M103 T4 L17

Question 1

What are the different types of occupational lung diseases?

Answer 1

COPD
Malignant diseases
Occupational asthma
Pneumoconioses (mineral dust)

Question 2

What are examples of malignant occupational lung diseases?

Answer 2

Lung cancer (asbestos and non asbestos related)
Mesothelioma

Question 3

What are examples of pneumoconioses? (CAS)

Answer 3

Coal Workers’ Lung
Asbestosis
Silicosis

Question 4

What are pneumoconioses caused by?

Answer 4

the inhalation of certain dusts

the lung tissue’s reaction to the dust

Question 5

Which job occupations are linked to silicosis?

Answer 5

Slate workers (Wales)
Potters (Stoke-on-Trent)
Knife grinders (Sheffield)
Hard rock miners (Canada etc)
Sand-blasting
Foundry workers

Question 6

What is silicosis a risk factor for?

Answer 6

lung cancer

TB

Question 7

What is the main aim for treatment of pneumoconioses?

Answer 7

to prevent further exposure

Question 8

Which symptoms of pneumoconioses have to be managed? (BCCD)

Answer 8

breathlessness, cough, cor pulmonale & dyspnoea

Question 9

Which areas was asbestos historically mined in?

Answer 9

Canada
Australia
South Africa

Question 10

How did asbestos get to the UK?

Answer 10

it was imported via docks (esp Southampton)

Question 11

When was asbestos widely used?

Answer 11

in the 1930s-70s

Question 12

What was asbestos used in?

Answer 12

building (roofs, insulation, plumbing)
power stations
ship-building (engine rooms, bulkheads)
railways
cars (brake pads)

Question 13

Other than from working in astestos-containing environments, how else could people get related illnesses?

Answer 13

family members at home who washed contaminated clothes

Question 14

When did Europe bring in a ban on all forms of asbestos?

Answer 14

2005

Question 15

Is asbestos still used?

Answer 15

yes, there are other countries outside of teh EU that are mining and exporting asbestos

Question 16

Which benign conditions can asbestos cause?

Answer 16

pleural plaques / thickening
benign pleural effusion
asbestosis

Question 17

What is the effect of pleural thickening?

Answer 17

restriction on lung function

Question 18

What do pleural plaques indicate?

Answer 18

they are a marker of exposure

Question 19

What pattern is seen on the lung function of a patient with penumoconioses?

Answer 19

a restrictive pattern of abnormality

Question 20

How would FVC and gas transfer of a patient with pneumoconioses be affected?

Answer 20

FVC - reduced

gas transfer - reduced

Question 21

Which malignant diseases can asbestos cause?

Answer 21

lung cancer

mesothelioma

Question 22

What features of a patient history can indicate a malignant disease caused by asbestos?

Answer 22

Pleural plaques on previous CXRs
persistent unexplained chest pain
Weight loss
Breathless / unilateral pleural effusion

Question 23

What are the two distinct scenarios of asthma related to work?

Answer 23

occupational

work-aggrevated

Question 24

What is occupational asthma caused by?

Answer 24

by workplace exposure to asbestos

Question 25

What is work-aggrevated asthma caused by?

Answer 25

by pre-existing cases that are exacerbated by asbestos in the workplace

Question 26

What are the other risk factors of occupational asthma? (SAR)

Answer 26

smoking atopy rhinitis

Question 27

What are two types of features in substances might lead to allergic occupational asthma?

Answer 27

HMW (80-90% cases) | LMW

Question 28

Which HMW substances can be assessed for by skin prick / allergy testing? (FALE)

Answer 28

Flour (bakers) Animals (farmers) Latex Enzymes (eg detergents)

Question 29

What is the relationship between LMW or HMW substances and IgE antibodies?

Answer 29

low - independent of IgE | high - IgE-dependent

Question 30

Which LMW substances can be assessed for by skin prick / allergy testing in limited circumstances?

Answer 30

Isocyanates (printing, plastics) Metals (welders) Dyes (hairdressers)

Question 31

What might be a consequence of irritant induced asthma?

Answer 31

the patient developing asthma

Question 32

What are the two types of irritant induced asthma?

Answer 32

acute | subacute

Question 33

What is an example of an acute irritant induced asthma?

Answer 33

Reactive Airways Dysfunction Syndrome

Question 34

What substances can cause Reactive Airways Dysfunction Syndrome? Can Chlorine Arise From Teachers Failing

Answer 34

``` Caustic vapours Chlorine Ammonia Fire/Smoke Tear Gas Floor Sealants ```

Question 35

What factors does exposure to a certain toxin depend on?

Answer 35

the concentration of the toxin / pollutant the duration and intensity of the exposure the route by which the exposure occured (skin vs inhaled) the mechanism and metabolism of the toxin any co-morbidities of the patient

Question 36

Which factors determine a patient's susceptibility to developing allergic occupational asthma?

Answer 36

Genetic factors Co-morbidity / underlying diseases Environmental factors

Question 37

Which Genetic factor might contribute to a patient developing allergic occupational asthma?

Answer 37

the protective effect of HbS against falciparum malaria

Question 38

What are examples of Environmental factors that might contribute to a patient developing allergic occupational asthma?

Answer 38

Heat waves cold snaps smogs

Question 39

Why might a co morbidity contribute to a patient developing allergic occupational asthma?

Answer 39

the co morbidity might augment the clinical impact of the toxic load

Question 40

What is the difference between primary and secondary pollutants?

Answer 40

1o - are from fossil fuel combustion | 2o - are from reactions between pollutants in the atmosphere

Question 41

What are examples of primary pollutants?

Answer 41

Nitrogen oxide Sulphur dioxide (diesel) Carbon monoxide Particulate matter

Question 42

What are the outdoor sources of NO?

Answer 42

vehicle exhausts | power stations

Question 43

What are the indoor sources of NO?

Answer 43

fuel burning cookers unfueled heaters cigarette smoke

Question 44

What conditions are NOs associated with?

Answer 44

COPD | asthma

Question 45

What are the health effects of ground level ozone?

Answer 45

decreases lung function decreases pro-inflammatory effects increases response to inhaled allergens increases respiratory morbidity

Question 46

What structures in the airways are affected by particulate matter?

Answer 46

cilia cell DNA mucus epithelium

Question 47

What is the effect of airway structural elements on the human body?

Answer 47

affects airway structural elements promotes airway inflammation promotes IgE production

Question 48

What are the two categories of exposure that can be reduced?

Answer 48

Occupational | Environmental

Question 49

What can be done to reduce Occupational exposure to pollutants?

Answer 49

the use of FFP3 masks | Ventilation / extraction of chemicals

Question 50

What can be done to reduce Environmental exposure to pollutants?

Answer 50

Air quality warnings Remain indoors, close windows Minimise duration/intensity of outdoor activities

Question 51

Why are airway provocation tests performed in the first place?

Answer 51

bc people with sensitive lungs will be affected by a much lower dose of this medication than people with healthy lungs

Question 52

What is the objective of airway provocation tests?

Answer 52

to carefully to make sure specific drugs for individual patients is safe

Question 53

How do airway provocation tests work?

Answer 53

by breathing in gradually increasing doses of a medication that can irritate the airways and cause them to get narrower

Question 54

*g* What structures are indicative of Progressive Massive Fibrosis on CXRs?

Answer 54

a fibrotic pneumoconiotic lesion with a diameter of x > 1cm | the formation of large mass-like conglomerates, predominantly in the upper pulmonary lobes

Question 55

*g* What are the consequences of Progressive Massive Fibrosis?

Answer 55

progressive scarring, causes stiff lungs

Question 56

*g* What is Progressive Massive Fibrosis primarily caused by ?

Answer 56

conioses, which results in the activation of alveolar macrophages, which phagocytose dust particles after their deposition

Question 57

What medication is used to manage a cough & breathlessness?

Answer 57

opiates

Question 58

What medication is used to manage r. HF?

Answer 58

diuretics

Question 59

What can specific IgE assays test for?

Answer 59

allergic reactions in most HMW allergens and some LMW agents

Question 60

What are the effects of particulate matter in the airways?

Answer 60

Mucous production Oxidative stress to cell DNA Induction of epithelial apoptosis

Question 61

What is the difference between FFP 1, FFP 2 or FFP 3 masks?

Answer 61

the higher the number, the better the protection against toxic substances