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C. Year 3 MLA Respiratory > Occupational Lung Disease > Flashcards

Occupational Lung Disease Flashcards

1
Q

How many people smoke worldwide?

1 - >2 billion
2 - >1 million
3 - >100,000
4 - 10,000

A

1 - >2 billion

  • men = 17.5%
  • women = 15.8%
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2
Q

How many people die each year from smoking worldwide?

1 - 100,000
2 - 1 million
3 - 5 million
4 - 2 billion

A

3 - 5 million
- aprox 5 million deaths/year

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3
Q

How does the carcinogen, tobacco from from smoking cause cancer?

1 - irritates endothelium and causes chronic inflammation
2 - smoke increases fibroblast activation that can lead to tumours
3 - smoke induces genetic mutations and malignancy
4 - all of the above

A

3 - smoke induces genetic mutations and malignancy

  • causes lung cancer
  • mesothelioma (tumour on myoepithelial cells)
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4
Q

In addition to containing carcinogens, tobacco also increase carbon monoxide intake. Does CO2 or O2 have a higher affinity to bind with haemoglobin?

A
  • CO has a stroger affinity to haemoglobin
  • becomes carboxyhaemoglobin
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5
Q

Tobacco damages cilia in the respiratory tract and reduces the muco-ciliary escalator (clearing of mucus from the lungs). What can this increase the risk of?

1 - infections
2 - malignancy
3 - granulomas
4 - fibrosis

A

1 - infections
- micro-organisms are difficult to remove

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6
Q

How does smoke cause an increase in mucus production?

1 - stimulates the secretion of surfactant from type 2 pneuomcytes
2 - damages cilary and mucus cannot be secreted
3 - seromucous glands become blocked by tobacco
4 - irritates the airways, stimulating goblet cell hyperplasia to protect the lungs

A

4 - irritates the airways, stimulating goblet cell hyperplasia to protect the lungs

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7
Q

Smoking can increase the risk of morbidity. Which of the following is associated with an increase in mortality in smokers?

1 - lung cancer
2 - mesothelioma
3 - bladder cancer
4 - renal cell cancer
5 - COPD
6 - Interstitial Lung Disease (ILD)
7 - Peripheral Vascular Disease
8 - Ischemic Heart Disease
9 - Cerebrovascular Accident
10 - Foetal Growth Development
11 - all of the above

A

11 - all of the above

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8
Q

Smoking can cause dependence on cigarettes. Nicotine can be addictive, why?

A
  • nicotine binds to nicotinic receptors - acetylcholine ⬆️
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9
Q

Nicotinic receptors are present throughout the body at the pre-ganglion in the parasympathetic and sympathetic nervous system. What is the main neurotransmitter that nicotine increases the release of that contributes to the addictive nature of smoking and pleasure?

1 - dopamine
2 - glutamate
3 - acetylcholine
4 - serotonin

A

1 - dopamine

  • the mesolimbic system (a reward pathway composed
  • glutamate and acetylcholine are increased, but dopamine is the main hormone
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10
Q

In addition to increasing pleasure, what other 2 of the following things can smoking do?

1 - increase appetite
2 - decrease appetite
3 - increase anxiety
4 - decrease anxiety

A

2 - decrease appetite
4 - decrease anxiety

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11
Q

When people try to quit smoking, this is called dependence. Does this lead to mental dependence only?

A
  • no
  • leads to both physical and psychological issues
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12
Q

Which one of the following is NOT one of the 5 As involved in helping people quit smoking?

1 - ASK - do you smoke
2 - ADVISE - that patients should quit
3 - ASSESS - is patient willing to quit
4 - ALERT - tell patient of risks of smoking
5 - ASSIST - provide support
6 - ARRANGE - follow up patient

A

4 - ALERT - tell patient of risks of smoking

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13
Q

Why is nicotine replacement therapy better than smoking?

1 - cheaper
2 - never addictive
3 - easier to administer
4 - no carcinogens

A

4 - no carcinogens

  • nicotinic replacement doubles the change a patient will quit
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14
Q

What is the most effective treatment for smoking cessation?

1 = advise and encouragement
2 = Buproprion (Zyban)
3 = Hypnosis
4 = NRT
5 = Varenicline (Champix)

A

5 = Varenicline (Champix)

  • binds to neuronal nicotinic Ach receptor (partial agonist)
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15
Q

How many people self report lung diseases due to occupation per year?

1 - 2000/year
2 - 20,000/year
3 - 200,000/year
4 - 2 million

A

2 - 20,000/year

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16
Q

What is the estimated prevalence of lung diseases due to occupation?

1 - 130/1000
2 - 130/10,000
3 - 130/100,000
4 - 130/1 million

A

2 - 130 / 100,000 people

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17
Q

How many people each year are estimated to die due to occupational exposure to toxins?

1 - 120/year
2 - 1200/year
3 - 12,000/year
4 - 120,000/year

A

3 - 12,000/year

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18
Q

Does occupational lung disease present immediately following exposure in the work place?

A
  • no
  • generally long latency period
  • generally around 15-20 years
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19
Q

What is the most common occupational lung disease?

1 - occupational COPD
2 - occupational pneumonia
3 - occupational malignancy
4 - occupational asthma

A

4 - occupational asthma
- 3000/year
- 10-15% adult occupational asthma

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20
Q

Which if the following are the common symptoms of occupational asthma?

1 - same as normal asthma
2 - breathlessness, tight chest and wheezing 3 - cough
4 - ⬇️ PEF
5 - reduces FVC/FEV1 ratio
6 - all of the above

A

6 - all of the above

  • symptoms may also improve when patient is at work
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21
Q

Which of these statements about occupational asthma is true?

1 = symptoms improve at work
2 = spirometry shows obstruction at work
3 = will not respond to asthma treatment
4 = will not improve by using mask and ventilation
5 = the allergen can always be identified

A

2 = spirometry shows obstruction at work

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22
Q

Pneumoconios is a group of diffuse parenchymal lung diseases (DPLD) (previously called interstitial lung disease (ILD) that cause lung fibrosis due to the inhalation of a variety of inorganic particles and mineral dust particles at work. Which of the following is NOT a common cause of pneumonconiosis?

1 - Coal
2 - Pollen
3 - Asbestos
4 - Silica
5 - Siderosis: iron and steel
6 - talc, beryllium, tin, barium, cobalt

A

2 - Pollen

  • inhaled particles are typically 1-4um
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23
Q

Which of the following is NOT a common symptoms patients with Pneumoconios present with?

1 - breathlessness
2 - cough
3 - sputum producing cough
4 - weight loss

A

3 - sputum producing cough

24
Q

Do all dusts and chemicals need to be inhales at the same concentration to cause the same damage?

A
  • no
  • high concentration of coal dust
  • lower concentration of silica or asbestos
25
Q

When we inhale small fibres of toxic substances, these can reach the alveoli of the lungs. Here what cell then engulf theses small fibres in an attempt to remove them from the lungs?

1 - T cells
2 - B cells
3 - dendritic cells
4 - macrophages

A

4 - macrophages

26
Q

When we inhale small fibres of toxic substances, these can reach the alveoli of the lungs. Macrophages engulf the particles and release which cytokines that then go onto to damage the alveolar epithelium?

1 - IL-1
2 - IL-18
3 - IL-6
4 - TNF-a

A

1 - IL-1
2 - IL-18

  • macrophages can also fill with dust and then lyse
  • enzymes and release that can also damage the alveolar epithelium
  • fibroblasts migrate and proliferate
  • fibrosis follows
27
Q

When we inhale small fibres of toxic substances, these can reach the alveoli of the lungs. Macrophages engulf the particles and release IL-1 and 18 that recruit more immune cells to the area. This can then increase the recruitment of what?

1 - collagen
2 - chondrocytes
3 - fibroblasts
4 - platelets

A

3 - fibroblasts
- deposit ECM, mostly collagen
- the ECM is not elastic and hence lungs become stiff and restrictive

28
Q

Are pneumoconiosis typically obstructive or restrictive in nature?

A
  • restrictive due to fibrosis
29
Q

Which of the following is the most common cause of death related to work?

1 - coal
2 - silica
3 - siderosis (iron and steel)
4 - asbestos

A

4 - asbestos

30
Q

Silicosis is a form of pneumoconiosis, and is caused by the inhalation of tiny silica particles which are very fibrogenic. Which of the following jobs are likely to have been exposed to silica?

1 - sandblasting/pottery
2 - carpenters/builders
3 - stone quarrying
4 - metal mining

A

2 - carpenters/builders

31
Q

Silicosis is a form of pneumoconiosis, and is caused by the inhalation of tiny silica particles which are very fibrogenic. Typically where in the lungs do silica particles settle?

1 - upper lobe
2 - middle lobe
3 - lower lobe
4 - anywhere

A

1 - upper lobe

32
Q

How many people a year die from Silicosis?

1 - 10-20 people
2 - 100-200 people
3 - 1000-2000 people
4 - >1 million people

A

1 - 10-20 people

33
Q

Silicosis can increase the risk of a lung cancer and a certain infection, what is the infection?

1 - Streptococcus pneumoniae
2 - Haemophilus species
3 - Staphylococcus aureus
4 - Mycobacterium tuberculosis

A

4 - Mycobacterium tuberculosis

34
Q

What is the 1st line scan and lung test clinicians should do if they suspect a patient has silicosis?

1 - ultrasound
2 - HRCT
3 - chest X-ray
4 - MRI

A

3 - chest X-ray
- spirometry and PEF should also be assessed

35
Q

When trying to diagnose a patient with silicosis, which 2 of the following might we expect to see on a chest X-ray?

1 - eggshell calcification of lymph nodes
2 - honeycomb appearance
3 - restriction of lung capacity
4 - pleural effusion

A

1 - eggshell calcification of lymph nodes
3 - restriction of lung capacity

  • look at upper lobes as this is typically where silica fibres collect
36
Q

Which of the following are treatment options available for patients with silicosis?

1 - symptomatic treatment
2 - cough treatment
3 - therapy to manage the dyspnoea
4 - long term O2 therapy
5 - all of the above

A

5 - all of the above
- there is no known cure

37
Q

How many deaths a year are attributed to coal worker pneumoconiosis?

1 - 20 people
2 - 140 people
3 - 1200 people
4 - >1 million people

A

2 - 140 people

38
Q

Where do coal particles typically collect in the lungs?

1 - upper lobe
2 - middle lobe
3 - lower lobe
4 - anywhere

A

1 - upper lobe

39
Q

When trying to diagnose a patient with coal worker pneumoconiosis, which of the following might we expect to see on a chest X-ray?

1 - eggshell calcification of lymph nodes
2 - honeycomb appearance
3 - large number of round opacities
4 - pleural effusion

A

3 - large number of round opacities
- typically begins peripherally and moves towards the hilum

40
Q

Although coal worker pneumoconiosis typically has a long latency period (15-20 years), this can progress to progressive massive fibrosis (PMF). Which of the following can patients with PMF present with on a chest X-ray?

1 - progressive dyspnea
2 - fibrosis
3 - increased pressure on right side of the heart
4 - cor pulmonale
5 - all of the above

A

5 - all of the above

  • typically patients can have bilateral mid-upper zone fibrotic masses on chest X-ray
41
Q

What is the name of the syndrome that encompasses pulmonary rheumatoid nodules, RA and pneumoconiosis?

1 - conns. syndrome
2 - caplans syndrome
3 - cushings syndrome
4 - graves syndrome

A

2 - caplans syndrome

  • conns. syndrome = excessive aldosterone
  • cushings syndrome = excessive cortisol
  • graves syndrome = excessive T3 and T4
42
Q

Which of the following are treatment options available for patients with coal worker pneumoconiosis ?

1 - symptomatic treatment
2 - cough treatment
3 - therapy to manage the dyspnoea
4 - long term O2 therapy
5 - all of the above

A

5 - all of the above

  • cannot cure so essentially treat the symptoms
43
Q

Which of the benign forms of lung disease can asbestos inhalation cause?

1 - calcified pleural plaques
2 - pleural effusion
3 - pleural thickening
4 - all of the above

A

4 - all of the above

44
Q

Asbestosis is fibrosis of the lungs due to long term inhalation of asbestos particles. Which type of cancer is this strongly associated with?

1 - small cell lung cancer
2 - bronchial adenocarcinoma
3 - mesothelioma
4 - lymphoma

A

3 - mesothelioma
- also associated with bronchial adenocarcinoma, just not as common

45
Q

Does asbestos occupational lung disease present immediately following exposure in the work place?

A
  • no
  • long latency period - 20-40 years
46
Q

Are all asbestos equally dangerous?

A
  • no
  • crocidolite (blue asbestos) is most dangerous
47
Q

Lung cancer risk is increased with exposure to asbestos. Does smoking combined with asbestos exposure increase the risk of lung disease further?

A
  • yes - asbestos alone = 7 fold ⬆️ risk of lung cancer
  • asbestos + smoking = 93 fold ⬆️ of lung cancer
48
Q

Mesothelium is a thin membrane layer composed of epithelial cells that line all organs and body spaces such as abdominal and thoracic cavity. Mesothelioma is a form of cancer of the mesothelium. Where in the body does this affect most?

1 - lungs
2 - heart
3 - peritoneum
4 - testes

A

1 - lungs
- mesothelioma cannot be cured, unless detected very early

49
Q

Which of the following are the common symptoms patients with mesothelioma typically present with?

1 - progressive development of dyspnea
2 - chest pain
3 - fine inspiratory crackles
4 - weight loss
5 - repeated unilateral pleural effusion (exudate)
6 - all of the above

A

6 - all of the above

50
Q

Which of the following is a key sign of asbestosis on a chest X-ray?

1 - progressive dyspnea
2 - fibrosis
3 - increased pressure on right side of the heart
4 - cor pulmonale
5 - pleural plaques

A

5 - pleural plaques
- others could also be seen

51
Q

If a patient has mesothelioma, which of the following are potential treatment options?

1 - surgery if detected early
2 - standard cancer treatment
3 - chemotherapy
4 - symptomatic treatment
5 - palliative care
6 - all of the above

A

6 - all of the above

52
Q

Do recreational drugs cause lung disease?

A
  • yes
53
Q

What does epistaxis mean?

1 - blood in pleural space
2 - blood causing a pneumothorax
3 - nose bleeds
4 - blood in stool

A

3 - nose bleed

54
Q

All of the following are forms for neuromuscular disorder:

  • motor neurone disease
  • muscular dystrophy
  • poliomyelitis
  • diaphragmatic palsy

Can these disorders affect breathing?

A
  • yes
  • diaphragm and intercostal muscles do not function properly
  • interstitial tissue is ok, but if lungs do not expand correctly then patient will experience SOB
  • this causes a restrictive respiratory pattern
55
Q

Obesity, kyphosis and scoliosis can all affect breathing, how?

1 - reduced respiratory drive
2 - diaphragm and intercostal muscle innervation is impaired
3 - interstitial tissue is fibrotic
4 - chest cavity is deformed so lungs are unable to expand properly and/or have too much weight on them to expand properly

A

4 - chest cavity is deformed so lungs are unable to expand properly and/or have too much weight on them to expand properly

  • this causes a restrictive respiratory pattern

C. Year 3 MLA Respiratory (15 decks)

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