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P&T Block 3 Pulm & GI > L64 > Flashcards

Flashcards in L64 Deck (39):
1

What is the most impt tool for dx occupational lung disease? How do you treat all of these lung diseases?

History/exam
Treat all by removing from exposure

2

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

3

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

4

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

5

What were the popcorn factory workers inhaling to give them bronchiolitis obliterans?

Diacetyl - directly decreases FEV1
Found in flavor compounds:
- Cookies
- Coffee
- Flavored e-cigs

6

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
- Blebs/pneumo
- Aspergillus

7

What is pneumoconioses?

Inhaling inorganic particles:
- Asbestos
- Silica
- Coal
- Metals

8

Describe why asbestos is bad to inhale

= silicates
Bad to inhale b/c
- Strong
- Flexible
- Resistant to breakdown // non-biodegradable
- Environmentally persistent

9

What past exposures put you at risk for asbestos exposure?

Mechanics
Construction workers
Shipyard workers
Military personnel
Household contacts of those ppl

10

What are current exposure that put you at risk for asbestos exposure?

Construction
Demolition
People in homes w/ friable material
Asbestos bearing rock

11

What are the 2 malignant diseases resulting from asbestos exposure?

Mesothelioma
Lung cancer in general

12

What is asbestosis?

Non-malignant asbestos disease
= Lung fibrosis
UIP + asbestos bodies (shown w/ iron stain)

13

How do you tell asbestos exposure on CT?

Calcified pleural plaques // white stuff on dome of diaphragm - no clinical significance, just proves exposure

14

What is silica?

Crystalline - tetrahedral shape
Toxic b/c has redox potential w/ O + N

15

What is the difference between newly fractured vs weathered silica?

Newly fractured is much more highly reactive

16

Name populations at risk for silicosis

SAND BLASTING
Agriculture - plowing
Mining
Road construction - tunneling, demolition
Glass - raw materials, installation, repair
Ceramics - brick, tiles, pottery, porcelain
Sand molds

17

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

18

Dx chronic silicosis w/ radiology and PE

Abnormal CXR/CT w/ small gray, rounded opacities
DOE, cough
Rales and wheezes possible

19

Definition of progressive massive fibrosis
PFT pattern

Masses > 1 cm diameter
- If cavitation, check for TB or cancer
PFT = mixed pattern
+/- emphysema

20

What is a new way to get silicosis you should be aware of

artificial granite

21

What is the toxic mechanism of coal

Direct damages cell membranes
Heavy metals -> free radicals
Activate oxidant product of alveolar macrophages
1. Inflammation
2. Fibrosis due to TNFa + IL1

22

Describe coal worker's pneumoconiosis

"Black lung"
Progressive lung scarring
Slowly progressive cough + SOB

23

Since silicosis and black lung present so similarly (symptoms + CXR/CT same), how do you differentiate?

Exposure history
Coal macule on patho

24

Coal changes to PFT

Obstructive
Loss of lung fxn = 1 pack/day of smoking

25

How do you get exposed to beryllium?

Metal in
- Tech
- Nuclear weapons manufacturing
- Air space
- Cell phones

26

What is chronic beryllium disease?

A chronic granulomatous lung disease
Scans look similar to sarcoid aka hilar LN adenopathy

27

What is the key biomarker for beryllium?

BeLPT = beryllium lymphocyte proliferation test

28

What is hypersensitivity pneumonitis?

Granulomatous disease
NOT infection
Cell mediated immune rxn to inhaled antigen
Presents SOB/cough

29

Name some things that can cause HST pneumonitis

Hot tubs (mycobacteria)
Birds
Aspergillus

30

What is the chest CT look like for acute vs sub acute HST pneumonitis?

Acute = ground glass
Sub acute = centrilobular nodularity

31

What is sarcoidosis

Systemic granulomatous disease
Look at lungs and lymphatics aka MORE than 1 organ system

32

Cause of sarcoid
Mechanism

Unknown cause
Activated macrophages + CD4 T cells -> Th1 type immune response

33

What is Lofgren's syndrome

Type of sacroid w/ specific symptoms:
1. Chest lymphadenopathy
2. Erythema nodosum - raised tender nodules
3. Arthritis
Might go away on own

34

What is Herefordt's syndrome?

Sarcoid w/ specifically:
1. Fever
2. Partoid enlargement
3. Facial palsy
4. Anterior uveitis

35

Imaging for sarcoid

Mediastinal adenopathy
Upper lobe > lower
Ground glass + consolidative opacities
Similar look to silicosis
Looks worse than presenting symptoms

36

Sarcoid PFTs

Restricted but does what i wants
Obstructive if granulomas in airway lumen

37

Do you need biopsy for sarcoid?

YEP
Should get non-necrotizing well formed granuloma
(Vs. TB = necrotizing
Vs. HST pneumonitis = poorly formed)

38

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

39

Can sarcoid resolve on own?

Yes - spont remission in 2/3 pts
Better chance of this w/ erythema nodosum, fever, and arthritis