Updated: 4/16/2018

Pneumoconioses

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Evidence
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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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Questions (6)
Lab Values
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/L
Female: 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/mL
Female: 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/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative 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/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 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/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 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/min
Female: 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 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 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
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(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

58%

(111/193)

2

Honeycombing

12%

(23/193)

3

Air bronchogram

3%

(5/193)

4

Granulomatous nodule

11%

(22/193)

5

Lower lobe cavitary mass

15%

(28/193)

M1

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(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

20%

(1/5)

2

Fibrocalcific parietal pleural plaques on the diaphragm

60%

(3/5)

3

Hyperinflated lungs with a loss of lung markings

0%

(0/5)

4

Nodular calcium lesions in the apex of the lung

20%

(1/5)

5

No specific radiographic findings

0%

(0/5)

M1

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(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

0%

(0/72)

2

Emphysema

12%

(9/72)

3

Multiple myeloma

1%

(1/72)

4

Malignant pulmonary mesothelioma

39%

(28/72)

5

Bronchogenic carcinoma

46%

(33/72)

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(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:
1

Asbestosis

10%

(1/10)

2

Progressive massive fibrosis

0%

(0/10)

3

Silicosis

30%

(3/10)

4

Berylliosis

0%

(0/10)

5

Bird fancier's lung

60%

(6/10)

M1

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