Occupational Lung Disease

Question 1

Give four occupational agents that can cause acute bronchitis:

Answer 1

1) sulphur dioxide
2) chlorine
3) ammonia
4) oxides nitrogen

Question 2

What occupational agent causes pulmonary fibrosis:

Answer 2

Mineral Dust

Question 3

Give three occupational agents that can cause bronchial carcinoma:

Answer 3

1) asbestos
2) polycyclic hydrocarbons
3) radon (found in mines)

Question 4

What is the most common industrial lung disease in the developed world?

Answer 4

occupational asthma

Question 5

What is the name given to iron deposits?

Answer 5

siderosis

Question 6

What is the name given to barium deposits?

Answer 6

baritosis

Question 7

What is the name given to tin deposits?

Answer 7

stannosis

Question 8

What CXR finding would support diagnosis iron/ barium/ tin deposits in the lung?

Answer 8

dramatic, dense, nodular shadowing

Question 9

True or false: iron/ barium/ tin deposits have a minimal effect on lung function

Answer 9

True

Question 10

Does asbestos and silica cause low, intermediate or high levels of lung fibrosis?

Answer 10

high

Question 11

Does coal dust cause low, intermediate or high levels of lung fibrosis

Answer 11

intermediate

Question 12

In which anatomical regions does coal dust get stuck?

Answer 12

1) small airways
2) alveoli

Question 13

What is the size of coal dust particles?

Answer 13

2-5um

Question 14

What are the two types of coal-worker’s pneumoconiosis?

Answer 14

1) simple pneumoconiosis
2) progressive massive fibrosis

Question 15

What is simple pneumoconiosis?

Answer 15

deposition of coal dust in the lungs causing minimal functional change

Question 16

What CXR finding would be associated with category 1 simple pneumoconiosis?

Answer 16

Small round or irregular opacities (nodules)

Usually less than 10 mm in diameter

Found bilaterally in the upper lung zones

Most often seen in the posterior segments of the upper lobes

No significant coalescence of opacities

They are discrete and well-spaced, not merging into larger masses (which is seen in complicated pneumoconiosis)

No signs of fibrosis or lung distortion

No evidence of progressive massive fibrosis (PMF)

Question 17

What CXR finding would be associated with category 2 simple pneumoconiosis?

Answer 17

numerous small round opacities but normal lung markings visible

Question 18

What CXR finding would be associated with category 3 simple pneumoconiosis?

Answer 18

very numerous small round opacities and normal lung markings are obscured

Question 19

True or false: it is not possible for simple pneumoconiosis to progress to progressive massive fibrosis

Answer 19

false (although it is rare in category 1)

Question 20

What is progressive massive fibrosis?

Answer 20

a form of coal-worker’s pneumoconiosis characterised by the patient developing round, fibrotic masses, several centimetres in diameter found in the upper lobe

Question 21

What two serum markers indicate progressive massive fibrosis?

Answer 21

1) rheumatoid factor
2) antinuclear antibodies

Question 22

Give 5 ways in which progressive massive fibrosis manifests:

Answer 22

1) apical destruction
2) emphysema and airway damage
3) reduces gas transfer
4) irreversible airflow limitation
5) loss of lung volume

Question 23

True or false: progressive massive fibrosis shows a mixed restrictive and obstructive ventilatory defect in lung function tests

Answer 23

True

Question 24

Give 3 clinical presentations associated with progressive massive fibrosis:

Answer 24

1) cough
2) considerable effort dyspnoea
3) black sputum

Question 26

Give 3 occupations that increase risk of silicosis?

Answer 26

1) stone masons 2) sand-blasters 3) pottery and ceramic workers

Question 27

Explain how silicon dust is so fibrogenic:

Answer 27

it is toxic to alveolar macrophages, causing them to recruit fibroblasts

Question 28

What is the classic CXR sign associated with silicosis?

Answer 28

eggshell calcification (distinctive thin streaks of calcification found around the hilar lymph nodes)

Question 29

What is the name given to lung disease caused by cotton dust?

Answer 29

Byssinosis

Question 30

What is Monday sickness?

Answer 30

the initial presentation of byssinosis which begins on the first day back at work after a break e.g. a weekend

Question 31

Give 3 symptoms of byssinosis:

Answer 31

1) tightness of the chest 2) cough 3) breathlessness

Question 32

Describe how cotton inhalation causes byssinosis:

Answer 32

raw cotton contains bacteria which produces endotoxins which cause constriction of airways

Question 33

True or false: dramatic CXR findings are seen in byssinosis

Answer 33

false (there are no CXR changes)

Question 34

What is the name given to lung disease caused by beryllium inhalation?

Answer 34

berylliosis

Question 35

Name 3 areas where there is an increased risk of beryllium inhalation:

Answer 35

1) aerospace industry 2) atomic reactors 3) electrical devices

Question 36

What are 3 presentations associated with berylliosis:

Answer 36

1) progressive dyspnoea 2) systemic illness 3) pulmonary fibrosis (similar picture to sarcoidosis)