L64 Flashcards
What is the most impt tool for dx occupational lung disease? How do you treat all of these lung diseases?
History/exam
Treat all by removing from exposure
What size particles are small enough to enter the alveoli? By comparison, how small are most man-made particles?
5 microns to get in
2.5 are most man made
How do particle solubility and SA determine toxicity?
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
What is constructive bronchiolitis/bronchiolitis obliterans? Cause? PFT? Treat?
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
What were the popcorn factory workers inhaling to give them bronchiolitis obliterans?
Diacetyl - directly decreases FEV1 Found in flavor compounds: - Cookies - Coffee - Flavored e-cigs
What 3 diseases are marijuana smokers at higher risk for? What are the 3 majors changes to the airway that occur?
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
What is pneumoconioses?
Inhaling inorganic particles:
- Asbestos
- Silica
- Coal
- Metals
Describe why asbestos is bad to inhale
= silicates Bad to inhale b/c - Strong - Flexible - Resistant to breakdown // non-biodegradable - Environmentally persistent
What past exposures put you at risk for asbestos exposure?
Mechanics Construction workers Shipyard workers Military personnel Household contacts of those ppl
What are current exposure that put you at risk for asbestos exposure?
Construction
Demolition
People in homes w/ friable material
Asbestos bearing rock
What are the 2 malignant diseases resulting from asbestos exposure?
Mesothelioma
Lung cancer in general
What is asbestosis?
Non-malignant asbestos disease
= Lung fibrosis
UIP + asbestos bodies (shown w/ iron stain)
How do you tell asbestos exposure on CT?
Calcified pleural plaques // white stuff on dome of diaphragm - no clinical significance, just proves exposure
What is silica?
Crystalline - tetrahedral shape
Toxic b/c has redox potential w/ O + N
What is the difference between newly fractured vs weathered silica?
Newly fractured is much more highly reactive
Name populations at risk for silicosis
SAND BLASTING
Agriculture - plowing
Mining
Road construction - tunneling, demolition
Glass - raw materials, installation, repair
Ceramics - brick, tiles, pottery, porcelain
Sand molds
What are the 3 forms of silicosis you need to know?
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
Dx chronic silicosis w/ radiology and PE
Abnormal CXR/CT w/ small gray, rounded opacities
DOE, cough
Rales and wheezes possible
Definition of progressive massive fibrosis
PFT pattern
Masses > 1 cm diameter
- If cavitation, check for TB or cancer
PFT = mixed pattern
+/- emphysema
What is a new way to get silicosis you should be aware of
artificial granite
What is the toxic mechanism of coal
Direct damages cell membranes Heavy metals -> free radicals Activate oxidant product of alveolar macrophages 1. Inflammation 2. Fibrosis due to TNFa + IL1
Describe coal worker’s pneumoconiosis
“Black lung”
Progressive lung scarring
Slowly progressive cough + SOB
Since silicosis and black lung present so similarly (symptoms + CXR/CT same), how do you differentiate?
Exposure history
Coal macule on patho
Coal changes to PFT
Obstructive
Loss of lung fxn = 1 pack/day of smoking
