Pneumoconiosis

Question 1

Define pneumoconiosis

Answer 1

Fibrosing interstitial lung disease caused by chronic inhalation of mineral dusts

Question 2

Types of pneumoconiosis

3

Answer 2

Simple - Coal worker’s pneumoconiosis or silicosis (symptom free)

Complicated - pneumoconiosis results in loss of lung function

Asbestos - pneumoconiosis where diffuse parenchyma lung fibrosis occurs as a result of prolonged exposure to asbestos

Question 3

Causes of pneumoconiosis

3

Answer 3

Caused by inhalation of particles of:
Coal dust
Silica
Asbestos

Question 4

Risk factors for pneumoconiosis

4

Answer 4

Occupational exposure
Risk dependent on extent of exposure & size/shape of particles
Individual susceptibility importance
Co-factors such as smoking & TB contribute

Question 5

Occupations relevant to pneumoconiosis

8

Answer 5

coal mining
quarrying
iron & steel foundries
stone cutting
sandblasting
insulation industry
plumbers
ship builders

Question 6

Epidemiology of pneumoconiosis

incidence, asbestos

Answer 6

Incidence increasing in developing countries

Disability & mortality from asbestosis will continue to increase for the next 20-30 yrs

Question 7

Presenting symptoms of pneumoconiosis

general + 1 +4

Answer 7

OCCUPATIONAL HISTORY very important

Asymptomatic
Picked up on routine CXR

Symptomatic
Insidious onset shortness of breath
Dry cough
Black sputum (melanoptysis)
produced occasionally in coal worker’s pneumoconiosis
Pleuritic chest pain (due to acute asbestos pleurisy)

Question 8

Signs of pneumoconiosis on physical examination

4

Answer 8

Examination may be NORMAL
Coal worker’s pneumoconiosis & silicosis
- decreased breath sounds
Asbestosis
- end-inspiratory crepitations
- clubbing
Signs of pleural effusion or right heart failure

Question 9

Investigations for pneumoconiosis

4 types

Answer 9

CXR
CT scan
Bronchoscopy
Lung function tests

Question 10

Investigations for pneumoconiosis - CXR

1 +4

Answer 10

Simple
Micro nodular mottling

Complicated
Nodular opacities in upper lobes
Micro nodular shadowing
Eggshell calcification of hilar lymph nodes (characteristic of silicosis)
Bilateral lower zone reticulonodular shadowing & pleural plaques (in asbestosis)

Question 11

Investigations for pneumoconiosis - CT

Answer 11

Fibrotic changes can be visualised early

Question 12

Investigations for pneumoconiosis - bronchoscopy

Answer 12

Allows visualisation & bronchoalveolar lavage

Question 13

Investigations for pneumoconiosis - lung function tests

Answer 13

Restrictive pattern