Pulmonary Occupational Diseases Flashcards

1
Q

Describe the absorption of air?

A

absorption from the lungs is greater than from the mouth or gut, which is greater than through the skin

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2
Q

Describe the absorption of particles in the lungs?

A

Particles can only reach the bottom of the lungs (alveoli) if they are small enough (less than 10 microns) aerodynamic diameter
- 1 micron: likely to be deposited in alveoli
> Particles absorbed, cause reaction, lung cancer
> Time from exposure to disease may be long (decades)

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3
Q

What are pulmonary occupational diseases?

A

Acute or chronic disorder arising from inhalation of airborne agents in the workplace
- Over 80% of chemicals gain access to body via pulmonary system

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4
Q

Name ways to conduct pulmonary testing?

A
  1. X-rays
    - may not always show disease
  2. spirometry
    - screening test
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5
Q

What is the function of spirometry?

A

measure airway resistance to air flow
Note: Disease may develop before pick up by spirogram
- Small airways (less than 2mm) contribute less to spirogram but affected earlier that larger airways

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6
Q

When is spirometry conducted in occupational health?

A
  1. pre and post employment
  2. disability evaluation
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7
Q

What is vital capacity?

A

Max volume of air that patient exhales after maximal inhalation
- FVC1: exhaled in 1 second
- Reduction in VC, FVC1 implies airway Obstruction

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8
Q

What is residual volume and TLC and their disease interpretation?

A

Increase in RV and RV/TLC ratio implies air distention and air trapping disease (Emphysema)

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9
Q

What are simple asphyxiants?

A

Interfere with air exchange by displacing oxygen from the air breathed in
e.g. Methane, Nitrogen, Carbon dioxide

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10
Q

Where are simple asphyxiants mostly found?

A

Enclosed, poorly ventilated spaces
- underground where methane can be produced by naturally occurring processes

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11
Q

What are symptoms of simple asphyxiation?

A
  1. breathlessness due to lack of oxygen.
  2. rapid breathing, headache and sweating
  3. loss of consciousness and death can result
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12
Q

How to prevent simple asphyxiation?

A
  1. Make sure tank is aerated
  2. Work in pairs:
    - Person in the tank is attached to a rope
    - Person on top should be ready to pull if colleague is overcome by chemical
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13
Q

What are chemical asphyxiants?

A

Interferes with transport of oxygen by hemoglobin from lungs to tissue
1. Higher affinity for Hb than O2
e.g. carbon monoxide
2. Cytochrome A oxydase inhibited
e.g. hydrogen cyanide
3. hydrogen sulfide
e.g. interferes with oxidative enzymes

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14
Q

Describe the characteristics of carbon monoxide?

A

colourless and odourless

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15
Q

Where is carbon monoxide usually found?

A
  1. Iron steel foundries
  2. welding
  3. garage
  4. paper mills
  5. gasoline forklifts
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16
Q

What are the symptoms of carbon monoxide asphyxiation?

A

headache, dizziness, loss of consciousness

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17
Q

Treatment of carbon monoxide asphyxiation?

A
  1. O2 intubation,
  2. hyperbaric chamber O2
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18
Q

How do you get hydrogen cyanide asphyxiation?

A
  1. Acid contact with cyanide compounds
  2. Burning of acrylonitrile plastics
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19
Q

Exposure sources of hydrogen cyanide?

A
  1. Chemical manufacturing,
  2. Fumigation
  3. autopsy room activities
20
Q

Symptoms of hydrogen cyanide asphyxiation?

A

Skin discoloration
itching
respiratory irritation
Headache
palpitations
dypnea
convulsions

21
Q

What is the exposure for hydrogen cyanide asphyxiation?

A

Exposure to 100 ppm for 30-60 min may be fatal

22
Q

What is the management of hydrogen cyanide asphyxiation?

A
  1. emergency antidote:
    - Amyl nitrite, sodium thiosulfate, sodium nitrite
  2. Hyperbaric O2
23
Q

Properties of hydrogen sulfide?

A
  • Causing tissue hypoxia
  • Rotten egg odour
24
Q

How do you get exposed to hydrogen sulfide?

A
  1. Tanneries
  2. Sewage treatment plants
  3. Oil drilling sites
25
Q

What is pneumoconosis?

A

dust in the lungs followed by tissue reaction

26
Q

How do you get pneumoconiosis?

A

Inert dusts/ nuisance particulates
- accumulate in lungs without causing tissue reaction

27
Q

Types of pneumoconioses?

A
  1. Silica-Silicosis
  2. Asbestos – Asbestosis
  3. Coal dust-Coal workers pneumoconiosis (CWP)
28
Q

Who gets CWP/black lung?

A
  • Pneumoconiosis caused by inhalation of coal dust
  • more prevalent in underground workers exposed to higher concentrations of carbonaceous dust than in surface workers.
29
Q

What causes CWP/black lung?

A

Mining, carbon black, graphite, carbon electrode industries

30
Q

Consequences of CWP?

A

The lung is destroyed by fibrosis and emphysema
- Chronic obstructive lung disease.

31
Q

Clinical features of CWP?

A

Slight cough
Productive (blackish sputum)
SOB rare unless develop complicated pneumoconiosis

32
Q

Diagnosis of CWP?

A

Chest x ray and history of coal exposure
ILO criteria

33
Q

Treatment of CWP?

A

Removal from exposure
Treat complications (Emphysema)

34
Q

Prevention of CWP?

A

Dust control (respirable coal dust of 2 mg/m cubic
Improved ventilation
Water spraying
Medical surveillance: periodic x rays
- CWP transfer to area with dust of 1 mg/m cubic

35
Q

What is silicosis?

A

Chronic fibrotic disease of lungs

36
Q

Causes of silicosis?

A

Prolonged and intense exposure to crystalline silica

37
Q

Types of silicosis?

A
  1. Chronic silicosis
  2. Accelerated
  3. Acute
38
Q

Industrial sources of free silica?

A

Foundry work
Mining, quarrying, tunneling
Abrasives and sand blasting
Stone cutting and polishing
Glass manufacturing
Ceramics

39
Q

Describe chronic/classical silicosis?

A

20-45 yrs exposure
Respirable dust with 30% quartz
X ray: 5mm nodules in upper lobes
Pulmonary function –normal
May develop to Pulmonary Massive Fibrosis (Massive fibrotic lesions)

40
Q

Describe accelerated silicosis?

A

Respirable dust with 40-80% quartz
5-15 years of exposure
Nodules smaller than classical silicosis
Massive fibrosis in mid zones of lungs
Seen mostly in sand blasters

41
Q

Describe acute silicosis?

A

Heavy exposure to dust with high silica content
1-3 years of exposure

42
Q

Clinical features of silicosis?

A

X rays - abnormal after 20 years of exposure

43
Q

Symptoms of silicosis?

A

shortness of breath on exertion
Productive cough later
Wheezing only if asthma or COPD develop
Restrictive disease pattern on PFTs
Predisposition to development of tuberculosis
Increased progression to bronchitis among smokers

44
Q

Management of silicosis?

A

Remove from further exposure
Symptomatic management
- Oxygen
- Antibiotics
- Standard TB medication

45
Q

What is asbestos?

A

Fibrous mineral silicate

46
Q

Types of asbestos?

A

Chrysotile (white asbestos)
95% of world production
Crocidolite (Blue asbestos)
Amosite (brown asbestos)
Anthrophyllite
Nemolite
Actinolite

47
Q

Where do you get exposed to asbestos?

A

Mining
Asbestos textile operations
Installation and removal of insulation on steam pipes and furnaces
Manufacturing
Tiles
Brakes and clutch linings
Paint filler