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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
Q

Caplans syndrome

A

CWP+ Rheumatoid arthritis
Round or oval opacities

26
Q

Managemnet of CMDLD

A
  • 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
Q

CXR in ILD

A

Bilateral reticular opacities worse in bases
Reduced lung volumes bilaterally
L sided calcified pleural plaques
No focal consolidation or pleural effisons

28
Q

CT scan of ILD findings

A

Reticular opacities throughout lung
Ass honeycombing w distortion architecture
Traditional bronchial dilatation seen
No ground glass or pleural effusions

29
Q

ILD history questions

A

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
Q

Qs about asbestos exposure

A

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
Q

Quantifying asbestos exposure

A

Fibre years = inhaled fibres/ml x years of exposure

32
Q

Exposure to disease presentation asbestosis

A

10-20 years

33
Q

BAL fluid fibre conc what used for

A

Reliable marker for prev exposure

34
Q

BAL fluid what is it

A

bronchoalveolar lavage, washing of upper resp tract in bronchoscopy to reflect what lungs are secreting

35
Q

Lung spirometry ILD

A

Restrictive spirometry - reduced FEV1+FVC, maintained ration
Reduced diffusion capcity - low TLCO and KCO
Trnasfer of gas impaired

36
Q

What are TLCO, KCO

A

TLCO = total diffusing cpacity

KCO = total alveolar volume

37
Q

How to differntiate extra vs inratpulmonary causes restrictive spirometry

A

Low TLCO + restrictive spirometry

38
Q

What does Low TLCO + restrictive spirometry suggest

A

ILD or pneumonitis
OR
HF - alveoli fluid filled decreasing diffusion capacity

39
Q

How o extrapulmonary casues of ILD cahnge TLCO, KCO

A

Normal TLCO
Raised KCO

40
Q

What diseases cause a pulmonary restricitve spirometry

A

Intersitial lung diseases

Occupational lung diseases

Pulmonary oedema

Lobectoy

Radiation therapy

41
Q

What are non pulmonary causes of restrictive spirometry

A
  • Kyphoscoliosis
  • NM diseases eg MND
  • Pleural diseases eg effusions, chronic empyema
  • Connective tissue diseases
  • Obesity or ascites
42
Q

Lights criteria for pleural fluid exudate are

A

Serum protein ratio >0.5
Serum LDH ratio >0.6
LDH >2/3 upper limit of normal serum LDH

43
Q

If large pleural effusion ass w plaques seen on X ray what is next step

A

Pleural aspiration under US guidance

44
Q

Pleural aspiration tests how much need

A

40ml cytology
5ml for microbiology + biochemistry (glucose, protein/albumin,LD,pH)

45
Q

Causes of exudate

A

infection
Malginncy
CTD
PR
Chylothorac
ARDS
Pancreatitis

46
Q

What do if pleural fluid analysis no diagnosis given

A

Request contrast CT thorax
Consider LA thorascopy or surgical VATs
Consider radiologically guided pleural biopsy + chest tube draingage if symptomatic

47
Q

What can cause pleural effusion

A

PE
TB
Chronic HF
Lymphoma

48
Q

CT ofmalignant mesothelioma

A

Diffuse soft tissue pleural thickening throughout left side of chest - best in mediastinal margins
Calcified pleural plaqus and large unilateralpleural effusionsn

49
Q

What is pleurodesis

A

sticking lung wall to chest to prevent re accumulation of pleural fluid

50
Q

CT silicosis

A

Egg shell calcification of lymph nodes
Enlarged lymph nodes + silicosis on CT

A- Resp and cardio (58 decks)

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