CM- pulm -11- Occupational Disease
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| If you have increased compliance but decreased elasticity what type of lung disease do you have | obstructive lung disease. Take long to force air out of the lungs
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| What will you see in residual volume in obstructive disease | you will have an increase in residual volume
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| What do you see in FEV1 and FVC, and FEV1/FVC in obstructive lung disease | FEV1 will be decreased
FVC will be decreased
FEV!/FVC will be less than normal (42%)
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| What are some common obstructive lung diseases | COPD, Emphysema, Chronic bronchitis, Asthma, and Bronchiectasis
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| lung disease where you have decreased TLC, (decreased lung compliance), Increased lung elasticity and decreased residual volume | Restrictive lung disease
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| Diffuse, chronic involvement of pulmonary interstitial tissue and fibrosis | restrictive lung disease
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| What will you see in restricive airway disease in FEV!, FVC, FEV!/FVC | FEV1 will be lower
FVC will be lower
FEV!/FVC will he increased to about 90%
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| What are the clinical s/sx of restrictive lung disease | dyspnea
tachypnea
cyanosis
hypoxemia
chest x-ray- diffuse infiltration "ground Glass"
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| What are common restricitve lung diseases | pneumoconiosis, hypersensitivity pneumonitis, sarcoidosis, idiopathic pulmonary fibrosis
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| What is pneumoconiosis | occupational disease where inhalation of materials predisposes lungs to damage.
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| How does pneumoconiosis develop | inhaled particles agravate lung and cause alveolar macrophages to migrate and start to secrete mediators that injure parenchymal cells
stimulates interstitial edema, and infalmmation response leading to interstitial fibrosis
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| What is disease coal worker is likely to present with | coal workers pneumoconiosis "BLACK lung disease"
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| Where are you most likely going to see the nodules associated with coal workers pneumoconiosis | in the upper lobes progresses to massive fibrosis and blackened scars
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| what is anthracosis | 1-2 mm nodules seen in coal workers pneumoconiosis which are carbon-laden macrophages. Lesions are scattered throughout the lung but especially in upper lobes
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| what is it called when a patient has coal workers pneumoconiosis and rheumatoid arthritis | Caplan's Syndrome
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| What is the tx for pneumoconiosis | relieve respiratory symptoms, manage hypoxia and cor pulmonale. Avoid respiratory tract irritants and infections
Monitor carefully for TB
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| What can you order to help respiratory symtpoms of patient with pneumoconiosis | bronchodilator therapy with theophylline or aminophylline
Oral or inhaled sympathomimetics, corticosteroids
or cromolyn sodium aerosol
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| What is the most prevalent occupational disease world wide | pneumoconiosis
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| what is the pneumoconiosis called when it is from inhalation of crystalline silicon dioxide. | silicosis
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| is there an association with silicosis and developing lung cancer | no
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| How does silicosis typically present | presents as a slow progressing nodular fibrosing pneumoconiosis of the UPPER LUNGS
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| where is silicosis common | sandblasting, crushing stones, quartz and iron-containing ore mining
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| Pneumoconiosis from inhaling asbestos fibers | asbestosis
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| Who is most likely to develop asbestosis | people working on brake linings, cement pipes and insulation materials (especially from awhile ago)
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| what are the 2 types of asbestos | serpentine-curly felixble fibers
amphiboles- straight stiff, brittle fibers that can be delivered into the lungs
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| What are the s/sx of asbestosis | dyspnea with productive cough. Generally appears >10yrs later
Chest x-rays reveal irregular linear densities in both lower lobes and mid thoracic pleural plaque formation
Pleural Plaques
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| What are asbestos bodies | golden brown beaded rods with a translucent center. macrophages attempt to phagocytize asbestos fibers and coat the fibers with iron protein complexes
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| if a person has exposure to asbestos and is a smoker what are they more likely to develop lung cancer or mesothelioma | bronchogenic carcinoma lung cancer
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| if a person has exposure to asbestos and is a NON-smoker what are they more likely to develop lung cancer or mesothelioma | mesothelioma
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| if your patient works in the nuclear or aerospace industry they have the highest exposure and risk of developing what type of occupational lung disease | berylliosis
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| If a person has prolonged exposure to metallic beryllium fumes what are they at risk for developing | non-caseating granulomatous lesions and hilar adenopathy similar to sarcoidosis
also lung cancer
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| immune mediated, interstitial lung disease caused by exposure to inhaled antigens | hypersensitivity pneumonitis
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| why do you need to recognize hypersensitivity pneumonitis early on | you can't prevent development of serious chronic fibrosis by removing exposure to the environmental agent
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| what are the most common causes of hypersensitivity pneomonitis | inhaling spores, fungi, animal proteins, or bacterial products
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| How long after exposure does a person typically develop symptoms of hypersensitivity pneumonitis | 4-6 hours
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| What are some common hypersensitivity pneumonitis conditions | farmer's lung
silo filler's disease
bird fancier's disease
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| What is the hypersensitivity generally developed in textile industry | byssinosis "brown lung disease"- from exposure to endotoxins from gram negative bacteria that grow on the cotton fiber the worker inhales
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| what is the deadly hypersensitivity pneumonitis that develops after inhaling water droplets containing bacteria. Generally grows in Air Conditioners | Legionnaire's disease
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| what is the tx for legionnaire's disease | erythromycin
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| what test would you order to determine if your patient is likely suffering from obstructive or restrictive | spirometry
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| What is TV in spirometry | Tidal Volume- the amount of air that moves into and out of the lungs during quiet, relaxed breathing. In the average person this is about 500 ml.
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| What is IRV | inspiratory reserve volume- amount of air that can be inspired forcibly beyond the tidal volume normally 2100-3200ml
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| What is ERV | expiratory reserve volume- amount of air that can be forcefully evacuated from the lung after tidal expiration. normally 1000-1200
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| What is RV | residual volume- help keeps lungs from collapsing. amount of air left after forced exhalation. normally 1200ml
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| What is TLC | Total lung capacity- sum of all lung volumes usually 6000ml
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| what is VC | vital capacity- total amout of exchangeable air usually 4800ml
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| what is IC | inspiratory capacity- total amount of air that can be inspired after tidal expiration usually 3600ml
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| What is FRC | functional residual capacity- volume of air that remains trapped in the lungs after a normal tidal volume expiration
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| What is FEV1 | forced expiratory volume 1- volume of air forcefully exhaled in one second
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| what is FVC | forced vital capacity- volume of air that can be maximally forcefully exhaled
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| what is FEV1/FVC | ratio of air expelled in 1 second to total air expelled
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| what is PEFT | peak flow rate during expiration
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| what is the normal FEV1/FVC ratio | 80%
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| what will you see in FEV1/FVC ratio in obstructive disease | ratio will decrease to 40% because FEV1 is decreased
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| what will you see in FEV1/FVC ratio in restrictive disease | FEV1/FVC will be increased to about 90% because patient can't inspire as much.
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