Occupational and Environmental Lung Disease Flashcards
Chest Xray: small rounded opacities
Silicosis, Coal worker pneumoconiosis
Chest xray: small, linear opacities
Asbestosis
Usual pattern of the disease
Restrictive Pattern
Decreased diffusing capacity
Measurement of ______ can be used to detect an acute bronchoconstrictive response
change in forced expiratory volume in 1 s (FEV1) before and after a working shift
For patients with history of asbestos exposure, CT scan is more sensitive in detecting ___
pleural thickening
What imaging improves detection of Asbestosis
High-resolution CT (HRCT)
____ are absorbed in the lining fluid of the upper and proximal airways and thus tend to produce irritative and bronchoconstrictive responses.
Water-soluble gases such as ammonia and sulfur dioxide
______ may penetrate to the bronchioles and alveoli in sufficient quantities to produce acute chemical pneumonitis
Less soluble gases such as nitrogen oxide and phosgene
Dust size and location
>10–15 μm in diameter do not penetrate beyond the nose and throat
<10 μm in size are deposited below the larynx
A diffuse interstitial fibrosing disease of the lung that is directly related to the intensity and duration of exposure
Abestosis
Abestosis resembles ___
Diffuse Interstitial Fibrosis
Clue: Ab copy D
Major effects from exposure to Asbestos
- Pleural and Pulmonary fibrosis
- Cancers of the respiratory tract
- Pleural and peritoneal mesothelioma
Exposure to asbestos has taken at least ______ before the disease becomes manifest
10 years
Pleural plaques in chest xray, signifies ___
Past exposure to asbestos
Chest radiographic hallmark of Asbestosis
Irregular or Linear opacities, in the lower lung field
HRCT finding in Asbestosis
Subpleural curvilinear lines 5-10 mm in length, that appears to be parallel to the pleural space
Spirometry in Asbestosis
Restrictive pattern
Mild flow obstruction : due to peribronchiolar fibrosis
(associated with decreased lung volume and diffusing capacity)
Most common cancer associated with Asbestos exposure
Lung cancer (associated with smoking)
(15-19 years between exposure and development of disease)
Associated with asbestos exposure, but not with smoking
Mesothelioma
(short-term asbestos exposures of ≤1–2 years, occurring up to 40 years in the past)
Oldest known occupational hazard
Free silica
Crystalline quartz
Acute silicosis can develop with as little as ________
10 months exposure
Clinical and Pathologic features of Silicosis is similar to ______
Pulmonary Alveolar Proteinosis
Clue: SiPAP
Chest Xray: Silicosis
Profuse miliary infiltration OR consolidation
HRCT: Silicosis
Crazy-paving pattern
____ may provide relief in silicosis, and slow its progression
Whole-lung lavage
Egg Shell Pattern
Silicosis
(Calcification of Hilar Nodes: 20% of cases)
SILICOSIS: With long-term, less intense exposure, small rounded opacities in for substances that contain no free silica, to the potentially large dust the upper lobes may appear on the chest radiograph after 15–20 years of exposure, usually without associated impairment of lung function
Simple Silicosis
SILICOSIS: The nodular fibrosis may be progressive in the absence of further exposure, with coalescence and formation of nonsegmental conglomerates of irregular masses >1 cm in diameter
Complicated Silicosis
SILICOSIS: masses can become quite large
Progressive Massive Fibrosis (PMF)
Because silica causes alveolar macrophage dysfunction, patients with silicosis are at greater risk of acquiring lung infections that involves these cells as a primary defense (3)
FAT
- Mycobacterium tuberculosis (latent TB should be treated longer)
- Atypical Mycobacteria
- Fungi
Silica has immunoadjuvant properties and may increase risk for the following:
Rheumatoid arthritis
Scleroderma
Exposure to coal dust
Coal Worker’s Pneumoconiosis
With prolonged exposure to coal dust, small rounded opacities similar to those of silicosis may develop.
Simple CWP
With prolonged exposure to coal dust, manifested by the appearance on the chest radiograph of nodules ≥1 cm in diameter generally confined to the upper half of the lungs.
Complicated CWP
This is the combination of pneumoconiotic nodules and seropositive rheumatoid arthritis.
Caplan Syndrome (seen in CWP)
It is a lightweight metal with tensile strength, good electrical conductivity, and value in the control of nuclear reactions through its ability to quench neutrons.
Beryllium
A chronic granulomatous inflammatory disease that is similar to sarcoidosis
Chronic Berrylium Disease
Bery similar to sarcoidosis
This compares the in vitro proliferation of lymphocytes from blood or bronchoalveolar lavage in the presence of beryllium salts with that of unstimulated cells.
Beryllium lymphocyte proliferation test (BeLPT)
Chest Xray is similar to sarcoidosis but hilar adenopathy is less common
Chronic Berrylium Disease
Tests required to make a diagnosis of CBD
Fiberoptic bronchoscopy with transbronchial lung biopsy
Exposure to Aluminum and titanium dioxide
Sarcoid-like reaction in lung tissue
Clue: ATS
Exposure to Tungsten carbide (tool and dye, saw blade, and drill)
Giant cell interstitial pneumonitis
Clue: G-Tan
Exposure to Cobalt (diamond polishing)
Interstitial pneumonitis
Clue: C.I.
In inorganic dust exposure: Initial site of pathologic response
Small airway inflammation
Exposure to cotton dust
Byssinosis
Characterized by clinically as occasional (early-stage) and then regular (late-stage) chest tightness toward the end of the first day of the work week
Monday chest tightness in Byssinosis
Spirometry: Byssinosis
Obstructive pattern
Presents 4–8 h after exposure to moldy hay with fever, chills, malaise, cough, and dyspnea without wheezing.
Acute Farmer’s Lung
Exposure to moldy hay
Farmer’s Lung
Inhaling this agent causes a characteristic syndrome of fever, chills, malaise, and occasionally mild wheezing, leading to the diagnosis of Polymer fume fever
Fluoropolymers (Teflon)
Clue: PFT
A similar self-limited, influenza-like syndrome—metal fume fever results from exposure to ____
Zinc oxide from welding of galvanized steel
Clue: Ang iwelding kay metal, metal consists of zinc
Exposure to nylon flock
Lymphocytic bronchiolitis
Clue: Nympho
Exposure to Diacetyl (used in butter, popcorn)
Bronchiolitis obliterans
Clue: BRead and BUTTER
Decreased ability to work due to the effects of a medical condition.
Disability
Physiologic Dysfunction
Impairment
TRUE OR FALSE
Outside Fine particulate matter is a risk factor for cardiovascular morbidity and mortality has prompted toxicologic investigations into the underlying mechanisms.
TRUE
