Medicine Marrow Pg 221-230 (Pulmonology)
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Medicine Marrow Pg 221-230 (Pulmonology)

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Questions and Answers

Which of the following is a type of occupational lung disease?

  • Chronic obstructive pulmonary disease
  • Pneumonia
  • Hypersensitivity pneumonitis (correct)
  • Asthma

    • Pneumoconiosis results from the accumulation of fumes in the lungs.

    False

    What is the primary cause of pneumoconiosis?

    Accumulation of dust in the lungs

    Dust particles larger than ______ µm are mainly found in the secondary bronchi.

    <p>3</p> Signup and view all the answers

    Match the dust particle size with its corresponding site in the respiratory system:

    <blockquote> <p>3 µm = Secondary bronchi 0.5-3 µm = Bronchiole</p> </blockquote> Signup and view all the answers

    Which of the following industries is NOT a risk factor for silicosis?

    <p>Automotive manufacturing</p> Signup and view all the answers

    Crystalline silica poses a higher risk of occupational hazard compared to amorphous silica.

    <p>True</p> Signup and view all the answers

    What is the primary feature distinguishing acute silicosis from chronic silicosis?

    <p>Duration of occupational exposure</p> Signup and view all the answers

    Patients with chronic silicosis may experience _____ dyspnea on exertion.

    <p>dry</p> Signup and view all the answers

    Which of the following symptoms are NOT findings of sarcoidosis in berylliosis?

    <p>CNS symptoms</p> Signup and view all the answers

    Match the type of silicosis with its main clinical feature:

    <p>Acute Silicosis = Severe dyspnea and weight loss Chronic Silicosis = Chronic dry cough Both = Involvement of lung parenchyma</p> Signup and view all the answers

    Dyspnea is a feature typically associated with berylliosis.

    <p>True</p> Signup and view all the answers

    Name one industry associated with an increased risk of berylliosis.

    <p>Ceramic industry</p> Signup and view all the answers

    The HRCT scan of a patient with berylliosis typically shows _____ appearance.

    <p>ground glass</p> Signup and view all the answers

    Match the following investigative findings with their descriptions in berylliosis:

    <p>Normal in 50% patients = X-ray chest findings Positive = Lymphocyte proliferation test Ground glass appearance = HRCT findings Interstitial markings = Chest scan findings</p> Signup and view all the answers

    What is the radiological appearance of large conglomerate nodules in chronic silicosis often referred to as?

    <p>Angel wing appearance</p> Signup and view all the answers

    Hilar lymphadenopathy in chronic silicosis typically shows solid calcification.

    <p>False</p> Signup and view all the answers

    What type of lung disease involves advanced lung scarring and fibrosis?

    <p>Progressive massive fibrosis (PMF)</p> Signup and view all the answers

    In chronic silicosis, the appearance of multiple small nodules and ground-glass opacities is known as _____ appearance.

    <p>crazy pavement</p> Signup and view all the answers

    Match the following radiological features of chronic silicosis with their descriptions:

    <p>Small bilateral symmetrical centrilobular nodules = Located between the lobes of the lung Cavitations = Areas of tissue destruction in the lungs Hilar Lymphadenopathy with egg shell calcification = Swollen lymph nodes with characteristic calcification Upper lobe interstitial lung disease = Inflammation and fibrosis in the upper parts of the lungs</p> Signup and view all the answers

    Which of the following industries is NOT considered a risk factor for chronic asbestosis?

    <p>Food processing industry</p> Signup and view all the answers

    Smoking has no relation to parenchyma problems and malignancy in chronic asbestosis.

    <p>False</p> Signup and view all the answers

    What is the earliest type of pleural effusion associated with benign asbestos exposure?

    <p>BAPE (Benign asbestos related pleural effusion)</p> Signup and view all the answers

    The clinical presentation of parietal pleura calcification includes progressive dyspnoea, chest pain, and __________.

    <p>no clinical signs</p> Signup and view all the answers

    Match the following clinical presentations with their corresponding pathologies:

    <p>Parietal pleura calcification = Progressive dyspnoea, chest pain, no clinical signs BAPE = Unilateral, hemorrhagic, exudative effusion</p> Signup and view all the answers

    What is the most common type of lung cancer?

    <p>Adenocarcinoma</p> Signup and view all the answers

    Mesothelioma is associated with smoking.

    <p>False</p> Signup and view all the answers

    What clinical features are associated with lung cancer?

    <p>Cough and Hemoptysis</p> Signup and view all the answers

    The latency period for mesothelioma is generally longer than _____ years.

    <p>30</p> Signup and view all the answers

    Match the following conditions with their characteristics:

    <p>Sarcoidosis = Non-caseating granulomas Tuberculosis = Caseating granulomas Berylliosis = Delayed hypersensitivity Mesothelioma = Asbestos exposure</p> Signup and view all the answers

    What is the PaO₂ threshold that indicates a hypoxemic respiratory failure?

    <p>PaO₂ &lt; 60 mmHg</p> Signup and view all the answers

    In hypercapnic respiratory failure, PaCO₂ levels are typically lower than normal.

    <p>False</p> Signup and view all the answers

    What does the abbreviation PaCO₂ stand for?

    <p>Partial pressure of carbon dioxide in artery</p> Signup and view all the answers

    In type 1 respiratory failure, there is _____ PaO₂ and _____ PaCO₂.

    <p>decreased; normal</p> Signup and view all the answers

    Which of the following conditions is associated with impaired diffusion type respiratory failure?

    <p>Pneumonia</p> Signup and view all the answers

    Match the following types of respiratory failure with their associated partial pressures:

    <p>Type 1 = ↓PaO₂, Normal PaCO₂ Type 11 = ↓PaO₂, ↑PaCO₂</p> Signup and view all the answers

    What is the primary pathology associated with type 11 respiratory failure?

    <p>Hypoventilation</p> Signup and view all the answers

    A patient with lung fibrosis has impaired diffusion and shows high levels of both PaO₂ and PaCO₂.

    <p>False</p> Signup and view all the answers

    What is a common characteristic of sputum in bronchiectasis?

    <p>Copious and foul smelling</p> Signup and view all the answers

    Clubbing is a common finding in adults with bronchiectasis.

    <p>False</p> Signup and view all the answers

    What is the term used to describe the appearance of dilated airways on an X-ray in bronchiectasis?

    <p>Tram track sign</p> Signup and view all the answers

    A patient with bronchiectasis often experiences ___ exacerbation due to infection.

    <p>acute</p> Signup and view all the answers

    Which of the following features is characteristic of Coal Workers' Pneumoconiosis (CWP)?

    <p>Upper lobe involvement</p> Signup and view all the answers

    Match the following terms related to bronchiectasis with their descriptions:

    <p>Tree in bud opacity = Endobronchial obstruction leading to nodules Finger in glove appearance = Mucus-filled airways Hemoptysis = Rupture of thin walled veins on bronchial wall Crackles = Early and mid inspiratory auscultation findings</p> Signup and view all the answers

    Caplan syndrome is associated with Coal Workers' Pneumoconiosis and involves calcification.

    <p>True</p> Signup and view all the answers

    What is the primary cause of Coal Workers' Pneumoconiosis?

    <p>Exposure to coal dust</p> Signup and view all the answers

    CWP is characterized by parenchymal nodules greater than _____ cm.

    <p>1</p> Signup and view all the answers

    Match the following conditions with their associated features:

    <p>CWP = Possible link to TB Silicosis = Caplan syndrome present Acute Eosinophilic Pneumonia = Crazy pavement pattern Pulmonary Alveolar Proteinosis = PAS positive milky white BAL</p> Signup and view all the answers

    What is the mainstay therapy for bronchiectasis?

    <p>Airway clearance</p> Signup and view all the answers

    Cor pulmonale is characterized by left ventricular dilation and failure.

    <p>False</p> Signup and view all the answers

    Name a common organism known to infect and weaken the bronchial wall in bronchiectasis.

    <p>Pseudomonas</p> Signup and view all the answers

    The recommended duration for Macrolides treatment for bronchiectasis is _____ months.

    <p>6-9</p> Signup and view all the answers

    Match the condition with its associated complication:

    <p>Bronchiectasis = Massive hemoptysis Cor pulmonale = Right ventricular failure Lung abscess = Localized infection in lung tissue Empyema = Collection of pus in pleural space</p> Signup and view all the answers

    Which of the following is a treatment used for CF-associated bronchiectasis?

    <p>Recombinant human DNase</p> Signup and view all the answers

    Chronic bronchiectasis is primarily caused by thromboembolism.

    <p>False</p> Signup and view all the answers

    What is the potential consequence of empyema with a bronchopleural fistula?

    <p>Abnormal connection between empyema and pleural space</p> Signup and view all the answers

    Study Notes

    Occupational Lung Diseases

    • Pneumoconiosis: A lung disease caused by the inhalation of dust particles, leading to inflammation and scarring.
      • Berylliosis: A type of pneumoconiosis caused by exposure to beryllium, a metal used in various industries.
        • Risk Factors: Ceramic industry, battery manufacturing, alloy industry.
        • Features: Dyspnea, upper lobe interstitial lung disease (ILD), and progressive massive fibrosis (PMF).
        • Investigations: Positive lymphocyte proliferation test, chest X-ray, and high-resolution computed tomography (HRCT).
        • HRCT: Ground glass appearance, parenchymal nodules, and septal lines.
      • Silicosis: A type of pneumoconiosis caused by exposure to silica dust.
        • Risk Factors: Mining, quarries, blast furnaces, slate industry, sandstone industry, ceramics, and rock cutting.
        • Types of Silica: Crystalline silica (quartz) and amorphous silica.
        • Features: Lung parenchymal involvement, risk of malignancy and chronic obstructive pulmonary disease (COPD).
        • Acute Silicosis: Large quantity of silica exposure for 2 years.
        • Chronic Silicosis: Exposure for 10-30 years.
      • Chronic Silicosis:
        • CT: Small bilateral symmetric centrilobular parenchymal nodule, large conglomerate nodules (Angel wing appearance), cavitations, and crazy pavement appearance.
        • Other Findings: Hilar lymphadenopathy with egg shell calcification, progressive massive fibrosis (PMF), and upper lobe interstitial lung disease (ILD).
    • Occupational Asthma: Asthma caused by exposure to substances in the workplace.
    • Hypersensitivity Pneumonitis: A type of lung inflammation caused by an allergic reaction to inhaled substances.

    Respiratory Failure and Acute Respiratory Distress Syndrome (ARDS)

    • Respiratory Failure: Inability of the pulmonary system to meet the body's oxygen demands. Defined by PaO₂ < 60 mmHg on room air or SpO₂ < 90%.
    • Hypercapnic Respiratory Failure: Increased PaCO₂ (> 50 mmHg).
    • Classification:
      • Type 1: Impaired diffusion, characterized by decreased PaO₂ but normal PaCO₂.
      • Type 11: Hypoventilation, characterized by decreased PaO₂ and increased PaCO₂.

    Chronic Asbestosis

    • Risk Factors: Textile industry, cement industry, shipbuilding work, automobile industry, and smoking.
    • Pleura:
      • Parietal pleura calcification - pleural plaques - Holly leaf sign - Subpleural plaque.
      • Benign asbestos related pleural effusion (BAPE): Earliest, unilateral, hemorrhagic, and exudative.
    • Malignancy:
      • Lung Cancer: The most common type, with adenocarcinoma being the most prevalent subtype.
        • Latency Period: 10-30 years.
        • Smoking Association: Present.
        • Clinical Features: Cough and hemoptysis.
      • Mesothelioma: A type of cancer that affects the lining of the lungs and chest cavity.
        • Latency Period: > 30 years.
        • Smoking Association: Absent.
        • Clinical Features: Chest pain, mass, and pleural effusion.
        • Markers: Pancytokeratin/calretinin.
        • Electron Microscopy: Microvilli, desmosomes, tonofilaments.

    Berylliosis

    • Similar to sarcoidosis, but with absent CNS, ocular, parotid, and erythemoid lesions.
    • Non-caseating granuloma: Inflammation with no center of necrosis.

    Bronchiectasis

    • A condition in which the airways in the lungs become permanently widened and damaged. Leading to chronic cough, sputum production, and recurrent respiratory infections.
    • Clinical Features:
      • Chronic cough, sputum production, early morning exacerbation, hemoptysis, and acute exacerbation.
      • Findings: Clubbing (in children), early and mid inspiratory coarse crackles, and diffuse ronchi.
    • Investigations: Chest X-ray, CT scan.
    • CT Features:
      • Airway dilatation 1-1.5 times than adjacent vessels
      • Lack of bronchial tapering
      • Tree in bud opacity
    • Treatment: Airway clearance, postural drainage, antibiotics, possible surgery.

    Coal Workers Pneumoconiosis (CWP)

    • CWP: A type of pneumoconiosis caused by exposure to coal dust.
    • CWP vs. Silicosis:
      • CWP: Upper lobe involvement, increased risk of COPD, possible link to TB or autoimmune disease, parenchymal nodules greater than 1 cm, possibly with cavitations. Absent hilar lymphadenopathy and Caplan syndrome.
      • Silicosis: Similar to CWP, but with present hilar lymphadenopathy and Caplan syndrome,
    • Caplan Syndrome: A combination of CWP and rheumatoid arthritis, presenting calcification and PMF (progressive massive fibrosis).
      • Characterized by coal worker pneumoconiosis (Necrobiotic nodule), rheumatoid arthritis (IgA rheumatoid factor positive), and active synovitis.

    Complications

    • Cor pulmonale: Right ventricular (RV) dilation or hypertrophy, possibly with RV failure.
    • Massive hemoptysis: Especially in cases of bronchiectasis.
    • Empyema with bronchopleural fistula: Collection of pus (empyema) and an abnormal connection (fistula) between the empyema and the pleural space.
    • Secondary Amyloidosis (AA): Related to inflammation in the lungs.
    • Lung abscess: Localized collection of pus or infected material in the lung tissue.

    Note

    • Conditions with crazy pavement appearance of lung: Diffuse alveolar hemorrhage (DAH), Acute eosinophilic pneumonia (AEP), and Pulmonary alveolar proteinosis (PAP).
    • Pulmonary alveolar proteinosis (PAP): Antibodies against granulocyte macrophage colony-stimulating factor (GM-CSF), abnormal clearance of surfactant, and PAS positive milky white bronchoalveolar lavage (BAL).
    • Bronchiectasis Types: Acute (often caused by thromboembolism) and Chronic (due to underlying lung parenchymal diseases like ILD and chronic bronchitis).

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    Description

    Test your knowledge on occupational lung diseases, particularly pneumoconiosis and its types such as berylliosis and silicosis. The quiz covers risk factors, diagnostic features, and investigations related to these conditions. Enhance your understanding of how specific industries affect lung health with this informative quiz.

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