SFP: Pneumoconiosis

Question 1

What is pneumoconiosis?

Answer 1

A disease of the lung due to inhalation of dusts that is characterized by inflammation, coughing, and fibrosis.

Question 2

What are the agents associated with pneumoconiosis?

Answer 2

Coal dust, silica, and asbestos.

Question 3

What is the pattern of development for pneumoconiosis?

Answer 3

Dyspnea that progresses 10-20 years after longstanding exposure.

Question 4

What is the clinical presentation of pneumoconiosis?

Answer 4

Dyspnea after 10-20 years, pulmonary HTN, cor pulmonale (right sided HF), clubbing from hypoxia.

Question 5

Describe how mineral dusts of different sizes are pathogenic.

Answer 5

1. > 5 micrometers: impact the mucociliary elevator in the upper respiratory tract. 2. <0.5 micrometers act like a gas and don’t get lodged. 3. 1-5 micrometers impact distal airways.

Question 6

What cell initiates the process associated with pneumoconiosis damage?

Answer 6

Macrophages; they ingest the dust particles and lead to recruitment of fibrotic, toxic, and inflammatory factors.

Question 7

What part of the lung does coal dust impact?

Answer 7

Upper lobes or upper zones of lower lobes.

Question 8

What part of the lung does silica impact?

Answer 8

Upper lobes or upper zones of lower lobes.

Question 9

Smoking enhances the effect of which mineral dusts?

Answer 9

All of them, but more so with asbestos.

Question 10

Which of the mineral dusts is the least pathogenic?

Answer 10

Coal dust.

Question 11

What is anthracosis?

Answer 11

Carbon in macrophages in alveolar spaces and interstitum; this is nonfibrogenic.

Question 12

Describe simple coal workers pneumoconiosis.

Answer 12

It has not progressed to progressive massive fibrosis; it may be picked up incidentally. Anthracosis will be seen, but usually not a lot of fibrosis.

Question 13

Describe complicated coal workers pneumoconiosis.

Answer 13

There is progressive massive fibrosis as well as anthracosis and possibly some honeycombing.

Question 14

Which pneumoconiosis increases TB risk?

Answer 14

Silica; it depresses cell mediated immunity, putting patients at higher risk of developing TB.

Question 15

What is the most preventable chronic occupational disease?

Answer 15

Silicosis.

Question 16

Describe silicosis.

Answer 16

Very prevalent chronic occupational disease associated with sandblasters, hard rock mining, or stone cutting. Also associated with quartz.

Question 17

What is a classic pathologic finding in silicosis?

Answer 17

Nodular fibrosis.

Question 18

What is the clinical presentation of chronic silicosis?

Answer 18

SOB later on, pulmonary HTN, cor pulmonale.

Question 19

How do we differentiate chronic silicosis from granulomas?

Answer 19

Granulomas have giant cells and epithelioid macrophages, while silicosis lesions have collagen and fibroblasts.

Question 20

Describe the morphology of asbestosis.

Answer 20

Diffuse interstitial fibrosis, pleural thickening, lower lobe predominance.

Question 21

What are the two asbestos fibers? Which is more pathogenic?

Answer 21

Serpentine and amphibole; amphibole is more pathogenic.

Question 22

What is a likely exposure in someone with mesothelioma?

Answer 22

Asbestos; NOT cigarette smoking.

Question 23

What is mesothelioma?

Answer 23

Malignant tumor of pleura and peritoneum.

Question 24

Which of the mineral dusts increase the risk of cancer?

Answer 24

Asbestos.

Question 25

What part of the lung does asbestos impact?

Answer 25

Lower lobes.

Question 26

What are asbestos bodies?

Answer 26

Macrophages that engulf asbestos fibers; Golden-brown, fusiform, or beaded rods with a translucent center.

Question 27

What is the most common manifestation of someone exposed to asbestos (non-cancer)?

Answer 27

Fibrous plaques.

Question 28

What are possible manifestations of someone exposed to asbestos?

Answer 28

Fibrous plaques, bronchogenic carcinoma, pleural effusion, interstitial pulmonary fibrosis.

Question 29

Briefly describe fibrous plaques in asbestos exposure.

Answer 29

They’re found in the parietal pleura and are dense with no asbestos bodies. They are benign.