Pulmonology #3 (Pneumoconioses/Environmental Lung Diseases)

Question 1

Silicosis, the pulmonary disease caused by inhalation of silicon dioxide, greatly increases the risk of ________

Answer 1

TB

Question 2

What are some occupations that are at risk for silicosis?

Answer 2

-Coal mining
-Quarry work with granite, slate, quartz
-Pottery makers
-Sandblasting
-Glass manufacturing
-Masonry

Question 3

Symptoms of silicosis are general, but name them

Answer 3

-Dyspnea on exertion
-Nonproductive cough
-Crackles (rales)
-Cough, weight loss, fatigue

Question 4

What is seen on CXR in a patient with silicosis?

Answer 4

-Multiple, small round nodular opacities primarily in the UPPER LOBES
-Eggshell calcifications of hilar and mediastinal nodes

Question 5

What is the definitive diagnostic for silicosis?

Answer 5

Lung biopsy

Question 6

What is the management for silicosis?

Answer 6

-Removal from exposure is the mainstay
-If needed, corticosteroids, oxygen, rehab

Question 7

Coal Worker’s Pneumoconiosis (black lung disease) is from inhalation of coal dust particles. In regards to this, what is Caplan Syndrome?

Answer 7

-Coal worker pneumoconiosis + Rheumatoid Arthritis

Question 8

What is seen on CXR in a patient with coal worker’s lung?

Answer 8

-Small nodules in the upper lung with hyperinflation of the lower lobes in obstructive pattern (resembles emphysema)

Question 9

What are some risk factors for berylliosis?

Answer 9

-Aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making, fluorescent light bulbs

Question 10

What does a PFT for berylliosis show?

Answer 10

Restrictive pattern

Question 11

On biopsy, for berylliosis, what is seen?

Answer 11

Noncaseating granulomas

Question 12

Treatment for berylliosis?

Answer 12

Corticosteroids, oxygen
Methotrexate if corticosteroids fail

Question 13

Berylliosis is associated with increased risk of ____, ____ and _____

Answer 13

-Lung, stomach, and colon cancer

Question 14

Byssinosis is lung disease due to _______ in those employed in the _______

Answer 14

cotton exposure

textile industry

Question 15

What is unique about the symptoms of Byssinosis

Answer 15

Symptoms tends to get worse at beginning of week and then improve later in the week or on weekend (Monday fever)

Question 16

Asbestosis is usually seen how long after exposure to asbestos?

Answer 16

15-20 years

Question 17

Risk factors for asbestosis

Answer 17

Destruction, repair, or renovation of old buildings, insulation and fire-resistant products, ship building

Question 18

What are some common findings in a patient with asbestosis on CXR?

Answer 18

-Pleural plaques involving the lower lobes
-Interstitial fibrosis (honeycomb lung): irregular linear opacities
-Shaggy heart sign: indistinct heart border, ground glass appearance of lungs

Question 19

On biopsy, asbestosis appears as

Answer 19

linear asbestos bodies in the lung tissue (ferruginous bodies)

Question 20

PFT for asbestosis is

Answer 20

Restrictive pattern: normal or increased FEV1/FVC, decreased lung volumes

Question 21

Although there is no specific management for asbestosis, what are some common complications?

Answer 21

-Bronchogenic carcinoma (MC)
-Mesothelioma (most specific)

Question 22

Alpha-1-Antitrpysin Deficiency is a genetic disorder that leads to

Answer 22

panacinar emphysema

Question 23

Explain the differences between panacinar and centriacinar emphysema

Answer 23

Panacinar: all parts of acinus are involved, lower zones of lungs

Centriacinar: proximal part of acinus (distal part is normal), upper zones of lungs

Question 24

What are other symptoms of alpha-1-antitrypsin deficiency?

Answer 24

-Emphysema (dyspnea)
-Bronchiectasis
-Hepatomegaly
-Cirrhosis

Question 25

Management of alpha-1-antitrypsin deficiency

Answer 25

-IV pooled A-1-A
-Lung transplant

Question 26

What is the source of farmer’s lung or cattle worker’s lung?

Answer 26

Moldy hay

Question 27

How is a patient able to get silo filler disease?

Answer 27

From nitrogen dioxide gas exposure released from plant matter stored in silos as they ferment (especially at the chute and base of the silo)

Question 28

The nitrogen dioxide gas is converted to _____ in the lungs when inhaled.

Answer 28

Nitric acid

Question 29

What are some avoidance tips for silo filler disease?

Answer 29

-Not entering recently filled silos for 2 weeks
-Entering at the top of the silo
-use of N95 masks

Question 30

What is parrot fever?

Answer 30

Infection with Chlamydia psittaci due to exposure to infected birds

Question 31

Symptoms of parrot fever

Answer 31

Flu like symptoms (dry cough, fever, malaise, headache)

-Rales, respiratory failure, hepatitis, endocarditis

Question 32

First-line management of parrot fever

Answer 32

-Tetracyclines

or Macrolides for another option