Pulmonary and Critical Care Medicine · Occupational Lung Disease · study mode — pick an answer, then reveal.
Question · easy
A 44-year-old machine operator presents with several months of cough and wheeze. Which feature of the history most strongly suggests an occupational etiology for his respiratory symptoms?
The classic clue to work-related lung disease is a temporal relationship to work: symptoms that improve away from work (weekends, vacations) and recur on return are the hallmark finding. Other clues include symptoms following a new process or agent, similarly affected coworkers, and otherwise unexplained findings. A smoking history and family history of asthma are common but point toward non-occupational disease, and symptoms that are constant regardless of location argue against a work-related trigger.
MKSAP 19 B.5 Ch.4; Harrison's 22e Ch.300
Question · medium
A 29-year-old man who has fabricated engineered (artificial) stone countertops for 3 years presents with progressive dyspnea. HRCT shows diffuse ground-glass opacification with septal thickening ('crazy paving'). Which statement about his likely diagnosis is correct?
Intense silica exposure in engineered-stone fabrication can produce acute silicosis after only months, with a pulmonary alveolar proteinosis-like picture (diffuse ground-glass and crazy paving on HRCT) that may be rapidly progressive and fatal even after cessation; whole-lung lavage may palliate. A short work history does NOT exclude silicosis because disease tracks cumulative dose, not tenure — PMF has appeared after as little as 2 years of fabrication work. Eggshell calcification and upper-lobe rounded opacities without impairment describe chronic simple silicosis, not the acute form.
MKSAP 19 B.5 Ch.4; Harrison's 22e Ch.300; Hoy RF, et al. Lancet Respir Med 2025;13(12):1057-1068
Question · medium
A 68-year-old retired shipyard insulator with a 40-pack-year smoking history is found to have pleural plaques and lower-lobe linear opacities. Regarding asbestos-related malignancy, which of the following is correct?
Two commonly tested distinctions: lung cancer risk from asbestos interacts multiplicatively with smoking, while mesothelioma has no association with smoking at all. Mesothelioma can follow brief exposures of only 1-2 years occurring up to 40 years earlier (including bystander/household contact), so heavy continuous exposure is not required. Amphiboles (crocidolite, amosite) are MORE pathogenic than serpentine (chrysotile), not less. Pleural plaques themselves mark exposure rather than impairment.
A 38-year-old aerospace alloy worker is found to have bilateral hilar adenopathy and noncaseating granulomas on transbronchial biopsy, and is labeled with sarcoidosis. Which finding would most specifically establish chronic beryllium disease instead?
Chronic beryllium disease is clinically, radiographically, and histologically indistinguishable from sarcoidosis — noncaseating granulomas, hilar adenopathy (somewhat less common than in sarcoidosis), restriction, and reduced DLCO occur in both, and ACE elevation is nonspecific. The distinguishing test is the BeLPT, which demonstrates a specific delayed-type hypersensitivity response to beryllium salts; diagnosis then requires biopsy-proven granulomas in a sensitized individual. Susceptibility is linked to HLA-DP alleles with glutamic acid at position 69 of the beta chain. Any 'sarcoidosis' in an aerospace, nuclear, electronics, or alloy worker should prompt beryllium testing.
MKSAP 19 B.5 Ch.4; Harrison's 22e Ch.300
Question · hard
A 52-year-old textile worker exposed to cotton dust reports chest tightness that is worst on the first day back at work after a weekend and fades as the week goes on. Spirometry shows a fall in FEV1 across the Monday shift. Which statement about this condition (byssinosis) is correct?
Byssinosis classically causes 'Monday chest tightness' with a measurable FEV1 fall across the first shift back; early symptoms do not recur later in the week, but with continued exposure they may persist, and after more than a decade an obstructive pattern can become fixed. It is linked to dust and endotoxin levels, not IgE-mediated allergy. Fever/chills/malaise 4-8 hours after exposure describes acute hypersensitivity pneumonitis (e.g., farmer's lung), not byssinosis. And for all occupational lung disease, the cornerstone of management is removal from exposure — medical therapy alone fails without it; workers with persistent symptoms or falling function should be moved to lower-exposure areas.