Clin Med: Occupational Lung Disease

Question 1

Coal workers pneumoconiosis is due to

Answer 1

carbon containing particulate from coal mining

Question 2

Coal workers pneumoconiosis aka =

Answer 2

‘black lung’
anthracosis
anthrasilicosis

Question 3

longer time in occupation =

Answer 3

higher risk

Question 4

Coal workers pneumoconiosis presentation

Answer 4

primarily asymptomatic
if sx develop they are non-specific:
SOB exertion to rest
Cough
Sputum production +/- black tinge
Chest tightness

Question 5

Coal workers pneumoconiosis workup

Answer 5

CXR - alveolar macrophages - coal macules, 2-5 diffuse, small, round, nodular opacities on CXR, upper lungs often with granular appearance
PFTs - CWP produces minimal PFT changes but can coexist with chronic bronchitis and/or COPD
+/- Chest CT - some lymph node enlargement

Question 6

Coal workers pneumoconiosis treatment

Answer 6

no cure or definitive treatment
supportive:
bronchodilators, pulm rehab, suppl O2, smoking cessation, lung transplant

Question 7

Coal workers pneumoconiosis complications

Answer 7

Pulm HTN
R-sided HF
Resp failure
Premature death

Question 8

Coal workers pneumoconiosis treatment goal

Answer 8

identify CWP early through screening
CXR
Include PFTs

Question 9

Screening protocol for CWP

Answer 9

baseline CXR then f/u at 3 years
Routine offered a min of once every 5 years
F/u screen every 2 years if any abnormal

screenings offered every year but at pts expense

Question 10

Coal workers pneumoconiosis prevention

Answer 10

PPE
education on acceptable working conditions
avoid smoking or smoking cessation
encourage periodic screenings

Question 11

Silicosis causative agent

Answer 11

silica dust

Question 12

Silicosis main forms

Answer 12

Acute Silicosis from large volume exposure (high mortality)
Accelerated form from 5-10 years of exposure
Chronic form from 15-20 years of exposure

Question 13

Silicosis acute presentation

Answer 13

dyspnea
wt loss
fatigue
diffuse bilateral crackles
respiratory failure within 2 years

Question 14

Silicosis chronic/ accelerated presentation

Answer 14

primarily asymptomatic
sx non-specific:
SOB
cough
sputum production

Question 15

Dx of Silicosis

Answer 15

Chest CT preferred - better to differentiate from asbestosis
CXR
PFTs

Question 16

Findings on CT for Silicosis

Answer 16

1-3mm small round opacities mostly upper lung fields
mediastinal and hilar lymphadenopathy
+/- lymph node calcifications - eggshell calcifications

Acute Silicosis = bilateral consolidation with ground glass opacities

Question 17

Silicosis treatment

Answer 17

no cure or definitive treatment
supportive:
bronchodilators, inhaled corticosteroids, pulm rehab, lung transplant

Question 18

Silicosis complications

Answer 18

TB and non-tb mycobacterial infections**
Spontaneous pneumothorax
emphysema
lung cancer**
pulm HTN
resp failure

Question 19

Silicosis prevention

Answer 19

best treatment is prevention
industrial intervention
PPE
screenings
smoking cessation
pneumo and flu vaccines in at risk pts

Question 20

Asbestosis causative agent

Answer 20

asbestos (old home remodeling, heat, fire, chemically, electrical resistant material)
Direct toxic and macrophage activation -> inflammation -> fibrosis

Question 21

Asbestosis dose dependent =

Answer 21

10-15 years post exposure

Question 22

Asbestosis presentation

Answer 22

primarily asymptomatic
if sx they are non-specific:
SOB
non-productive cough **
fatigue
clubbing of digits - sign of hypoxia
bibasilar crackles

Question 23

Dx Asbestosis workup

Answer 23

CT chest preferred
CXR
lung bx to confirm (rarely necessary)
PFTs for monitoring of progression

Question 24

CT chest for Asbestosis shows

Answer 24

bilateral linear reticular opacities (honeycombing)
predilection of lower lungs
pleural plaques** (pathognomic)

Question 25

Treatment for Asbestosis

Answer 25

no cure or definitive treatment
symptomatic relief

Question 26

Asbestosis complications

Answer 26

lung cancer - mesothelioma (main cause if Asbestosis), non-small cell lung cancer (bigger risk but other things can cause as well)***
Pulmonary HTN
R-sided HF
Resp failure
premature death

Question 27

Asbestosis prevention

Answer 27

annual lung cancer screening (low dose CT scan)
smoking cessation
flu and pneumococcal immunizations

Question 28

Hypersensitivity Pneumonitis exposure to causative agent leads to

Answer 28

exposure to agent –> inflammation
aka extrinsic allergic alveolitis

Question 29

Hypersensitivity Pneumonitis primarily manifests as

Answer 29

acute illness 4-8 hours after exposure

Question 30

Symptoms of Hypersensitivity Pneumonitis

Answer 30

fever
chills
malaise
cough
dyspnea
nausea

Question 31

PE for Hypersensitivity Pneumonitis

Answer 31

bibasilar crackles
resp distress:
tachycardia
tachypnea
+/- cyanosis

Question 32

Hypersensitivity Pneumonitis workup

Answer 32

CXR - small nodular densities in the central lungs
CBC - elevated WBC count
check for antibodies to common substances
restrictive pattern on PFTs

Question 33

Hypersensitivity Pneumonitis treatment

Answer 33

oral corticosteroids if severe
avoid further exposure
likely occupational change

Question 34

Smoke inhalation 3 possible mechanisms of damage

Answer 34

1. impaired Oxygenation – CO or cyanide - oxygen displacement
2. upper airway thermal burns
3. lower airway chemical injury or physical irritants

Question 35

sign of inhalation injury

Answer 35

occurred in enclosed space
singed nasal hair or burns on lips
deep or full thickness burns to face, neck, upper torso
black colored sputum or soot around nasal passages

Question 36

Smoking inhalation treatment

Answer 36

100% O2 to treat any CO poisoning
Humidification O2 or helium -O2 mixture too aid in breathing
Bronchodilators
monitor hypoxia
intubation
suctioning or chest PT
fluid resuscitation

Question 37

what can monitor infection from smoking inhalation daily

Answer 37

Sputum cultures
Prophylactic abx not indicated