Occupational lung disorders

Question 1

Examples (of pneumoconiosis)

Answer 1

Coal workers pneumoconiosis
Bauxite fibrosis
Berylliosis
Asbestosis
Siderosis
Silicosis (Potters rot)

Question 2

Cause/pathology of coal workers pneumoconiosis

Answer 2

Inhaling coal dust
Dust particles accumulate in the lung parenchyma and are engulfed by macrophages
These macrophages then die, releasing enzymes resulting in tissue fibrosis

Question 3

Cause of bauxite fibrosis (Shavers disease)

Answer 3

Inhaling bauxite fumes

Question 4

Cause/pathology of berylliosis

Answer 4

Caused by inhaling beryllium
Causes granuloma formation (of giant cells, macrophages and epithelioid cells)
Progressive dyspnoea with pulmonary fibrosis

Question 5

What is granuloma made up of

Answer 5

(Giant cells)
Macrophages
Epithelioid cells

Question 6

Examples of other granulomatous conditions other than berylliosis

Answer 6

Tuberculosis
Leprosy
Cat-scratch disease
Sarcoidosis

Question 7

Cause/pathology of asbestosis

Answer 7

Inhalation of asbestos fibres
Associated with malignant mesothelioma
CXR also shows pleural plaques

Question 8

What cell contains fusiform rods

Answer 8

Macrophages

Question 9

Types of asbestosis (which has higher fibrogenicity)

Answer 9

White asbestos - lowest fibrogenicity

Blue asbestos - highest

Question 10

Define fibrogenicity

Answer 10

promoting the development of fibers

Question 11

Cause/pathology of siderosis

Answer 11

Caused by inhaling iron particles

Benign with no apparent respiratory symptoms or altered lung function

Question 12

Cause of silicosis

Answer 12

Caused by inhaling silica particles that can not by removed by respiratory defences

Question 13

Pathology of silicosis

Answer 13

Macrophages engulf the silica particles releasing tumour necrosis factor (TNF) and cytokines that induce fibroblasts, resulting in fibrosis and collagen deposition.
Eggshell calcification of hilar lymph nodes is apparent on CXR + nodular lesions in the upper lobes

Question 14

Which pneumoconiosis increases risk of TB infection

Answer 14

Silicosis

Question 15

What is pneumoconiosis

Answer 15

The accumulation of dust in the lungs and the reaction of the tissue to its presence

Question 16

Describe Progressive Massive Fibrosis

Answer 16

Due to progression of coal workers pneumonconiosis
Patients develop round fibrotic masses mostly situated in upper lobes
Atypical destruction of lung, resulting in emphysema and airway damage
DYSPNOEA and Fibrosis
Sputum may be black

Question 17

Describe serum sample of progressive massive fibrosis or asbestosis or silicosis

Answer 17

Rheumatoid factor and anti-nuclear antibodies are both often present in the serum of patients

Question 18

Complications of Progressive Massive Fibrosis

Answer 18

Disease can progress or develop even after coal exposure has ceased and may lead to respiratory failure

Question 19

Describe lung function test of Progressive Massive Fibrosis

Answer 19

Mixed restrictive and obstructive ventilatory defect with loss of lung volume, irreversible airflow limitation and reduced gas transfer

Question 20

Silicosis:

Describe Spirometry and CXR

Answer 20

CXR appearance show diffuse nodular pattern in upper and mid-zone and thin streaks of calcification (egg-shell calcification) of the hilar nodes
Spirometry shows a restrictive ventilatory defect

Question 21

Presentation of silicosis

Answer 21

Progressive dyspnoea

Increased incidence of TB

Question 22

Management of silicosis

Answer 22

Avoiding exposure to silica and claim compensation

Question 23

*Different types of asbestos

Which are most fibrogenic

Answer 23

90% of asbestos is chrysolite (white asbestos) which is the least fibrogenic

6% is crocidolite (blue asbestos) which is the most fibrogenic and most likely to cause asbestosis and mesothelioma due to the fact that it is readily trapped in the lung

4% is amosite (brown asbestos) which is the least common and has intermediate fibrogencicity

Question 24

Complications of asbestos

Answer 24

Risk of primary lung cancers (usually adenocarcinomas)

Significant time lag however between exposure and development of disease

Question 25

What is asbestosis + pathophysiology

Answer 25

Type of interstitial lung disease
Deposition in lung distal to the terminal bronchiole
Fibrosis of the lungs caused by asbestos dust (may or may not be associated with fibrosis of the parietal or visceral layers of the pleura)
Progressive
Also causes pleural plaques and increases risk of mesothelioma and bronchial adenocarcinoma

Question 26

Clinical presentation of asbestosis

Answer 26

Progressive disease characterised by breathlessness and progressive dyspnoea and accompanied by finger clubbing and bilateral basal end-inspiratory crackles

Question 27

Management of asbestosis

Answer 27

Symptomatic e.g. corticosteroids

Question 28

What is Byssinosis

Answer 28

Cotton dust (instead of asbestos)
Chest tightness, cough and breathlessness soon after exposure
Bad in those already with asthma

Question 29

Most common type of pneumoconiosis

Answer 29

Simple pneumoconiosis

Question 30

Chest X-ray of pneumoconiosis

Answer 30

Fine micro nodular shadowing

CXR used to grade it

Question 31

What can also cause symptoms of pneumoconiosis

Answer 31

COPD related to smoking