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 Epidemiology 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 Epidemiology 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
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PL.17.4709) A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. 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 of the following is the most likely finding on this patient's chest CT? Tested Concept QID: 108478 Type & Select Correct Answer 1 Nodular mass spreading along pleural surfaces 55% (127/232) 2 Honeycombing 13% (31/232) 3 Air bronchogram 3% (7/232) 4 Granulomatous nodule 10% (24/232) 5 Lower lobe cavitary mass 16% (38/232) M 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (M1.PL.15.118) 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? Tested Concept QID: 100921 FIGURES: A Type & Select Correct Answer 1 Asbestosis 12% (5/40) 2 Progressive massive fibrosis 0% (0/40) 3 Silicosis 30% (12/40) 4 Berylliosis 0% (0/40) 5 Bird fancier's lung 58% (23/40) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PL.13.21) 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? Tested Concept QID: 100824 Type & Select Correct Answer 1 Enlarged hilar lymph nodes 10% (4/39) 2 Fibrocalcific parietal pleural plaques on the diaphragm 85% (33/39) 3 Hyperinflated lungs with a loss of lung markings 0% (0/39) 4 Nodular calcium lesions in the apex of the lung 5% (2/39) 5 No specific radiographic findings 0% (0/39) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (M1.PL.13.101) 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? Tested Concept QID: 100904 Type & Select Correct Answer 1 Chronic bronchitis 2% (2/103) 2 Emphysema 9% (9/103) 3 Multiple myeloma 1% (1/103) 4 Malignant pulmonary mesothelioma 30% (31/103) 5 Bronchogenic carcinoma 57% (59/103) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Login to View Community Videos Login to View Community Videos Silicosis Chris Battista Respiratory - Pneumoconioses E 3/11/2013 49 views 3.0 (1)