T4 - Occupational lung disease

Question 1

does occupational lung disease have a long or short latency period?

Answer 1

long

Question 2

give four examples of OLD

Answer 2

COPD, mesothelioma, occupational asthma and pneumoconiosis

Question 3

that is the principle cause of pneumoconiosis

Answer 3

dust

Question 4

what is the FEV1:FVC ratio in restrictive lung disease?

Answer 4

> 70%

Question 5

what is the FEV1:FVC in obstructive lung disease?

Answer 5

<70%

Question 6

which OLD results in massive fibrosis, activation of alveolar macrophages and stiff lungs?

Answer 6

pneumoconiosis

Question 7

what type of pneumoconiosis causes fibrotic lung disease, restriction, eggshell calcification of LN and scarring?

Answer 7

silicosis

Question 8

what is the increased scarring in silicosis a risk factor for?

Answer 8

TB and lung cancer

Question 9

give three main symptoms of pneumoconiosis

Answer 9

dyspnoea, cough and cor pulmonale

Question 10

what is the key diagnostic feature seen on CXR for asbestosis?

Answer 10

pleural plaques

Question 11

what are two benign manifestations of asbestosis?

Answer 11

benign pleural effusion and pleural thickening

Question 12

what is restricted spirometry in asbestosis a sign of?

Answer 12

pleural thickening

Question 13

what can asbestosis lead to and what are two key features of this?

Answer 13

intersistial lung disease

• reduced lung function
• reduced gas transfer

Question 14

what are two malignant manifestations of asbestosis?

Answer 14

Lung cancer and mesothelioma (malignancy of pleura and peritoneum)

Question 15

give five features that should direct to a diagnosis of mesothelioma

Answer 15

1) pleural plaques on CXR
2) chest pain
3) weight loss
4) dyspnoea
5) unilateral pleural effusion

Question 16

what are the two types of occupational asthma?

Answer 16

1) caused by workplace exposure (didn’t have asthma before)

2) aggravated by workplace exposure (pre-existing asthma that has worsened)

Question 17

what is challenge testing for occupational asthma?

Answer 17

expose a patient to an agent that is thought to be the cause after a placebo exposure day then monitor spirometry

Question 18

what are the requirements for a patient to undergo challenge testing?

Answer 18

patient needs to be stable and not on bronchodilators

Question 19

what are differential diagnoses for OA?

Answer 19

COPD, HF, interstitial lung disease

Question 20

who should be considered for having OA?

Answer 20

any patient presenting with asthma in their adult life

Question 21

what two agents can allergic OA be due to?

Answer 21

low or high molecular weight agents

Question 22

what are two key features of high mw agents that cause allergic OA?

Answer 22

1) account for 80-90% of cases

2) IgE dependent

Question 23

what test is done for high mw agent causes of allergic OA?

Answer 23

skin prick or allergy test for flour, animals, latex and enzymes

Question 24

are low mw agents for allergic OA IgE dependent?

Answer 24

no

Question 25

what low mw agents can cause allergic OA?

Answer 25

isocyanates (plastics) or metals/dyes (hairdressers)

Question 26

is irritant induced/non allergic asthma immune mediated?

Answer 26

no

Question 27

what may a patient present to A&E with in irritant induced asthma?

Answer 27

reactive airway dysfunction syndrome (RADS)

Question 28

what are five causative agents of RADS?

Answer 28

vapour, chlorine, tear gas, fire, smoke

Question 29

what are primary vehicle exhaust pollutants and give four examples

Answer 29

pollutants from fossil fuel combustion

• NO, diesel, CO and particulate matter

Question 30

what are secondary vehicle exhaust pollutants?

Answer 30

pollutants produced from reactions between pollutants and the atmosphere

Question 31

what two conditions is NO associated with?

Answer 31

COPD and asthma

Question 32

what is ground level ozone?

Answer 32

heat, sunlight and volatile organic compounds plus NO

Question 33

what four things does ground level ozone cause?

Answer 33

1) decreased lung function
2) pro inflammatory effects (increased cytokine production)
3) increased response to allergens
4) increased respiratory morbidity

Question 34

what effect does particulate matter have on asthma?

Answer 34

increases its risk, increases airway inflammation and increases IgE production