questions 5

Pneumoconioses

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Topic updated on 12/17/16 2:57pm

Overview
  • Definition
    • inhalation of small dust particles (coni = latin for dust)
  • Pathophysiology
    • varied and based on the type of dust
    • fibrogenicity
      • coal (least), asbestos, silica, and beryllium (most)
    • region of respiratory tract involved (and mechanism of clearance) depends on particle size
      • small particles affect alveoli (< 2 microns)
        • phagocytosed by macrophages
      • intermediate particles affect respiratory bronchioles ( > 2 microns but < 10 microns)
        • cleared by mucociliary transport
      • large particles are trapped in the upper respiratory tract
    • all result in interstitial fibrosis
      • ↑ incidence of cor pulmonale due to pulmonary hypertension
Coal workers pneumoconiosis (CWP)
  • Epidemiology
    • workers of coal mines and inhabitants of large cities
  • Pathology
    • affects upper lobes (high ventilation)
    • macrophages phagocytose particles ("dust cells")
  • Sequelae
    • no association with lung cancer
    • simple CWP
      • like smoking, can produce centrilobular emphysema
      • 1 cm fibrotic centers
    • complicated CWP
      • 1-2 cm fibrotic centers
    • Caplan's syndrome
      • CWP + rheumatoid nodules in lungs
Asbestosis
  • asbestosbodEpidemiology
    • workers in shipbuilding, roofing, and plumbing industries
      • asbestos used for insulation
  • Pathology
    • affects lower lobes including the entire respiratory unit
    • presence of asbestos bodies (aka ferruginous bodies)
      • golden-brown fusiform rods (due to iron and protein deposition)
        • resemble dumbbells → made of iron!
      • located inside macrophages
  • Sequelae
    • calcified pleural plaques in the diaphragm and posterolateral mid lung 
    • ↑ incidence of bronchogenic carcinoma and mesothelioma 
      • bronchogenic carcinoma more common than mesothelioma
      • mesothelioma takes longer time to develop (25-40 years) so is less common
      • smoking has no effect on mesothelium, but amplifies the risk of bronchogenic carcinoma when combined with asbestos
    • no association with TB
    • may also result in Caplan's syndrome
Silicosis
  • silicosisEpidemiology
    • workers in foundries, sandblasting, and mining industries
  • Pathology
    • affects upper lobes
    • macrophages activated by silica (quartz)
      • release fibrogenic cytokines
    • biopsy shows silica particles (birefringent) surrounded by collagen 
    • "eggshell" calcification of hilar lymph nodes 
  • Sequelae
    • may impair macrophage function
      • ↑ susceptibility to TB
    • ↑ incidence of primary lung cancer
Berylliosis
  • Epidemiology 
    • aerospace or nuclear industry workers
  • Pathology
    • noncaseating granulomas, nodular infiltrates, and enlarged lymph nodes
      • resembles sarcoidosis
  • Sequelae
    • ↑ risk for primary lung cancer 


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Qbank (4 Questions)

TAG
(M1.PL.21) A 72-year-old retired shipyard worker received a chest x-ray as part of a routine medical work-up. The radiologist reported incidental findings suggestive of an occupational lung disease. Which of the following descriptions is most consistent with this patient's film? Topic Review Topic

1. Enlarged hilar lymph nodes
2. Fibrocalcific parietal pleural plaques on the diaphragm
3. Hyperinflated lungs with a loss of lung markings
4. Nodular calcium lesions in the apex of the lung
5. No specific radiographic findings

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TAG
(M1.PL.101) A 45-year-old male reports several years of asbestos exposure while working in the construction industry. He reports smoking 2 packs of cigarettes per day for over 20 years. Smoking and asbestos exposure increase the incidence of which of the following diseases? Topic Review Topic

1. Chronic bronchitis
2. Emphysema
3. Multiple myeloma
4. Malignant pulmonary mesothelioma
5. Bronchogenic carcinoma

PREFERRED RESPONSE ▶
TAG
(M1.PL.118) A 42-year-old male presents to your office complaining of dyspnea on exertion. During the interview, the patient notes that he is a contractor specializing in the construction of aviaries at zoos. A radiograph of his chest is shown in Figure A . What is the diagnosis? Topic Review Topic
FIGURES: A          

1. Asbestosis
2. Progressive massive fibrosis
3. Silicosis
4. Berylliosis
5. Bird fancier's lung

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TAG
(M1.PL.4709) A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion. He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Chest radiograph shows increased bronchovascular markings, reticular parenchymal opacities, and multiple pleural plaques. Labs are unremarkable except for a slight anemia. Which chest CT finding is most concerning for malignancy in this patient? Topic Review Topic

1. Nodular mass spreading along pleural surfaces
2. Honeycombing
3. Air bronchogram
4. Granulomatous nodule
5. Upper lobe cavitary mass

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