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Clinical Occupational Medicine > Occupational Pulmonary Disorders > Flashcards

Occupational Pulmonary Disorders Flashcards

1
Q

CXR showing tiny round opacities primarily in the upper lung fields with hilar adenopathy is most characteristic of:

a. silicosis
b. asbestosis
c. hypersensitivity pneumonitis
d. metal fume fever

A

a. silicosis

NB: egg shell calcifications of hilar nodes occur in 20% of cases

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2
Q

Wool handlers are most likely to be exposed to:

a. psittacosis
b. candidiasis
c. anthrax
d. sporotrichosis

A 
c. anthrax
NB: 
psittacosis: chlamydial infection transmitted by infected birds
brucellosis: slaughter houses
sporotrichosis: horticulturists
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3
Q

Two types of work-related asthma?

A

new onset asthma; “work-exacerbated” asthma

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4
Q

T or F: Work-related asthma are IgE mediated?

A

true

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5
Q

WRA: examples of high MW allergens:

A

pollen, wood dust, animal allergens, molds, enzymes

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6
Q

WRA: examples of low MW allergens:

A

isocyanates, acid anhydrides; colophony-fluxes; biocides.

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7
Q

T or F: Can RADS occur with single, high dose exposure?

A

True

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8
Q

Examples of RADS due to single, high dose exposure:

A

chlorine spill, hypochlorite fumes, WTC dust, acide fumes in metal plating.

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9
Q

Diagnostic tests for WRA?

A

spirometry; PEFR; IgE antigen RAST testing; rare bronchoprovocation testing

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10
Q

IgE antigen RAST testing is best for?

A

HMW antigen; problematic for LMW such is isocyanate

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11
Q

What is “gold standard” for sensitizer-induced occ asthma testing?

A

Specific bronchoprovocation testing.

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12
Q

T or F: sensitization for occ asthma may occur at levels at or below PEL?

A

True

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13
Q

Acute inhalation injury: high water solubility likely to affect?

A

upper respiratory tract and larynx; ammonia, acids, oxides of sulfur

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14
Q

Acute inhalation injury: low water solubility likely to affect? Examples:

A

lower airways; phosgene, oxides of nitrogen (NO2), MAY CAUSE DELAYED EFFECTS

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15
Q

Examples of Acute Inhalation Injury sequelae:

A

ARDS, airway scarring, RADS, BO, upper resp dysfunction, vocal chord dysfunction, PTSD

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16
Q

Among never-smokers, cause of COPD likely due to work in ___% of cases.

A

31%

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17
Q

In all COPD cases, occupational causes account for __%?

A

19%

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18
Q

In asbestos lung disease, what is the most common effect seen?

A

pleural effusions within 20 years (frequently less than 10 years)

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19
Q

What marker demonstrates significant asbestos exposure?

A

pleural plaques

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20
Q

What is latency for asbestosis?

A

25 years

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21
Q

Interstitial fibrosis (asbestosis) can resemble which radiographic feature?

A

“B-lines”

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22
Q

What spirometric measurements are affected by asbestosis?

A

decreased TLC, DLCO

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23
Q

Asbestosis affects which part of the lungs?

A

predominantly the lower lungs.

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24
Q

What is latency for mesothelioma?

A

30-35 years

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25
Q

T or F: significant asbestos exposure needed for mesothelioma?

A

False. Exposure may be short in duration and low intensity, especially if genetic factors.

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26
Q

What is the risk/synergy between smoking and mesothelioma?

A

none. (if true, there would be more cases of mesothelioma without asbestos exposure.)

27
Q

What other cancers can be due to asbestos exposure?

A

laryngeal, colon, peritoneal mesothelioma

28
Q

What occupations are at risk for silicosis?

A

mining, milling, quarry, foundry, sandblasting, pottery, glassmaking, boilers

29
Q

What disease can be associated with silicosis?

A

collagen vascular disease (scleroderma)

30
Q

“Angel wing” fibrosis is associated with?

A

progressive silicosis

31
Q

PMF, progressive massive fibrosis, is associated with what exposure?

A

silica

32
Q

Silicotic nodules differ from asbestos findings in what way?

A

Silica: rounded upper lung nodules; asbestos: linear lower lung nodules.

33
Q

“Eggshell” calcification in hilar nodes is associated with?

A

progressive silicosis

34
Q

Famous event associated with acute silicosis exposure?

A

Hawk’s Nest Disaster killed 400 workers.

35
Q

What form of silica is IARC Group 1?

A

crystalline (cystobalite from occ sources)

36
Q

What form of silica is IARC Group 3?

A

amorphous silica

37
Q

Histologic findings associated with CWP?

A

“coal macules”

38
Q

CWP: usual prognosis?

A

mild

39
Q

Caplan’s Syndrome is?

A

rheumatoid coal pneumoconiosis

40
Q

“Hard metal” disease.

A

fibrosis with giant-cell interstitial pneumonitis on biopsy

41
Q

tungsten carbide with cobalt to harden alloys

A

“hard metal” disease

42
Q

Hypersensitivity pneumonitis AKA

A

extrinsic allergic alveolitis EAA

43
Q

Examples of Hypersensitivity Pneumonitis

A

Farmer’s lung; pigeon breeder’s lung; woodworker’s lung; metal working fluids; isocyanates

44
Q

Hypersensitivity Pneumonitis cliinical findings:

A

CXR granulomata; CT scan granuloma or fibrosis; bronchoalveolar lavage `

45
Q

What disease is “immunologic from metal”?

A

beryllium lung disease

46
Q

What organ systems are affected by beryllium?

A

skin and lungs

47
Q

What is famous beryllium case?

A

“Salem Sarcoid”

48
Q

With regard to beryllium exposure, it is important to distinguish between?

A

Be DZ and Be sensitization.

49
Q

What is used to determine Be sensitization?

A

lymphocyte proliferation or transformation test.

50
Q

Chromium VI is IARC Group?

A

Group 1

51
Q

What is “popcorn lung?”

A

Bronchiolitis obliterans in diacetyl workers

52
Q

What is bronchiolitis obliterans?

A

inflammatory disease of small airways AKA constrictive or obliterative bronchiolitis

53
Q

What is PFT finding in BO?

A

fixed obstruction

54
Q

What are other suspected exposures related to BO besides diacetyl?

A

e-cigarettes, coffee processing

55
Q

Diagnosis of TB is delayed in nearly 50% of patients with active TB. T or F?

A

true

56
Q

Occupational risk for PPD conversion are high in what settings?

A

Nursing homes, correctional facilities

57
Q

Re: TST/PPD testing, assume “booster effect” if:

A

second PPD (done 1-3 weeks after initial negative PPD) is positive.

58
Q

What are cut-off values for TST?

A

5mm for immunocompromised or HIV +; 10mm or more for recent immigrant (less than 5 years) from high prevalence country, high risk population, fungal lab workers, children less than 4 years old; 15 mm no risk factors.

59
Q

Advantages of interferon-gamma testing for TB?

A

single visit, no booster effect, reduced reader bias, BCG inconsequential.

60
Q

What is current recommendation for LTBI?

A

Nine months of daily INH therapy

61
Q

What can be used is INH not tolerated for LTBI preventive therapy?

A

rifampin

62
Q

T or F: Can HCW on LTBI preventive therapy continue to work?

A

Yes. Pose no risk.

63
Q

T or F: Can HCW without evidence of active TB continue to work?

A

Yes, if counseled and periodically monitored.

64
Q

Is N-95 sufficient for RP for work with TB?

A

Yes.

Clinical Occupational Medicine (13 decks)

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