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Pulm > SM_171: Occupational Disorders > Flashcards

SM_171: Occupational Disorders Flashcards

1
Q

What are the challenges of diagnosing occupational lung disease?

A
  • Clinical and pathologic expressions indistinguishable from those of non-occupational disease
  • Long latency period between onset of exposure and first expression of disease
  • Clinical effects of many toxic exposures related to exposure dose
  • Multifactorial causation
  • Underreporting of work-related conditions
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2
Q

What are occupations at risk for silicosis?

A
  • Agriculture
  • Mining
  • Road construction
  • Glass
  • Ceramics
  • Foundries
  • Construction
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3
Q

What are silica-related health effects?

A
  • Silicosis: chronic simple silicosis, progressive massive fibrosis, accelerated silicosis, acute silicosis/silicoproteinosis
  • Mycobacterial infections: TB and NTM
  • Industrial bronchitis and COPD
  • Extrapulmonary disease (autoimmune and renal)
  • Lung cancer
  • Pleural abnormalities
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4
Q

Describe chronic simple silicosis

A
  • Usually recognized first by abnormal radiograph: upper lobe nodules
  • Latency period 20-30 years
  • Few symptoms and normal pulmonary function tests in early disease
  • May slowly progress
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5
Q

Describe progressive massive fibrosis

A
  • Mass > 1 cm in diameter
  • Mixed pattern of restriction and obstruction on pulmonary function tests
  • Cicatricial emphysema may be seen
  • Usually symmetric, occasionally R>L
  • Asymmetry, rapid greowth, and cavitation possible but should prompt search for mycobacterial disease or cancer
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6
Q

Describe acute silicosis / silicoproteinosis

A
  • Requires intense high exposures - often associated with sandblasters
  • Symptoms appear within weeks to 2 years of exposure
  • Pathologic findings of alveolar proteinosis
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7
Q

How are silica exposure and COPD connected?

A
  • Increased symptoms of chronic bronchitis in silica-exposed people with silicosis
  • Silica potentiates effects of smoking in emphysema patients
  • Accelerated rates of FEV1 decline reported in several industries using silica: miners, granite crushers, concrete, and pottery workers
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8
Q

How are silica exposure and lung cancer connected?

A
  • Association w/ lung cancer, strongest in those w/ silicosis
  • Causal link confounded by co-exposure to radon, arsenic, diesel exhaust, and cigarette smoke
  • Association seen in miners, foundry, quarry, and diatomaceous earth workers
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9
Q

What are diseases caused by inhalation of coal mine dust and the body’s reaction to it?

A
  • Fibrotic diseases - damage/destroy lung tissue: silicosis, coal workers pneumoconiosis
  • Airflow diseases (COPD) - block movement of air in and out of lungs: bronchitis, emphysema, mineral dust airways disease
  • Infectious diseases - dust reducses immunity: TB
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10
Q

What are the medicolegal and public health aspects of managing patients with pneumoconiosis?

A
  • Removal from exposure
  • Counseling / legal referral: workers compensation, benefits, exposure screening and education
  • Impairment / disability assessment
  • Medical follow-up and assessment of disease progression / complications
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11
Q

What are the pathologic features of hypersensitivity pneumonitis?

A

Hypersensitivity pneumonitis

  • Loosely organized granuloma
  • Area surrounding alveoli largely unaffected
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12
Q

Hypersensitivity pneumonitis is ______

A

Hypersensitivity pneumonitis is an immunologically-mediated inflammatory disease of the lung induced by inhalation of certain organ ducts

  • Repeated inhalation, sensitization, and immunologically-mediated lung damage
  • Acute form from intense exposure
  • Chronic form from recurrent low-level exposure
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13
Q

What are the causes of hypersensitivity pneumonitis?

A
  • Bacteria: farmer’s lung, mushroom worker’s lung, bagassosis, humidifier lung
  • Fungi: malt worker’s lung, suberosis, cheese worker’s lung
  • Amoebae: humidifier lung
  • Animal proteins: bird breeder’s lung, wheat weevil lung
  • Chemicals: isocyanate lung
  • Mixed: metal working fluids
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14
Q

What is the definition of occupational lung disease?

A

The occupation

  • Was the sole cause of the disease
  • Was one of the factors which caused the disease
  • Aggravated, accelerated, or exacerbated the condition
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15
Q

Making a diagnosis of occupational lung disease requires ______ and ______ and/or ______ and/or ______ and/or ______

A

Making a diagnosis of occupational lung disease requires history of exposure and chest imaging abnormalities and/or lung function abnormalities and/or laboratory testing (immunology) and/or lung pathology

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16
Q

Describe the components of an occupational history

A
  • Where do you work? (chronology)
  • What job titles have you had?
  • What were your specific job duties?
  • Specific exposures
  • Description of workplace and work processes
  • Use of person protective equipment
  • Similar symptoms in co-workers
17
Q

Chest radiography is useful in screening and surveillance of ______ exposed workers

A

Chest radiography is useful in screening and surveillance of dust exposed workers

  • Has been helpful in exposure-response relationships
  • Documents failures of dust control
18
Q

Describe pathology samples for occupational disease

A
  • Not often obtained in cases of living workers for medical legal reasons
  • Necessary when there is confusion about the diagnosis
  • Often obtained at autopsy, lung biopsy, or lung resection for other reasons
  • Subject to sampling bias
19
Q

Describe the role of the clinician in occupation lung disease medical and public health responses

A
  • High index of suspicion
  • Disease recognition (careful occupational and environmental history taking)
    Accurate disease diagnosis and exposure removal
  • Benefits counseling and referral
  • Diagnosis may be a sentinel health event (index case of a disease, disability, or untimely death) - public health intervention needed to protect others with shared exposure (prevention)
20
Q

What is the role of medical surveillance in occupational lung disease?

A
  • Primary prevention: control exposures
  • Secondary prevention: identify early disease and prevent progression
  • Tertiary prevention: treatment of established disease
21
Q

_______ is a respiratory disease found in coal miners that has increased in prevalence

A

Pneumoconiosis (black lung) / pulmonary massive fibrosis is a respiratory disease found in coal miners that has resurged in prevalence

(pulmonary massive fibrosis is complicated pneumoconiosis)

Pulm (32 decks)

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