Occupational Lung disease Flashcards

1
Q

What is pneumoconiosis?

A

A common dust disease in countries that have or have had underground coal mines. It resluts from inhalation of coal dust particles over 15-20 years. These particles are ingested by macrophages, which die and release enzymes, leading to pulmonary fibrosis

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2
Q

What are the main causes of pneumoconiosis?

A
  • Coal
  • Silica
  • Beryllium
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3
Q

What is silicosis?

A

Restrictive lung disease caused by inhalation of silica particles, which are very fibrogenic

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4
Q

What jobs may be associated with the development of silicosis?

A
  • Metal mining
  • Stone quarrying
  • Snadblasting
  • Pottery/ceramic manufacture
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5
Q

What are features of pneumoconiosis?

A

Often asymptomatic

  • Dyspnoea
  • Cough
  • Chest tightness/wheezing
  • Clubbing
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6
Q

What respiratory problem commonly co-exists with pneumoconiosis?

A

Bronchitis

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7
Q

How might you investigate someone with suspected pneumoconiosis?

A
  • PFTs
  • CXR/CT
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8
Q

What might you see on CXR in someone with pneumoconiosis?

A

Many round opacities, especially in the upper zones

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9
Q

How would you manage pneumoconiosis?

A
  • Avoid dust exposure
  • Stop smoking
  • Treat co-exisitng bronchitis
  • Consider pulmonary rehab
  • Consider supplemental oxygen therapy
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10
Q

Can those with pneumoconiosis claim compensation?

A

Yes (industrial injuries act)

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11
Q

What are clinical featurs of silicosis?

A

Progressive dyspnoea

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12
Q

What respiratory infection is found more commonly in those with silicosis?

A

TB

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13
Q

What might you find on CXR in someone with silicosis?

A
  • Diffuse miliary or nodular pattern in upper and mid-zones
  • Egg shell calcificaiton of hilar nodes
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14
Q

What is caplan’s syndrome?

A

A combination of rheumatoid arthritis (RA) and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray

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15
Q

What spirometric defect will someone with silicosis have?

A

Restrictive

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16
Q

How would you manage someone with silicosis?

A
  • Avoid silica
  • Stop smoking
  • Manage complications - O2 requirement etc.
17
Q

Can those with silicosis claim compensation?

A

Yes (Industrial injuries act)

18
Q

What can coal worker’s pneumoconiosis progress to?

A

Progressive massive fibrosis - causes progressive dyspnoea, fibrosis and cor pulmonale

19
Q

What is asbestosis?

A

Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres

20
Q

What are the main abnormalities caused by asbestos inhalation?

A
  • Plaques
  • Diffuse pleural thickening
  • Benign pleural effusions
  • ROunded atelectasis
21
Q

What are the main forms of asbestos?

A
  • Chrocidolite
  • Amosite
  • Chrysilate
22
Q

What is the most fibrogenic asbestos fibre type?

A

Chrocidolite

23
Q

What is the least fibrogenic asbestos fibre type?

A

Chyrsolite

24
Q

What is the most common asbestos fibre?

A

Chrysolite

25
Q

What are features of asbestosis?

A
  • Progressive Dyspnoea
  • Cough
  • Clubbing
  • Fine end inspiratory crackles
26
Q

What investigations would you consider doing in someone with suspected asbestosis?

A
  • CXR
  • PFTs
  • HRCT
  • BA Lavage/biopsy
27
Q

What might you see on CXR in someone with asbestosis?

A
  • Lower zone linear interstitial fibrosis -> spreads to entire lung
  • Pleural thickening
  • Plaques
28
Q

How would you manage someone with asbestosis?

A
  • Stop smoking
  • Consider pulmonary rehab and oxygen therapy
  • Consider lung transplant
29
Q

Are those with asbestosis eligible to claim compensation?

A

Often able to - Industrial injuries act

30
Q

What is mesothelioma?

A

Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis.

It is one of the few cancers related directly to an environmental exposure; asbestos is the chief causative agent.

31
Q

What are clinical features of malignant mesothelioma?

A
  • Chest pain
  • Dyspnoea
  • Weight loss
  • Cough
  • Finger clubbing
  • Recurrent pleural effusion
  • Signs of mets - Lymphadenopathy, Hepatomegaly, bone pain, abdo pain/obstruction
32
Q

Is compensation available for those with mesothelioma?

A

Often yes - Industrial injuries act

33
Q

What investigations would you consider doing in someone with suspected mesothelioma?

A
  • Bloods - FBCs, U+E’s, LFTs
  • Imaging - CXR, CT scan, PET scan
  • Specific - thoracocentesis, pleural biopsy, PFTs
34
Q

How can pathological confirmation of mesothelioma be obtained?

A
  • Thoracocentesis
  • Pleural biopsy
35
Q

What might you see on CXR in someone with mesothelioma?

A
  • Unilateral pleural effusion
  • Irregular pleural thickening
  • Reduced lung volumes
  • Parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)
36
Q

How is diagnosis of mesothelioma made?

A

Thoracoscopy specimen on histology

37
Q

How would you manage someone mesothelioma?

A
  • Consider if operable
  • Pemetrexed and cisplatin
  • Palliative procedures - Pleurodesis, indwelling drains, radiotherapy
38
Q

What is the prognosis of mesothelioma?

A

Very poor - Overall, the median survival is 10 to 15 months