Occupational/Environmental

Question 1

Byssinosis= (syndrome)

Answer 1

Monday Morning Fever

-associated with raw cotton

Question 2

Test to show sensitization to beryllium

Answer 2

beryllium proliferation test

Question 3

Occupational exposure associated with emphysema

Answer 3

Cadmium

Question 4

Metal fume fever mostly due to

Answer 4

zinc oxides from welding

Question 5

Occupational Assoc with Platinum

Answer 5

Asthma (type 1 sensitization)

-catalytic converter or Jewelry

Question 6

Occupational Assoc with Chromium

Answer 6

Nasal septum perforation (chrome holes) or lesions on fingers

Question 7

Perforated nasal septum = (3 things)

Answer 7

1. Chromium
2. Blasto
3. Cocaine

Question 8

Garlic odor on breath or sweat

Answer 8

Selenium

Question 9

Green tongue (+/- ILD)

Answer 9

Vanadium

Question 10

Garlic or fishy odor and massive hemolysis –>

Answer 10

Arsine gas (preservative in wood)

Question 11

Bone necrosis (phossy jaw) and contact burns

Answer 11

Phosphorus

Question 12

Hypocalcemia and severe burns

Answer 12

Hydrofluoric acids

Question 13

Silicosis associated with other conditions:

Answer 13

1. Mycobacterial and fungal infection (cavity as clue)
2. Lung cancer (independent of smoking)
3. airflow obstruction (if COPD- 2/2 smoking; but can get obstruction due to compression of nodules or LN)
4. ?scleroderma, RA, vasculitis

Question 14

Coal and emphysema

Answer 14

Unlike silicosis, coal can directly lead to emphysema

-PFTs change less than silica, usually asx

Question 15

Is coal a carcinogen?

Answer 15

No.

Unlike silica and asbestos.

Question 16

Caplan syndrome:

Answer 16

Patient with RA (or dx in the near future), exposed to coal dust, nodule with necrotic center

Question 17

Asbestos fiber more strongly tied to malignancy?

Answer 17

amphibole (straight, insoluble in macrophage)

Question 18

Asbestos and malignancy

Answer 18

1. multiplicative risk with smoking for bronchogenic carcinoma
2. Mesothelioma- no synergy with tobacco smoke

Question 19

Pleural plaque: significance

-not useful for

Answer 19

• present in 80-90% of patients with asbestosis

- not clear that there is increased risk of malignancy with pleural plaque

Question 20

Famer’s lung antigen

Answer 20

thermophilic actinomycetes (Faenia rectivirgula)

Question 21

Occupational HP associated with plastic/resin

Answer 21

Toluene diisocyanate or trimellitic anhydrides