Occupational Lung

Question 1

___ between onset of exposure and first expression of disease

Answer 1

latency period

Question 2

clinical effects of many toxic exposures related to ___

Answer 2

exposure dose

Question 3

what are examples of multifactorial causation

Answer 3

1) smoking and coal mine dust = emphysema

2) allergies + isocyanates (paint/auto body)= asthma

Question 4

definition of dose KNOW!!!

Answer 4

dose = duration x concentration

Question 5

where do most water soluble agents deposit

where do less water soluble agents deposit?

Answer 5

water soluble = upper airway (chlorine = nasopharyngeal mucosa

less soluble = distal airways/bronchioles = nitrogen oxides1

Question 6

where are particles > 10 um

particles

Answer 6

> 10 um = filtered in upper airway

Question 7

what questions to ask about history

Answer 7

1) where do you work?
2) what jobs?
3) job duties?
4) specific exposures/ventilation/

Question 8

2 major categories of occupational lung disease

Answer 8

1) airways disease

2) interstitial disease

Question 9

types of airways diseases (4)

Answer 9

1) Immunologic asthma (asthma with latency)
2) Irritant asthma (RADS)
3) Emphysema/COPD (coal mine dust)
4) Bronchiolitis (obliterative/ constrictive)

Question 10

types of interstitial lung diseases

Answer 10

3 pneumoconioses
• Asbestos-related lung diseases
• Silicosis
• Coal Workers Pneumoconiosis (Black Lung)

Other:
• Chronic Beryllium Disease
• Hypersensitivity Pneumonitis (Farmer’s Lung)

Question 11

Where do airways diseases occur?

PFT?

Imaging?

Answer 11

Large or small airways

obstructive = Low FEV1
air trapping = incr RV and/or decr DLCO

normal or show airway wall thickening, air trapping, emphysema

Question 12

Interstitial diseases
define

PFT?

IMaging

Answer 12

inflammation/fibrosis of interstitial/distal/gas exchange units

restrictive (low TLC/FVC)
decr DLCO

centrilobular inflamm/ground glass opacity
fibrosis (rounded or linear opacity)

Question 13

causes of immunologic asthma (asthma with latency)

Answer 13

HMW: baking flours, latex, detergent enzymes –> IgE rxn

LMW: isocyanates (car), platinum salts, red cedar (plicatic acid)
(combine with endogenous proteins to create new antigens)

Question 14

causes of irritant asthma (RADS)

Answer 14

• Strong acids and bases (eg, chlorine-containing chemicals)

(world trade center worker exposed ot high pH alkaline dust)

Question 15

causes of emphysema/COPD

Answer 15

• Coal mine dust, silica

biomass combustion, silica, vanadium, dusts

Question 16

causes of bronchiolitis (obliterative/constrictive)

Answer 16

Flavoring chemicals (diacetyl), oxides of nitrogen, deployment particulate matter

Question 17

Define occupational asthma

Presentation

Answer 17

1) variable airflow obstruction
airway hyperresponsive + inflamm from immunologic properties of exposure (like isocyanates= quaternary ammonium)

2) Onset = months to years after (long latnecy)
Temporal pattern (improve symptoms on certain times)

Question 18

Define RADS

Presentation

Answer 18

airway eptihelial injury from exposure to inhalants with irritant properties –> persistent hyperresponsiveness and obstruction

NO LATENCY; WITHIN 24-48 HRS AFTER EXPOSURE

Question 19

Occupational chronic
Obstructive Pulm Disease

Presentation

Answer 19

COPD/emphysema (fixed airflow limitation) from occupation

cough, sputum, wheeze, chest tightness, dyspnea

Question 20

____ found in coal mine exposure

Answer 20

emphysema (not just smoking)

Question 21

constrictive/obliterative bronchiolitis

presentation

Answer 21

pathologic injury of small airways (extrinsic or intrinsic bronchiolar narrowing)

subtle onset with cough, dyspnea, chest tightness

Question 22

2 major forms of asbestos related lung diseases

Answer 22

• Serpentine: chrysotile

* Amphibole: croccidolite, amosite, anthophyllite, tremolite, actinolite

Question 23

asbestos lung diseases
cause

exposed groups

Answer 23

asbestos fibers = magnesium silicates when crushed break into fibers; aspect ratio (shape and size) confer disease

construction trade (boilermaker, shipyard, dock, mechanics with brakes)

Question 24

define nonmalignant asbestos related lung disease consequences

vs. malignant asbetos lung disease

Answer 24

1) benign asbestos pleural effusion, pleural thickening/calcif, rounded atelectasis, asbestosis (LOWER LUNG)
2) lung cancer, mesothelioma

Question 25

definition of silicosis causes of silicosis presentation

Answer 25

exposure to silica --> interstitial lung disease --> fibrotic lung disease (can't get rid of silica from lung) crystal silica (quartz), blast cut or grind gold or silver, foundry, sandblasters, granite, LONG LATNECY unless high grade exposure (SOB and cough)

Question 26

coal worker pneumoconiosis (black lung) definition causes presentation PFT imaging

Answer 26

1) coal mine --> interstitial lung disease 2) inhalation of coal mine dust (underground > surface) 3) cough + shortness of breath 4) normal PFT 5) upper lobe small rounde nodular opacity DUST MACULES

Question 27

CHRONIC beryllium disease definition causes presentation

Answer 27

1) granulomatous disease can't tell from sarcoidosis (except due to exposure and immune response to beryllium) 2) beryllium, inhaled during maching/grinding 3) subtle onset + cough + dyspnea + chest tightness

Question 28

``` Hypersensitivity pneumonitis (extrinsic allergic alveolitis) definiton ``` causes presentation

Answer 28

1) immune response to animal proteins (BIRD FANCIER'S OR FARMER'S LUNG 2) birds, fungi, contaminated hay, hot tubes and pools (tuberculous myco, gram neg), 3) acute = flu illness with respiratory sx subacute/chronic = insidious (gradual)

Question 29

Role of clinician in occupational expsoure

Answer 29

OCCUPATIONAL AND ENVIRON HISTORY-TAKING DIAGNOSIS MAY BE SENTINEL HEALTH EVENT PREVENTION

Question 30

What are the 3 main determinants of the site and severity of occupational lung disease?

Answer 30

Dose (= duration x concentration), solubility, and particle size

Question 31

What is the difference in onset of symptoms between occupational asthma and reactive airways dysfunction syndrome (RADS)?

Answer 31

No latency with RADS, symptoms occur within 24-48 hours after exposure

Question 32

What are the 3 major types of pneumoconioses?

Answer 32

* Asbestos-related lung diseases * Silicosis * Coal Workers Pneumoconiosis (Black Lung)

Question 33

What is the most useful clinical tool in assessing a patient for occupational lung disease?

Answer 33

Occupational and environmental history

Question 34

Which occupations are associated with the radiographic finding of progressive massive fibrosis?

Answer 34

* Foundry work * Hard rock mining * Sandblasting * Stone cutting (e.g. granite countertops)

Question 35

What type of exposure should you suspect when you see pleural plaques on chest imaging?

Answer 35

Asbestos

Question 36

Which of the following is NOT an occupation or exposure associated with hypersensitivity pneumonitis? A. Bird breeding B. Farming C. Hot tub and indoor pools D. Cat breeding E. All of the above are associated with hypersensitivity pneumonitis

Answer 36

D – cat breeding