RESPIRATORY: 606 - 607

Question 1

What are pneumoconioses?

Answer 1

Chronic occupational exposure to small fibrogenic particles that leads to interstitial fibrosis

Question 2

Give 4 examples of pneumoconioses.

Answer 2

1. Asbestosis
2. Coal workers’ pneumoconiosis
3. Silicosis
4. Berylliosis

Question 3

What does pneumoconiosis increase the risk of?

Answer 3

1. Cor pulmonale

2. Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules)

Question 4

What professions are associated with asbestosis?

Answer 4

Shipbuilding, roofing, plumbing

Question 5

Describe the plaques found in asbestosis.

Answer 5

Ivory white, calcified pleural plaques

Question 6

Asbestosis is associated with increased risk of what 2 cancers.

Answer 6

Bronchogenic carcinoma&raquo_space; mesothelioma

Question 7

Does asbestosis tend to affect the upper or lower lobes?

Answer 7

Lower

Question 8

What do asbestos (ferruginous) bodies look like?

Answer 8

Golden-brown fusiform rods resembling dumbbells; has iron deposits

Question 9

What accumulates in macrophages in coal workers’ pneumoconiosis?

Answer 9

Carbon

Question 10

Are the lung in coal workers’ pneumoconiosis shrunken or swollen?

Answer 10

Shrunken (from inflammation and fibrosis)

Question 11

What is another name for coal workers’ pneumoconiosis?

Answer 11

Black lung disease

Question 12

Does coal workers’ pneumoconiosis tend to affect the upper or lower lobes?

Answer 12

Upper

Question 13

What is anthracosis?

Answer 13

Asymptomatic condition found in many urban dwellers exposed to sooty air –> collection of carbon laden macrophages in the lung from mild exposure

Question 14

What is silicosis associated with?

Answer 14

Foundries, sandblasting, mines

Question 15

Describe the pathophysiology of silicosis.

Answer 15

Macrophages respond to silica and release fibrogenic factors leading to fibrosis

Question 16

Why is silicosis thought to relate to increased risk of TB?

Answer 16

Silica may disrupt phagolysosomes and impair macrophages increasing susceptibility to TB infection

Question 17

What is the only pneumoconiosis associated with an increased risk of TB?

Answer 17

Silicosis

Question 18

Does silicosis tend to affect the upper or lower lobes?

Answer 18

Upper

Question 19

Describe the hilar lymph nodes in silicosis.

Answer 19

“Eggshell” calcification

Question 20

What two occupations are at increased risk of berylliosis?

Answer 20

1. Beryllium miners

2. Workers in aerospace industry

Question 21

In what ways is berylliosis similar to sarcoidosis?

Answer 21

Both present with noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs

Question 22

Berylliosis increase the risk of what?

Answer 22

Lung cancer

Question 23

Describe the pathophysiology in neonatal respiratory distress syndrome.

Answer 23

Surfactant deficiency –> increased surface tension –> alveolar collapse

Question 24

What is predictive of neonatal respiratory distress syndrome as a lab test?

Answer 24

Lecithin:sphingomyelin ratio < 1.5 in amniotic fluid

Question 25

Why is there a risk of patent ductus arteriosus in neonatal respiratory distress syndrome?

Answer 25

Persistently low O2 tension

Question 26

Therapeutic supplemental O2 for NRDS can result in what sort of damage?

Answer 26

Free radical damage: 1. Retinopathy of prematuriy 2. Bronchopulmonary dysplasia

Question 27

How can we treat neonatal respiratory distress syndrome?

Answer 27

1. Maternal steroids before birth | 2. Artificial surfactant for infant

Question 28

What are 3 risk factors for NRDS?

Answer 28

1. Prematurity 2. Maternal diabetes 3. C-section delivery

Question 29

Why is maternal diabetes a risk factor for NRDS?

Answer 29

Increased sugars --> increased fetal insulin --> insulin inhibits surfactant production

Question 30

Why is C-section delivery a risk factor for NRDS?

Answer 30

Decreased release of glucocorticoids With a normal delivery, there is release of glucocorticoids (stress hormone) which increases production of surfactant and causes already made surfactant to be released by type II pneumocytes into the lung

Question 31

What are some of the clinical features of NRDS?

Answer 31

1. Increased respiratory effort after birth 2. Tachypnea with use of accessory muscles 3. Grunting 4. Hypoxemia with cyanosis 5. Diffuse granularity of lung on X ray

Question 32

What are some of the causes of acute respiratory distress syndrome?

Answer 32

1. Trauma 2. Sepsis 3. Shock 4. Gastric aspiration 5. Uremia 6. Acute pancreatitis 7. Amniotic fluid embolism

Question 33

Describe the pathophysiology in acute respiratory distress syndrome.

Answer 33

Diffuse alveolar damage --> increase alveolar capillary permeability --> protein-rich leakage into alveoli and noncardiogenic pulmonary edema --> eventual formation of intra-alveolar hyaline membrane

Question 34

What are 2 problems resulting from the formation of hyaline membrane?

Answer 34

1. Thickened diffusion membrane leads to hypoxemia and cyanosis 2. Membranes are sticky and increase the surface tension of the air sacs leading to diffuse collapse

Question 35

What is the initial damage of ARDS due to?

Answer 35

Activation of neutrophils induces protease mediated and free radical damage to type I and type II pneumocytes Also activates coagulation cascade

Question 36

Compare FEV1/FVC in normal vs. obstructive vs. restrictive lung disease.

Answer 36

Normal = 80% Obstructive < 80% Restrictive > 80%