Flashcards in Occupational Pulmonary Disorders Deck (64):
CXR showing tiny round opacities primarily in the upper lung fields with hilar adenopathy is most characteristic of:
c. hypersensitivity pneumonitis
d. metal fume fever
NB: egg shell calcifications of hilar nodes occur in 20% of cases
Wool handlers are most likely to be exposed to:
psittacosis: chlamydial infection transmitted by infected birds
brucellosis: slaughter houses
Two types of work-related asthma?
new onset asthma; "work-exacerbated" asthma
T or F: Work-related asthma are IgE mediated?
WRA: examples of high MW allergens:
pollen, wood dust, animal allergens, molds, enzymes
WRA: examples of low MW allergens:
isocyanates, acid anhydrides; colophony-fluxes; biocides.
T or F: Can RADS occur with single, high dose exposure?
Examples of RADS due to single, high dose exposure:
chlorine spill, hypochlorite fumes, WTC dust, acide fumes in metal plating.
Diagnostic tests for WRA?
spirometry; PEFR; IgE antigen RAST testing; rare bronchoprovocation testing
IgE antigen RAST testing is best for?
HMW antigen; problematic for LMW such is isocyanate
What is "gold standard" for sensitizer-induced occ asthma testing?
Specific bronchoprovocation testing.
T or F: sensitization for occ asthma may occur at levels at or below PEL?
Acute inhalation injury: high water solubility likely to affect?
upper respiratory tract and larynx; ammonia, acids, oxides of sulfur
Acute inhalation injury: low water solubility likely to affect? Examples:
lower airways; phosgene, oxides of nitrogen (NO2), MAY CAUSE DELAYED EFFECTS
Examples of Acute Inhalation Injury sequelae:
ARDS, airway scarring, RADS, BO, upper resp dysfunction, vocal chord dysfunction, PTSD
Among never-smokers, cause of COPD likely due to work in ___% of cases.
In all COPD cases, occupational causes account for __%?
In asbestos lung disease, what is the most common effect seen?
pleural effusions within 20 years (frequently less than 10 years)
What marker demonstrates significant asbestos exposure?
What is latency for asbestosis?
Interstitial fibrosis (asbestosis) can resemble which radiographic feature?
What spirometric measurements are affected by asbestosis?
decreased TLC, DLCO
Asbestosis affects which part of the lungs?
predominantly the lower lungs.
What is latency for mesothelioma?
T or F: significant asbestos exposure needed for mesothelioma?
False. Exposure may be short in duration and low intensity, especially if genetic factors.
What is the risk/synergy between smoking and mesothelioma?
none. (if true, there would be more cases of mesothelioma without asbestos exposure.)
What other cancers can be due to asbestos exposure?
laryngeal, colon, peritoneal mesothelioma
What occupations are at risk for silicosis?
mining, milling, quarry, foundry, sandblasting, pottery, glassmaking, boilers
What disease can be associated with silicosis?
collagen vascular disease (scleroderma)
"Angel wing" fibrosis is associated with?
PMF, progressive massive fibrosis, is associated with what exposure?
Silicotic nodules differ from asbestos findings in what way?
Silica: rounded upper lung nodules; asbestos: linear lower lung nodules.
"Eggshell" calcification in hilar nodes is associated with?
Famous event associated with acute silicosis exposure?
Hawk's Nest Disaster killed 400 workers.
What form of silica is IARC Group 1?
crystalline (cystobalite from occ sources)
What form of silica is IARC Group 3?
Histologic findings associated with CWP?
CWP: usual prognosis?
Caplan's Syndrome is?
rheumatoid coal pneumoconiosis
"Hard metal" disease.
fibrosis with giant-cell interstitial pneumonitis on biopsy
tungsten carbide with cobalt to harden alloys
"hard metal" disease
Hypersensitivity pneumonitis AKA
extrinsic allergic alveolitis EAA
Examples of Hypersensitivity Pneumonitis
Farmer's lung; pigeon breeder's lung; woodworker's lung; metal working fluids; isocyanates
Hypersensitivity Pneumonitis cliinical findings:
CXR granulomata; CT scan granuloma or fibrosis; bronchoalveolar lavage `
What disease is "immunologic from metal"?
beryllium lung disease
What organ systems are affected by beryllium?
skin and lungs
What is famous beryllium case?
With regard to beryllium exposure, it is important to distinguish between?
Be DZ and Be sensitization.
What is used to determine Be sensitization?
lymphocyte proliferation or transformation test.
Chromium VI is IARC Group?
What is "popcorn lung?"
Bronchiolitis obliterans in diacetyl workers
What is bronchiolitis obliterans?
inflammatory disease of small airways AKA constrictive or obliterative bronchiolitis
What is PFT finding in BO?
What are other suspected exposures related to BO besides diacetyl?
e-cigarettes, coffee processing
Diagnosis of TB is delayed in nearly 50% of patients with active TB. T or F?
Occupational risk for PPD conversion are high in what settings?
Nursing homes, correctional facilities
Re: TST/PPD testing, assume "booster effect" if:
second PPD (done 1-3 weeks after initial negative PPD) is positive.
What are cut-off values for TST?
5mm for immunocompromised or HIV +; 10mm or more for recent immigrant (less than 5 years) from high prevalence country, high risk population, fungal lab workers, children less than 4 years old; 15 mm no risk factors.
Advantages of interferon-gamma testing for TB?
single visit, no booster effect, reduced reader bias, BCG inconsequential.
What is current recommendation for LTBI?
Nine months of daily INH therapy
What can be used is INH not tolerated for LTBI preventive therapy?
T or F: Can HCW on LTBI preventive therapy continue to work?
Yes. Pose no risk.
T or F: Can HCW without evidence of active TB continue to work?
Yes, if counseled and periodically monitored.