Occupational and Environmental Lung Diseases Flashcards
Small rounded opacities are seen in ___
Silicosis
Coal worker’s pneumoconiosis
Small linear opacities are seen in _____
Asbestosis
For patients with a history of asbestos exposure, conventional computed tomography (CT) is more sensitive for the detection of _________
pleural thickening
Particles ____ in diameter do not penetrate beyond the nose and throat
> 10–15 μm
Particles <10 μm in size are deposited below the ____.
larynx
Particles ~2.5–10 μm (coarse-mode fraction) contain crustal elements such as ___, aluminum, and iron. These particles mostly deposit relatively high in the _____.
silica, aluminum, and iron
tracheobronchial tree
These fine particles are created primarily by the burning of fossil fuels or hightemperature industrial processes resulting in condensation products from gases, fumes, or vapors.
Fine mode fraction <2.5um
The major health effects from exposure to asbestos are _____
pleural and pulmonary fibrosis
cancers of the respiratory tract
pleural and peritoneal mesothelioma.
A diffuse interstitial fibrosing disease of the lung that is directly related to the intensity and duration of exposure.
Asbestosis
Exposure has taken place for at least ___ before the disease becomes manifest.
10 years
The mechanisms by which asbestos fibers induce lung fibrosis are not completely understood but are known to involve ____ due to the generation of reactive oxygen species by the transition metals on the surface of the fibers as well as from cells engaged in phagocytosis.
oxidative injury
____ that usually are first noted in the ____ are the chest radiographic hallmark of asbestosis.
Irregular or linear opacities
lower lung fields
An indistinct heart border or a _____ appearance in the lung fields may be seen. [Asbestosis]
“ground-glass”
HRCT may show distinct changes of _____ in length that appear to be parallel to the pleural surface
subpleural curvilinear lines 5–10 mm
Pulmonary function testing in asbestosis reveals a ____ pattern with a decrease in both lung volumes and diffusing capacity.
restrictive
_____ is the most common cancer associated with asbestos exposure.
Lung cancer
____ , both pleural and peritoneal, are also associated with asbestos exposure.
Mesotheliomas
In contrast to lung cancers, these tumors do not appear to be associated with smoking.
Mesotheliomas
The risk of mesothelioma is much ____ than that of lung cancer among asbestos-exposed workers,
less
The major occupational exposures include mining; s ting; sand blasting; glass and cement manufacturing; foundry work; packing of silica flour; and quarrying, particularly of granite.
Silicosis
A characteristic HRCT pattern known as ____ in Silicosis
“crazy paving”
With long-term, less intense exposure, small rounded opacities in the upper lobes may appear on the chest radiograph after 15–20 years of exposure, usually without associated impairment of lung function
Simple Silicosis
Calcification of hilar nodes may occur in as many as 20% of cases and produces a characteristic “eggshell” pattern.
Silicosis
Silicotic nodules may be identified more readily by HRCT (Fig. 289-3). 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
Which of the following BEST describes the chest radiograph findings in acute silicosis?
A. Irregular opacities in the lower lung fields
B. Profuse miliary infiltration or consolidation
C. Rounded nodules in the upper lung fields
D. Eggshell calcification of hilar nodes
B
Which of the following imaging findings on high-resolution computed tomography (HRCT) is characteristic of acute silicosis?
A. Pleural plaques
B. Honeycombing in the lower lobes
C. “Crazy paving” pattern
D. Subpleural curvilinear lines
C
Which of the following BEST describes the cause of “eggshell” calcification seen in chronic silicosis?
A. Granulomatous inflammation
B. Silica-induced alveolar macrophage activation
C. Calcification of hilar lymph nodes
D. Pleural fibrosis from silica exposure
C
Which pathogen poses the GREATEST risk to patients with silicosis due to impaired alveolar macrophage function?
A. Influenza virus
B. Streptococcus pneumoniae
C. Mycobacterium tuberculosis
D. Aspergillus fumigatus
C
What is the MOST common pulmonary function test (PFT) pattern seen in complicated silicosis with progressive massive fibrosis (PMF)?
A. Normal PFT results
B. Isolated restrictive pattern
C. Isolated obstructive pattern
D. Mixed restrictive and obstructive pattern
D
Which of the following is considered a potential autoimmune complication of chronic silicosis?
A. Systemic lupus erythematosus
B. Scleroderma
C. Crohn’s disease
D. Multiple sclerosis
B
RA
Scleroderma
______ is 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
As in s cosis, the presence of these nodules (_____) usually is not associated with pulmonary impairment.
simple CWP
The combination of pneumoconiotic nodules and seropositive rheumatoid arthritis
Caplan Syndrome
_____ 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
Although beryllium may produce an ________, it is far more commonly associated with a _________ that is similar to sarcoidosis
acute pneumonitis
chronic granulomatous inflammatory disease
What distinguishes CBD from sarcoidosis is evidence of a _________ to beryllium.
specific cell-mediated immune response (i.e., delayed hypersensitivity)
Susceptibility to CBD is highly associated with _____ alleles that have a _____ in position 69 of the β chain
human leukocyte antigen DP (HLA-DP)
glutamic acid
______ with transbronchial lung biopsy usually is required to make the diagnosis of CBD.
Fiberoptic bronchoscopy
Exposure to dust containing tungsten carbide, also known as “hard metal,” may produce ______
Giant cell interstitial pneumonitis.
Fiberoptic bronchoscopy with transbronchial lung biopsy usually is required to make the diagnosis of CBD.
_____ is a constituent of tungsten carbide and is the likely etiologic agent of both the interstitial pneumonitis and the occupational asthma that may occur.
Cobalt
Workers occupationally exposed to cotton dust (but also to flax, hemp, or jute dust) in the production of yarns for textiles and rope making are at risk for an asthma-like syndrome known as ______.
byssinosis
_______ is characterized clinically as occasional (early-stage) and then regular (late-stage) chest tightness toward the end of the first day of the workweek (“Monday chest tightness”).
Byssinosis
After >10 years of exposure, workers with recurrent symptoms are more likely to have an _____ pattern on pulmonary function testing. [Byssinosis]
obstructive
The presentation of obstructive airway disease _____ is virtually identical to the characteristic findings in cigarette smokers, i.e., persistent cough, mucus hypersecretion, wheeze and dyspnea on exertion, and reduced FEV 1 and FEV1/FVC (forced vital capacity) ratio
in grain dust–exposed workers
This condition results from exposure to moldy hay containing spores of thermophilic actinomycetes that produce a hypersensitivity pneumonitis
Farmer’s Lung
Smoke inhalation kills more fire victims than does thermal injury.
Occupational exposure to nylon flock has been shown to induce a _______
lymphocytic bronchiolitis
Workers exposed to _______, which is used to provide “butter” flavor in the manufacture of microwave popcorn and other foods, have developed bronchiolitis obliterans.
diacetyl
Which of the following occupations is MOST strongly associated with mesothelioma?
A. Coal mining
B. Asbestos mining and ship repair
C. Sandblasting and quarrying
D. Processing alloys for nuclear power
B
Workers exposed to which of the following substances are at risk for progressive massive fibrosis (PMF) and tuberculosis?
A. Silica dust
B. Cotton dust
C. Beryllium
D. Aluminum fumes
A
A worker in the textile industry presenting with chest tightness on Mondays is likely suffering from which condition?
A. Asthma
B. Byssinosis
C. Chronic bronchitis
D. Hypersensitivity pneumonitis
B
Which occupational exposure is associated with hypersensitivity pneumonitis, particularly known as “farmer’s lung”?
A. Grain dust
B. Fungal spores and animal dander
C. Coal dust
D. Toxic chemicals
B
A worker in a battery production facility presents with acute respiratory distress syndrome (ARDS). Which toxic chemical exposure is MOST likely responsible?
A. Formaldehyde
B. Cadmium fumes
C. Sulfur dioxide
D. Hydrogen sulfide
B
A chemical worker involved in resin manufacturing develops chronic bronchitis and hypersensitivity pneumonitis. Which of the following agents is MOST likely the cause?
A. Acid anhydrides
B. Acrolein
C. Halides and acid salts
D. Nitrogen dioxide
A
Which chemical agent is MOST associated with nasopharyngeal cancer in workers exposed during the manufacture of resins, leathers, and foam insulation?
A. Halides and acid salts
B. Formaldehyde
C. Ozone
D. Cadmium fumes
B
