Pneumoconiosis Flashcards by Iseoluwa Ojo

Pneumoconiosis was originally referred to as

‘The __________ lung reaction to ___________________’

Now defined as
‘The ______________ reaction of lung tissue to ______________, _________ and _______

non-neoplastic

inhalation of mineral dust

non-neoplastic

particulates (organic and inorganic)

chemical fumes and vapors.’

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Pneumoconiosis usually develops from (poorly or well?)- defined ____________
e.g.
 Coal mining
 Sand blasting, hard rock mining, stone cutting etc
 metal mining
 Farming
 Bird handling
 Manufacturing

Well

occupational exposure

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Increasing air pollution world wide, is associated with _________________

high ambient air particulate levels.

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Populations exposed to these high air particulate levels have increased morbidity from lung diseases such as ______,____,______, and ______

pneumoconiosis, asthma, pneumonitis and bronchitis.

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Aetiologic agents of pneumoconiosis

_______ particulates (________)

_______ particulates

________ and _______

Inorganic; mineral dust

Organic

Chemical fumes and vapors

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Aetiologic agents

Inorganic particulates (mineral dust)

_____ dust,_____,______,_______, iron oxalate, barium sulfate, Tin oxide

Coal

silica

asbestos

beryllium

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Aetiologic agents

Organic particulates that induce

1) Hypersensitivity pneumonitis :______,______

2) Asthma
Cotton, flax, hemp, red cedar (wood) dust

Moldy hay, bird droppings

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Aetiologic agents

Chemical fumes and vapors

_______ oxide, _______ dioxide, ammonia, benzene, insecticides

Nitrous

sulphur

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Aetiologic agents

Organic particulates that induce

1) __________

2)________

Hypersensitivity pneumonitis

Asthma

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Classification – based on causative agent

 Anthracosis- ___________
 Silicosis –______ dust
 Asbestosis–______ particles
 Berylliosis – ________ particles

coaldustpneumoconiosis

silica

asbestos

beryllium

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Development of all pneumoconiosis depends on some basic principles

Amount of dust retained in lungs. This depends on

i. _________________ in the air
ii. _________ of exposure
iii.__________ of _______

Concentration of dust

Duration

Effectiveness of pulmonary clearance mechanisms

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Development of all pneumoconiosis depends on some basic principles

__________ retained in lungs
_____________ of particle
____________ to the lungs

Amount of dust

Size and shape

Mechanism of damage

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Size & shape of particles Determines buoyancy of particles

T/F

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Size & shape of particles

• Particles <____ in size tend to reach the ________ and settle in their lining.

• Bigger particles are cleared by _______ and _____ from the _______ & the ________ respectively

5μm; terminal airways

sneezing & mucociliary action

nasopharynx; tracheobronchial tree

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Size & shape of particles

• The smaller the particle, the (more or less?) soluble & the (more or less?) toxic

More; more

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Size & shape of particles

• The bigger the particle, the (more or less ?) resistant to dissolution & the (shorter or longer?) its duration in the lung l, leading to _____________ pneumoconiosis

Longer

fibrosing collagenous

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Mechanism of damage to the lung involves:

i._______ to tissue

ii. Activation of ______

iii. Direct interaction with & activation of _________

iv. Initiation of ________

v.________ effect of ________

Direct injury

macrophages; fibroblasts

immune response

Additional; other irritants

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Mechanism of damage to the lung involves:
i. Direct injury to tissue via _______ & other chemical groups on the particle surface

ii. Activation of macrophages to release ______________

iii. Direct interaction with & activation of fibroblasts by ____________

iv. Initiation of immune response by ________ or __________

v. Additional effect of other irritants e.g. _____________

free radicals

proinflammatory & fibrosing mediators

particles that cross the epithelial cell lining

components of the particles or self-proteins modified by the particles

tobacco smoke magnifies the reaction

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Coal workers Pneumoconiosis(CWP)

▪__________ reaction of lung tissue to _______

Non- neoplastic

coal dust

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Coal workers Pneumoconiosis(CWP)

▪ The spectrum of findings

 ___________ –
_________
__________

Anthracosis

Simple CWP

Complicated CWP

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Anthracosis is (asymptomatic or symptomatic?)

asymptomatic

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MORPHOLOGY
Anthracosis:

_______ of ______ pigment are seen.

Microscopy reveals ______ pigment within _________, as well as streaks & aggregates of pigment in pulmonary ______ and ____

Macules; black

anthracotic; alveolar macrophages

lymphatics & lymph nodes.

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MORPHOLOGY

Simple CWP:

Coal ___________(_____) & nodules.

Microscopy of these lesions reveal aggregates of _________.

A (delicate or dense?) network of ______ is also present in nodules.

macules ; 1-2mm

carbon laden macrophages

Delicate; collagen

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PMF:

▪ Multiple ————- scars (>______).

▪ Microscopy reveals lesions with (delicate or dense?) _____ deposits and pigment initially adjacent to __________

intensely blackened

2cm; dense; collagen

respiratory bronchioles.

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PMF: ▪ The (upper or lower?) lobes & (upper or lower?) zones of the (upper or lower?) lobes are more heavily involved. ____________ is often present.

Upper Upper; lower Central necrosis

CLINICOPATHOLOGICAL CORRELATION A. Anthracosis- _____________ B. CWP-_______ reduction in lung function. May be associated with _____ ,______,______ C. PMF- significant pulmonary _______, pulmonary _______ & consequently ______

asymptomatic little or no; tuberculosis, chronic bronchitis and emphysema. dysfunction; hypertension; cor pulmonale.

SILICOSIS Silica (_________________ ) induced pneumoconiosis

crystalline silicon dioxide

__________ is the 2nd commonest element on earth

Silicon

EPIDEMIOLOGY ➢Silicosis, caused by inhalation of _______ silica, is consequently the most prevalent _________ disease in the world.

crystalline chronic occupational

Silicosis ➢Those at risk include: miners, sandblasters, stone cutters, metal grinders etc T/F🌚

Silicon constitutes ____% of the worlds crust.

______ is the principal constituent of sand

Silica

Silicosis usually presents after _______ of exposure

decades

PATHOGENESIS of silicosis ➢ Silica exists in both _______ and _______ forms.

crystalline & amorphous

PATHOGENESIS of silicosis On inhalation, ______ ingest these particles, become activated and release _______ and ________ mediators ➢ These particles damage the _______ of _______ and ______ by forming bonds with ________ and ———- via surface _____ groups

macrophages membranes ; epithelial cells and macrophages membrane proteins & phospholipids SiOH

PATHOGENESIS of solicosis _______ of silica (as occurs in stone crushing) generates ———- with a half life of ______, this greatly increases it’s cytotoxicity

Cleavage; free radicals 30hrs

The _________ forms of silica are much more fibrogenic.

crystalline

The crystalline forms of silica– ______,_______, and _______

quartz, crystobalite & tridymite

PATHOGENESIS of solicosis ➢ Quartz is less fibrogenic when _______________ e.g ___________ usually have a milder lung disease

mixed with other minerals miners of haematite who are also exposed to quartz

most commonly implicated form of silica in silicosis is ???

Quartz

PATHOGENESIS of solicosis ➢ (Light or Heavy?) lung burdens of amorphous silica (biologically (more or less?) active) may also produce lung lesions

Heavy Less

Examples of amorphous silica

. talc, mica & vermiculite

MORPHOLOGY of silicosis ➢ Early stage: (tiny or large?) , barely palpable, (discrete or obvious?) , ____ nodules. If coal dust is present the nodules are _____. ➢ Intermediate stage: nodules coalesce into _______ with central ___________ due to _________. M

Tiny; discrete ; pale; black hard scars; softening & cavitation; ischaemia or superimposed TB

MORPHOLOGY of silicosis ➢ Intermediate stage: The intervening lung tissue is over ________ , leading to an _______ pattern; or ________. Associated findings: _____ fibrosis, _______ fibrosis & calcification ((thin or thick ?) sheets of ‘ _______ ’ calcification)

expanded; honeycomb; compressed Pleural; lymph node ; Thin; eggshell

PMF (silicosis) Microscopy: Nodules consist of ___________ of ________ in the center and an outer capsule of ___________. Silica particles appear ________ under ________ light

concentric layers of hyalinized collagen dense collagen birefringent; polarized

Stages of silicosis?

Early Intermediate PMF

CLINICOPATHOLOGICAL CORRELATION of silicosis Early stage: (Asymptomatic or symptomatic?) Picked up on routine XR which shows ______ in (upper or lower?) lung zones.

Asymptomatic; fine nodularity Upper

CLINICOPATHOLOGICAL CORRELATION of silicosis Intermediate stage: _____________ lung function

Normal or slightly decreased

CLINICOPATHOLOGICAL CORRELATION of silicosis PMF: Causes impaired pulmonary function. (Slowly or Rapidly?) progressive disease i.e. (slow or fast?) to kill.

Slowly; slow

________ silica is carcinogenic in humans

crystalline

Asbestos is the _______ form of several minerals and exists as ____________

fibrous crystalline hydrated silicates.

Asbestos o It is a (poor or good?) conductor of heat & also (flammable or nonflammable ?) hence, useful as ____ textiles & ______ products.

Poor Nonflammable fireproof; insulation

Asbestos is widely used in construction, jet parts, brake lining, paints, flooring etc. T/F

Asbestos It exists in two distinct geometric forms: o__________ o_________

Chrysotile Amphibole

Asbestos Chrysotile : ———- and _______ fibres Amphibole (_____,_____, and ______ fibres) m

serpentine-curly & flexible straight, stiff & brittle

Pathogenesis of Asbestosis ________ are more pathogenic than ______ particularly with respect to inducing mesotheliomas.

Amphiboles; chrysotiles

Asbestosis However cases of mesotheliomas associated with chrysotile workers are probably due to ___________

contamination with amphiboles..

(Amphiboles or Chrysotile?) are more aerodynamic and therefore tend to get carried, in the inhaled air stream, to the deeper parts of the lungs.

Amphiboles

(Amphiboles or Chrysotile?) are more likely to get impacted in the upper airway and get removed by mucociliary action.

Chrysotile

Abestosis Amphiboles are also (more or less?) soluble, hence (more or less?) toxic.

Less More

Abestosis The (longer or shorter ?) and (thicker or thinner?) the fibre the more injurious.

Longer Thinner

Potentially toxic chemicals (e.g. tobacco carcinogens) may adhere to asbestos fibres and increase the tumor initiating & promoting properties of asbestos. T/F

Only amphiboles and not chrysotiles are fibrogenic T/F

F Both chrysotiles & amphiboles are fibrogenic

Abestosis Interaction of these fibres with _____ leads to the release of inflammatory & fibrogenic mediators resulting in a ___________ and __________.

macrophages generalized interstitial inflammation & fibrosis

Asbestos tends to ______ the macrophage on contact

rupture

MORPHOLOGY: Diffuse pulmonary fibrosis In abestosis ➢ Early- around ______ and _____. Begins in the (upper or lower?) lobes & extends ___wards. ➢ Later- extends to _______  widened air spaces encased in fibrous walls leading to ______ appearance. ➢End stage- Pleural _______ , _____ around pulmonary vessels,____________ & other features of _________.

respiratory bronchioles & alveolar ducts ; Lower; upwards alveolar sacs; honeycomb plaques; scarring; right heart hypertrophy ; cor pulmonale

MORPHOLOGY: Diffuse pulmonary fibrosis In abestosis ➢End stage- ➢Microscopy: ________ deposits in the previously described distribution

eosinophilic collagen

Beryllium and its salts are both toxic and carcinogenic. T/F

Berylliosis ▪ Characteristics: Beryllium is (light or heavy?) ______ color relatively (soft or hard?( metal that is (weak or strong ?) but _____.

Light Silver -gray Soft Strong Brittle

Berylliosis ▪ Berylliosis: Due to heavy exposure to dusts or fumes of beryllium, more common in ________ and _______ industries

nuclear and aerospace

Berylliosis ▪ Acute disease has disappeared due to ____________

exposure standards

Berylliosis ▪ Low dose exposure may cause ———- lesions that mimic ______

granulomatous sarcoidosis

Berylliosis ▪ Chronic berylliosis is due to __________

cell mediated immunity

Berylliosis ▪____% of those exposed develop disease; delayed hypersensitivity leads to ___________ in lungs and hilar nodes, which become progressively _____;_____ symptoms until late

2; noncaseating granulomas fibrotic no

Berylliosis ▪ Heavy beryllium exposure is linked to __________

lung cancer

PMF = ________

Progressive massive fibrosis

a (small or large?) percentage of exposed people develop pneumoconioses, and indicates a ______ predisposition.

Small genetic

The patients have increased susceptibility to lung infections such as ___,______, and ______

Mycobacterium tuberculosis, atypical mycobacteria and fungi

Concomitant cigarette smoking in a patient with abestosis markedly increases the risk of mesothelioma . T/F

F Concomitant cigarette smoking markedly increases the risk of lung carcinoma but not that of mesothelioma .

Mesothelioma ________ is the only known risk factor

Abestos

Pneumoconiosis Flashcards

(80 cards)