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P&T Block 3 Pulm & GI > L64 > Flashcards

L64 Flashcards

1
Q

What is the most impt tool for dx occupational lung disease? How do you treat all of these lung diseases?

A

History/exam

Treat all by removing from exposure

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2
Q

What size particles are small enough to enter the alveoli? By comparison, how small are most man-made particles?

A

5 microns to get in

2.5 are most man made

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3
Q

How do particle solubility and SA determine toxicity?

A

Water soluble: exert its effect when hits a mucous membrane
No water sol - more likely to go all way down to alveoli
Sphere particles have more SA to make contact with the body

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4
Q

What is constructive bronchiolitis/bronchiolitis obliterans? Cause? PFT? Treat?

A

Fibrosis around a bronchiole -> scarring and narrowing of bronchiole lumen
Due to inhalation sulfur & nitrogen oxides
PFT = OBSTRUCTIVE w/ low DLco
Irreversible, poorly responsive to therapy

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5
Q

What were the popcorn factory workers inhaling to give them bronchiolitis obliterans?

A 
Diacetyl - directly decreases FEV1
Found in flavor compounds:
- Cookies
- Coffee 
- Flavored e-cigs
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6
Q

What 3 diseases are marijuana smokers at higher risk for? What are the 3 majors changes to the airway that occur?

A 
General decrease mucociliary clearance + increased goblet cells (similar to all smoking airway epi damage)
Decreased alveolar fxn
Increased risk for:
- Acute + chronic bronchitis
- Blebs/pneumo
- Aspergillus
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7
Q

What is pneumoconioses?

A

Inhaling inorganic particles:

  • Asbestos
  • Silica
  • Coal
  • Metals
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8
Q

Describe why asbestos is bad to inhale

A 
= silicates 
Bad to inhale b/c
- Strong
- Flexible
- Resistant to breakdown // non-biodegradable 
- Environmentally persistent
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9
Q

What past exposures put you at risk for asbestos exposure?

A 
Mechanics
Construction workers
Shipyard workers
Military personnel 
Household contacts of those ppl
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10
Q

What are current exposure that put you at risk for asbestos exposure?

A

Construction
Demolition
People in homes w/ friable material
Asbestos bearing rock

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11
Q

What are the 2 malignant diseases resulting from asbestos exposure?

A

Mesothelioma

Lung cancer in general

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12
Q

What is asbestosis?

A

Non-malignant asbestos disease
= Lung fibrosis
UIP + asbestos bodies (shown w/ iron stain)

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13
Q

How do you tell asbestos exposure on CT?

A

Calcified pleural plaques // white stuff on dome of diaphragm - no clinical significance, just proves exposure

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14
Q

What is silica?

A

Crystalline - tetrahedral shape

Toxic b/c has redox potential w/ O + N

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15
Q

What is the difference between newly fractured vs weathered silica?

A

Newly fractured is much more highly reactive

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16
Q

Name populations at risk for silicosis

A

SAND BLASTING
Agriculture - plowing
Mining
Road construction - tunneling, demolition
Glass - raw materials, installation, repair
Ceramics - brick, tiles, pottery, porcelain
Sand molds

17
Q

What are the 3 forms of silicosis you need to know?

A

Acute silicosis - presents as hypoxia as protein fills alveoli (high silica load needed - sand blasters)
Chronic simple silicosis - over 10 yrs
Progressive massive fibrosis - end stage

18
Q

Dx chronic silicosis w/ radiology and PE

A

Abnormal CXR/CT w/ small gray, rounded opacities
DOE, cough
Rales and wheezes possible

19
Q

Definition of progressive massive fibrosis

PFT pattern

A

Masses > 1 cm diameter
- If cavitation, check for TB or cancer
PFT = mixed pattern
+/- emphysema

20
Q

What is a new way to get silicosis you should be aware of

A

artificial granite

21
Q

What is the toxic mechanism of coal

A 
Direct damages cell membranes 
Heavy metals -> free radicals 
Activate oxidant product of alveolar macrophages
1. Inflammation 
2. Fibrosis due to TNFa + IL1
22
Q

Describe coal worker’s pneumoconiosis

A

“Black lung”
Progressive lung scarring
Slowly progressive cough + SOB

23
Q

Since silicosis and black lung present so similarly (symptoms + CXR/CT same), how do you differentiate?

A

Exposure history

Coal macule on patho

24
Q

Coal changes to PFT

A

Obstructive

Loss of lung fxn = 1 pack/day of smoking

25
Q

How do you get exposed to beryllium?

A

Metal in

  • Tech
  • Nuclear weapons manufacturing
  • Air space
  • Cell phones
26
Q

What is chronic beryllium disease?

A

A chronic granulomatous lung disease

Scans look similar to sarcoid aka hilar LN adenopathy

27
Q

What is the key biomarker for beryllium?

A

BeLPT = beryllium lymphocyte proliferation test

28
Q

What is hypersensitivity pneumonitis?

A

Granulomatous disease
NOT infection
Cell mediated immune rxn to inhaled antigen
Presents SOB/cough

29
Q

Name some things that can cause HST pneumonitis

A

Hot tubs (mycobacteria)
Birds
Aspergillus

30
Q

What is the chest CT look like for acute vs sub acute HST pneumonitis?

A

Acute = ground glass

Sub acute = centrilobular nodularity

31
Q

What is sarcoidosis

A

Systemic granulomatous disease

Look at lungs and lymphatics aka MORE than 1 organ system

32
Q

Cause of sarcoid

Mechanism

A

Unknown cause

Activated macrophages + CD4 T cells -> Th1 type immune response

33
Q

What is Lofgren’s syndrome

A 
Type of sacroid w/ specific symptoms:
1. Chest lymphadenopathy
2. Erythema nodosum - raised tender nodules 
3. Arthritis 
Might go away on own
34
Q

What is Herefordt’s syndrome?

A

Sarcoid w/ specifically:

  1. Fever
  2. Partoid enlargement
  3. Facial palsy
  4. Anterior uveitis
35
Q

Imaging for sarcoid

A 
Mediastinal adenopathy 
Upper lobe > lower
Ground glass + consolidative opacities 
Similar look to silicosis 
Looks worse than presenting symptoms
36
Q

Sarcoid PFTs

A

Restricted but does what i wants

Obstructive if granulomas in airway lumen

37
Q

Do you need biopsy for sarcoid?

A

YEP
Should get non-necrotizing well formed granuloma
(Vs. TB = necrotizing
Vs. HST pneumonitis = poorly formed)

38
Q

Treat sarcoid aka where are the most likely sites of extra-pulm disease

A

Inhaled steroids if changed PFTs
Heart + brain -> systemic CS (prednisone)
If cardiac disease - you are at risk for sudden death form arrhythmia -> + implantable cardiac defibrillator

39
Q

Can sarcoid resolve on own?

A

Yes - spont remission in 2/3 pts

Better chance of this w/ erythema nodosum, fever, and arthritis

P&T Block 3 Pulm & GI (31 decks)

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