10. Environment and Lifestyle-Related Pathology

Question 1

What is pneumoconioses?

Answer 1

Fibrosing pulmonary disease caused by inhalation of an aerosol (mineral dusts, particles, vapors, or fumes).

Question 2

What is anthracosis?

Answer 2

When carbon pigment (anthracotic pigment) accumulates in macrophages along the pleural lymphatics. It is asymptomatic.

Question 3

What is simple coal worker’s pneumoconiosis?

Answer 3

AKA black lung disease, coal-dust macules and nodules in the upper lobes. Little pulmonary dysfunction.

Question 4

What is complicated coal worker’s pneumoconiosis?

Answer 4

Progressive massive fibrosis with increasing respiratory distress. May progress to pulmonary hypertension and cor pulmonale.

Question 5

What is Caplan syndrome?

Answer 5

Pneumoconiosis and rheumatoid arthritis.

Question 6

Which type of asbestos is associated with being more pathogenic and highly associated with mesotheliomas?

Answer 6

The amphibole kind which are straight and brittle fibers. There are crocidolite, tremolite and amosite subtypes. Serpentine are not so much pathogenic and are curved, flexible fibers with chrysolite subtype.

Question 7

What happens in asbestosis?

Answer 7

Diffuse interstitial fibrosis, which is most severe in the lower lobes. Asbestos bodies that may become coated with iron (ferruginous bodies). Slowly progressive dyspnea that may progress to pulmonary hypertension and cor pulmonale.

Question 8

What other syndrome is associated with asbestosis?

Answer 8

Caplan syndrome.

Question 9

How is silicosis acquired?

Answer 9

Exposure to silicon dioxide (silica).

Question 10

What is the most common type of tumor in asbestos-exposed individuals?

Answer 10

Bronchogenic carcinoma.

Question 11

What are the clinical symptoms of malignant mesotheliomas?

Answer 11

Recurrent pleural effusions, dyspnea and chest pain. There is an encasement and compression of the lungs. Micro: carcinomatous and sarcomatous elements (biphasic parttern).

Question 12

What do we seen in X-ray of someone with silicosis?

Answer 12

Fibrotic nodules in the upper zones.

Question 13

What are the clinical symptoms of silicosis?

Answer 13

Insidious onset of dysnea, slowly progressive despite cessation of exposure.

Question 14

How does berylliosis damage the lungs?

Answer 14

Causes type IV hypersensitivity reaction, resulting in granuloma formation.

Question 15

What does acute exposure to beryllium cause?

Answer 15

Acute pneumonitis.

Question 16

Who are in danger for berylliosis?

Answer 16

Personel on aerospace industry and nuclear reactors.

Question 17

What does chronic exposure to beryllium cause?

Answer 17

Pulmonary noncaseating granulomas and fibrosis, hilar lymph node granulomas, and systemic granulomas.

Question 18

What does aspirin do?

Answer 18

Irreversibly acetylates cyclooxygenase, preventing platelet production of thromboxane A2.

Question 19

How does carbon monoxide does damage to the body?

Answer 19

With its high affinity to oxygen, it forms carboxyhemoglobin, which shifts the oxygen dissociation curve causing systemic hypoxia.

Question 20

What does 10% concentration of carbon monoxide in the body do?

Answer 20

Asymptomatic.

Question 21

What does 30% concentration of carbon monoxide in the body do?

Answer 21

Headache and shortness of breath on exertion.

Question 22

What does 50% concentration of carbon monoxide in the body do?

Answer 22

Loss of consciousness, convulsion and coma.

Question 23

What does 60% and above concentration of carbon monoxide in the body do?

Answer 23

Death.

Question 24

What are the symptoms of carbon monoxide poisoning?

Answer 24

Bright “cherry-red” color of the skin, mucosal membranes, and the blood.

Question 25

What are the symptoms of acute arsenic poisoning?

Answer 25

Garlic-scented breath, hemorrhagic gastroenteritis, CNS toxicity that may lead to coma and seizure.

Question 26

What are the symptoms of chronic arsenic poisoning?

Answer 26

Malaise and abdominal pain, peripheral neurpathy and muscular weakness, sking changes (hyperpigmentation and dermatitis), Mees lines (transverse bands on the finger nails seen in heavy metal poisoning).

Question 27

How does lead interfere with heme production?

Answer 27

It inhibits d-aminolevulinic acid dehydratase and ferrochelatase.

Question 28

What are the symptoms of lead poisoning?

Answer 28

CNS toxicity, wrist and foot drop (in adults due to peripheral motor never demyelination), abdominal pain (colic pain), renal tubular acidosis, and renal failure, microcytic anemia with basophilic stippling, deposition of lead at the gingivodental line (“lead line”).

Question 29

What do we expect to see in X-ray of someone with chronic lead poisoning?

Answer 29

Long bones have lead lines (increased bone density) at the epiphyseal growth plates.

Question 30

What does mercury poisoning cause?

Answer 30

Neurotoxicity (intention tremors, dementia and delirium (mad as a hatter), and nephrotoxicity (acute tubular necrosis).

Question 31

What are the symptoms of cyanide poisoning?

Answer 31

“Bitter almond” scented breath, causes systemic asphyxia.

Question 32

What is the mechanism of cyanide poisoning?

Answer 32

Blocks cellular respiration by binding to mitochondrial cytochrome oxidase.

Question 33

What does methanol convert to inside the body and what is its treatment?

Answer 33

Metabolized to fomaldehyde (by alcohol dehydrogenase) and formic acid. Treatment is ethyl alcohol (ethanol, normal alcohol).

Question 34

What are the symptoms of methyl alcohol poisoning?

Answer 34

Blindness by necrosis of retinal ganglion cells and can lead to inebriation, coma, and death.

Question 35

What is the telltale sign of IV drug abuse and why?

Answer 35

“Track marks” in the antecubital fossa, which are produced from the healing of skin abscesses.

Question 36

What can chronic use of cocaine cause?

Answer 36

Perforation of the nasal septum and dilated cardiomyopathy.