Occupational and Environmental Lung Disease Flashcards by Shield Lim

Chest Xray: small rounded opacities

Silicosis, Coal worker pneumoconiosis

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Chest xray: small, linear opacities

Asbestosis

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Usual pattern of the disease

Restrictive Pattern
Decreased diffusing capacity

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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

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For patients with history of asbestos exposure, CT scan is more sensitive in detecting ___

pleural thickening

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What imaging improves detection of Asbestosis

High-resolution CT (HRCT)

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____ 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

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______ may penetrate to the bronchioles and alveoli in sufficient quantities to produce acute chemical pneumonitis

Less soluble gases such as nitrogen oxide and phosgene

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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

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A diffuse interstitial fibrosing disease of the lung that is directly related to the intensity and duration of exposure

Abestosis

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Abestosis resembles ___

Diffuse Interstitial Fibrosis

Clue: Ab copy D

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Major effects from exposure to Asbestos

Pleural and Pulmonary fibrosis
Cancers of the respiratory tract
Pleural and peritoneal mesothelioma

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Exposure to asbestos has taken at least ______ before the disease becomes manifest

10 years

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Pleural plaques in chest xray, signifies ___

Past exposure to asbestos

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Chest radiographic hallmark of Asbestosis

Irregular or Linear opacities, in the lower lung field

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HRCT finding in Asbestosis

Subpleural curvilinear lines 5-10 mm in length, that appears to be parallel to the pleural space

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Spirometry in Asbestosis

Restrictive pattern
Mild flow obstruction : due to peribronchiolar fibrosis

(associated with decreased lung volume and diffusing capacity)

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Most common cancer associated with Asbestos exposure

Lung cancer (associated with smoking)
(15-19 years between exposure and development of disease)

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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)

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Oldest known occupational hazard

Free silica
Crystalline quartz

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Acute silicosis can develop with as little as ________

10 months exposure

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Clinical and Pathologic features of Silicosis is similar to ______

Pulmonary Alveolar Proteinosis

Clue: SiPAP

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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** 1. Mycobacterium tuberculosis (latent TB should be treated longer) 2. Atypical Mycobacteria 3. 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