SM 171a - Occupational Disorders Flashcards

1
Q

Pathologic findings of alveolar proteinosis are associated with which disease/exposure?

A

Acute silicosis

Often associated with sandblaster use (within the last 2 weeks)

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2
Q

Which of the following is unlikely to be a noxious workplace exposure?

  1. Heat/Cold
  2. Streptococcus pneumoniae
  3. Chlorine gas
  4. Dust
  5. Animal dander
A

b. Streptococcus pneumoniae

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3
Q

The new Permissible Exposure Level (PEL) for silica is ____ mg

A

The new Permissible Exposure Level (PEL) for silica is 0.05 mg

Industries have pushed back against this, even though compliance with the previous OSHA rule resulted in a 0.4-11% lifetime risk of silicosis

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4
Q

List the 4 categories of silicosis

A
  • Chronic simple silicosis
  • Progressive massive fibrosis
  • Accelerated silicosis
  • Acute silicosis/silicoproteinosis (alveolar proteinosis)
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5
Q

Humidifier lung is associated with what exposure?

A

Amoebae

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6
Q

Which of the following would not be considered an occupational lung disease:

  1. New onset asthma in a isocyanate exposed worker
  2. Exacerbations of Asthma caused by cold air in a refrigeration worker at a meat packing plant.
  3. New onset COPD in a heavily grain dust exposed agricultural worker with a 40 pack year history of tobacco smoke exposure.
  4. Bronchiolitis caused by diacetyl exposure in a consumer of flavored microwave popcorn.
  5. Hypersensitivity pneumonitis in a zoo keeper working with avian species.
A

d. Bronchiolitis caused by diacetyl exposure in a consumer of flavored microwave popcorn.

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7
Q

Which of the following is not a required part of the work up needed to make the diagnosis of a disabling occupational lung disease?

  1. Medical History
  2. Occupational and Exposure History
  3. Lung function testing
  4. Pulmonary pathology specimens
  5. Chest imaging
A

d. Pulmonary pathology specimens

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8
Q

Describe the presentation and progression of chronic simple silicosis

A
  • 20-30 year latency period
  • Recognized by abnormal radiograph: upper and lower lobe nodules
  • Few symptoms and normal PFTs in early disease
  • May progress slowly
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9
Q

Malt worker’s lung, suberosis, and cheese worker’s lung are associated with which exposure?

A

Fungi

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10
Q

Farmer’s lung, mushroom worker’s lung, and bagassosis are associated with what exposure?

A

Bacteria

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11
Q

Association between silica and lung cancer is most often seen in which occupations?

A
  • Miners
  • Foundry workers
  • Quarry workers
  • Diatomaceous earth workers
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12
Q

What is a sentinal occupational health event?

A

The index case of a disease, diability, or untimiely death in a workplace

Sifnifies failure of hygiene and/or safety measures that are meant to protect workers

Indicates a sick worker and a sick workplace!

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13
Q

What diseases are caused by inhalation of coal mine dust?

A
  • Fibrotic diseases
    • Silicosis
    • Coal worker’s pneumoconiosis (CWP)
  • Airflow diseases (COPD)
    • Bronchitis
    • Emphysema
    • Mineral dust airways disease
      • bronchiolitis due to scarring around airways
  • Infectious diseases
    • Tuberculosis
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14
Q

How are radiographs of dust exposed workers classified?

A
  • Small opacities
    • 0/0 is a normal lung
    • 3/3 is the worst
  • Large opacities - categorize progressive massive fibrosis
    • A: 1-5 cm
    • B: 5cm - size of right upper lobe
    • C: Everywhere
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15
Q

What are the 4 major categories of occupational lung diseases?

A
  • Immunologic asthma
  • Irritant asthma
  • Emphysema/cold
  • Bronchiolitis

(Word on the street is that this is from the PBJ deck; if you see anything different in our lectures, suggest an edit!)

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16
Q

Why is it difficult to diagnose an occupational lung disease?

A
  • Clinical and pathologic expressions of most of these diseases are indistinguishable from non-occupational diseases
  • Long latency period between onset of exposure and first expression of disease
  • Multifactorial causation
  • Underreporting of work-related conditions
17
Q

List the silica-related health effects

A
  • Silicosis
  • Mycobacterial infections: MTB and NTM
  • Industrial bronchitis & COPD
  • Extrapulmonary diseases
    • Autoimmune and renal
  • Lung cancer
  • Pleural abnormalities
18
Q

All of the following are important components of the occupational history except:

  1. Chronology of jobs and job titles
  2. Description of work place processes
  3. Data on specific exposures – i.e. MSDS sheets
  4. Names of managers at each workplace
  5. Use of Personal Protective Equipment
A
19
Q

What disease is pictured?

How do you know?

A

Chronic simple silicosis

  • Small amounts of very fine carbonaceous (black) pigment
  • Think “little flecks”
20
Q

How is occupational lung disease diagnosed?

A

Need history of exposure + other diagnostic tools

  • Chest imaging abnormality (must have)
  • Lung function abnormalities
  • Consistent laboratory tests
  • Lung pathology
21
Q

What disease is pictured?

How do you know?

A

Acute silicosis aka silicoproteinosis

  • You can see pathologic findings of alveolar proteinosis
    • Abnormal buildup of surfactant protein in the lungs
22
Q

What is the difference between impairment and disability, with regard to occupational lung disease?

A
  • Impairment
    • Loss of physical function
    • Usually determined by health care provider, based on objective findings
  • Disability
    • Legal definition regarding the impact of impairment on social and work function
    • Depends on whether impairment precludes carrying out the patient’s job

Note: Impairment may occur w/o disability, depending on the patient’s occupation

23
Q

What test may detect asthma in patients with normal resting spirometry?

A

Bronchoprovocation testing

24
Q

What occupational hazard is associated with acute silicosis?

A

Sandblasters

25
Q

In Illinois, what is the definition of an occupational lung disease?

A

A disease is classified as an occupational lung disease if the occupations was a contributor to the disease

Does not have to be the sole cause

26
Q

Describe the presentation of acute silicosis/silicoproteinosis

A
  • Requires intense, high exposures
  • Symptoms within 2 weeks of exposure
27
Q

What host factors contribute to silicosis?

A

Race may play a role; African Americans had a 2x higher rater of silicosis than Whites

28
Q

Silica is classified as a group ____ substance: “carcinogenic to humans”

A

Silica is classified as a group 1 substance: “carcinogenic to humans”

29
Q

What kinds of occupation/work are associated with silicosis?

A
  • Agriculture
  • Mining
  • Road construction
  • Glass
  • Ceramics
  • Foundries
  • Construction
30
Q

What is pneumoconiosis?

A

An interstitial lung disease caused by inhalation of dust

(Asbestos, coal dust, silica)

31
Q

Describe the presentation of progressive massive fibrosis (PMF)

A
  • Mass > 1cm in diameter
  • Mixed pattern of restriction and obstruction on PFTs
  • Cicatricial emphysema
  • Usually symmetric, occasionally R>L
  • Asymmetric, rapid growth, cavitation possible
    • But if seen, search for mycobacterial disease or cancer