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 5 1 2 3 4 5 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + (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 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? Review Topic QID: 108478 1 Nodular mass spreading along pleural surfaces 56% (115/205) 2 Honeycombing 13% (26/205) 3 Air bronchogram 3% (6/205) 4 Granulomatous nodule 11% (23/205) 5 Lower lobe cavitary mass 15% (30/205) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Review Topic QID: 100824 1 Enlarged hilar lymph nodes 9% (1/11) 2 Fibrocalcific parietal pleural plaques on the diaphragm 73% (8/11) 3 Hyperinflated lungs with a loss of lung markings 0% (0/11) 4 Nodular calcium lesions in the apex of the lung 18% (2/11) 5 No specific radiographic findings 0% (0/11) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (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? Review Topic QID: 100904 1 Chronic bronchitis 1% (1/75) 2 Emphysema 12% (9/75) 3 Multiple myeloma 1% (1/75) 4 Malignant pulmonary mesothelioma 37% (28/75) 5 Bronchogenic carcinoma 47% (35/75) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (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? Review Topic QID: 100921 FIGURES: A 1 Asbestosis 12% (2/16) 2 Progressive massive fibrosis 0% (0/16) 3 Silicosis 31% (5/16) 4 Berylliosis 0% (0/16) 5 Bird fancier's lung 56% (9/16) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 3
Login to View Community Videos Login to View Community Videos Silicosis Chris Battista Respiratory - Pneumoconioses 3/11/2013 17 views