Pulmonology #3 (Pneumoconioses/Environmental Lung Diseases) Flashcards
Silicosis, the pulmonary disease caused by inhalation of silicon dioxide, greatly increases the risk of ________
TB
What are some occupations that are at risk for silicosis?
-Coal mining
-Quarry work with granite, slate, quartz
-Pottery makers
-Sandblasting
-Glass manufacturing
-Masonry
Symptoms of silicosis are general, but name them
-Dyspnea on exertion
-Nonproductive cough
-Crackles (rales)
-Cough, weight loss, fatigue
What is seen on CXR in a patient with silicosis?
-Multiple, small round nodular opacities primarily in the UPPER LOBES
-Eggshell calcifications of hilar and mediastinal nodes
What is the definitive diagnostic for silicosis?
Lung biopsy
What is the management for silicosis?
-Removal from exposure is the mainstay
-If needed, corticosteroids, oxygen, rehab
Coal Worker’s Pneumoconiosis (black lung disease) is from inhalation of coal dust particles. In regards to this, what is Caplan Syndrome?
-Coal worker pneumoconiosis + Rheumatoid Arthritis
What is seen on CXR in a patient with coal worker’s lung?
-Small nodules in the upper lung with hyperinflation of the lower lobes in obstructive pattern (resembles emphysema)
What are some risk factors for berylliosis?
-Aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making, fluorescent light bulbs
What does a PFT for berylliosis show?
Restrictive pattern
On biopsy, for berylliosis, what is seen?
Noncaseating granulomas
Treatment for berylliosis?
Corticosteroids, oxygen
Methotrexate if corticosteroids fail
Berylliosis is associated with increased risk of ____, ____ and _____
-Lung, stomach, and colon cancer
Byssinosis is lung disease due to _______ in those employed in the _______
cotton exposure
textile industry
What is unique about the symptoms of Byssinosis
Symptoms tends to get worse at beginning of week and then improve later in the week or on weekend (Monday fever)
Asbestosis is usually seen how long after exposure to asbestos?
15-20 years
Risk factors for asbestosis
Destruction, repair, or renovation of old buildings, insulation and fire-resistant products, ship building
What are some common findings in a patient with asbestosis on CXR?
-Pleural plaques involving the lower lobes
-Interstitial fibrosis (honeycomb lung): irregular linear opacities
-Shaggy heart sign: indistinct heart border, ground glass appearance of lungs
On biopsy, asbestosis appears as
linear asbestos bodies in the lung tissue (ferruginous bodies)
PFT for asbestosis is
Restrictive pattern: normal or increased FEV1/FVC, decreased lung volumes
Although there is no specific management for asbestosis, what are some common complications?
-Bronchogenic carcinoma (MC)
-Mesothelioma (most specific)
Alpha-1-Antitrpysin Deficiency is a genetic disorder that leads to
panacinar emphysema
Explain the differences between panacinar and centriacinar emphysema
Panacinar: all parts of acinus are involved, lower zones of lungs
Centriacinar: proximal part of acinus (distal part is normal), upper zones of lungs
What are other symptoms of alpha-1-antitrypsin deficiency?
-Emphysema (dyspnea)
-Bronchiectasis
-Hepatomegaly
-Cirrhosis
Management of alpha-1-antitrypsin deficiency
-IV pooled A-1-A
-Lung transplant
What is the source of farmer’s lung or cattle worker’s lung?
Moldy hay
How is a patient able to get silo filler disease?
From nitrogen dioxide gas exposure released from plant matter stored in silos as they ferment (especially at the chute and base of the silo)
The nitrogen dioxide gas is converted to _____ in the lungs when inhaled.
Nitric acid
What are some avoidance tips for silo filler disease?
-Not entering recently filled silos for 2 weeks
-Entering at the top of the silo
-use of N95 masks
What is parrot fever?
Infection with Chlamydia psittaci due to exposure to infected birds
Symptoms of parrot fever
Flu like symptoms (dry cough, fever, malaise, headache)
-Rales, respiratory failure, hepatitis, endocarditis
First-line management of parrot fever
-Tetracyclines
or Macrolides for another option
