Resp - Path (Hypersensitivity pneumonitis & Pneumoconioses)

Question 1

What type of hypersensitivity is hypersensitivity pneumonitis?

Answer 1

Mixed type III/IV hypersensitivity

Question 2

What causes hypersensitivity pneumonitis? What are 4 of its symptoms?

Answer 2

Mixed type III/IV hypersensitivity reaction to environmental antigen –> dyspnea, cough, chest tightness, headache.

Question 3

What 2 patient populations often present with hypersensitivity pneumonitis?

Answer 3

Often seen in farmers and those exposed to birds

Question 4

What are 3 types of pneumoconioses?

Answer 4

(1) Coal workers’ pneumoconiosis (2) Silicosis (3) Asbestosis

Question 5

What are 2 increased risks due to Pneumoconioses?

Answer 5

Increased risk of cor pulmonale and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules)

Question 6

With are three activities/professions with which asbestosis is associated?

Answer 6

Associated with shipbuilding, roofing, and plumbing

Question 7

What is pathognomonic for asbestosis on CT?

Answer 7

“Ivory white,” calcified pleural plaques are pathognomonic of asbestos exposure, but are not precancerous

Question 8

Are the pleural plaques associated with asbestos precancerous?

Answer 8

“Ivory white,” calcified pleural plaques are pathognomonic of asbestos exposure, but are not precancerous

Question 9

Asbestosis is associated with an increased incidence of what 2 conditions?

Answer 9

Associated with an increased incidence of bronchogenic carcinoma and mesothelioma

Question 10

What part of the lungs does asbestosis affect?

Answer 10

Affects lower lobes.

Question 11

Describe Asbestos bodies. What is another name for them?

Answer 11

Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells

Question 12

What parts of the the lung do asbestos, silica, and coal affect?

Answer 12

Think: “ASBESTOS is from the ROOF (was common in insulation), but affects the BASE (lower lobes). SILICA & COAL are from the BASE (earth), but affect the ROOF (upper lobes).”

Question 13

What is the pathogenesis of coal workers’ pneumoconiosis?

Answer 13

Prolonged coal dust exposure –> macrophages laden with carbon –> inflammation and fibrosis

Question 14

What is another name for Coal workers’ pneumoconiosis?

Answer 14

Also known as black lung disease

Question 15

What part of the lungs does Coal workers’ pneumoconiosis affect?

Answer 15

Affects upper lobes

Question 16

What kind of condition is Anthracosis? In what patient population is it found, and what causes it?

Answer 16

Anthracosis - Asymptomatic condition found in many urban dwellers exposed to sooty air.

Question 17

What are 3 activities associated with Silicosis?

Answer 17

Associated with foundries, sandblasting, and mines.

Question 18

What is the macrophage response to Silicosis, and what effect does it have?

Answer 18

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis

Question 19

To what infection is silica thought to increase susceptibility, and how?

Answer 19

It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.

Question 20

For what non-infectious condition does silica increase the risk?

Answer 20

Also increase risk of bronchogenic carcinoma.

Question 21

What part of the lungs does Silicosis affect?

Answer 21

Affects upper lobes

Question 22

What is the (CT) finding associated with Silicosis?

Answer 22

“Eggshell” calcification of hilar lymph nodes