RESPIRATORY - Occupational Lung diseases Flashcards by Izzy Burns

What is asbestos

Mix of silicates of Fe,Mg,Ni,Cd,Al

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Who gets asbestos exposure

Patients over age 50

Who worked in building industry /shipyardsd before 1960’s

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What is the longest latent period for asbestos exposure

Up to 50 years

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What is the risk of asbestos disease proportional to?

Intensity of exposure

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What are Asbestos body

Markers of asbestos exposure histologically

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How can asbestos bodies be seen?

Histologically after a lung biopssies

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When do pleural plaques occur?

After light exposure to asbestos

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Sx pleural plaques

Usually asymp

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Ix findings pleural plaques (3)

Mild restrictive deficit on spiromertry
Pleural thickening
Calcification CXR

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Are pleural plauques progressive

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Def diffuse pleural thickening

affects > ¼ of the pleural surface

Caused by more heavy exposure

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PS diffuse pleural thickenings

Restrictive deficits

Effort dyspnoea

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Are diffuse pleural thickenings progressive?

Yes

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Onset mesothelioma

After light asbestos exposure

20-40y after exposure

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PS mesothelioma + CXR findings (3)

Pleuritic chest pain
Increasing dyspnoea
Unilateral pleural effusion on CXR

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Prognosis mesothelioma

not good

med survival 2y from diagnosis

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Onset absestosis

By heavy exposure

5-10 years from exposure to diagnosis

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PS asbestosis + CXR fingins

Progressive dyspnoea

Diffuse bilateral streaky strokes on CXR w/ honey combing

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Prognosis asbestosis

Poor

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Which patients can obtain occupational compensation? (4)

Bilateral diffuse pleural thickening
Mesothelioma
Asbestos related bronchial carcinoma
Asbestosis

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Which other ca can be caused by asbestos exposure

Asbestos related carcinoma of the bronchus

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What is pneumoconiosis and what is it caused by

Disease of the lungs caused by inhalaltion of dusts,, particularly coal

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pathology pneumococoniosis

Dust = toxic to macrophages so = local inflammatory response

If it becomes chronic –> fibrosis –> restrictive lung defects

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What is the risk of developing coal workers pneumoconiosis related to

Degree of exposure to the dust

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Def simple coal workers pneumoconiosis

Small nodules (2-5mm) on CXR - not assoc w/ any clinically signif impairment of resp fct

What may coal workers pneumoconiosis develop into

PMF

Def progressive massive fibrosis (PMF)

Presence of large nodules (>10mm) on CXR

Development of PMF

Progresses relentlessly --> mixed obstructive + restrictive pattern --> Respiratory failure

Problem in obstructive lung diseases

SOB due to difficult exhaling all air from their lungs Exhaled air comes out slower than normal At end of full exhal, abnorm high amount of air = still in lungs

E.g.s of obstructive lung diseases (4)

COPD Asthma Bronchiectasis Cystic fibrosis

Problem in restrictive lung diseases

Cannot fully fill lungs with air Lungs are restricted from expanding From conditions causing stiffness in the lungs itself

E.g.s of restrictive lung. diseases (5)

``` ILD - PF Sarcoidosis Obesity Scoliosis NM disease ```

Sx of restrictive lung diseases (2)

Progressive exertional dyspnoea | Dry cough

What is pulmonary fibrosis

Umbrella term for different conditions --> build up of scar tissue in the lungs

What type of disease is pulmonary fibrosis

An interstial lung disease

What is an interstitial lung diesase

Disease affecting the tissue that lies between the alveoli and pulmonary capillaries

Cause of idiopathic PF

Unknown | Some links to acid reflux, viruses, breathing in dusts

type of HS reaction hypersensitivity pneumonitis

III

What is hypersensitivity pneumonitis due to

Inhaled antigens -> chronic inflammation --> fibrosis

3 e.g.s of hypersentivity pneumonitis

Farmers lungs Bird fanciers lungs Malt workers lungs

Cause of farmers lungs

Micropolyspora

Cause of bird fanciers lungs

Proteins in bird droppings

Cause of malt workers lungs

Aspergillus

Drugs causing pulmonary fibrosis (2)

Penicillamine | Nitrofurantoin

Cause of T1RF

Disease of the lung parenchyma | E.g.s asthma, pulm oedema, pneumonia, PE, COPD. ARDS

Cause of T2RF

When alveolar ventilation is insufficient to excrete the vol of CO2 being prod by tissue metabolism

Causes of T2RF (14)

``` Severe asthma Severe COPD Severe PF PSA CNS pathology Sedative Dx Rib fracture Kyphoscoliosis Flail chest Diaphragmatic paralysis MG GBS Cord lesions Poliomyelitis ```

What is pectus excavatum

Anterior chest wall abnormality --> displacement of heart + slight breathlessness

Is pectus carinatum signif?

CF of hypoxia (4)

Dyspnoea Agitation Confusion Central cyanosis

Features of hypercapnia (6)

``` Headache TachyC Bounding pulse CO2 retention flap Papilloedema Features of acidosis ```

Kussmual resp

Air hunger --> deep + laboured breathing

pH in acute hypercapnic respiratory failure

<7.3

pH in chronic respiratory failure

Just slightly < than normal

What is the normal anion gap?

11-18mmol/L

What does a normal anion gap in metabolic acidosis suggest?

Loss of bicarbonate

Causes of metabolic acidosis with normal anion gap (4)

RTA Diarrhoea Drugs (acetazolomide) Pancreatic/intestinal fl

What is a raised anion gap in metabolic acidosis suggest?

Production of organic acids

Causes of metabolic acidosis / raised anion gap (4)

Lactic acidosis Ketosis urate (renal failure) Dx

causes of respiratory alkalosis (5)

``` Anything --> hyperventilation Anxiety Pain Altitude Incr met demands - pregnant, sepsis, fever, hypothyroid Dx (NSAIDS/OD) ```

Causes of metabolic alkalosis

XS base - antacids | Loss of acid - vomiting, hypokalaemia, burns, hyperaldosteronism

Lobectomy - indications (4)

Lung cancer Bronchiectasis Chronic lung abscess, TB Fungal infections

Inspection findings - lobectomy

Thoracotomy scar | CHx wall flattening on side of surgery

Palpation findings - lobectomy

Tracheal displacement towards surgical side | Reduced expansion

Percussion findings - lobectomy

Hyper-resonant on side of lobectomy

Ausculation findings - lobectomy

Reduced air entry over site

What is sarcoidosis

Systemic, non-caseating granulomatous disease

Who gets sarcoidosis

F 20-40

PS sarcoidosis

Non-specific malaise + arthralgia

Other manifestations of sarcoid

``` Pulmonary fibrosis Erythem nodosum Glomerulonephritis Cardiomyopathy Arthritis CN lesions ```

Mx sarcoidosis

Simple analgesia NSAIDs If lung fibrosis - CCS

What 5 ways can aspergillus affect the lungs

``` Asthma (T1HS spores) EAA - malt workers lung Allergic bronchopulmonary asperigillosis Aspergilloma Invasive aspergillosis ```

Causes of clubbing

Intrathoracic neoplasm Suppurative (pus) lung diseases - Abscess/CF/bronchiectasis/fungal infection Fibrotic lung disease - IPF/asbestosis/fungal infection CV disease - congen lesion/infective endocarditis/aortic aneurysm GI - IBD/Coeliac Liver - chronic hepatitis/cirrhosis Thyroid acropachy

RESPIRATORY - Occupational Lung diseases Flashcards

(73 cards)