RESPIRATORY - Occupational Lung diseases Flashcards
What is asbestos
Mix of silicates of Fe,Mg,Ni,Cd,Al
Who gets asbestos exposure
Patients over age 50
Who worked in building industry /shipyardsd before 1960’s
What is the longest latent period for asbestos exposure
Up to 50 years
What is the risk of asbestos disease proportional to?
Intensity of exposure
What are Asbestos body
Markers of asbestos exposure histologically
How can asbestos bodies be seen?
Histologically after a lung biopssies
When do pleural plaques occur?
After light exposure to asbestos
Sx pleural plaques
Usually asymp
Ix findings pleural plaques (3)
Mild restrictive deficit on spiromertry
Pleural thickening
Calcification CXR
Are pleural plauques progressive
No
Def diffuse pleural thickening
affects > ¼ of the pleural surface
Caused by more heavy exposure
PS diffuse pleural thickenings
Restrictive deficits
Effort dyspnoea
Are diffuse pleural thickenings progressive?
Yes
Onset mesothelioma
After light asbestos exposure
20-40y after exposure
PS mesothelioma + CXR findings (3)
Pleuritic chest pain
Increasing dyspnoea
Unilateral pleural effusion on CXR
Prognosis mesothelioma
not good
med survival 2y from diagnosis
Onset absestosis
By heavy exposure
5-10 years from exposure to diagnosis
PS asbestosis + CXR fingins
Progressive dyspnoea
Diffuse bilateral streaky strokes on CXR w/ honey combing
Prognosis asbestosis
Poor
Which patients can obtain occupational compensation? (4)
Bilateral diffuse pleural thickening
Mesothelioma
Asbestos related bronchial carcinoma
Asbestosis
Which other ca can be caused by asbestos exposure
Asbestos related carcinoma of the bronchus
What is pneumoconiosis and what is it caused by
Disease of the lungs caused by inhalaltion of dusts,, particularly coal
pathology pneumococoniosis
Dust = toxic to macrophages so = local inflammatory response
If it becomes chronic –> fibrosis –> restrictive lung defects
What is the risk of developing coal workers pneumoconiosis related to
Degree of exposure to the dust
Def simple coal workers pneumoconiosis
Small nodules (2-5mm) on CXR - not assoc w/ any clinically signif impairment of resp fct
What may coal workers pneumoconiosis develop into
PMF
Def progressive massive fibrosis (PMF)
Presence of large nodules (>10mm) on CXR
Development of PMF
Progresses relentlessly –> mixed obstructive + restrictive pattern
–> Respiratory failure
Problem in obstructive lung diseases
SOB due to difficult exhaling all air from their lungs
Exhaled air comes out slower than normal
At end of full exhal, abnorm high amount of air = still in lungs
E.g.s of obstructive lung diseases (4)
COPD
Asthma
Bronchiectasis
Cystic fibrosis
Problem in restrictive lung diseases
Cannot fully fill lungs with air
Lungs are restricted from expanding
From conditions causing stiffness in the lungs itself
E.g.s of restrictive lung. diseases (5)
ILD - PF Sarcoidosis Obesity Scoliosis NM disease
Sx of restrictive lung diseases (2)
Progressive exertional dyspnoea
Dry cough
What is pulmonary fibrosis
Umbrella term for different conditions –> build up of scar tissue in the lungs
What type of disease is pulmonary fibrosis
An interstial lung disease
What is an interstitial lung diesase
Disease affecting the tissue that lies between the alveoli and pulmonary capillaries
Cause of idiopathic PF
Unknown
Some links to acid reflux, viruses, breathing in dusts
type of HS reaction hypersensitivity pneumonitis
III
What is hypersensitivity pneumonitis due to
Inhaled antigens -> chronic inflammation –> fibrosis
3 e.g.s of hypersentivity pneumonitis
Farmers lungs
Bird fanciers lungs
Malt workers lungs
Cause of farmers lungs
Micropolyspora
Cause of bird fanciers lungs
Proteins in bird droppings
Cause of malt workers lungs
Aspergillus
Drugs causing pulmonary fibrosis (2)
Penicillamine
Nitrofurantoin
Cause of T1RF
Disease of the lung parenchyma
E.g.s asthma, pulm oedema, pneumonia, PE, COPD. ARDS
Cause of T2RF
When alveolar ventilation is insufficient to excrete the vol of CO2 being prod by tissue metabolism
Causes of T2RF (14)
Severe asthma Severe COPD Severe PF PSA CNS pathology Sedative Dx Rib fracture Kyphoscoliosis Flail chest Diaphragmatic paralysis MG GBS Cord lesions Poliomyelitis
What is pectus excavatum
Anterior chest wall abnormality –> displacement of heart + slight breathlessness
Is pectus carinatum signif?
No
CF of hypoxia (4)
Dyspnoea
Agitation
Confusion
Central cyanosis
Features of hypercapnia (6)
Headache TachyC Bounding pulse CO2 retention flap Papilloedema Features of acidosis
Kussmual resp
Air hunger –> deep + laboured breathing
pH in acute hypercapnic respiratory failure
<7.3
pH in chronic respiratory failure
Just slightly < than normal
What is the normal anion gap?
11-18mmol/L
What does a normal anion gap in metabolic acidosis suggest?
Loss of bicarbonate
Causes of metabolic acidosis with normal anion gap (4)
RTA
Diarrhoea
Drugs (acetazolomide)
Pancreatic/intestinal fl
What is a raised anion gap in metabolic acidosis suggest?
Production of organic acids
Causes of metabolic acidosis / raised anion gap (4)
Lactic acidosis
Ketosis
urate (renal failure)
Dx
causes of respiratory alkalosis (5)
Anything --> hyperventilation Anxiety Pain Altitude Incr met demands - pregnant, sepsis, fever, hypothyroid Dx (NSAIDS/OD)
Causes of metabolic alkalosis
XS base - antacids
Loss of acid - vomiting, hypokalaemia, burns, hyperaldosteronism
Lobectomy - indications (4)
Lung cancer
Bronchiectasis
Chronic lung abscess, TB
Fungal infections
Inspection findings - lobectomy
Thoracotomy scar
CHx wall flattening on side of surgery
Palpation findings - lobectomy
Tracheal displacement towards surgical side
Reduced expansion
Percussion findings - lobectomy
Hyper-resonant on side of lobectomy
Ausculation findings - lobectomy
Reduced air entry over site
What is sarcoidosis
Systemic, non-caseating granulomatous disease
Who gets sarcoidosis
F 20-40
PS sarcoidosis
Non-specific malaise + arthralgia
Other manifestations of sarcoid
Pulmonary fibrosis Erythem nodosum Glomerulonephritis Cardiomyopathy Arthritis CN lesions
Mx sarcoidosis
Simple analgesia
NSAIDs
If lung fibrosis - CCS
What 5 ways can aspergillus affect the lungs
Asthma (T1HS spores) EAA - malt workers lung Allergic bronchopulmonary asperigillosis Aspergilloma Invasive aspergillosis
Causes of clubbing
Intrathoracic neoplasm
Suppurative (pus) lung diseases - Abscess/CF/bronchiectasis/fungal infection
Fibrotic lung disease - IPF/asbestosis/fungal infection
CV disease - congen lesion/infective endocarditis/aortic aneurysm
GI - IBD/Coeliac
Liver - chronic hepatitis/cirrhosis
Thyroid acropachy
