Occupational & altitude disease flashcards
13 high-yield MRCP Part 1 cards from the Intellect Medicos Respiratory Medicine course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Which type of asbestos is most strongly linked with mesothelioma?
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Crocidolite (blue asbestos), an amphibole with straight fibres.
Why? Chrysotile (white, serpentine, curly fibres) is the commonest type but less carcinogenic.
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Which lung zones are mainly affected in asbestosis?
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The lower lobes (bibasal fibrosis).
Why? This contrasts with silicosis and coal workers' pneumoconiosis, which are upper-lobe predominant.
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How should asymptomatic pleural plaques found on imaging be managed?
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Reassure: they are benign, rarely affect lung function, do not turn into cancer, and need no routine follow-up imaging.
Why? Plaques are a marker of past asbestos exposure only. Advise stopping smoking and avoiding further exposure.
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What is the best investigation to diagnose suspected mesothelioma?
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Pleural biopsy, ideally at thoracoscopy.
Why? Pleural fluid cytology is often insensitive for mesothelioma.
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Mesothelioma immunotherapy: nivolumab blocks ______ and ipilimumab blocks CTLA-4.
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PD-1
Why? Both are immune checkpoint inhibitors that release the brakes on T cells. Chemotherapy option: pemetrexed plus platinum.
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Mesothelioma immunotherapy: nivolumab blocks PD-1 and ipilimumab blocks ______.
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CTLA-4
Why? Both are immune checkpoint inhibitors that release the brakes on T cells. Chemotherapy option: pemetrexed plus platinum.
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Silicosis increases susceptibility to which infection?
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Tuberculosis.
Why? Silica impairs macrophage function. Patients need a low threshold for TB investigation and treatment.
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What are the classic chest X-ray findings in silicosis?
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Multiple small upper-lobe nodules with "eggshell" calcification of hilar lymph nodes.
Why? High-risk jobs include mining, quarrying, sandblasting, stone cutting (including engineered stone) and foundry work.
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What is Caplan's syndrome?
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Rheumatoid arthritis plus pneumoconiosis (classically coal workers') with multiple, rapidly appearing peripheral lung nodules.
Why? The nodules are rheumatoid nodules and may cavitate.
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What is the single most effective way to prevent altitude illness?
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Gradual ascent (acclimatisation).
Why? Risk usually starts above about 2,500 m. Acetazolamide can be used as prophylaxis, starting 1 day before ascent.
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How does acetazolamide help prevent acute mountain sickness?
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It inhibits carbonic anhydrase, causing bicarbonate loss in urine and a mild metabolic acidosis that stimulates breathing.
Why? The extra ventilatory drive speeds acclimatisation to hypoxia at altitude.
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Apart from descent and oxygen, which drug is used for high-altitude PULMONARY oedema (HAPE)?
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Nifedipine (a pulmonary vasodilator).
Why? HAPE is non-cardiogenic oedema from high pulmonary artery pressure; nifedipine lowers it. PDE-5 inhibitors are alternatives.
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Apart from immediate descent, which drug is essential in high-altitude CEREBRAL oedema (HACE)?
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Dexamethasone.
Why? HACE is vasogenic cerebral oedema (ataxia, confusion, papilloedema); dexamethasone reduces the oedema. Descent is the definitive treatment.