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EKG/Radiology > Occupational > Flashcards

Occupational Flashcards

1
Q

Can enter throat

A

Inhalable fraction

Irritation

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2
Q

Particle goes past bronchus

A

Thoracic fraction

ACUTE DZ

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3
Q

Particle reaches alveoli

A

Respirable fraction

CHRONIC DZ

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4
Q

Low water solubility

Bronchiole, alveoli

A

NO2, Phosgen

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5
Q

Medium water solubility

Trachea, Bronchi

A

Ozone

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6
Q

High water solubility

A

Ammonia, Chlorine, Sulfur dioxide

NOSE, PHARANX, LARYNX

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7
Q

Upper airway exposure

S/s

A

Short lived

Burning
Couching
Sputum
Sneezing
Difficulty breathing
Bronchospasm
Hemoorrhage
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8
Q

Occupational lung dz

Had asthma but made worse by exposure

A

CAUSED or EXACERBATED by exposuer

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9
Q

Factors resulting in pathology

A 
Size
Solubility
Concentration
Duration of Exposure
Host Factors
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10
Q

Upper airway exposure

Agents

A

Ammonia

Chlorine gas

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11
Q

Upper airway exposure

Treatment

A
  • remove from area
  • Irrigation
  • Supplemental O2
  • secure airway
  • racemic Epi
  • +/- steroid
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12
Q

Lower Airway Disease

*Chonic sequelae
(Sulfur dioxide, NO)
*DOE
*+/- early inspiratory crackle
*CXR = possibly normal
*PFTs= possibly obstructive

(Ex. Burn pits)

?

A

Bronchiolitis Obliterans (BO)

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13
Q

Lower Airway Dz - BO

DX

A

Biopsy

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14
Q

Lower Airway Dz - BO

Tx

A

Systemic steroid = but little help

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15
Q

*Chronic sequelae of irritant gas exposure
*fever, dry cough, DOE
*Late inspiratory crackle
*CXR = bilat patchy infiltrate
*PFT = restrictive,
*DLCO (CO gas exchange test) = low
??

A

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

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16
Q

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

DX

A

Lung biops

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17
Q

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

Tx

A

Systemic steroid

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18
Q
  • asthma-like short-term (often single), high intensity exposure
  • Onset= hours to a day (NOT LONG AGO)
  • Acute damage, desquamation of airway epithelium
  • Cough, Wheeze, SOB

??

A

Reactive Airway Dysfunction Syndrome (RADS)

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19
Q

Reactive Airway Dysfunction Syndrome (RADS)

Tx

A

Bronchodialators

S/s last for months or permanently

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20
Q

*asthma induced/exacerbated by exposures in the workplace

A

Occupational Asthma (OA) / Work Related Asthma

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21
Q

Occupational Asthma (OA) / Work Related Asthma

Types

A

W/ latency

  • high molecular weight
  • low molecular weight

W/o latency (irritant asthma/RADS)

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22
Q
  • chronic daily exposure
  • Upper airway irritation
  • rhinorrhea
  • eye itching
  • wheezing
  • SOB
  • IMPROVE W/ leaving workplace

?

A

Occupational Asthma (OA) / Work Related Asthma. W/ LATENCY

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23
Q

Occupational Asthma (OA) / Work Related Asthma

Risks

A

Atopy, smoking

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24
Q

Occupational Asthma (OA) / Work Related Asthma

Path

A

High mol weight

  • IgE attacks (classic hypersensitivity)
  • -plants, animal products, insects–

Low mol weight

  • IgE against (LMW + Protein)
  • -Diisocyanates, anhydrides, wood dust
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25
Q

Occupational Asthma (OA) / Work Related Asthma

Dx

A
  • asthma Dx
  • onset after entering work
  • associate to work
  • Association between s/s + work
  • 1-2: tests associated between particle + s/s
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26
Q

Occupational Asthma (OA) / Work Related Asthma

Tx

A
  • avoid exposure
  • protective devices
  • usual asthma meds not so helpful (CONTINUOUS EXPOSURE)
  • continuous exposure may cause damage
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27
Q
  • Monday morning fever + chest tightness
  • s/s seem to improve upon repeated workers
  • may go chronic

*cotton processing workers

A

Byssinosis

28
Q

20-30 years of coal exposure

  • parynchymal disease
  • coal macule –> coal nodule
A

Coal workers Pneumoconiosis (CWP)

29
Q

Coal workers Pneumoconiosis (CWP)

Type of coal

A

Antracite>Bituminous

30
Q

Coal workers Pneumoconiosis (CWP)

  • Asymptomatic
  • CXR = W/ small (less than 1cm) nodules in UPPER PART OF LUNG
A

Simple
Coal workers Pneumoconiosis (CWP)

Tx = stop work

31
Q

Coal workers Pneumoconiosis (CWP)

DX

A

*Hx of work in mine

  • Historically - needed biopsy
  • think cancer? (PMF) = biospsy
  • nodules = bleeding w/ biopsy
32
Q

CXR: small nodule, 1st in upper lobes, then diffuse

PFT: decline in FEV1, FVC; decline in DLCO/hypoxia (advanced)

A

Coal workers Pneumoconiosis (CWP)

33
Q

Coal workers Pneumoconiosis (CWP)

Tx

A

Nothing, stop work
Surveil
Vaccinate

34
Q

inhalation/reaction of silia dust

A

Silicosis

35
Q
  • Small round nodular densities in upper lobes
  • slow progression w/ PMF exposure
  • over decade of exposure to silia
A

Chronic (classic) silicosis

36
Q
  • 5-10 years high concentration exposure
  • fast progression
  • Autoimmune dz
A

Accelerated SIlicosis

37
Q
  • few months - 5 years massive silica exposure
  • acute dyspnea
  • diffuse lung involvement (lower)
  • Rapid progression to respiratory failure/death - no TX but ventilator
A

Acute Silicosis

38
Q 
DOE
Cough sputum
Chronic hypoxic failure
PMF
*up risk of cancer (class 2A)

General s/s?

A

Silicosis

Watch hemoptysis/weightloss (cancer, TB added)

39
Q
  • silicosis w/ acceleration

* Fever, weight loss, producive cough

A

W/ TB

40
Q
  • PFT : possibly before radiographic changes
  • down DLCO
  • restrictive/obstructive/mixed
  • decrease DLCO
  • Low PaO2

+ history

DX?

A

Silicosis

Looks like coal

41
Q

Silicosis

Tx

A
  • Prevention
  • complication Tx (TB)
  • acute? = whole lung lavage, lung/heart+lung transplant
42
Q

Silicosis path

A
  • Silica in macrophage
  • Macrophate release cytokines
  • Fibroblasts come
  • Release reticulin/form hyalinized collagen fibers
  • Nodule
43
Q
  • coal exposure
  • progressive dyspnea/cough/melanoptysis
  • crackles
  • clubbing
  • Pulmonary fibrosis
A

Complicated CWP

44
Q
  • asbestos exposure
  • choronic fibrosing lung dz
  • lower lobes (as Base Tosis)
  • no PMF
  • Smoking AFFECTS
  • exposure 20+ yrs or sooner
  • trapped in type I cells
A

Asbestosis

45
Q
  • asbestos exposure
  • younger (10-15 years)
  • fluid in lungs, clears, then reappears other side
  • effusion - exudative, bloody
  • RISK - diffuse pleural thickening
A

Benign asbestosis related Pleural effusion

46
Q
  • construction/shipbuilding/pipefitting
  • cough/sputum
  • chest tightness
  • wheezing

CXR: reticulonodular pattern in Base (as BASE tosis) , Pleural plaques, interstitial fibrosis/honeycomb

PFT: restrictive pattern
Low DLCO

A

Asbestosis

47
Q

*parietal lesions = white, raised, focal, irregular
*reaction to mesothelial cells to asbestos
*grow slow, never cancer
PFT : slow FVC delcine

A

Pleural plaque

48
Q

Round atelectasis

A
  • asymptomatic, maybe Dyspnea, Cough, pain
  • surgery
  • men
49
Q
  • asbestos exposure
  • tumor on parietal/visceral pleura, peritoneum
  • +/- pleural effusion (+/- large)
  • men

*pain, dyspnea, fever, hemoptysis, night sweats weight loss

A

Mesothelioma

50
Q

Mesothelioma

Tx

A

Localized = surgery Pleurectomy

Diffuse = chemo/radiation, resection

*8-12 month survival

51
Q

Most dangerous fiber in mesothelioma

A

Crocidolite fiber

52
Q

Grain dust

A

COPD like symptoms

Productive cough
Obstructive PFT

53
Q

Flu-like s/s - fever, chills, malaise, mild wheezing

Volatized upon burning

A

Polymer fume fever

teflon

54
Q

Exposure

Flu-like symtpoms

Resolve quickly

Welding of steel

A

Metal fume fever

Zinc oxide

55
Q
  • exposure: drill bits, cutting tools, tech industry
  • bronchiolitis, granulatomous/fibrotic dz
  • pulm fibrosis s/s NOT occupation asthma (must differentiate)
A

Hard metal lung dz

Tungsten carbide, cobalt

Tx: steroid

56
Q
  • working in fluorescent light/ computer/electronic industry
  • acute relatively large exposure –> tracheo bronchitis

*chronic exposure –> granulomatous parenchymal disease –> like sarcoidosis

CXR: miliary pattern + HILAR LYMPHADENOPATHY + interstitial markings

A

Berylliosis

Tx: Corticosteroids

Dx: Hz, Lymphocyte Proliferation Test, Beryllium in lung w/ biopsy

57
Q

*farmer’s lung/bird fancier’s dz/ chemical workers/ many jobs / take care of animals
*inflammatory dz of lung involving alveolar walls + terminal airways w/ repeated exposure (Th1 cell)
*granuloma formation
LAB: IgG antibody
BIOPSY: loose, non-caseating granuloma

??

A

Hypersensitivity pneumonitis (HP)

58
Q

Hypersensitivty with Th1 cell vs. Th2 cell

A

Th1 = HP

Th2 = asthma

59
Q
  • 4-12 hrs after exposure + abrupt onset of viral-like respiratory s/s
  • +/- crackles, tachycardia, tachypnea, fever
  • CXR: micronodular interstitial (often lower)
  • PFTs: Restrictive, DOWN DLCO
  • proteolytic enzyme destruction

Biopsy: non-caseating granulomas

A

Acute Hypersensitivity pneumonitis (HP)

Tx: avoid allergen, corticosteroids

60
Q

Acute Hypersensitivity pneumonitis (HP)

Progress to:

A

Subacute :
W/ weight loss

Chronic:
Heart failure s/s
Lung failure s/s = cyanosis, clubbing, crackles, peripheral edema

61
Q

CT : ill-defined nodules

A

Hypersensitivity pneumonitis (HP)

62
Q

Hypersensitivity pneumonitis (HP)

Tx

A
  • avoid exposure
  • steriod
  • chronic- nothing/transplant
63
Q

*exposure NO2 from plant matter = bleach smell, reddish brown gas

  • Mild exposure: airway irritation, cough, tightness,
  • Heavy exposure: p edema, asphyxiation

*sept-october

A

Silo Filler’s Dz

64
Q

Benign Asbestos-related Pleural Effusion (BAPE)

Dx

A

Thoracentesis + Pleural biopsy

Tumor-free interval of 3 years

65
Q

asbestos body

A

Yellow-brown on light microscopy

Asbestos fiber in Fe/Ca salt/protein

66
Q
  • coal exposure
  • coalesces of small nodules to greater than 1 cm (PROGRESSIVE MASSIVE FIBROSIS)
  • before death
A

Complicated Coal Workers Pneumoconiosis (CWP)

67
Q

Coal Worker’s Pneumoconiosis + Rheumatoid arthritis

A

Caplan Syndrome

EKG/Radiology (10 decks)

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