Outdoor/indoor Air Pollution, Occupational Lung Dz

Front 1

List symptoms which often result when healthy people breathe polluted outdoor air.

Back 1

Healthy people experience unpleasant symptoms like burning eyes, sort throat, HA, nausea, cough, and substernal discomfort.

Front 2

Poor air quality causes increased prevalence of respiratory dzs, especially [ what two dzs ] , and more frequent relapses of episodic dzs. For example, high sulfur dioxide or particular levels can cause attacks of _____________ and high CO levels can cause attacks of ____________.

Back 2

poor air quality causes increased CHRONIC BRONCHITIS AND ASTHMA

high sulfur dioxide --> asthma attacks
high CO levels --> angina pectoris

Front 3

The four kinds of evidence that convince scientist that air pollution damages health are:

Back 3

- air pollution disasters
- results of animal exposure experiments (high dose)
- results of human exposure experiments (low dosee)
- epidemiologic studies correlating pollutant levels with dzs and symptom prevalence

Front 4

Some pollutants are regulated by allowing a certain concentration in a region, others by how much can come out of a given source. Match the above with the correct names below and list what pollutants are included.
A. air toxics
B. criteria pollutants
C. emission standards
D. noncriteria pollutants

Back 4

B. criteria pollutants - concentration in a region : ozone, nitrogen oxides, sulflur dioxide, CO, lead
C. emission standards - output from a source : asbestos, mercury, arsenic

air toxics and noncriteria pollutants are just all the rest of the chemicals int eh air that have a wide range of hazards that are also regulated but in a much more complicated way by state and federal law

Front 5

Particles less than ___ microns but larger than ___microns deposit in the larger airways that have a mucus covering and ciliated epithelium that sweeps the surface clean, so large particles can cause bronchitis but are less likely to remain in the lungs long enough to cause trouble.

Back 5

less than 10 microns, but larger than 2.5 microns

Front 6

Diesels are 2% of the vehicles on the road, but produce _____ of the particles coming from motor vehicles.

Back 6

2/3

Front 7

Regarding indoor air pollution, which of the following is FALSE?
A. ETS increase srisk of lung cancer, CHD and other dzs known to be caused by smoking.
B. Children who grow up in homes where parents smoke have a greater risk fo lung cancer, asthma, bronchitis, pneumonia, otitis media, and respiratory symptoms.
C. Radon is the second leading cause of lung cancer after smoking.
D. Sick building syndrome is when a building harbors a disease causing agent.

Back 7

D. Sick building syndrome is when a building harbors a disease causing agent.

this is actually BUILDING ASSOCIATED ILLNESS (BAI)

Front 8

What are the key four points to diagnosis and management of occupational lung dz?

Back 8

1. Occupational history - identify job and specific activities, relationship of symptoms to "time off", what "antigens" are present, symptoms during "accidents"
2. Hazards assessment
3. Prevention of further exposure
4. Regular and appropriate surveillance

Front 9

There are a large plethora that can be encountered at work, but the lung can respond to injury in a limited amount of ways in reality. What are the three broad categories of response to inhaled materials?

Back 9

- neoplastic response (carcinogens at work)
- parenchymal response (primary effect is in acinus - pertinent examples include fibrogenic dusts like asbestos, silica and coal, granulomatous dz like beryllium which is indistinguishable from sarcoidosis, and hypersensitivity pneumonitis)
- Airway response : primary effect no bronchi and larger bronchioles

Front 10

Occupations prone to asbestos leading to asbestosis are:
A. pipefitters, insulators, shipyard workers
B. sandblasters, foundry workers, miners, ceramic workers
C. miners, trimmers
D. mining, ceramics, electronics

Back 10

A. pipefitters, insulators, shipyard workers

Front 11

Occupations prone to silica exposure leading to silicosis or silico-tuberculosis are:
A. pipefitters, insulators, shipyard workers
B. sandblasters, foundry workers, miners, ceramic workers
C. miners, trimmers
D. mining, ceramics, electronics

Back 11

B. sandblasters, foundry workers, miners, ceramic workers

Front 12

Occupations prone to coal workers' pneumoconiosis are:
A. pipefitters, insulators, shipyard workers
B. sandblasters, foundry workers, miners, ceramic workers
C. miners, trimmers
D. mining, ceramics, electronics

Back 12

C. miners, trimmers

Front 13

Occupations prone to beryllium exposure leading to berylliosis are:
A. pipefitters, insulators, shipyard workers
B. sandblasters, foundry workers, miners, ceramic workers
C. miners, trimmers
D. mining, ceramics, electronics

Back 13

D. mining, ceramics, electronics

Front 14

Occupations prone to a dz that is virtually indistinguishable from sarcoidosis are:
A. pipefitters, insulators, shipyard workers
B. sandblasters, foundry workers, miners, ceramic workers
C. miners, trimmers
D. mining, ceramics, electronics

Back 14

D. mining, ceramics, electronics

Front 15

Name what occupational lung dzs the following workers are susceptible to:
A. miners (3)
B. ceramic workers (2)

Back 15

A. miners are susceptible to: silicosis, coal worker's pneumoconiosis (both fibrogenic dusts), and berylliosis (granulomatous parencyhmal response)

B. ceramic workers: silicosis and berylliosis

Front 16

Which occupational lung dz CXR is described:
bibasilar linear opacities
A. asbestosis
B. silicosis
C. coal worker's pneumoconiosis
D. berylliosis
E. hypersensitivity pneumonitis - acute
F. hypersensitivity pneumonitis - chronic

Back 16

bibasilar linear opacities
A. asbestosis

restrictive dz

Front 17

Which occupational lung dz CXR is described:
small, rounded nodular opacities in upper lobes, "eggshell" calcification of nodes
A. asbestosis
B. silicosis
C. coal worker's pneumoconiosis
D. berylliosis
E. hypersensitivity pneumonitis - acute
F. hypersensitivity pneumonitis - chronic

Back 17

B. silicosis

restrictive dz if advanced

Front 18

Which occupational lung dz CXR is described:
small <3mm round opacities with upper lobe predominance, large opacities (>1 cm) with progressive massive fibrosis.
A. asbestosis
B. silicosis
C. coal worker's pneumoconiosis
D. berylliosis
E. hypersensitivity pneumonitis - acute
F. hypersensitivity pneumonitis - chronic

Back 18

C. coal worker's pneumoconiosis

note: PFTs are normal, very slight obstruction until PMF develops

Front 19

Which occupational lung dz CXR is described:
"air space" pattern like pneumonia
A. asbestosis
B. silicosis
C. coal worker's pneumoconiosis
D. berylliosis
E. hypersensitivity pneumonitis - acute
F. hypersensitivity pneumonitis - chronic

Back 19

E. hypersensitivity pneumonitis - acute

symptoms: cough, dyspnea, fever, chills, myalgia 4-6 hours after exposure

Front 20

Which occupational lung dz CXR is described:
interstitial pattern like idiopathic pulmonary fibrosis
A. asbestosis
B. silicosis
C. coal worker's pneumoconiosis
D. berylliosis
E. hypersensitivity pneumonitis - acute
F. hypersensitivity pneumonitis - chronic

Back 20

F. hypersensitivity pneumonitis - chronic

symptoms: insidious dyspnea, cough, weight loss, restrictive PFT

Front 21

What is the cause of progressive massive fibrosis and what response occurs?

Back 21

- high total dust content
- immunologic responses

Front 22

True or False:
Although tobacco smoking worsens the effects of all inhaled mineral dusts, the effects of asbestos are particularly magnified by smoking.

Back 22

True!

The effects of inhaled particles are not confined to the lung alone, since solutes from particles can enter the blood and lung inflammation invokes systemic responses.

Front 23

In general, only a small percentage of exposed people develop occupational respiratory diseases, implying a ....

Back 23

genetic predisposition to their development.

In one study, genetic variation of serum and erythrocytic proteins was shown to correlate with susceptibility to developing silicosis, chronic bronchitis, and occupational asthma.

Front 24

The spectrum of lung findings in coal workers is wide, varying from (1) asymptomatic ____________ to (2) simple CWP with little to no pulmonary dysfunction to (3) complicated CWP, or progressive massive fibrosis (PMF), in which lung function is compromised.

Back 24

The spectrum of lung findings in coal workers is wide, varying from (1) asymptomatic ANTHRACOSIS to (2) simple CWP with little to no pulmonary dysfunction to (3) complicated CWP, or progressive massive fibrosis (PMF), in which lung function is compromised.

Anthracosis is the most innocuous coal-induced pulmonary lesion in coal miners and is also seen to some degree in urban dwellers and tobacco smokers. Inhaled carbon pigment is engulfed by alveolar or interstitial macrophages, which then accumulate in the connective tissue along the lymphatics, including the pleural lymphatics, or in organized lymphoid tissue along the bronchi or in the lung hilus.

Front 25

Simple CWP is characterized by:
A. coal macules (1 to 2 mm in diameter) and the somewhat larger coal nodules.
B. intensely blackened scars larger than 2 cm, sometimes up to 10 cm in greatest diameter. They are usually multiple

Back 25

A. coal macules (1 to 2 mm in diameter) and the somewhat larger coal nodules.

The coal macule consists of carbon-laden macrophages; the nodule also contains small amounts of a delicate network of collagen fibers. Although these lesions are scattered throughout the lung, the upper lobes and upper zones of the lower lobes are more heavily involved. They are located primarily adjacent to respiratory bronchioles, the site of initial dust accumulation. In due course dilation of adjacent alveoli occurs, a condition sometimes referred to as centrilobular emphysema.

Front 26

Which of the following is FALSE about coal worker's pneumoconiosis?
A. In a minority of cases (fewer than 10%), PMF develops, leading to increasing pulmonary dysfunction, pulmonary hypertension, and cor pulmonale
B. Once PMF develops, it may become progressive even if further exposure to dust is prevented.
C. Like silicosis, there is evidence that coal dust increases susceptibility to tuberculosis.
D. There is no compelling evidence that CWP in the absence of smoking predisposes to cancer.

Back 26

C. Like silicosis, there is evidence that coal dust increases susceptibility to tuberculosis.

Should read UNlike silicosis, there is NO evidence that coal dust increases susceptibiltiy to TB.

Front 27

Heavy exposure over months to a few years can result in acute silicosis, a disorder characterized by ......

Back 27

the accumulation of abundant lipoproteinaceous material within alveoli

contrasted with chronic low exposure which ususally presents as usually presents after decades of exposure as a slowly progressing, nodular, fibrosing pneumoconiosis.

Within the macrophages silica causes activation and release of mediators.

Front 28

True or False:
Within the macrophages silica causes activation and release of mediators includnig IL-1, TNF, fibronectin, lipid mediators, oxygen-derived free radicals, and fibrogenic cytokines.

Back 28

True!

Front 29

Which occupational lung dz is described?
Chest radiographs typically show a fine nodularity in the upper zones of the lung, but pulmonary functions are either normal or only moderately affected. Most patients do not develop shortness of breath until late in the course, after progressive massive fibrosis is present. The disease may be progressive even if the patient is no longer exposed. The disease is slow to kill, but impaired pulmonary function may severely limit activity. This is associated with an increased susceptibility to tuberculosis.

Back 29

Silicosis

Front 30

There are two distinct geometric forms of asbestos: serpentine and amphibole. Which is more pathogenic and can even become a risk factor for mesothliomas?

Back 30

The serpentine chrysotile chemical form accounts for most of the asbestos used in industry. Amphiboles, even though less prevalent, are more pathogenic than chrysotiles particularly with respect to induction of malignant pleural tumors (mesotheliomas). Both amphiboles and serpentines are fibrogenic, and increasing doses are associated with a higher incidence of all asbestos-related diseases except mesothelioma, which is only associated with amphibole exposure.

Front 31

True or False:
In contrast to other inorganic dusts, asbestos can also act as a tumor initiator and promoter.

Back 31

True

Some of its oncogenic effects are mediated by reactive free radicals generated by asbestos fibers, which preferentially localize in the distal lung, close to the mesothelial layers. Potentially toxic chemicals adsorbed onto the asbestos fibers most likely contribute to the oncogenicity of the fibers. For example, the adsorption of carcinogens in tobacco smoke onto asbestos fibers may well contribute to the remarkable synergy between tobacco smoking and the development of lung carcinoma in asbestos workers. One study of asbestos workers found a fivefold increase of lung carcinoma with asbestos exposure alone, while asbestos exposure and smoking together led to a 55-fold increase in the risk of lung cancer.

Both lung carcinomas and mesotheliomas (pleural and peritoneal) develop in workers exposed to asbestos.

Front 32

What is the most common manifestation of asbestos exposure?

Back 32

Pleural plaques, the most common manifestation of asbestos exposure, are well-circumscribed plaques of dense collagen (Fig. 15-21), often containing calcium. They develop most frequently on the anterior and posterolateral aspects of the parietal pleura and over the domes of the diaphragm.

Front 33

What compounds are commonly associated with neoplastic occupational lung dz? (5)

Back 33

- asbestos
- uranium
- nickel
- arsenic
-chromates

these have same pathology, presentation, treatment as smoking related cancer (small cell, non-small cell and its subtypes)