Occupational Pulmonary Disorders Flashcards Preview

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Flashcards in Occupational Pulmonary Disorders Deck (64):
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

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

2

Wool handlers are most likely to be exposed to:
a. psittacosis
b. candidiasis
c. anthrax
d. sporotrichosis

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

3

Two types of work-related asthma?

new onset asthma; "work-exacerbated" asthma

4

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

true

5

WRA: examples of high MW allergens:

pollen, wood dust, animal allergens, molds, enzymes

6

WRA: examples of low MW allergens:

isocyanates, acid anhydrides; colophony-fluxes; biocides.

7

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

True

8

Examples of RADS due to single, high dose exposure:

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

9

Diagnostic tests for WRA?

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

10

IgE antigen RAST testing is best for?

HMW antigen; problematic for LMW such is isocyanate

11

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

Specific bronchoprovocation testing.

12

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

True

13

Acute inhalation injury: high water solubility likely to affect?

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

14

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

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

15

Examples of Acute Inhalation Injury sequelae:

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

16

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

31%

17

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

19%

18

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

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

19

What marker demonstrates significant asbestos exposure?

pleural plaques

20

What is latency for asbestosis?

25 years

21

Interstitial fibrosis (asbestosis) can resemble which radiographic feature?

"B-lines"

22

What spirometric measurements are affected by asbestosis?

decreased TLC, DLCO

23

Asbestosis affects which part of the lungs?

predominantly the lower lungs.

24

What is latency for mesothelioma?

30-35 years

25

T or F: significant asbestos exposure needed for mesothelioma?

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

26

What is the risk/synergy between smoking and mesothelioma?

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

27

What other cancers can be due to asbestos exposure?

laryngeal, colon, peritoneal mesothelioma

28

What occupations are at risk for silicosis?

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

29

What disease can be associated with silicosis?

collagen vascular disease (scleroderma)

30

"Angel wing" fibrosis is associated with?

progressive silicosis

31

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

silica

32

Silicotic nodules differ from asbestos findings in what way?

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

33

"Eggshell" calcification in hilar nodes is associated with?

progressive silicosis

34

Famous event associated with acute silicosis exposure?

Hawk's Nest Disaster killed 400 workers.

35

What form of silica is IARC Group 1?

crystalline (cystobalite from occ sources)

36

What form of silica is IARC Group 3?

amorphous silica

37

Histologic findings associated with CWP?

"coal macules"

38

CWP: usual prognosis?

mild

39

Caplan's Syndrome is?

rheumatoid coal pneumoconiosis

40

"Hard metal" disease.

fibrosis with giant-cell interstitial pneumonitis on biopsy

41

tungsten carbide with cobalt to harden alloys

"hard metal" disease

42

Hypersensitivity pneumonitis AKA

extrinsic allergic alveolitis EAA

43

Examples of Hypersensitivity Pneumonitis

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

44

Hypersensitivity Pneumonitis cliinical findings:

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

45

What disease is "immunologic from metal"?

beryllium lung disease

46

What organ systems are affected by beryllium?

skin and lungs

47

What is famous beryllium case?

"Salem Sarcoid"

48

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

Be DZ and Be sensitization.

49

What is used to determine Be sensitization?

lymphocyte proliferation or transformation test.

50

Chromium VI is IARC Group?

Group 1

51

What is "popcorn lung?"

Bronchiolitis obliterans in diacetyl workers

52

What is bronchiolitis obliterans?

inflammatory disease of small airways AKA constrictive or obliterative bronchiolitis

53

What is PFT finding in BO?

fixed obstruction

54

What are other suspected exposures related to BO besides diacetyl?

e-cigarettes, coffee processing

55

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

true

56

Occupational risk for PPD conversion are high in what settings?

Nursing homes, correctional facilities

57

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

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

58

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.

59

Advantages of interferon-gamma testing for TB?

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

60

What is current recommendation for LTBI?

Nine months of daily INH therapy

61

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

rifampin

62

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

Yes. Pose no risk.

63

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

Yes, if counseled and periodically monitored.

64

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

Yes.