Pneumoconioses, Toxins, Pollution

Question 1

What exposure causes Byssinosis?

Answer 1

chronic exposure to raw, unprocessed cotton

Question 2

What are symptoms of byssinosis? PFTs?

Answer 2

Symptoms of RAD. Obstructive PFTs

Chronic exposure to raw cotton

Question 3

What exposure causes Organic Dust Toxic Syndrome?

AKA “Toxic Alveolitis” or “Pulmonary Mycotoxicosis”

Answer 3

hog confinment facilities, incluing grinding.

Question 4

What exposure causes Metal Fume Fever?

Answer 4

Zinc Oxide, from welding or brazing galvonized metal.

Question 5

What are symptoms of Metal Fume Fever?

Answer 5

Flu-like symptoms, hours after exposure. Worse after time away from work, such as a weekend.

Question 6

What exposure causes “Polymer Plume Fever’? What other disease is closely related?

Answer 6

Melting teflon, such as on a heating element.

Works like Metal Fume Fever (Zn-Oxide, welding)

Question 7

What molecule causes Silo Filler’s Disease?

Answer 7

Nitrogen Oxide (NO2)

Question 8

What are symptoms of silo filler’s disease?

Answer 8

mild, self-limiting cough, dyspnea, fatigue.

Longer exposures cause asphyxiation, pulmonary edema, BOOP, ARDS.

Question 9

What exposure causes Ornithosis?

Answer 9

Chlamydia Psittaci.
Ornothosis, AKA Psittacosis)
From birds - owners, pet shops, vets. Parrots and parakeets.

Question 10

What are symptoms of ornithosis?

Answer 10

blood tinged cough, flu like symptoms

Question 11

What is treatment for ornithosis?

Answer 11

Doxycycline.
2nd line is azithromycin.
Due to Chlamydia Psittaci.

Question 12

What are the symptoms of Nylon Flock Worker’s Lung?

Answer 12

ILD

Question 13

What exposure causes Hydrogen Sulfite exposure?

Answer 13

Sewer gas

Question 14

What is the treatemnt for hydrogen sulfite exposure?

Answer 14

humidified O2, bronchodilators.

Question 15

What are symptoms of hydrogen sulfite exposure?

Answer 15

Low dose is irritant, but high dose is asphysant and interferes with oxygen utilization and CNS function.
Exposure causes loss of sense of smell quickly, so prolonged exposure may occur. Smells like rotten eggs.

Question 16

What is the timeline of acute HP?

Answer 16

Symptoms start in 4-8 hours, last 12-24 hours.

Brief, intense exposure.

Question 17

What are the CT findings of HP?

Answer 17

Poorly defined micronodules, widespread GGOs with mosaic pattern in upper & middle lung zones.

Question 18

What are the PFT findings of HP?

Answer 18

Restrictive PFTs and decreased diffusion capacity.

Question 19

What are the BAL findings of HP?

Answer 19

Lymphocytosis (>65%; normal is 6%), and decreased CD4/CD8 ratio.

Question 20

What is the most common occupational lung disease worldwide?

Answer 20

Silicosis

Question 21

What are the CT findings of silicosis?

Answer 21

Egg shell calcifications, calcified lymph nodes, crazy paving (if acute), poorly formed nodules.

Question 22

What is the buzz-word histology of silicosis? What is the other ddx?

Answer 22

• Bire-fringent. Ddx: Talc

- Acute has alveolar proteinosis.

Question 23

What does acute silicosis progress to?

Answer 23

Progressive Massive Fibrosis

Question 24

What are the PFT findings of silicosis?

Answer 24

restrictive, diffusion capacity decreased

Question 25

Silicosis causes increased risk for what other two diseases?

Answer 25

TB, lung cancer

Question 26

What is the histology of coal worker's pneumoconoisis?

Answer 26

black nodules & lymph nodes, centrilobular emphysema, coal-laden alveolar macrophages.

Question 27

What is the increased risk for lung cancer with coal-worker's pneumoconoisis?

Answer 27

None

Question 28

What are the two major types of asbestos fibers? Which is worse?

Answer 28

- Crocidolite is most fibrogenic and carcinogenic. | - Chrysotile (serpentine) is not as bad.

Question 29

What is the histology of asbestos?

Answer 29

Ferruginous bodies, looks like barbells. Coated with iron and mucopolysaccharide.

Question 30

Are asbestos pleural plauqes on the parietal or visceral pleura?

Answer 30

Parietal pleura

Question 31

How long after asbestos exposure do pleural plaques develop?

Answer 31

>20 years

Question 32

Does asbestos exposure increased you risk for: Lung cancer? COPD? TB?

Answer 32

Increased risk for lung cancer, multiplicative with tobacco smoking. No risk for TB or COPD.

Question 33

What are the CT findings of mesothelioma?

Answer 33

Circumferential, unilateral pleural thickening

Question 34

What exposure gives you beryllium exposure?

Answer 34

flourescent light manufacturing or aerospace industry

Question 35

How is Chronic Berylium Disease diagnosed?

Answer 35

- beryllium sensitivity on BAL CD4 cells | - Lymphocyte proliferate response

Question 36

What is treatment for Chronic Beryllium Disease?

Answer 36

steroids

Question 37

What disease does Chronic Beryllium Disease look like, in terms of disease progression?

Answer 37

Sarcoidosis

Question 38

Buzzword: drill bits, metal hardening

Answer 38

Cobalt with giant interstitial pneumonitis or hard metal lung disease

Question 39

Buzzword: nasal septum perforation or lesions on fingers

Answer 39

Chrome exposure. Ddx with nasal perforation is cocaine and blastomycosis

Question 40

Buzzword: catalytic converter or jewelry manufacturers with asthma

Answer 40

Platinum (type 1 hypersensitivity)

Question 41

Buzzword: Garlic odor on breath

Answer 41

selenium

Question 42

Buzzword: garlic/fish odor and massive hemolysis

Answer 42

arsine gas

Question 43

Buzzword: methamphetamine production

Answer 43

ammonia or phosgene gas

Question 44

Buzzword: bone necrosis, deep burns on contact

Answer 44

phosphorus

Question 45

Buzzword: refining nickel with diffuse ILD

Answer 45

Nickel carbonyl

Question 46

Buzzword: hypocalcemia and severe burns

Answer 46

hydroflouric acid

Question 47

Buzzword: oil industry and rotten egg smell:

Answer 47

hydrogen sulfide H2S)

Question 48

Buzzword: Pathology looks like granulomas and sarcoid, but history has occupational exposure

Answer 48

berrylium

Question 49

Buzzword: confused, elderly, in home, in winter

Answer 49

carbon monoxide.