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45 Cards in this Set

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What are the 3 major types of pneumoconiosis that we studied in this block?
1. Coal worker's pneumoconiosis (CWP)
2. Asbestosis
3. Silicosis
What are the pathogenic principles that apply to all pneumoconiosis regardless of the nature of the injurious agent?
1. The amount of dust in the lungs and airways.

2. The size, shape, and buoyancy of the dust particles

3. The particle solubility and physico-chemical properties

4. The possible additional (synergistic) effects of other airway irritants such as cigarette smoke.
What are the three different types of reactions that someone can have to inhaled coal dust?
1. Anthracosis

2. Simple coal worker's pneumoconiosis (CWP)

3. Progressive massive fibrosis (PMF)
Describe anthracosis
"Fairly innocuous"
Accumulation of coal dust in pulmonary macrophages.
Coal miners, city dwellers, tobacco smokers.
Describe simple coal worker's pneumoconiosis.
A condition resulting from the inhalation and deposition of coal dust and the response to such deposition. Severity is related to cumulative exposure.
What are the hallmarks of CWP?
The dust macule and the dust nodule.
c/c the dust macule vs. the dust nodule.
The dust macule is a centrilobar coal deposit with a stellate outline of macrophages heavily laden with coal dust. NO colligenization is seen.

The dust nodule is also a stellate shaped centrilobular accumulation of dust, but WITH collagenization.
The pathogenesis of CWP has much in common with what other pneumonicosis?
With silicosis.
The pathogenesis of CWP is due to the release of what?
Cytokines such as PDGF, TGF-beta, TNF-alpha, etc.
The advent of PMF may cause what clinical complications?
Pulmonary hypertension
Cor pulmonale
Is CWP associated with cancer?
No (there is no compelling evidence).
Define asbestosis.
Asbestosis is a parenchymal disorder of the lung characterized by slow, progressive pulmonary fibrosis caused by the inhalation of asbestos fibers.
What are the two different forms of asbestos called?
The amphiboles (straight, rod-like, stiff, and brittle)

The serpentines (curly, wavy, more flexible)
Gross specimens with asbestosis show what findings?
Fine subpleural fibrosis more prominent at the bases.
What is especially important about the physical shape of the asbestos fibers?
The aspect ratio (length to width ratio)
A microscopic analysis of asbestosis can look similar to what other disease?
UIP
Is lung cancer associated with asbestosis?
Yes.
What is the most prevalent occupational disease in the world?
Silicosis.
What is the hallmark pathological feature of silicosis?
The silicotic nodule.
Describe the appearance of the silicotic nodule.
The nodule contains tiny birefringent silica particles. The nodules are concentrated at the Macklin's dust sumps (lympoid aggregates guarding the mouths of lymphatics of the lung.)
How does silica cause damage?
Silica has fibrogenic properties.

Macrophages injest silica --> silicilic acid is produced --> macrophage lyses, releasing cytokines.
Symptoms of silicosis?
Cough
SOB
Silicosis: gross presentation
Lungs shrink
Overlying fibrosis of the pleura
Does silicosis cause lung cancer?
The association between the two is not clear yet, but probably yes.
What does RADS stand for?
Reactive Airway dysfunction Syndrome
Pneumoconiosis: from inorganic or organic dusts?
Inorganic
What pneumoconiosis/hypersensitivity pneumonitis is associated with clubbing?

With crackles?

With wheezing?
Clubbing = asbestosis, IPF

Crackles = asbestosis or HSP (generally not with silicosis or CWP)

Wheezing = (athsma, HSP, RADS)
What pneumoconiosis/hypersensitivity pneumonitis is associated with increased interstitial markings?

Nodular densities?

"Eggshell" calcifications of hilar lymph nodes?

Pleural plaques
Interstitial markings = asbestosis, HSP

Nodular densities = silicosis, CWP

"Eggshell" calcifications = silicosis

Pleural plaques = asbestosis
Abrasive blasting. Think what?
Silicosis
Wheezing, breathing trouble that increases from Mon to Fri and then gets better over the weekend. Think what?
Occupational athsma.
If you see "eggshell" calicifications of hilar lymph nodes on CT scan, do you need a biopsy to confirm your suspicions?
No, it's silicosis.
Silicosis: PFTs
Will show pure restrictive pattern.
Silicosis: risk of cancer
Increased risk. Maybe just because you can't see the cancer on a CT scan.
Silicosis: increased risk of getting what disease?
3 fold increased risk of Mycobacterial TB infection!
Asbestosis: PFTs
Restrictive pattern with a decreased diffusing capacity.
Asbestosis: hilar/mediastinal lymphadenopathy
NOT seen
What is the histopathologic diagnosis of asbestosis?
The presence of asbestos bodies (transparent fibers coated with iron and protein) in association with IPF that is similar in appearance to UIP
Mesothelioma: increased risk of TB?
No.
What is the only known risk factor for development of malignant mesothelioma?
Asbestosis
What are the most common causative agents of occupational asthma (OA)?
Isocyanates (used in the production of plastics and rubber)
OA: treatment
Switch jobs!
OA: methacholine challenge
Usually positive.
What is the definition of RADS?
A persistent (over 3 months) asthma-like illness (cough, wheeze, dyspnea) after a single exposure to high levels of an irritating vapor, fume, or smoke. Onset of symptoms is usually around 24 hours after exposure.
RADS: methacholine challenge
Usually negative.

Note that a positive methacholine test does not rule out RADS
RADS: bronchodilators
Usually not all that helpful. Usually steroids are necessary.