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Pulmonology > SM 171 Occupational Lung Disease > Flashcards

SM 171 Occupational Lung Disease Flashcards

1
Q

What is an occupational illness?

A

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

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2
Q

Why do occupational illnesses tend to be underreported?

A

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

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3
Q

What types of jobs have the highest injury rates?

A

Physical jobs such as construction and transportation

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4
Q

What are the general categories of work place exposures?

A

Physical, chemical, biological, and psychological

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

Are toxic exposures effected by dose?

A

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

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8
Q

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

A

Emphysema

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9
Q

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

A

Asthma

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10
Q

How effective are PPE at preventing occupational lung disease?

A

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

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11
Q

Which federal organization sets requirements for workplace safety?

A

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

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12
Q

Which occupations bear a risk for Silicosis?

A

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

Agriculture
Mining
Construction/Foundaries
Glass

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13
Q

What are the types of Silicosis?

A

PAAC

Progressive Massive Fibrosis
Accelerated Silicosis
Acute Silicosis
Chronic Simple Silicosis

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14
Q

What differentiates Accelerated Silicosis?

A

Occurs due to relatively strong exposures, and progresses faster

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15
Q

What differentiates Acute Silicosis?

A

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

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16
Q

What diseases can Silica exposure cause?

A

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

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17
Q

What are the Mycobacterial infections?

A

TB and non-Tuberculoid Mycobacteria

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18
Q

Where does Chronic Simple Silicosis affect the lungs?

A

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

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19
Q

Does Chronic Simple Silicosis have a high latency period?

A

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

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20
Q

What size are the nodules in Chronic Simple Silicosis?

A

Nodules are < 1cm

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21
Q

How can silica crystals in the Lung be detected?

A

Polarized light

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22
Q

Where does Progressive Massive Fibrosis affect the lungs?

A

Usually symmetric

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23
Q

What size are the nodules in Progressive Massive Fibrosis?

A

Nodules are > 1cm

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24
Q

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

A

A mixed pattern of restriction and obstruction

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25
Q

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

A

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

26
Q

What does Progressive Massive Fibrosis predispose?

A

Mycobacterial disease and cancer

27
Q

What is the requirement for Acute Silicosis to develop?

A

Intense high exposures to silica particles, such as sandblasters

28
Q

What do sandblasters predispose?

A

Acute Silicosis

29
Q

How soon do symptoms occur in Acute Silicosis?

A

Weeks to 2 years

30
Q

What is the pathologic finding in Acute Silicosis?

A

Alveolar Proteinosis

31
Q

What disease is associated with Alveolar Proteinosis?

A

Acute Silicosis

32
Q

How does Silicosis affect COPD?

A

Silicosis worsens the effect of emphysema and further decreases FEV1

33
Q

How does Silicosis effect Lung Cancer?

A

Silica is a powerful carcinogen, and can cause lung cancer

34
Q

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

A

Both

35
Q

What diseases can coal dust cause?

A

Fibrotic diseases, airflow diseases, and infectious diseases

36
Q

Which fibrotic diseases can coal dust predispose?

A

Silicosis and Pneumoconiosis

37
Q

What airflow diseases can coal dust predispose?

A

Bronchitis and Emphysema

38
Q

What infectious diseases can coal dust predispose?

A

Tuberculosis, due to the dust reducing immunity

39
Q

What is the composition of coal dust?

A

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

40
Q

What are the medicolegal aspects of managing occupational lung disease?

A

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

41
Q

Is worker’s compensation state or federally based?

A

State based

42
Q

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

A

On an MSDS sheet, found in every occupation

43
Q

What can cause acute Hypersensitivity Pneumonitis?

A

Intense exposure to an organic compound

44
Q

What can cause chronic Hypersensitivity Pneumonitis?

A

Recurrent low level exposure to an organic compound

45
Q

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

A

Haptens

46
Q

What types of organic antigens can cause Hypersensitvity Pneumonitis?

A

Bacteria, fungi, amoebae, animal proteins, and chemicals

47
Q

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

A

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

48
Q

Is Lung Pathology important for diagnosing Occupational Lung Disease?

A

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

49
Q

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

A

Womb to Tomb - all work experience can involve potential exposures

50
Q

What 3 questions should be asked in an occupational history?

A

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

51
Q

What information should be elicited in an occupational history?

A

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

52
Q

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

A

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

53
Q

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

A

Chest radiography

54
Q

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

A

Chest radiography

55
Q

How are radiographs classified?

A

For small opacities, by the number of them (0-3/3)

For large opacities, by the size of them (A/B/C)

56
Q

When is pathology useful in Occupational Lung Disease?

A

When there is confusion about the diagnosis

57
Q

How can Occupational Lung Disease be prevented?

A

Administrative controls, Environmental controls, and PPE

58
Q

What do administrative controls focus on?

A

Changing the process and changing logistics

59
Q

What do environmental controls focus on?

A

Local exhaust ventilation, barriers, and dust suppression

60
Q

What is a sentinel occupational health event?

A

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

61
Q

What is the benefit of a sentinel health event?

A

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

Pulmonology (22 decks)

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