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Pneumoconiosis Flashcards

1
Q

Pneumoconiosis was originally referred to as

‘The __________ lung reaction to ___________________’

Now defined as
‘The ______________ reaction of lung tissue to ______________, _________ and _______

A

non-neoplastic

inhalation of mineral dust

non-neoplastic

particulates (organic and inorganic)

chemical fumes and vapors.’

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2
Q

Pneumoconiosis usually develops from (poorly or well?)- defined ____________
e.g.
 Coal mining
 Sand blasting, hard rock mining, stone cutting etc
 metal mining
 Farming
 Bird handling
 Manufacturing

A

Well

occupational exposure

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3
Q

Increasing air pollution world wide, is associated with _________________

A

high ambient air particulate levels.

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4
Q

Populations exposed to these high air particulate levels have increased morbidity from lung diseases such as ______,____,______, and ______

A

pneumoconiosis, asthma, pneumonitis and bronchitis.

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5
Q

Aetiologic agents of pneumoconiosis

_______ particulates (________)

_______ particulates

________ and _______

A

Inorganic; mineral dust

Organic

Chemical fumes and vapors

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6
Q

Aetiologic agents

Inorganic particulates (mineral dust)

_____ dust,_____,______,_______, iron oxalate, barium sulfate, Tin oxide

A

Coal

silica

asbestos

beryllium

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7
Q

Aetiologic agents

Organic particulates that induce

1) Hypersensitivity pneumonitis :______,______

2) Asthma
Cotton, flax, hemp, red cedar (wood) dust

A

Moldy hay, bird droppings

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8
Q

Aetiologic agents

Chemical fumes and vapors

_______ oxide, _______ dioxide, ammonia, benzene, insecticides

A

Nitrous

sulphur

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9
Q

Aetiologic agents

Organic particulates that induce

1) __________

2)________

A

Hypersensitivity pneumonitis

Asthma

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10
Q

Classification – based on causative agent

 Anthracosis- ___________
 Silicosis –______ dust
 Asbestosis–______ particles
 Berylliosis – ________ particles

A

coaldustpneumoconiosis

silica

asbestos

beryllium

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11
Q

Development of all pneumoconiosis depends on some basic principles

Amount of dust retained in lungs. This depends on

i. _________________ in the air
ii. _________ of exposure
iii.__________ of _______

A

Concentration of dust

Duration

Effectiveness of pulmonary clearance mechanisms

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12
Q

Development of all pneumoconiosis depends on some basic principles

__________ retained in lungs
_____________ of particle
____________ to the lungs

A

Amount of dust

Size and shape

Mechanism of damage

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13
Q

Size & shape of particles Determines buoyancy of particles

T/F

A

T

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14
Q

Size & shape of particles

• Particles <____ in size tend to reach the ________ and settle in their lining.

• Bigger particles are cleared by _______ and _____ from the _______ & the ________ respectively

A

5μm; terminal airways

sneezing & mucociliary action

nasopharynx; tracheobronchial tree

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15
Q

Size & shape of particles

• The smaller the particle, the (more or less?) soluble & the (more or less?) toxic

A

More; more

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16
Q

Size & shape of particles

• The bigger the particle, the (more or less ?) resistant to dissolution & the (shorter or longer?) its duration in the lung l, leading to _____________ pneumoconiosis

A

More

Longer

fibrosing collagenous

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17
Q

Mechanism of damage to the lung involves:

i._______ to tissue

ii. Activation of ______

iii. Direct interaction with & activation of _________

iv. Initiation of ________

v.________ effect of ________

A

Direct injury

macrophages; fibroblasts

immune response

Additional; other irritants

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18
Q

Mechanism of damage to the lung involves:
i. Direct injury to tissue via _______ & other chemical groups on the particle surface

ii. Activation of macrophages to release ______________

iii. Direct interaction with & activation of fibroblasts by ____________

iv. Initiation of immune response by ________ or __________

v. Additional effect of other irritants e.g. _____________

A

free radicals

proinflammatory & fibrosing mediators

particles that cross the epithelial cell lining

components of the particles or self-proteins modified by the particles

tobacco smoke magnifies the reaction

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19
Q

Coal workers Pneumoconiosis(CWP)

▪__________ reaction of lung tissue to _______

A

Non- neoplastic

coal dust

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20
Q

Coal workers Pneumoconiosis(CWP)

▪ The spectrum of findings

 ___________ –
_________
__________

A

Anthracosis

Simple CWP

Complicated CWP

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21
Q

Anthracosis is (asymptomatic or symptomatic?)

A

asymptomatic

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22
Q

MORPHOLOGY
Anthracosis:

_______ of ______ pigment are seen.

Microscopy reveals ______ pigment within _________, as well as streaks & aggregates of pigment in pulmonary ______ and ____

A

Macules; black

anthracotic; alveolar macrophages

lymphatics & lymph nodes.

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23
Q

MORPHOLOGY

Simple CWP:

Coal ___________(_____) & nodules.

Microscopy of these lesions reveal aggregates of _________.

A (delicate or dense?) network of ______ is also present in nodules.

A

macules ; 1-2mm

carbon laden macrophages

Delicate; collagen

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24
Q

PMF:

▪ Multiple ————- scars (>______).

▪ Microscopy reveals lesions with (delicate or dense?) _____ deposits and pigment initially adjacent to __________

A

intensely blackened

2cm; dense; collagen

respiratory bronchioles.

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25
Q

PMF:

▪ The (upper or lower?) lobes & (upper or lower?) zones of the (upper or lower?) lobes are more heavily involved.

____________ is often present.

A

Upper

Upper; lower

Central necrosis

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26
Q

CLINICOPATHOLOGICAL CORRELATION

A. Anthracosis- _____________

B. CWP-_______ reduction in lung function. May be associated with _____ ,______,______

C. PMF- significant pulmonary _______, pulmonary _______ & consequently ______

A

asymptomatic

little or no; tuberculosis, chronic bronchitis and emphysema.

dysfunction; hypertension; cor pulmonale.

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27
Q

SILICOSIS

Silica (_________________ ) induced pneumoconiosis

A

crystalline silicon dioxide

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28
Q

__________ is the 2nd commonest element on earth

A

Silicon

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29
Q

EPIDEMIOLOGY

➢Silicosis, caused by inhalation of _______ silica, is consequently the most prevalent _________ disease in the world.

A

crystalline

chronic occupational

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30
Q

Silicosis

➢Those at risk include: miners, sandblasters, stone cutters, metal grinders etc

T/F🌚

A

T

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31
Q

Silicon constitutes ____% of the worlds crust.

A

28

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32
Q

______ is the principal constituent of sand

A

Silica

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33
Q

Silicosis usually presents after _______ of exposure

A

decades

34
Q

PATHOGENESIS of silicosis

➢ Silica exists in both _______ and _______ forms.

A

crystalline & amorphous

35
Q

PATHOGENESIS of silicosis

On inhalation, ______ ingest these particles, become activated and release _______ and ________ mediators

➢ These particles damage the _______ of _______ and ______ by forming bonds with ________ and ———- via surface _____ groups

A

macrophages

membranes ; epithelial cells and macrophages

membrane proteins & phospholipids

SiOH

36
Q

PATHOGENESIS of solicosis

_______ of silica (as occurs in stone crushing) generates ———- with a half life of ______, this greatly increases it’s cytotoxicity

A

Cleavage; free radicals

30hrs

37
Q

The _________ forms of silica are much more fibrogenic.

A

crystalline

38
Q

The crystalline forms of silica– ______,_______, and _______

A

quartz, crystobalite & tridymite

39
Q

PATHOGENESIS of solicosis

➢ Quartz is less fibrogenic when _______________ e.g ___________ usually have a milder lung disease

A

mixed with other minerals

miners of haematite who are also exposed to quartz

40
Q

most commonly implicated form of silica in silicosis is ???

A

Quartz

41
Q

PATHOGENESIS of solicosis

➢ (Light or Heavy?) lung burdens of amorphous silica (biologically (more or less?) active) may also produce lung lesions

A

Heavy

Less

42
Q

Examples of amorphous silica

A

. talc, mica & vermiculite

43
Q

MORPHOLOGY of silicosis

➢ Early stage: (tiny or large?) , barely palpable, (discrete or obvious?) , ____ nodules. If coal dust is present the nodules are _____.

➢ Intermediate stage: nodules coalesce into _______ with central ___________ due to _________. M

A

Tiny; discrete ; pale; black

hard scars; softening & cavitation; ischaemia or superimposed TB

44
Q

MORPHOLOGY of silicosis

➢ Intermediate stage:

The intervening lung tissue is over ________ , leading to an _______ pattern; or ________.

Associated findings: _____ fibrosis, _______ fibrosis & calcification ((thin or thick ?) sheets of ‘ _______ ’ calcification)

A

expanded; honeycomb; compressed

Pleural; lymph node ; Thin; eggshell

45
Q

PMF (silicosis)

Microscopy:

Nodules consist of ___________ of ________ in the center and an outer capsule of ___________.

Silica particles appear ________ under ________ light

A

concentric layers of hyalinized collagen

dense collagen

birefringent; polarized

46
Q

Stages of silicosis?

A

Early

Intermediate

PMF

47
Q

CLINICOPATHOLOGICAL CORRELATION of silicosis

Early stage: (Asymptomatic or symptomatic?)

Picked up on routine XR which shows ______ in (upper or lower?) lung zones.

A

Asymptomatic; fine nodularity

Upper

48
Q

CLINICOPATHOLOGICAL CORRELATION of silicosis

Intermediate stage: _____________ lung function

A

Normal or slightly decreased

49
Q

CLINICOPATHOLOGICAL CORRELATION of silicosis

PMF:

Causes impaired pulmonary function.

(Slowly or Rapidly?) progressive disease i.e. (slow or fast?) to kill.

A

Slowly; slow

50
Q

________ silica is carcinogenic in humans

A

crystalline

51
Q

Asbestos is the _______ form of several minerals and exists as ____________

A

fibrous

crystalline hydrated silicates.

52
Q

Asbestos

o It is a (poor or good?) conductor of heat & also (flammable or nonflammable
?) hence, useful as ____ textiles & ______ products.

A

Poor

Nonflammable

fireproof; insulation

53
Q

Asbestos is widely used in construction, jet parts, brake lining, paints, flooring etc.

T/F

A

T

54
Q

Asbestos

It exists in two distinct geometric forms:
o__________
o_________

A

Chrysotile

Amphibole

55
Q

Asbestos

Chrysotile : ———- and _______ fibres

Amphibole (_____,_____, and ______ fibres) m

A

serpentine-curly & flexible

straight, stiff & brittle

56
Q

Pathogenesis of Asbestosis

________ are more pathogenic than ______ particularly with respect to inducing mesotheliomas.

A

Amphiboles; chrysotiles

57
Q

Asbestosis

However cases of mesotheliomas associated with chrysotile workers are probably due to ___________

A

contamination with amphiboles..

58
Q

(Amphiboles or Chrysotile?) are more aerodynamic and therefore tend to get carried, in the inhaled air stream, to the deeper parts of the lungs.

A

Amphiboles

59
Q

(Amphiboles or Chrysotile?) are more likely to get impacted in the upper airway and get removed by mucociliary action.

A

Chrysotile

60
Q

Abestosis

Amphiboles are also (more or less?) soluble, hence (more or less?) toxic.

A

Less

More

61
Q

Abestosis

The (longer or shorter ?) and (thicker or thinner?) the fibre the more injurious.

A

Longer

Thinner

62
Q

Potentially toxic chemicals (e.g. tobacco carcinogens) may adhere to asbestos fibres and increase the tumor initiating & promoting properties of asbestos.

T/F

A

T

63
Q

Only amphiboles and not chrysotiles are fibrogenic

T/F

A

F

Both chrysotiles & amphiboles are fibrogenic

64
Q

Abestosis

Interaction of these fibres with _____ leads to the release of inflammatory & fibrogenic mediators resulting in a ___________ and __________.

A

macrophages

generalized interstitial inflammation & fibrosis

65
Q

Asbestos tends to ______ the macrophage on contact

A

rupture

66
Q

MORPHOLOGY: Diffuse pulmonary fibrosis In abestosis

➢ Early- around ______ and _____. Begins in the (upper or lower?) lobes & extends ___wards.

➢ Later- extends to _______  widened air spaces encased in fibrous walls leading to ______ appearance.

➢End stage- Pleural _______ , _____ around pulmonary vessels,____________ & other features of _________.

A

respiratory bronchioles & alveolar ducts ; Lower; upwards

alveolar sacs; honeycomb

plaques; scarring; right heart hypertrophy ; cor pulmonale

67
Q

MORPHOLOGY: Diffuse pulmonary fibrosis In abestosis

➢End stage-

➢Microscopy: ________ deposits in the previously described distribution

A

eosinophilic collagen

68
Q

Beryllium and its salts are both toxic and carcinogenic.

T/F

A

T

69
Q

Berylliosis

▪ Characteristics:

Beryllium is (light or heavy?)

______ color

relatively (soft or hard?( metal that is (weak or strong ?) but _____.

A

Light

Silver -gray

Soft

Strong

Brittle

70
Q

Berylliosis

▪ Berylliosis: Due to heavy exposure to dusts or fumes of beryllium, more common in ________ and _______ industries

A

nuclear and aerospace

71
Q

Berylliosis

▪ Acute disease has disappeared due to ____________

A

exposure standards

72
Q

Berylliosis
▪ Low dose exposure may cause ———- lesions that mimic ______

A

granulomatous

sarcoidosis

73
Q

Berylliosis

▪ Chronic berylliosis is due to __________

A

cell mediated immunity

74
Q

Berylliosis

▪____% of those exposed develop disease; delayed hypersensitivity leads to ___________ in lungs and hilar nodes, which become progressively _____;_____ symptoms until late

A

2; noncaseating granulomas

fibrotic

no

75
Q

Berylliosis

▪ Heavy beryllium exposure is linked to __________

A

lung cancer

76
Q

PMF = ________

A

Progressive massive fibrosis

77
Q

a (small or large?) percentage of exposed people develop pneumoconioses, and indicates a ______ predisposition.

A

Small

genetic

78
Q

The patients have increased susceptibility to lung infections such as ___,______, and ______

A

Mycobacterium tuberculosis, atypical mycobacteria and fungi

79
Q

Concomitant cigarette smoking in a patient with abestosis markedly increases the risk of mesothelioma .

T/F

A

F

Concomitant cigarette smoking markedly increases the risk of lung carcinoma but not that of mesothelioma .

80
Q

Mesothelioma

________ is the only known risk factor

A

Abestos

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