SM 171 Occupational Lung Disease

Question 1

What is an occupational illness?

Answer 1

An illness that is caused by or exacerbated by exposures or stressors in the work place

Question 2

Why do occupational illnesses tend to be underreported?

Answer 2

Fear of retaliation from employers, slow onset of symptoms, and symptoms developing after the patient leaves an occupation

Question 3

What types of jobs have the highest injury rates?

Answer 3

Physical jobs such as construction and transportation

Question 4

What are the general categories of work place exposures?

Answer 4

Physical, chemical, biological, and psychological

Question 5

How does the presentation of an occupational lung disease compare to other lung diseases?

Answer 5

Often times, the presentation of occupational lung diseases are undistinguishable from non-occupational lung diseases, which makes it hard to diagnose

Question 6

What is the latency period of an occupational lung disease and how does it affect the natural history of the disease?

Answer 6

A latency period is the delay between first exposure and first expression of symptoms of the disease, which makes it hard to diagnose

Question 7

Are toxic exposures effected by dose?

Answer 7

Yes, higher dose = faster onset of symptoms + greater severity

Question 8

What occupational lung disease can manifest from exposure to coal mine dust and smoking?

Answer 8

Emphysema

Question 9

What occupational lung disease can manifest from exposure to isocyanates and allergies?

Answer 9

Asthma

Question 10

How effective are PPE at preventing occupational lung disease?

Answer 10

PPE is a last line of defense and generally ineffective at preventing harmful exposures; workplace dynamics are much more important

Question 11

Which federal organization sets requirements for workplace safety?

Answer 11

OSHA, which sets guidelines for exposures in a variety of industries

Question 12

Which occupations bear a risk for Silicosis?

Answer 12

Anything that can potentially expose you to Silica dust, including:

Agriculture
Mining
Construction/Foundaries
Glass

Question 13

What are the types of Silicosis?

Answer 13

PAAC

Progressive Massive Fibrosis
Accelerated Silicosis
Acute Silicosis
Chronic Simple Silicosis

Question 14

What differentiates Accelerated Silicosis?

Answer 14

Occurs due to relatively strong exposures, and progresses faster

Question 15

What differentiates Acute Silicosis?

Answer 15

Occurs due to very strong exposures over a short time period, and progresses rapidly

Question 16

What diseases can Silica exposure cause?

Answer 16

Silicosis, Mycobacterial infections, bronchitis/COPD, lung cancer, fibrosis

Question 17

What are the Mycobacterial infections?

Answer 17

TB and non-Tuberculoid Mycobacteria

Question 18

Where does Chronic Simple Silicosis affect the lungs?

Answer 18

Chronic Simple Silicosis produces nodules (size < 1cm) in the upper lobe

Question 19

Does Chronic Simple Silicosis have a high latency period?

Answer 19

Yes, Chronic Simple Silicosis has a latency period of 20-30 years and progresses slowly

Question 20

What size are the nodules in Chronic Simple Silicosis?

Answer 20

Nodules are < 1cm

Question 21

How can silica crystals in the Lung be detected?

Answer 21

Polarized light

Question 22

Where does Progressive Massive Fibrosis affect the lungs?

Answer 22

Usually symmetric

Question 23

What size are the nodules in Progressive Massive Fibrosis?

Answer 23

Nodules are > 1cm

Question 24

What pattern does Progressive Massive Fibrosis present on PFT’s?

Answer 24

A mixed pattern of restriction and obstruction

Question 25

How do the nodules in Chronic Simple Silicosis and Progressive Massive Fibrosis compare, and why?

Answer 25

CSS = nodules < 1cm while PMF = nodules > 1cm; in PMF, silicates form larger conglomerates

Question 26

What does Progressive Massive Fibrosis predispose?

Answer 26

Mycobacterial disease and cancer

Question 27

What is the requirement for Acute Silicosis to develop?

Answer 27

Intense high exposures to silica particles, such as sandblasters

Question 28

What do sandblasters predispose?

Answer 28

Acute Silicosis

Question 29

How soon do symptoms occur in Acute Silicosis?

Answer 29

Weeks to 2 years

Question 30

What is the pathologic finding in Acute Silicosis?

Answer 30

Alveolar Proteinosis

Question 31

What disease is associated with Alveolar Proteinosis?

Answer 31

Acute Silicosis

Question 32

How does Silicosis affect COPD?

Answer 32

Silicosis worsens the effect of emphysema and further decreases FEV1

Question 33

How does Silicosis effect Lung Cancer?

Answer 33

Silica is a powerful carcinogen, and can cause lung cancer

Question 34

Does coal mine cause disease directly or due to the bodies response?

Answer 34

Both

Question 35

What diseases can coal dust cause?

Answer 35

Fibrotic diseases, airflow diseases, and infectious diseases

Question 36

Which fibrotic diseases can coal dust predispose?

Answer 36

Silicosis and Pneumoconiosis

Question 37

What airflow diseases can coal dust predispose?

Answer 37

Bronchitis and Emphysema

Question 38

What infectious diseases can coal dust predispose?

Answer 38

Tuberculosis, due to the dust reducing immunity

Question 39

What is the composition of coal dust?

Answer 39

Heterogenous, with the dust coming from many different rocks and silicates

Question 40

What are the medicolegal aspects of managing occupational lung disease?

Answer 40

Remove a patient from exposure and refer to legal counseling for worker's compensation, as well as disability assessment and maintaining followup

Question 41

Is worker's compensation state or federally based?

Answer 41

State based

Question 42

Where can information about potentially dangerous exposures in an environment be found?

Answer 42

On an MSDS sheet, found in every occupation

Question 43

What can cause acute Hypersensitivity Pneumonitis?

Answer 43

Intense exposure to an organic compound

Question 44

What can cause chronic Hypersensitivity Pneumonitis?

Answer 44

Recurrent low level exposure to an organic compound

Question 45

What type of molecule mediates the immune response in Hypersensitivity Pneumonitis?

Answer 45

Haptens

Question 46

What types of organic antigens can cause Hypersensitvity Pneumonitis?

Answer 46

Bacteria, fungi, amoebae, animal proteins, and chemicals

Question 47

What factors can define an occupational lung disease, and what factor is used in Illinois?

Answer 47

Occupation as the sole cause of a disease Occupation as one of many factors that cause a disease = Used by Illinois Occupation aggravated or exacerbated a condition

Question 48

Is Lung Pathology important for diagnosing Occupational Lung Disease?

Answer 48

Not particularly; history + imaging + lung function tests are most important

Question 49

What type of history should be taken when searching for an Occupational Lung Disease?

Answer 49

Womb to Tomb - all work experience can involve potential exposures

Question 50

What 3 questions should be asked in an occupational history?

Answer 50

What kind of work do you do? What does that mean? What did you do before that?

Question 51

What information should be elicited in an occupational history?

Answer 51

Specific exposures (see MSDS), description of workplace, use of PPE, and similar symptoms in co-workers

Question 52

What are some of the challenges in eliciting an occupational history?

Answer 52

Detailed work information may be in technical jargon, workers may be unaware of exposures, and workers may fear retaliation from their employers

Question 53

What test is used for diagnosis of dust-induced diseases?

Answer 53

Chest radiography

Question 54

What test is used for screening of dust-induced diseases?

Answer 54

Chest radiography

Question 55

How are radiographs classified?

Answer 55

For small opacities, by the number of them (0-3/3) | For large opacities, by the size of them (A/B/C)

Question 56

When is pathology useful in Occupational Lung Disease?

Answer 56

When there is confusion about the diagnosis

Question 57

How can Occupational Lung Disease be prevented?

Answer 57

Administrative controls, Environmental controls, and PPE

Question 58

What do administrative controls focus on?

Answer 58

Changing the process and changing logistics

Question 59

What do environmental controls focus on?

Answer 59

Local exhaust ventilation, barriers, and dust suppression

Question 60

What is a sentinel occupational health event?

Answer 60

An index case of disease/disability/death that indicates a workplace is unsafe

Question 61

What is the benefit of a sentinel health event?

Answer 61

Can spark a public health intervention to protect others with shared exposure