Flashcards in L64 Deck (39):
What is the most impt tool for dx occupational lung disease? How do you treat all of these lung diseases?
Treat all by removing from exposure
What size particles are small enough to enter the alveoli? By comparison, how small are most man-made particles?
5 microns to get in
2.5 are most man made
How do particle solubility and SA determine toxicity?
Water soluble: exert its effect when hits a mucous membrane
No water sol - more likely to go all way down to alveoli
Sphere particles have more SA to make contact with the body
What is constructive bronchiolitis/bronchiolitis obliterans? Cause? PFT? Treat?
Fibrosis around a bronchiole -> scarring and narrowing of bronchiole lumen
Due to inhalation sulfur & nitrogen oxides
PFT = OBSTRUCTIVE w/ low DLco
Irreversible, poorly responsive to therapy
What were the popcorn factory workers inhaling to give them bronchiolitis obliterans?
Diacetyl - directly decreases FEV1
Found in flavor compounds:
- Flavored e-cigs
What 3 diseases are marijuana smokers at higher risk for? What are the 3 majors changes to the airway that occur?
General decrease mucociliary clearance + increased goblet cells (similar to all smoking airway epi damage)
Decreased alveolar fxn
Increased risk for:
- Acute + chronic bronchitis
What is pneumoconioses?
Inhaling inorganic particles:
Describe why asbestos is bad to inhale
Bad to inhale b/c
- Resistant to breakdown // non-biodegradable
- Environmentally persistent
What past exposures put you at risk for asbestos exposure?
Household contacts of those ppl
What are current exposure that put you at risk for asbestos exposure?
People in homes w/ friable material
Asbestos bearing rock
What are the 2 malignant diseases resulting from asbestos exposure?
Lung cancer in general
What is asbestosis?
Non-malignant asbestos disease
= Lung fibrosis
UIP + asbestos bodies (shown w/ iron stain)
How do you tell asbestos exposure on CT?
Calcified pleural plaques // white stuff on dome of diaphragm - no clinical significance, just proves exposure
What is silica?
Crystalline - tetrahedral shape
Toxic b/c has redox potential w/ O + N
What is the difference between newly fractured vs weathered silica?
Newly fractured is much more highly reactive
Name populations at risk for silicosis
Agriculture - plowing
Road construction - tunneling, demolition
Glass - raw materials, installation, repair
Ceramics - brick, tiles, pottery, porcelain
What are the 3 forms of silicosis you need to know?
Acute silicosis - presents as hypoxia as protein fills alveoli (high silica load needed - sand blasters)
Chronic simple silicosis - over 10 yrs
Progressive massive fibrosis - end stage
Dx chronic silicosis w/ radiology and PE
Abnormal CXR/CT w/ small gray, rounded opacities
Rales and wheezes possible
Definition of progressive massive fibrosis
Masses > 1 cm diameter
- If cavitation, check for TB or cancer
PFT = mixed pattern
What is a new way to get silicosis you should be aware of
What is the toxic mechanism of coal
Direct damages cell membranes
Heavy metals -> free radicals
Activate oxidant product of alveolar macrophages
2. Fibrosis due to TNFa + IL1
Describe coal worker's pneumoconiosis
Progressive lung scarring
Slowly progressive cough + SOB
Since silicosis and black lung present so similarly (symptoms + CXR/CT same), how do you differentiate?
Coal macule on patho
Coal changes to PFT
Loss of lung fxn = 1 pack/day of smoking
How do you get exposed to beryllium?
- Nuclear weapons manufacturing
- Air space
- Cell phones
What is chronic beryllium disease?
A chronic granulomatous lung disease
Scans look similar to sarcoid aka hilar LN adenopathy
What is the key biomarker for beryllium?
BeLPT = beryllium lymphocyte proliferation test
What is hypersensitivity pneumonitis?
Cell mediated immune rxn to inhaled antigen
Name some things that can cause HST pneumonitis
Hot tubs (mycobacteria)
What is the chest CT look like for acute vs sub acute HST pneumonitis?
Acute = ground glass
Sub acute = centrilobular nodularity
What is sarcoidosis
Systemic granulomatous disease
Look at lungs and lymphatics aka MORE than 1 organ system
Cause of sarcoid
Activated macrophages + CD4 T cells -> Th1 type immune response
What is Lofgren's syndrome
Type of sacroid w/ specific symptoms:
1. Chest lymphadenopathy
2. Erythema nodosum - raised tender nodules
Might go away on own
What is Herefordt's syndrome?
Sarcoid w/ specifically:
2. Partoid enlargement
3. Facial palsy
4. Anterior uveitis
Imaging for sarcoid
Upper lobe > lower
Ground glass + consolidative opacities
Similar look to silicosis
Looks worse than presenting symptoms
Restricted but does what i wants
Obstructive if granulomas in airway lumen
Do you need biopsy for sarcoid?
Should get non-necrotizing well formed granuloma
(Vs. TB = necrotizing
Vs. HST pneumonitis = poorly formed)
Treat sarcoid aka where are the most likely sites of extra-pulm disease
Inhaled steroids if changed PFTs
Heart + brain -> systemic CS (prednisone)
If cardiac disease - you are at risk for sudden death form arrhythmia -> + implantable cardiac defibrillator