develop pain in their anterior shoulder. That's worse when they hyperabdomin. You do a plain film. So the question may be, what would be your first test? And then it could be and then what would you do? So that would be a multi layered, almost a third level. That I can help you with. And again, I'm not going to steal Dr. Myers thunder, but he talks a little bit about that in the ortho lecture. So the first thing is guidelines. The ACOM guidelines, which have been revised a bit, at one point were used for board questions. And the reason they were used is because many states adopted them. Some states have not adopted them and the ACOM guidelines have been revised. And so, you know, whereas we used to say you really should know the ACOM guidelines, now it's more you should be aware of the ACOM guidelines, because there are a diversity of physicians who are writing this. That said, the questions on the board are not about things that are fuzzy, right? They are, what would you do next questions, but mindful of things that wouldn't be done next. So for example, having somebody come in who has a simple wrist strain, the MRI would be the wrong answer. But in terms of the when to get the MRI, again, that is not so much controversial, but a matter of clinical judgment. So I would say you're more likely to get questions and we've stressed more in the ortho section, questions around detection of something that's more likely due to an toxicant exposure, vice musculoskeletal like the example I gave you before. I'm not even so much because again, we're not emergency medicine. So we're not asking you if you know, you know, what a surgical emergency is around the back, if you know what red flags are, you're expected to know that as doctors, right, but you are as an occupational medicine doctor expected to know that most people with musculoskeletal back strains will get better within a period of time, no matter what we do, that that most people who have heart attacks will be able to get back to work. You know, you're not going to get a question about how many met somebody needs to do to be qualified as a firefighter, firefighter under NFPA guidance, because that's guidance. So again, I would I would definitely recommend, you know, asking those questions, especially of ortho, ask them of Dr. Meyer. But I think what he will guide you is that, again, the boards are ensuring the specialty practice in occupational medicine. And what's special about occupational medicine is toxicology, a knowledge of the work environment, a knowledge of prevention of needless disability, and knowledge of laws like the Americans with Disabilities Act. So to the extent that those things temper clinical decisions, that's the type of questions. But also keep in mind, there's only so many questions. Again, there's only so much space time real estate for questions. I think Dr. Meyer, and I'm, I'm just going to look at the syllabus, because I'm pretty sure that he gives like the the percentages in that first lecture. So in the syllabus, it's the first lecture, it has the outline, it has essential books here. And then starting on page 16 is his introductory slide set. And on page 17, the second slide on the left hand side says, What do I study? And it talks about, you know, on this specialty exam, you know, hazard assessment, recognition, evaluation and control 20% clinical occupational medicine 60%. The majority of that 60% of clinical occupational medicine is tox. The rest of it is musculoskeletal. You could record the last paragraph that you just said. Well, everything is being recorded. No, my point is, your point is that you answered the question in the sense that, in my point about the case, I gave the 55 year old, everybody who does works in an occupational production scenario is 55 probably has degenerative labral tear. And do you get an MRA or an MRI? Or do you do plain film? And I mean, those are the kinds of almost third level thinking that you're looking at both occupational and non occupational in the real world when we treat patients. We're also thinking, oh, gee, do I have to talk to their commercial insurance? And do we have to get a month for procedure out of this and have it paid for by occupational? And I mean, there's a lot of complexity, right? And that that again, I think is really beyond the scope. That's what I wanted to know. Yeah, of, you know, this is the science of things that are not controversial. You know, and you'll see it in the end, please come back when I do the special topics lecture, because there are certain things in there. You know, and we get into, and I'll review the repro psych when when we're here Thursday night as well. But there are certain things that again, might be intuitive, like, hey, do people who have an increased do people who abuse illicit drugs or illicitly use prescription drugs have higher risk of workplace absences? Well, that makes sense, but it is actually true. So knowing that type of information is important. And again, that's why we put that type of information in the review course. Right. And and we can reason some things we may be fuzzy on during the exam, because you've just explained how to couch that's, that's the takeaway I'm looking for in these lectures, which is, how do I reason through these questions, and make sure that I don't get down in the weeds on things that are irrelevant, because we're looking for laws, regulatory compliance, your special knowledge and occupational toxicology, and so on. That answer that you gave, I think, is more insightful than, than just reading through these papers. Well, I appreciate that. And please, you know, come in and come to the other sessions, because, you know, Dr. Meyer, and I, again, we each of us have done this class by ourselves at times, but it is a team effort. And I do think we complement each other in the information that we share, and in our perspectives. Great, thank you. That's great answer. Okay. Appreciate it. We've got just about 12 minutes left here in our session tonight. Are there any other questions? And again, if you don't have a chance to ask your question, fear not, you have every other night this week and then email. Are we going to talk about CCBs in further detail in an upcoming lecture? I know he talked about it a little bit along with the dioxin in the skin lecture, but just kind of like pearls. So I think, you know, we've tried so PCBs are polychlorinated biphenyls. And again, we used to think about them when we think about old transmitter towers, and you know, having the oils that stayed there after the fact, and so they end up in things like national priority list, Superfund sites, and you know, contaminated places, you know, we think about them with not only occupational exposure, but also with environmental contamination. A lot of that type of information is really environmental health. So a lot of the stories that you have heard, and I don't mean stories like fiction, I just mean historical stories, although we touch on some of them like Minimata Bay, other things like Itai Itai disease or contaminated food with the osteolytic bone lesions that that are associated with cadmium exposure. Those are probably things you heard about in environmental medicine, which is actually beyond the scope of this course. So if you're feeling like, hey, what happened to CERCLA and RCLA and PCBs and all of that, we're focusing more on the toxicology of it. And for most of these things, it's more their potential for being carcinogens, or liver toxicants. But you're right, we're not focusing a whole lot around the environmental contamination stories that that would be more environmental health. So hopefully that's an okay answer to your question. Yes, I just often mix up like PAHs and PCBs. So I didn't know if he was going to go over it again later on. But that's helpful. Thank you. Yeah. And I think, you know, you're bringing up also another good point. There's a lot of information, you know, like lead and mercury, right? Lots of kinds, you know, lead mercury, arsenic, kind of the big three, which is why I have so many slides on them, and why you hear those three over and over again, because they think we're trying to clear up the mud. Again, some of the things that we spent a lot of time on during courses in environmental health, and it's because they made good stories, but they don't necessarily make good board review questions. So I would say kind of following what the gentleman was just saying before, if you hear something a lot, it's probably because it's important. If you hear less of it, it's probably because it's less important. And not that PCB contamination and sort of these classical environmental health problems aren't important. It's just that we have so many other things now to talk about. And that that real estate again, of questions is an economy that that people who are writing this exam have to consider because they can't leave stuff out. Got it. Thanks. Okay. I mean, likewise, I can tell you, I love doing the special topics lecture because I get to talk about commercial driver medical exams and MRO stuff. There's really very little of that on the board exam. It's fun to talk about. And what we've given you what I've given you is, is an awareness level of what a general occupational medicine physician needs to know about commercial driver medical exams, and about MRO work, which is why there's questions about shine bladder and, and hypertension, and, you know, sort of the go no go things like knowing that examiners are now in charge of the exemption for diabetes, you know, that happened in 2018. It's now 2020. That's fair game, knowing that the drug testing panel now has opioids on it. That's fair game because it happened in 2018. So again, we're trying to highlight things that are generalist knowledge. But you know, we don't spend a whole lot of time talking about how to do a shy bladder evaluation or, you know, what length of a follow up program is appropriate for a worker coming back from a federal violation. Some of that detail really is just beyond generalist. It's really interesting. And I work with with Natalie Hartenbaum. She's actually a contractor for me now. So I really enjoy talking with her about stuff that happens on commercial driver medical exams. All of that is really beyond the generalist scope of this board exam that that certification exam is separate. So that's why we don't spend a whole lot of time on it. But again, I think that's part of the the challenge of preparing for an exam, where really the game is to take the exam and succeed. You are probably going to know many of you know, lots of things that are not on the exam. But to prepare for the exam, you have to prepare to a standard that is broad. And then in your practice, then you can have fun then you can spend time pondering interesting questions for this course in this exam, we really just want to get you ready to succeed on the exam. You make a good point about the DOT exam. Because it is complex. People don't remember what's in the CFR. They don't remember the guideline committee's recommendations. They don't even remember the medications. So none of that is on your board. And again, I mean, I, I am the chief medical officer for railroad. I love what I do. You know, Dr. Meyer has been a residency professor since I met him when I interviewed him. And he's been a great mentor to me. He's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a great mentor to me. And he's been a residency professor since I met him when I interviewed with him to be a resident in his program in West Virginia 20 some odd years ago. We really like talking about what we do. And it is a challenge narrowing that conversation when we're on the podium teaching board review. But both of us really do enjoy talking about all the interesting things about what we do when we're not teaching board review. We appreciate you focus on us being prepared for the board review. Well, I think that is probably a perfect place to end. Bernice I'll give you the floor here. She's been our wonderful moderator. Thank you. Yeah, so we'll go ahead and I will post the recordings for this into the LMS where the other content is for the course. And I have a note here to send information related to the occupational self assessment tool. So I will get that over to all the registrants. And so then we will see everyone hopefully back tomorrow at 8pm Eastern Time. And if there's any questions in the meantime, feel free to reach out. I believe all of you have my contact info as well. Also feel free to ask any questions ahead of time. And I think I got this chat thing figured out so we should have a good to go tomorrow. Great. All right. Thank you, Bernice. And I will see you all Thursday from seven to nine. But you are in expert hands with Dr. Meyer. And I will look forward to seeing and hearing you and maybe some others on Thursday. So have a good evening. Great. Transcribed by https://otter.ai

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