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Clinical Medicine Restrictive Diseases Month 1 Week 2 Day 4
Clinical Medicine Restrictive Diseases Month 1 Week 2 Day 4
36
Medical
Graduate
05/17/2018

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Cards

Term
pneumoconiosis (occupational lung diseases)
Definition
inhalation of inorganic particulate matter. silicosis (hard rock miners), coal worker's, asbestos (inhalation and heat treatment), talc, berylliosis (metal alloys)
Term
hypersensitivity pneumonitis (occupational lung diseases)
Definition
inhalation of organic dust
Term
history for occupational lung diseases
Definition
job (chronology of all- titles and tasks), exposure at work, use of preventative mechanisms (respirators..),. other exposures outside of work?, family member brought dust to home?
Term
clinical picture for occupational lung diseases
Definition
signs, symptoms, pulmonary function tests, onset (gradual),
Term
silicosis
Definition
very common, 3 forms of free silica (quartz, cristobalite, tridymite), want dosage of silica, intensity, duration, 7x inc rate in african americans, host factors
Term
occupations at risk of silicosis
Definition
agrucultural (plowing, harvesting...), crushing operations (road construction, tunneling...), raw material processing (glass, ceramics, sandblasting!..), automotive repair. Seen a lot in Pennsylvania, coal mining regions, West Coast
Term
pathophysiology of silicosis
Definition
inhaled silica -> acute inflammation -> fibrosis of lungs -> large particles deposit in ciliated airways (middle sized are worst)-> strong macrophage response and they release TNF and ILs -> inflammation, collagen synthesis, fibrosis -> silica dioxide bonds w phospholipids -> destruction of macrophages -> destroyed macrophages release silicone and toxic products and get silica nodule made of pink collagen, more exposure and more nodules -> restrictive lung disease and increased risk of lung carcinoma
Term
related health effects of silicosis
Definition
inc risk of mycobacterium infection, industrial bronchitis and COPD, extrapulmonary disease, lung cancer. slowly progressing, few symptoms early on, latency period of greater than 10 years after exposure,
Term
CT and Xray findings for silicosis
Definition
nodules, subpleural plaques, can have progressive massive fibrosis (mass >2cm), mixed restrictive and obstructive on PFTs but typically restrictive, empysema may be seen, cavitation is possible (look for cancer or mycobacteria)
Term
accelerated silicosis
Definition
very short latency between 2 and 10 years, typically in patients with high, high, high rate of exposure, get progressive massive fibrosis, higher risk for mortality
Term
how does silicosis affect your immune system
Definition
reduces defenses, alters lymphatic function, destruction and dysfunction of alveolar machrophages (which are impt in fighting off tb)
Term
silica exposure and COPD
Definition
inc symptoms of chronic bronchitis, can develop emphysema, potentiates the effects of smoking- destruction of alveoli, accelerated rates of FEV1 decline
Term
extrapulmonary disease and silica
Definition
can spread to lymph nodes, liver, spleen, kidneys, can get scleroderma, rheumatoid arthritis, other CT diseases
Term
silica group __ substance
Definition
1, carcinogenic
Term
medical management of silicosis
Definition
smoking cessation, oxygen, vaccination, screen for TB and bacterial infections
Term
coal worker's pneumocosis
Definition
deposits of coal and silica in the lungs, highly inflammatory, long-term exposure
Term
risk factors for coal worker's pneumocosis
Definition
duration of exposure, intensity, prevalence of the disease
Term
pathophysiology of simple coal worker's pneumocosis
Definition
accumulation of carbon dust in lungs -> enters terminal bronchioles and engulfed by alveolar macrophage which surround the bronchioles and tissues in the lungs -> dilation of respiratory units -> dysfunction of smooth muscle, alterations in structural components -> signs/symptoms
Term
pathophysiology of complicated coal worker's pneumocosis
Definition
the dust removal process fails. we normally have ciliated cells in our upper airways and lungs to flush out these particles but they get paralyzed -> macrophages accumulate -> inflammatory reaction -> fibroblasts activated, lay down collagen -> snares the macrophages there which lyse and release carbon, silica, cause more inflammation. inflammatory lesions coalesce and get massive pulmonary fibrosis
Term
potential complications of coal miner's pneumocosis
Definition
mycobacterial infection, diffuse pulmonary interstitial fibrosis, rapidly progressive coal worker's pneumonitis, cavitations, fungal infections in the cavitary lesions, and hilar node involvement (can affect recurrent laryngeal nerve- hoarseness)
Term
total respiratory disability
Definition
clinical findings of progressive massive fibrosis, FEV1 less than 60% of predicted, abnormal ABGs, reasoned medical opinion
Term
Asbestosis
Definition
minerals that when crushed produce fibers, causes diffuse interstitial fibrosis, exposed removing from old buildings or asbestos mining or talc contaminated w it
Term
pathophys of asbestosis
Definition
fibers inhaled -> deposit in wall of distal airways and alveoli -> ingested partially by macrophages, may penetrate the interstitial spaces -> develop asbestos bodies, coated fibers -> inflammation w activated macrophages -> inc growth factors -> production of fibroblasts -> fibrosis -> airway obstruction and interstitial fibrosis
Term
asbestosis linked to
Definition
mesothelioma (cancer of the lining of the pleural space, even w lower exposures) , also benign diffusions, pleural plaques
Term
symptoms of asbestosis
Definition
dyspnea on exertion, dry mouth, crackles in lungs, clubbing, scarring begins around the bronchioles, 10% do not have pleural plaques (usually bilateral), small volume pleural effusions that may be hemorrhagic or eosinophilic
Term
tests and findings of asbestosis
Definition
restrictive pattern on PFT w dec diffusion capacity
Term
benign asbestosis pleural plaques
Definition
shorter latency
Term
malignant mesothelioma
Definition
asbestos-related cancer, fiber diameter <2.2mm or length >8mm is high risk, 30-50 year latency
Term
treatment for asbestosis
Definition
treat COPD, emphysema, chronic bronchitis, smoking cessation, supplementary oxygen, pulmonary rehab, bronchodilators, antibiotics
Term
hypersensitivity pneumonitis
Definition
granulomanous lung disease resulting from repeated inhalation and sensitization to organic aerosols and low molecular weight antigens. an immune-complex mediated disorder, delayed hypersensitivity reaction, only occurs in susceptible individuals, have to have exposure, symptoms highly variable in duration and intensity, signs and symptoms due to repeated exposures
Term
symptoms of hypersensitivity pneumonitis
Definition
fevers, chills, SOB, within 4-12 hrs of exposure, can be associated by work, hobbies, symptoms may improve w change of environment
Term
pathophy of hypersensitivity pneumonitis
Definition
inc neutrophils in terminal bronchioles and alveoli, then become mononuclear cells -> migrate to affected areas -> delayed hypersensitivity rxn, interleukins, interferon, TNF -> upregulation of TNF and reduction of lymphocyte death -> triggers underlying delayed hypersensitivity rxn, can be acute or chronic, hypersensitivity rxn type III or IV
Term
etiologies of hypersensitivity penumonitis
Definition
just about anything, bacteria, fungi, aspergillus, penicillin, animal proteins, bird proteins, fishmeal, rat urine
Term
classic hypersensitivity pneumonitis
Definition
farmer's lung- bacilli or actinomycetes from grains and silage, bird pancier's lung in ppl who deal w pigeons adn birds, avian proteins, moldy environments, contaminated AC, hottubs, mushroom workers, construction or industrial workers
Term
diagnosis of hypersensitivity pneumonitis
Definition
exposure to a known sensitizer, abnormal spirometry, restrictive, obstructive or mixed, presence of specific IgG Ab's to the substance/protein, abnormal imaging, lymphocytosis on bronchioalveolar fluid eval
Term
treatment of hypersensitivity pneumonitis
Definition
minimize contact, clean source, protective equipment, glucocorticoids for acute exacerbation
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