Interstitial Lung diseases, Part II, D Kinder, DSA

Question 1

Silicosis

Answer 1

fibrotic lung disease caused by inhalation of crystalline silica in form of quartz

Question 2

What industries are at risk for silicosis

Answer 2

mining, tunneling, excavating, quarrying, stonework, foundries, sandblasting, ceramics

Question 3

What are the categories of silicosis

Answer 3

chronic
accelerated
acute
progressive massive

Question 4

what is hallmark pathology of chronic silicosis

Answer 4

silicotic nodule characterized by whorled hyalinized collagen fibers with more peripheral zone of dust laden macrophages
most common form of silicosis

Question 5

describe acclereated silicosis

Answer 5

nodules develop after 3-10 yrs exposure

clinical course is progressive

Question 6

describe acute silicosis

Answer 6

develops 6 mo-2 yrs post exposure
dyspnea, cough, weight loss and rapid progress to respiratory failure and death
alveolar filling process

Question 7

What characterizes progressive massive fibrosis

Answer 7

lesions at least 1 cm in diameter and larger
lesions involve upper lobe
leads to resp failure, cor pulmonale, weight loss and death

Question 8

what are associated diseases with silicosis

Answer 8

TB
COPD and chronic bronchitis
collagen vascular disease: RA and scleroderma
lung cancer

Question 9

CXR silicosis

Answer 9

symmetric nodular pattern with upper lobes

hilar adenopathy with eggshell calcification

Question 10

acute vs progressive massive silicosis on CXR

Answer 10

acute- air space and interstitial pattern

progressive- coalescence of nodules with larger mass lesions

Question 11

PFT silicosis

Answer 11

normal ealry in chronic

later it is mixed pattern

Question 12

Dx silicosis

Answer 12

based on Hx and characteristic X ray changes

Question 13

management silicosis

Answer 13

irreversible
avoid further damage
TB testing
stop smoking

Question 14

when do you consider lung transplants in silicosis

Answer 14

acute and accelerated

Question 15

What causes coal workers pneumoconiosis CWP

Answer 15

deposits of coal dust in lung
increase with intensity of exposure and carbon content
anthracite is most toxic

Question 16

patholgy CWP

Answer 16

coal macule with macrophages laden with coal dust in walls of respiratory bronchiles and adjacent alveoli
coal nodules
may have progressive massive fibrosis

Question 17

clinical presentation CWP

Answer 17

no Sx or signs
can have Sx bronchitis
may lead to progressive massive fibrosis

Question 18

assoc diseases with CWP

Answer 18

silicosis
scleroderma and RA
caplan

Question 19

Caplan syndrome

Answer 19

RA with large cavitary pulmonary nodules assoc with silicosis and CWP

Question 20

CXR of CWP

Answer 20

resembles silicosis
small rounded opacities in the lung parenchyma
can progress to progressie massive fibrosis with nodules 0.5 cm- 5 cm

Question 21

PFT CWP

Answer 21

normal in early
often obstructive can have restrictive if fibrosis present
shown to lead to emphysema

Question 22

Dx CWP

Answer 22

coal dust exposure

CXR

Question 23

mangement CWP

Answer 23

avoid exposure

stop smoking

Question 24

What is asbestosis

Answer 24

chronic fibrotic interstital lung disease secondary to prolonged inhalation of asbestos fibers
20 latency after exposure

Question 25

industries at risk for asbestosis

Answer 25

mining, milling, transportation asbestos, building demolition, brake lining, ship building, insulations, fireproofing

Question 26

What is unique pathologically to asbestosis

Answer 26

ferruginous bodies, asbestos bodies | sputum or BAL fluid

Question 27

Signs and Sx asbestosis

Answer 27

signs: inspiratory crackles, clubbing Sx: dyspnea, dry cough, chest tightness/pain

Question 28

Assoc diseases of asbestosis

Answer 28

mesothelioma lung cancer pleural effusion

Question 29

CXR asbestosis

Answer 29

``` pleural plaques pleural effusion pleural thickening rounded atelectasis with "comet tail" lower lobe and subpleural disease prominent ```

Question 30

PFT asbestosis

Answer 30

restrictive | may be obstructive

Question 31

Dx asbestosis

Answer 31

``` Hx exposure!!!!! appropriate lag time exposure and disease lung fibrosis on CXR or CT!!!!!! restrictive PFT b/l inspiratory crackles clubbing ```

Question 32

management asbestosis

Answer 32

no effective Tx avoid exposure stop smoking lung transplantation

Question 33

what industries are at higher risk beryllium disease

Answer 33

aerospace, electronics, ceramics, metal, nuclear, telecommunications, tool and die, welding

Question 34

clinical presentation acute beryllium disease

Answer 34

acute pneumonitis: high exposure cough, dyspnea, chest pain blood tinged sputum and crackles

Question 35

Sx chronic beryllium disease

Answer 35

dyspnea, cough, chest pain, lb loss, fatigue, arthralgias similar to sarcoidosis ranging from asymptomatic to severe granulomatous restrictive lung disease 20 yrs post exposure

Question 36

CXR beryllium disease

Answer 36

``` enlarged hilar or mediastinal nodes or multiple lung nodules or both later: patchy fibrosis, hyperinflation and honeycombing ```

Question 37

Dx beryllium disease

Answer 37

documented exposure to beryllium evidence lung disease positive BeLPT performed on blood or BAL fluid

Question 38

management beryllium disease

Answer 38

avoid further exposure stop smoking steroids