Occupational Pulmonary Disorders

Question 1

CXR showing tiny round opacities primarily in the upper lung fields with hilar adenopathy is most characteristic of:

a. silicosis
b. asbestosis
c. hypersensitivity pneumonitis
d. metal fume fever

Answer 1

a. silicosis

NB: egg shell calcifications of hilar nodes occur in 20% of cases

Question 2

Wool handlers are most likely to be exposed to:

a. psittacosis
b. candidiasis
c. anthrax
d. sporotrichosis

Answer 2

c. anthrax
NB: 
psittacosis: chlamydial infection transmitted by infected birds
brucellosis: slaughter houses
sporotrichosis: horticulturists

Question 3

Two types of work-related asthma?

Answer 3

new onset asthma; “work-exacerbated” asthma

Question 4

T or F: Work-related asthma are IgE mediated?

Answer 4

true

Question 5

WRA: examples of high MW allergens:

Answer 5

pollen, wood dust, animal allergens, molds, enzymes

Question 6

WRA: examples of low MW allergens:

Answer 6

isocyanates, acid anhydrides; colophony-fluxes; biocides.

Question 7

T or F: Can RADS occur with single, high dose exposure?

Answer 7

True

Question 8

Examples of RADS due to single, high dose exposure:

Answer 8

chlorine spill, hypochlorite fumes, WTC dust, acide fumes in metal plating.

Question 9

Diagnostic tests for WRA?

Answer 9

spirometry; PEFR; IgE antigen RAST testing; rare bronchoprovocation testing

Question 10

IgE antigen RAST testing is best for?

Answer 10

HMW antigen; problematic for LMW such is isocyanate

Question 11

What is “gold standard” for sensitizer-induced occ asthma testing?

Answer 11

Specific bronchoprovocation testing.

Question 12

T or F: sensitization for occ asthma may occur at levels at or below PEL?

Answer 12

True

Question 13

Acute inhalation injury: high water solubility likely to affect?

Answer 13

upper respiratory tract and larynx; ammonia, acids, oxides of sulfur

Question 14

Acute inhalation injury: low water solubility likely to affect? Examples:

Answer 14

lower airways; phosgene, oxides of nitrogen (NO2), MAY CAUSE DELAYED EFFECTS

Question 15

Examples of Acute Inhalation Injury sequelae:

Answer 15

ARDS, airway scarring, RADS, BO, upper resp dysfunction, vocal chord dysfunction, PTSD

Question 16

Among never-smokers, cause of COPD likely due to work in ___% of cases.

Answer 16

31%

Question 17

In all COPD cases, occupational causes account for __%?

Answer 17

19%

Question 18

In asbestos lung disease, what is the most common effect seen?

Answer 18

pleural effusions within 20 years (frequently less than 10 years)

Question 19

What marker demonstrates significant asbestos exposure?

Answer 19

pleural plaques

Question 20

What is latency for asbestosis?

Answer 20

25 years

Question 21

Interstitial fibrosis (asbestosis) can resemble which radiographic feature?

Answer 21

“B-lines”

Question 22

What spirometric measurements are affected by asbestosis?

Answer 22

decreased TLC, DLCO

Question 23

Asbestosis affects which part of the lungs?

Answer 23

predominantly the lower lungs.

Question 24

What is latency for mesothelioma?

Answer 24

30-35 years

Question 25

T or F: significant asbestos exposure needed for mesothelioma?

Answer 25

False. Exposure may be short in duration and low intensity, especially if genetic factors.

Question 26

What is the risk/synergy between smoking and mesothelioma?

Answer 26

none. (if true, there would be more cases of mesothelioma without asbestos exposure.)

Question 27

What other cancers can be due to asbestos exposure?

Answer 27

laryngeal, colon, peritoneal mesothelioma

Question 28

What occupations are at risk for silicosis?

Answer 28

mining, milling, quarry, foundry, sandblasting, pottery, glassmaking, boilers

Question 29

What disease can be associated with silicosis?

Answer 29

collagen vascular disease (scleroderma)

Question 30

"Angel wing" fibrosis is associated with?

Answer 30

progressive silicosis

Question 31

PMF, progressive massive fibrosis, is associated with what exposure?

Answer 31

silica

Question 32

Silicotic nodules differ from asbestos findings in what way?

Answer 32

Silica: rounded upper lung nodules; asbestos: linear lower lung nodules.

Question 33

"Eggshell" calcification in hilar nodes is associated with?

Answer 33

progressive silicosis

Question 34

Famous event associated with acute silicosis exposure?

Answer 34

Hawk's Nest Disaster killed 400 workers.

Question 35

What form of silica is IARC Group 1?

Answer 35

crystalline (cystobalite from occ sources)

Question 36

What form of silica is IARC Group 3?

Answer 36

amorphous silica

Question 37

Histologic findings associated with CWP?

Answer 37

"coal macules"

Question 38

CWP: usual prognosis?

Answer 38

mild

Question 39

Caplan's Syndrome is?

Answer 39

rheumatoid coal pneumoconiosis

Question 40

"Hard metal" disease.

Answer 40

fibrosis with giant-cell interstitial pneumonitis on biopsy

Question 41

tungsten carbide with cobalt to harden alloys

Answer 41

"hard metal" disease

Question 42

Hypersensitivity pneumonitis AKA

Answer 42

extrinsic allergic alveolitis EAA

Question 43

Examples of Hypersensitivity Pneumonitis

Answer 43

Farmer's lung; pigeon breeder's lung; woodworker's lung; metal working fluids; isocyanates

Question 44

Hypersensitivity Pneumonitis cliinical findings:

Answer 44

CXR granulomata; CT scan granuloma or fibrosis; bronchoalveolar lavage `

Question 45

What disease is "immunologic from metal"?

Answer 45

beryllium lung disease

Question 46

What organ systems are affected by beryllium?

Answer 46

skin and lungs

Question 47

What is famous beryllium case?

Answer 47

"Salem Sarcoid"

Question 48

With regard to beryllium exposure, it is important to distinguish between?

Answer 48

Be DZ and Be sensitization.

Question 49

What is used to determine Be sensitization?

Answer 49

lymphocyte proliferation or transformation test.

Question 50

Chromium VI is IARC Group?

Answer 50

Group 1

Question 51

What is "popcorn lung?"

Answer 51

Bronchiolitis obliterans in diacetyl workers

Question 52

What is bronchiolitis obliterans?

Answer 52

inflammatory disease of small airways AKA constrictive or obliterative bronchiolitis

Question 53

What is PFT finding in BO?

Answer 53

fixed obstruction

Question 54

What are other suspected exposures related to BO besides diacetyl?

Answer 54

e-cigarettes, coffee processing

Question 55

Diagnosis of TB is delayed in nearly 50% of patients with active TB. T or F?

Answer 55

true

Question 56

Occupational risk for PPD conversion are high in what settings?

Answer 56

Nursing homes, correctional facilities

Question 57

Re: TST/PPD testing, assume "booster effect" if:

Answer 57

second PPD (done 1-3 weeks after initial negative PPD) is positive.

Question 58

What are cut-off values for TST?

Answer 58

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.

Question 59

Advantages of interferon-gamma testing for TB?

Answer 59

single visit, no booster effect, reduced reader bias, BCG inconsequential.

Question 60

What is current recommendation for LTBI?

Answer 60

Nine months of daily INH therapy

Question 61

What can be used is INH not tolerated for LTBI preventive therapy?

Answer 61

rifampin

Question 62

T or F: Can HCW on LTBI preventive therapy continue to work?

Answer 62

Yes. Pose no risk.

Question 63

T or F: Can HCW without evidence of active TB continue to work?

Answer 63

Yes, if counseled and periodically monitored.

Question 64

Is N-95 sufficient for RP for work with TB?

Answer 64

Yes.