Occupational Lung Diseases Flashcards
What types of things do you want to ask about when getting a full occupational history?
Not just their current job, but all the jobs they’ve ever held (can be a latency period) and a description of their actual duties with those jobs
Why protective gear did they wear?
What is silicoproteinosis and how will a patient’s chest X-ray present?
Acute silicosis
CXR - ground glass appearance, esp. in upper lobes of lungs
Progressive and often fatal reaction to massive exposure
What is the worst stage of chronic silicosis and what will happen pathologically to the lungs because of dis?
Progressive Massive Fibrosis
- > fibrotic nodules in the upper lobe become so coalesced that it pulls the base towards the upper lobe
- > forms retraction bullae at lung bases
What is the prognosis of progressive massive fibrosis and why?
Superior vena cava can become involved, and there will be inadequate return of blood to the heart
Extensive lung and cardiovascular disease often leads to cardiovascular compromise and death
-> disease progresses even in the absence of more silica
What should all patients with X-ray evidence of silicosis have yearly?
PPD skin test for TB
-> 4-6 fold increased risk for TB because of macrophage poisoning
What are the common example findings of simple CWP (coal worker’s pneumoconiosis)?
Anthracosis with fine nodules on CXR
-> PFTs usually normal, except coal miners tend to smoke so many have COPD
How do you distinguish between benign and malignant mesothelioma?
By tumor behavior rather than cell types
- > malignant tends to be invasive
- > benign has more discrete borders and push on the lungs
How can you get GI and bladder cancer from asbestos?
Asbestos can be swallowed
What is the temporal course of occupational asthma and its treatment?
Worsens each day while on the job, improves when away from work
Treatment: Bronchodilators work short-term, but true treatment is to avoid exposure
What are common asthma inducing professions / things?
Plastics manufacturings, refrigerants, hair care products
Give an example of a toxic lung injury caused by a poorly soluble agent?
Silo filler’s disease - caused by oxides of nitrogen
-> frequent in fall after harvesting hay, overlying gas can be inhaled
What are the symptoms and clinical findings of Silo filler’s disease?
Bilateral diffuse lung infiltrates on CXR
Patient will be hypoxemic and short of breath, with ARDS and diffuse alveolar damage / bronchiolitis obliterans
What is the treatment for silo filler’s disease?
Oxygen and ventilation
Corticosteroids
