Occupational lung diseases, D Kinder, DSA

Question 1

silicosis

Answer 1

fibrotic lung disease caused by inhalation of crystalline silica usually in form of quartz

Question 2

What industries are at risk for silicosis

Answer 2

mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics and stressed denim jean manufacturing

Question 3

Most common form and presentation of silicosis

Answer 3

chronic silicosis: silicotic nodule characterized by whorled hyalinized collagen fibers with a more peripheral zone of dust laden macrophages
may be asymptomatic or complain of dyspnea. productive cough

Question 4

What is accelerated silicosis

Answer 4

nodules develop after 3-10 yrs of exposure

clinical course is progressive

Question 5

what is acute silicosis

Answer 5

6 mo-2 yrs after massive exposure

Sx: dyspnea, cough, wheezing and weight loss that rapidly progresses to respiraotry failure and death

Question 6

what is progressive massive fibrosis from silicosis

Answer 6

lesions at least 1 cm in diameter, often larger and usually involve the upper lobes
leads to respiratory failure, cor pulmonale, weight loss and death

Question 7

What are some diseases associated with silicosis

Answer 7

TB
COPD and chronic bronchitis
Collagen vascular disease: RA and scleroderma
Lung cancer

Question 8

what will a CXR show with silicosis

Answer 8

symmetric nodular pattern involving upper lobes
hilar adenopathy with eggshell calcidication is strongly suggestive
progressive massive fibrosis characterized by coalescence of the nodules with larger mass lesions
acute will show air space and interstitial pattern on x ray

Question 9

What will silicosis show on PFT

Answer 9

normal early in chronic silicosis, later mixed pattern obstructive and restrictive

Question 10

Dx of silicosis

Answer 10

based on Hx and characteristic CXR changes

Question 11

management of silicosis

Answer 11

disease is irreversible
TB testing
stop smoking
consider lung transplants in acute and acclerated silicosis

Question 12

Coal Workers Pneumoconiosis

Answer 12

deposits of coal dust in lung, increases with intensity of exposure and carbon content

Question 13

msot toxic component of coal dust

Answer 13

anthracite

Question 14

pathology of coal pneumoconiosis

Answer 14

coal macule of macrophages laden with coal dust in the walls of respiratory bronchioles and adjacent alveoli
coal nodules
progressive massive fibrosis may be seen

Question 15

What is clinical presentation of coal workers pneumoconiosis

Answer 15

no Sx or signs
have Sx of bronchitis
may lead to progressive massive fibrosis

Question 16

What are associated diseases with coal workers pneumoconiosis

Answer 16

silicosis
scleroderma, RA nodules
caplan syndrome

Question 17

What is caplan syndrome

Answer 17

RA with large cavitary pulmonary nodules associated with silicosis and coal workers pneumoconiosis

Question 18

What will CXR look like in coal pneumoconiosis

Answer 18

resembles silicosis, small rounded opacities in the lung parenchyma
can prgress to PMF with nodules from 0.5-5cm

Question 19

what will PFT show in coal pneumoconiosis

Answer 19

normal in early phase
often obstructive in later
someitmes restriction in fibrosis present
shown to lead to emphysema

Question 20

Dx of coal pneumoconiosis

Answer 20

coal dust exposure, CXR

Question 21

management of coal pneumoconiosis

Answer 21

avoid exposure and stop smoking

Question 22

Asbestosis

Answer 22

chronic fibrotic interstitial lung disease secondary to prolonged inhalation of asbestos fibers
20 yr latency between disease and exposure is common

Question 23

What industries are at risk for asbestosis

Answer 23

mining, milling and transportation of asbestos, building demolition, brake lining, shipbuilding, insulations, fireproofing

Question 24

What is pathology of asbestosis

Answer 24

ferruginous bodies, asbestos bodies can be found in sputum or BAL fluid

Question 25

Sx and signs asbestosis

Answer 25

dyspnea, dry cough, chest tightness/pain

inspiratory basal crackles and clubbing

Question 26

what diseases are associated with asbestosis

Answer 26

mesothelioma
lung cancer
pleural effusion

Question 27

CXR for asbestosis

Answer 27

pleural plaques, pleural effusion with latency 10-15 yrs

pleural thickening and rounded atelectasis with comet tail, lower lobe and subpleural diseases prominent

Question 28

PFT for asbestosis

Answer 28

restrictive, may see obstructive

Question 29

Dx of asbestosis

Answer 29

1 reliable Hx of exposure!!!
2 appropriate lag time between exposure and disease
3 lung fibrosis on CXR!!!
4 restrictive PFT
5 b/l inspiratory crackles
6 clubbing

Question 30

management of asbestosis

Answer 30

no effective Tx, avoid exposure, stop smoking, lung transplant

Question 31

What industries are at risk for beryllium disease

Answer 31

aerospace, electronics, ceramic, metal, nuclear, telecommunications, tool and die, welding

Question 32

What is clniical presentation of acute toxic penumonitis(beryllium disease)

Answer 32

high exposure can lead to HS response that is now rare due to better recognition of beryllium assoc disease
Sx: cough and chest pain
Signs: blood tinged sputum and crackles

Question 33

Clinical presentation of chronic beryllium disease

Answer 33

similar to sarcoidosis from asymptomatic to severe granulomatous restrictive lung disease
Sx: dyspnea, cough, chest pain, weight loss, fatigue and arthralgias
signs: crackles
osnet 20 yrs after exposure

Question 34

what will CXR show in beryllium disease

Answer 34

enlarged hilar or mediastinal lymph nodes, multiple lung nodules or both
later stages: patchy fibrosis, hyperinflation and honeycombing

Question 35

PFT of beryllium disease

Answer 35

restrictive

Question 36

Dx beryllium disease

Answer 36

documented exposure
evidence lung disease
+ BeLPT performed on blood or BAL fluid

Question 37

What is BeLPT

Answer 37

beryllium lymphocyte proliferation test

Question 38

Management of beryllium disease

Answer 38

avoid further exposure, stop smoking, steroids