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Spr2015_Week7 > Occupational Lung > Flashcards

Occupational Lung Flashcards

1
Q

___ between onset of exposure and first expression of disease

A

latency period

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2
Q

clinical effects of many toxic exposures related to ___

A

exposure dose

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3
Q

what are examples of multifactorial causation

A

1) smoking and coal mine dust = emphysema

2) allergies + isocyanates (paint/auto body)= asthma

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4
Q

definition of dose KNOW!!!

A

dose = duration x concentration

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5
Q

where do most water soluble agents deposit

where do less water soluble agents deposit?

A

water soluble = upper airway (chlorine = nasopharyngeal mucosa

less soluble = distal airways/bronchioles = nitrogen oxides1

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6
Q

where are particles > 10 um

particles

A

> 10 um = filtered in upper airway

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7
Q

what questions to ask about history

A

1) where do you work?
2) what jobs?
3) job duties?
4) specific exposures/ventilation/

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8
Q

2 major categories of occupational lung disease

A

1) airways disease

2) interstitial disease

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9
Q

types of airways diseases (4)

A

1) Immunologic asthma (asthma with latency)
2) Irritant asthma (RADS)
3) Emphysema/COPD (coal mine dust)
4) Bronchiolitis (obliterative/ constrictive)

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10
Q

types of interstitial lung diseases

A

3 pneumoconioses
• Asbestos-related lung diseases
• Silicosis
• Coal Workers Pneumoconiosis (Black Lung)

Other:
• Chronic Beryllium Disease
• Hypersensitivity Pneumonitis (Farmer’s Lung)

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11
Q

Where do airways diseases occur?

PFT?

Imaging?

A

Large or small airways

obstructive = Low FEV1
air trapping = incr RV and/or decr DLCO

normal or show airway wall thickening, air trapping, emphysema

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12
Q

Interstitial diseases
define

PFT?

IMaging

A

inflammation/fibrosis of interstitial/distal/gas exchange units

restrictive (low TLC/FVC)
decr DLCO

centrilobular inflamm/ground glass opacity
fibrosis (rounded or linear opacity)

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13
Q

causes of immunologic asthma (asthma with latency)

A

HMW: baking flours, latex, detergent enzymes –> IgE rxn

LMW: isocyanates (car), platinum salts, red cedar (plicatic acid)
(combine with endogenous proteins to create new antigens)

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14
Q

causes of irritant asthma (RADS)

A

• Strong acids and bases (eg, chlorine-containing chemicals)

(world trade center worker exposed ot high pH alkaline dust)

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15
Q

causes of emphysema/COPD

A

• Coal mine dust, silica

biomass combustion, silica, vanadium, dusts

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16
Q

causes of bronchiolitis (obliterative/constrictive)

A

Flavoring chemicals (diacetyl), oxides of nitrogen, deployment particulate matter

17
Q

Define occupational asthma

Presentation

A

1) variable airflow obstruction
airway hyperresponsive + inflamm from immunologic properties of exposure (like isocyanates= quaternary ammonium)

2) Onset = months to years after (long latnecy)
Temporal pattern (improve symptoms on certain times)
18
Q

Define RADS

Presentation

A

airway eptihelial injury from exposure to inhalants with irritant properties –> persistent hyperresponsiveness and obstruction

NO LATENCY; WITHIN 24-48 HRS AFTER EXPOSURE

19
Q

Occupational chronic
Obstructive Pulm Disease

Presentation

A

COPD/emphysema (fixed airflow limitation) from occupation

cough, sputum, wheeze, chest tightness, dyspnea

20
Q

____ found in coal mine exposure

A

emphysema (not just smoking)

21
Q

constrictive/obliterative bronchiolitis

presentation

A

pathologic injury of small airways (extrinsic or intrinsic bronchiolar narrowing)

subtle onset with cough, dyspnea, chest tightness

22
Q

2 major forms of asbestos related lung diseases

A
  • Serpentine: chrysotile

* Amphibole: croccidolite, amosite, anthophyllite, tremolite, actinolite

23
Q

asbestos lung diseases
cause

exposed groups

A

asbestos fibers = magnesium silicates when crushed break into fibers; aspect ratio (shape and size) confer disease

construction trade (boilermaker, shipyard, dock, mechanics with brakes)

24
Q

define nonmalignant asbestos related lung disease consequences

vs. malignant asbetos lung disease

A

1) benign asbestos pleural effusion, pleural thickening/calcif, rounded atelectasis, asbestosis (LOWER LUNG)
2) lung cancer, mesothelioma

25
Q

definition of silicosis

causes of silicosis

presentation

A

exposure to silica –> interstitial lung disease –> fibrotic lung disease (can’t get rid of silica from lung)

crystal silica (quartz), blast cut or grind gold or silver, foundry, sandblasters, granite,

LONG LATNECY unless high grade exposure (SOB and cough)

26
Q

coal worker pneumoconiosis
(black lung)
definition

causes

presentation

PFT

imaging

A

1) coal mine –> interstitial lung disease
2) inhalation of coal mine dust (underground > surface)
3) cough + shortness of breath
4) normal PFT
5) upper lobe small rounde nodular opacity

DUST MACULES

27
Q

CHRONIC beryllium disease
definition

causes

presentation

A

1) granulomatous disease can’t tell from sarcoidosis (except due to exposure and immune response to beryllium)
2) beryllium, inhaled during maching/grinding
3) subtle onset + cough + dyspnea + chest tightness

28
Q 
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)
definiton

causes

presentation

A

1) immune response to animal proteins (BIRD FANCIER’S OR FARMER’S LUNG
2) birds, fungi, contaminated hay, hot tubes and pools (tuberculous myco, gram neg),

3) acute = flu illness with respiratory sx
subacute/chronic = insidious (gradual)

29
Q

Role of clinician in occupational expsoure

A

OCCUPATIONAL AND ENVIRON HISTORY-TAKING

DIAGNOSIS MAY BE SENTINEL HEALTH EVENT

PREVENTION

30
Q

What are the 3 main determinants of the site and severity of occupational lung disease?

A

Dose (= duration x concentration), solubility, and particle size

31
Q

What is the difference in onset of symptoms between occupational asthma and reactive airways dysfunction syndrome (RADS)?

A

No latency with RADS, symptoms occur within 24-48 hours after exposure

32
Q

What are the 3 major types of pneumoconioses?

A
  • Asbestos-related lung diseases
  • Silicosis
  • Coal Workers Pneumoconiosis (Black Lung)
33
Q

What is the most useful clinical tool in assessing a patient for occupational lung disease?

A

Occupational and environmental history

34
Q

Which occupations are associated with the radiographic finding of progressive massive fibrosis?

A
  • Foundry work
  • Hard rock mining
  • Sandblasting
  • Stone cutting (e.g. granite countertops)
35
Q

What type of exposure should you suspect when you see pleural plaques on chest imaging?

A

Asbestos

36
Q

Which of the following is NOT an occupation or exposure associated with hypersensitivity pneumonitis?
A. Bird breeding
B. Farming
C. Hot tub and indoor pools
D. Cat breeding
E. All of the above are associated with hypersensitivity pneumonitis

A

D – cat breeding

Spr2015_Week7 (10 decks)

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