SM 171a - Occupational Disorders Flashcards
Pathologic findings of alveolar proteinosis are associated with which disease/exposure?
Acute silicosis
Often associated with sandblaster use (within the last 2 weeks)
Which of the following is unlikely to be a noxious workplace exposure?
- Heat/Cold
- Streptococcus pneumoniae
- Chlorine gas
- Dust
- Animal dander
b. Streptococcus pneumoniae
The new Permissible Exposure Level (PEL) for silica is ____ mg
The new Permissible Exposure Level (PEL) for silica is 0.05 mg
Industries have pushed back against this, even though compliance with the previous OSHA rule resulted in a 0.4-11% lifetime risk of silicosis
List the 4 categories of silicosis
- Chronic simple silicosis
- Progressive massive fibrosis
- Accelerated silicosis
- Acute silicosis/silicoproteinosis (alveolar proteinosis)
Humidifier lung is associated with what exposure?
Amoebae
Which of the following would not be considered an occupational lung disease:
- New onset asthma in a isocyanate exposed worker
- Exacerbations of Asthma caused by cold air in a refrigeration worker at a meat packing plant.
- New onset COPD in a heavily grain dust exposed agricultural worker with a 40 pack year history of tobacco smoke exposure.
- Bronchiolitis caused by diacetyl exposure in a consumer of flavored microwave popcorn.
- Hypersensitivity pneumonitis in a zoo keeper working with avian species.
d. Bronchiolitis caused by diacetyl exposure in a consumer of flavored microwave popcorn.
Which of the following is not a required part of the work up needed to make the diagnosis of a disabling occupational lung disease?
- Medical History
- Occupational and Exposure History
- Lung function testing
- Pulmonary pathology specimens
- Chest imaging
d. Pulmonary pathology specimens
Describe the presentation and progression of chronic simple silicosis
- 20-30 year latency period
- Recognized by abnormal radiograph: upper and lower lobe nodules
- Few symptoms and normal PFTs in early disease
- May progress slowly
Malt worker’s lung, suberosis, and cheese worker’s lung are associated with which exposure?
Fungi
Farmer’s lung, mushroom worker’s lung, and bagassosis are associated with what exposure?
Bacteria
Association between silica and lung cancer is most often seen in which occupations?
- Miners
- Foundry workers
- Quarry workers
- Diatomaceous earth workers
What is a sentinal occupational health event?
The index case of a disease, diability, or untimiely death in a workplace
Sifnifies failure of hygiene and/or safety measures that are meant to protect workers
Indicates a sick worker and a sick workplace!
What diseases are caused by inhalation of coal mine dust?
- Fibrotic diseases
- Silicosis
- Coal worker’s pneumoconiosis (CWP)
- Airflow diseases (COPD)
- Bronchitis
- Emphysema
- Mineral dust airways disease
- bronchiolitis due to scarring around airways
- bronchiolitis due to scarring around airways
- Infectious diseases
- Tuberculosis
How are radiographs of dust exposed workers classified?
- Small opacities
- 0/0 is a normal lung
- 3/3 is the worst
- Large opacities - categorize progressive massive fibrosis
- A: 1-5 cm
- B: 5cm - size of right upper lobe
- C: Everywhere
What are the 4 major categories of occupational lung diseases?
- Immunologic asthma
- Irritant asthma
- Emphysema/cold
- Bronchiolitis
(Word on the street is that this is from the PBJ deck; if you see anything different in our lectures, suggest an edit!)
Why is it difficult to diagnose an occupational lung disease?
- Clinical and pathologic expressions of most of these diseases are indistinguishable from non-occupational diseases
- Long latency period between onset of exposure and first expression of disease
- Multifactorial causation
- Underreporting of work-related conditions
List the silica-related health effects
- Silicosis
- Mycobacterial infections: MTB and NTM
- Industrial bronchitis & COPD
- Extrapulmonary diseases
- Autoimmune and renal
- Lung cancer
- Pleural abnormalities
All of the following are important components of the occupational history except:
- Chronology of jobs and job titles
- Description of work place processes
- Data on specific exposures – i.e. MSDS sheets
- Names of managers at each workplace
- Use of Personal Protective Equipment
What disease is pictured?
How do you know?
Chronic simple silicosis
- Small amounts of very fine carbonaceous (black) pigment
- Think “little flecks”
How is occupational lung disease diagnosed?
Need history of exposure + other diagnostic tools
- Chest imaging abnormality (must have)
- Lung function abnormalities
- Consistent laboratory tests
- Lung pathology
What disease is pictured?
How do you know?
Acute silicosis aka silicoproteinosis
- You can see pathologic findings of alveolar proteinosis
- Abnormal buildup of surfactant protein in the lungs
What is the difference between impairment and disability, with regard to occupational lung disease?
- Impairment
- Loss of physical function
- Usually determined by health care provider, based on objective findings
- Disability
- Legal definition regarding the impact of impairment on social and work function
- Depends on whether impairment precludes carrying out the patient’s job
Note: Impairment may occur w/o disability, depending on the patient’s occupation
What test may detect asthma in patients with normal resting spirometry?
Bronchoprovocation testing
What occupational hazard is associated with acute silicosis?
Sandblasters
In Illinois, what is the definition of an occupational lung disease?
A disease is classified as an occupational lung disease if the occupations was a contributor to the disease
Does not have to be the sole cause
Describe the presentation of acute silicosis/silicoproteinosis
- Requires intense, high exposures
- Symptoms within 2 weeks of exposure
What host factors contribute to silicosis?
Race may play a role; African Americans had a 2x higher rater of silicosis than Whites
Silica is classified as a group ____ substance: “carcinogenic to humans”
Silica is classified as a group 1 substance: “carcinogenic to humans”
What kinds of occupation/work are associated with silicosis?
- Agriculture
- Mining
- Road construction
- Glass
- Ceramics
- Foundries
- Construction
What is pneumoconiosis?
An interstitial lung disease caused by inhalation of dust
(Asbestos, coal dust, silica)
Describe the presentation of progressive massive fibrosis (PMF)
- Mass > 1cm in diameter
- Mixed pattern of restriction and obstruction on PFTs
- Cicatricial emphysema
- Usually symmetric, occasionally R>L
- Asymmetric, rapid growth, cavitation possible
- But if seen, search for mycobacterial disease or cancer
