Classic exposures Flashcards
(19 cards)
Asbestos
Diseases: Asbestosis, bronchogenic carcinoma, mesothelioma
• Clue: Shipyard worker, construction, insulation, roofing
• Finding: Pleural plaques, lower lobe interstitial fibrosis
Tip: Bronchogenic carcinoma is more common than mesothelioma in asbestos exposure.
Silica
Diseases: Silicosis, TB susceptibility
• Clue: Sandblasting, mining, quarrying
• Finding: Upper lobe nodules, eggshell calcification of hilar nodes
Tip: Silica impairs macrophages → increased TB risk.
Coal dust
Diseases: Coal workers’ pneumoconiosis
• Clue: Coal miner
• Finding: Upper lobe nodules, anthracosis (carbon-laden macrophages)
Beryllium
Diseases: Berylliosis (noncaseating granulomas, similar to sarcoidosis)
• Clue: Aerospace, electronics
• Finding: Upper lobe granulomatous disease
Vinyl chloride
Disease: Angiosarcoma of the liver
• Clue: Plastic/PVC exposure, industrial setting
Benzene
Diseases: Aplastic anemia, acute leukemia (especially AML)
• Clue: Industrial solvents, rubber industry, printing
Radon
Disease: Lung cancer (2nd most common cause after smoking)
• Clue: Basements, uranium mines
Arsenic
Diseases: Acute poisoning (GI distress, QT prolongation), skin cancer, Mees lines
• Clue: Pesticides, contaminated water, antique wood
• Finding: Garlic breath, vomiting, rice-water stools
Tip: Arsenic inhibits pyruvate dehydrogenase.
Lead
Diseases: Lead poisoning → anemia, encephalopathy, neuropathy
• Clue: Battery factory, old paint, solder, pottery
• Finding: Basophilic stippling, Burton line on gums, wrist/foot drop
Tip: Lead inhibits ALAD and ferrochelatase → microcytic anemia.
Mercury
Diseases: Tremor, neurotoxicity, acrodynia (pink fingers/toes)
• Clue: Broken thermometers, batteries, fish consumption
Tip: Treatment = chelation (dimercaprol, succimer)
Nitroglycerin (industrial)
Diseases: Tolerance → “Monday disease” (headache on re-exposure)
• Clue: Explosives workers, nitrate exposure
Ammonia
Disease: Chemical burn, pulmonary edema
• Clue: Cleaning products, industrial exposure
Organophosphates
Disease: Cholinergic toxicity
• Clue: Pesticide exposure (farmer, field worker)
• Symptoms: SLUDGE: salivation, lacrimation, urination, diarrhea, GI distress, emesis
Tip: Treatment = atropine + pralidoxime (regenerates AChE)
Carbon monoxide
Disease: Hypoxia without cyanosis
• Clue: House fire, faulty furnace
• Finding: Headache, confusion, cherry-red skin
Tip: Normal PaO₂, ↓ SaO₂; treat with 100% O₂ or hyperbaric O₂.
Ethylene glycol
Disease: Renal failure (oxalate crystals)
• Clue: Antifreeze ingestion
• Finding: AG metabolic acidosis, envelope-shaped crystals
Methanol
Disease: Blindness, optic neuropathy
• Clue: Moonshine or homemade alcohol
• Treatment: Fomepizole (ADH inhibitor)
Ionizing radiation
Disease: DNA damage → cancer (thyroid, leukemia)
• Clue: Radiation worker, nuclear exposure
Latex
Disease: Type I or IV hypersensitivity
• Clue: Healthcare worker, frequent glove use
Tips
Recognize buzzwords: e.g., “shipyard” → asbestos, “farmer + SLUDGE symptoms” → organophosphates
• Focus on mechanisms: e.g., arsenic → inhibits PDH; lead → affects heme synthesis
• Be able to differentiate occupational lung diseases based on lobe involvement and granulomas vs fibrosis
• Know specific toxins → cancers: vinyl chloride → liver angiosarcoma; benzene → leukemia
• For poisonings, understand treatment mechanisms: e.g., atropine vs pralidoxime
