Sketchy Path: Pneumoconioses

Question 1

Particles that are 1 to 5 microns typically get stuck in _________________.

Answer 1

the respiratory bronchioles and then phagocytosed by macrophages (like the pieces of coal that got stuck in the final division and had to be manually moved to the cages)

Question 2

Particles greater than 10 microns will typically get stuck in _______________.

Answer 2

the mucociliary elevator (like the guy sweeping coal back up the ramp)

Question 3

After macrophages engulf dust, they secrete ______________.

Answer 3

cytokines like PDGF and IGF which stimulates collagen deposition and hence fibrosis (like the poor kid with COINS in his hat and a SHARK tattoo)

Question 4

___________ worsens the pathogenesis of all pneumonconioses.

Answer 4

Smoking (like the rich guy smoking)

Question 5

Most of the coal dust inhaled gets _____________.

Answer 5

caught in the mucociliary clearance system

Question 6

Nonsymptomatic discoloration of the lungs due to coal dust is called _____________.

Answer 6

anthracosis (like the asymptomatic pANTHer who’s black)

Question 7

Why are black streaks often seen in the lungs of those with pulmonary anthracosis?

Answer 7

The macrophages spread via lymphatics and create stripes (like the black stripes in the background emanating from the factory)

Note: this can also lead to coal-dust-laden macrophages in the hilar lymph nodes (like the two cages hanging beside the mediastinum mast).

Question 8

Coal worker’s pneumoconiosis usually affects the ____________ lungs.

Answer 8

upper (like the fibrotic pieces of coral sticking out of the sea)

Question 9

What lung pathologies are common in coal worker’s pneumoconiosis?

Answer 9

• Coal nodules that induce fibrosis

* Centriacinar emphysema

Question 10

What will x-ray of someone with CWP show?

Answer 10

Nodules in the upper lobes

Question 11

Silica pneumoconiosis also affects the ___________ lungs.

Answer 11

upper (like the second set of fibrotic coral sticking out of the water)

Question 12

The nodules in silicosis are ______________ than coal nodules.

Answer 12

smaller (like the scattered round sand bits)

Question 13

On histologic exam, silicosis will present with ______________.

Answer 13

whorls of collagen (like the whorled conch shell held by the rich lady by the sand blaster) and birefringent particles (like the bi-colored smoke)

Question 14

Silicosis can progress to _______________ of the lungs.

Answer 14

honeycombing (like the honeycomb pattern being sprayed by the blaster)

Question 15

Silicosis can worsen ____________.

Answer 15

TB (like how the TB cowboy is kicking open the macrophage cage and releasing bacteria)

Question 16

Asbestos has two forms: _______________.

Answer 16

serpentine (like the screws) and straight/amphibole (like the nails)

Question 17

It’s thought that the _______________ form of asbestos is more destructive.

Answer 17

amphibole/straight (like the straight nail being pounded into the worker on accident)

It’s thought that the straight particles make it farther down the airway.

Question 18

What is unique about the distribution of asbestos compared to the other silicoses?

Answer 18

Asbestosis affects the lower lobe sub pleural region (like how the anchor by the ship’s insulation has erosions on its lower edges)

Question 19

Describe pleural plaques.

Answer 19

• The most common result of asbestos exposure
• Do not lead to mesothelioma
• Do not contain asbestos bodies

(Think of the big white buttons on the old man’s blue pleural jacket.)

Question 20

Progressive asbestosis can also lead to _____________ of the lungs.

Answer 20

honeycombing (like the honeycomb pattern of the ship)

Question 21

______________ bodies are seen in asbestosis.

Answer 21

Ferruginous

These are shards of asbestos with iron beading the sides (like the screw covered with iron bolts.)

Question 22

The plaques made from asbestos are usually __________.

Answer 22

benign (like how the old man isn’t bothered by his huge buttons)