Pulmonary Pathophysiology - Environmental and Other Diseases

Question 1

Examples of environmental / occupational lung diseases

Answer 1

Coal workers’ pneumoconiosis
Silicosis
Asbestos related diseases
Byssinosis
Occupational asthma

Question 2

Types of coal workers’ pneumoconiosis

Answer 2

Simple pneumoconiosis

Progressive massive fibrosis

Question 3

Clinical features of simple coal workers’ pneumoconiosis

Answer 3

Little change to pulmonary function

May have cough

Mild exertional dyspnoea

Small fall in FEV

Question 4

Clinical features of progressive massive fibrosis

Answer 4

Less common

Extensive fibrous tissue surrounded by lung destruction

Major pulmonary function impairment

Mixed obstructive and restrictive picture with pulmonary function test

Question 5

Clinical features of silicosis

Answer 5

Silica particles highly toxic

Generalised interstitial fibrosis

Ranges from mild disease to advanced disease to progressive massive fibrosis

Question 6

Mild silicosis

Answer 6

Radiological changes but no symptoms

Question 7

Advanced silicosis

Answer 7

Cough
Severe dyspnoea

Question 8

Pulmonary function in silicosis

Answer 8

Restrictive pattern

Reduced diffusing capacity

Question 9

Asbestos related diseases

Answer 9

Asbestosis - diffuse interstitial fibrosis

Bronchial carcinoma

Mesothelioma / other pleural disease

Question 10

Features of asbestosis

Answer 10

Occurs after heavy exposure

Progressive dyspnoea

Crackles esp at lung bases

Restrictive pulmonary function pattern

Question 11

Features of pleural related asbestos diseases

Answer 11

Can occur with minimal exposure

Pleural plaques - usually harmless

Can develop mesothelioma many years after exposure

Question 12

Byssinosis features

Answer 12

Caused by bracts surrounding cotton bol plant

Symptoms worse after period of absence from mill / exposure

Pulmonary function show obstructive patterns

Normal CXR

Question 13

Symptoms of byssinosis

Answer 13

Dyspnoea

Chest tightness

Wheeze

Cough

After long exposure can develop COPD

Question 14

Occupational asthma

Answer 14

Hypersensitivity on exposure to allergenic dusts

Eg. flour, printers, fur, feathers

Question 15

Classification of lung cancer

Answer 15

Small cell lung carcinoma

Non-small cell carcinoma

Question 16

Features of small cell lung ca

Answer 16

Highly malignant

around 1/3rd of all lung ca

Question 17

Types of non-small cell lung ca

Answer 17

Squamous carcinoma

Large cell carcinoma

Adenocarcinomas

Question 18

Squamous cell carcinoma features

Answer 18

Around half of all lung ca cases

Intercellular bridges

Associated with extrinsic Parathyroid hormone secretion

Question 19

Large cell carcinoma features

Answer 19

Occur in periphery

Around 10% of lung ca cases

Question 20

Adenocarcinomas

Answer 20

Occur more centrally

More common in females

Often produce mucus

Question 21

Why does primary TB tend to present in the apex of lung

Answer 21

TB thrives better at higher PO2

Question 22

Cystic fibrosis genetics

Answer 22

Disease of all exocrine glands

Autosomal recessive

Mutation of CFTR gene - affects Na+ and Cl- transport

Question 23

Cystic fibrosis diagnosis

Answer 23

Pilocarpine sweat test

Question 24

Cystic fibrosis signs / symptoms

Answer 24

Excessive thick secretions in lung
Pancreas affected
Small airway mucus plugging
Frequent chest infections
Finger clubbing