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A- Resp and cardio > Occupational lung disease > Flashcards

Occupational lung disease Flashcards

1
Q

Cause of silicosis

A

Free silica toxic to lungs generates O2 radicals

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2
Q

Risk factors for silicosis

A

Mining
Gold, oil, gas, coal, shale, soft sedimentary rock
Miners, drillers, crushing machine operator
Abrasive blasting with sand

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3
Q

What see on CT scan in silicosis

A

Bilateral pulmonary calcified nodules- egg shell calcification
Upper and post zones
pleural thickening
Centrilobular and sub pleural distribution
Nodules have sharp margins

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4
Q

What is subpleural on CT

A

<1cm from pleura

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5
Q

What does IGRA test test for

A

Latent TB

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6
Q

What is simple silicosis

A

Asymptomatic
Exertional dyspnoea
Patient -» SOB -> cough and sputum
Risk progression w cumulative exposure - younger present and lower initial lung function

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7
Q

What is complicated/progressive silicosis

A

Nodules merge -> mass>1cm
Mostly upper lobes
Nodules united by fibrosis, destroy alveoli -> secondary emphysema and extensive pleural thickening
Worsening SOB and hypoxia
Pulmonary HPTN, cor pulmonale, resp failure

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8
Q

What is acute silicosis

A

Vhigh exposure to inhaled silica
Prevents macrophages clearing surfactant, accumulates in aveoli
SOB + cough

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9
Q

CT acute silicosis

A

Ground glass
Crazy paving patterns

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10
Q

What is Accelerated silicosis

A

Between chronic and acute
Rapid progression
Presence of PMF wihin 10 years exposure
Softer less defined nodules

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11
Q

Investigations for silicosis

A

FVC/FEV1, TLCO
Bronchoscopy
PET scan

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12
Q

What is best amrker for prognosis in silicosis

A

Reduced TLCO

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13
Q

What find on bronchoscopy in chronic silicosis vs acute

A

Lymphocytes with reduced macrophage count
BAL WCC differnetial normal
Acute - >70% increased macrophages, visible silica particles

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14
Q

PET scan in silicosis

A

Biospy hilar and mediastinal lymphadenopathy - high negative value exclude malignancy

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15
Q

Diseases ass w silica

A

COPD without siliosis - dose reponse
Silica ass TB - increases risk of T ad HIV
High risk of non TB mycobacterium and fungal infections
Carcingoen and lung cancer risk

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16
Q

Treatment for silicosis

A

Lung transplant only treatment - no drugs work

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17
Q

CXR of coal workers pneumocosis

A

Large irregular shadowing in both upper zones
R upper lobe mass is more defined
Hyer-lucency
Smaller distinct nodules <5mm all zones bilaterally

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18
Q

History questions for CWP

A

Any repiratory symptoms prior
Any systemic symptoms
Exact smoking history
Other co-morbidities
Duties and exposure to coal dust
PPE/controls

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19
Q

Causes of obstructive AW disease

A

COPD
Asthma
Bronchiectasis
CF
bronchiolitis

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20
Q

Grading of FEV1/FVC

A

Mild - FEV1 - 80%
Mod - FEV1 - 50-80% Sev 30-50%
V severe FEV1 <30%

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21
Q

What is coal mine dust lung idsease

A

Mixed dust pneumoconiosis - coal macules -> nodules as disease progresses

22
Q

What do coal macules cuase

A

Centrilobular focal emphysema can surround macules

23
Q

When does all exposure diseases develop

A

CWP - 10 years of exposure
Silicosis - 15-30 years

24
Q

COPD and coal dust

A

Dose repsonse relationship
Bullous emphysema

25
Caplans syndrome
CWP+ Rheumatoid arthritis Round or oval opacities
26
Managemnet of CMDLD
- Many patients asymptomatic - Gradual dyspnoea may be attributed to ageing - Symptoms severity doesnt correlate w radiological featires - Symptomatic management - bronchodilators, O2 for hypoxia - Smoking cessation - Antifibrotics - Lung transplantation
27
CXR in ILD
Bilateral reticular opacities worse in bases Reduced lung volumes bilaterally L sided calcified pleural plaques No focal consolidation or pleural effisons
28
CT scan of ILD findings
Reticular opacities throughout lung Ass honeycombing w distortion architecture Traditional bronchial dilatation seen No ground glass or pleural effusions
29
ILD history questions
Sympoms review + red flags PMH - IBD, connective tissue diseases, malignancy, immunosupression Medication history incl chemo or raido Smoking Occupational Social - pets etc FH resp disease
30
Qs about asbestos exposure
Comprehensive list of positions and roles Location Dates Tasks being performed PPE or ventialtion Exposure to other hazardous materials Colleagues known to have occupational lung disease?
31
Quantifying asbestos exposure
Fibre years = inhaled fibres/ml x years of exposure
32
Exposure to disease presentation asbestosis
10-20 years
33
BAL fluid fibre conc what used for
Reliable marker for prev exposure
34
BAL fluid what is it
bronchoalveolar lavage, washing of upper resp tract in bronchoscopy to reflect what lungs are secreting
35
Lung spirometry ILD
Restrictive spirometry - reduced FEV1+FVC, maintained ration Reduced diffusion capcity - low TLCO and KCO Trnasfer of gas impaired
36
What are TLCO, KCO
TLCO = total diffusing cpacity KCO = total alveolar volume
37
How to differntiate extra vs inratpulmonary causes restrictive spirometry
Low TLCO + restrictive spirometry
38
What does Low TLCO + restrictive spirometry suggest
ILD or pneumonitis OR HF - alveoli fluid filled decreasing diffusion capacity
39
How o extrapulmonary casues of ILD cahnge TLCO, KCO
Normal TLCO Raised KCO
40
What diseases cause a pulmonary restricitve spirometry
Intersitial lung diseases Occupational lung diseases Pulmonary oedema Lobectoy Radiation therapy
41
What are non pulmonary causes of restrictive spirometry
- Kyphoscoliosis - NM diseases eg MND - Pleural diseases eg effusions, chronic empyema - Connective tissue diseases - Obesity or ascites
42
Lights criteria for pleural fluid exudate are
Serum protein ratio >0.5 Serum LDH ratio >0.6 LDH >2/3 upper limit of normal serum LDH
43
If large pleural effusion ass w plaques seen on X ray what is next step
Pleural aspiration under US guidance
44
Pleural aspiration tests how much need
40ml cytology 5ml for microbiology + biochemistry (glucose, protein/albumin,LD,pH)
45
Causes of exudate
infection Malginncy CTD PR Chylothorac ARDS Pancreatitis
46
What do if pleural fluid analysis no diagnosis given
Request contrast CT thorax Consider LA thorascopy or surgical VATs Consider radiologically guided pleural biopsy + chest tube draingage if symptomatic
47
What can cause pleural effusion
PE TB Chronic HF Lymphoma
48
CT ofmalignant mesothelioma
Diffuse soft tissue pleural thickening throughout left side of chest - best in mediastinal margins Calcified pleural plaqus and large unilateralpleural effusionsn
49
What is pleurodesis
sticking lung wall to chest to prevent re accumulation of pleural fluid
50
CT silicosis
Egg shell calcification of lymph nodes Enlarged lymph nodes + silicosis on CT

A- Resp and cardio (58 decks)

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