pulmo 2 - darkhorse

[ArchivalUser]

A 60-year-old male is seen in the clinic for counseling about asbestos exposure. He is well and has no
symptoms. He also has hypertension, for which he takes hydrochlorothiazide. The patient smokes one
pack of cigarettes a day but has no other habits. He is currently retired but worked for 30 years as a
pipefitter and says he was around "lots" of asbestos, often without wearing a mask or other protective
devices. Physical examination is normal except for nicotine stains on the left second and third fingers.
Chest radiography shows pleural plaques but no other changes. Pulmonary function tests, including lung
volumes, are normal. Which of the following statements should be made to this patient?


A. He must quit smoking immediately as his risk of emphysema is higher than that of other smokers
because of asbestos exposure.
B. He does not have asbestosis.
C. His risk of mesothelioma is higher than that of other patients with asbestos exposure because he has
a history of tobacco use.
D. He has no evidence of asbestos exposure on chest radiography.
E. He should undergo biannual chest radiography screening for lung cancer

[ArchivalUser]

C-----
Is there any lung cancer screening protocol??

[ArchivalUser]

e?

[ArchivalUser]

I think E

Asbestos doen't put anyone at higher risk for emphysema

Mesothelioma is caused by asbestos but not by smoking

As he has pleural plaque he has high chance of lung cancer. Though I don't know how to screen him regularly, E seems to be the only option giving regular follow up

[ArchivalUser]

C.

[ArchivalUser]

The Answer is B

Asbestos was a commonly used insulating material from the 1940s to the mid-1970s, after which it was
largely replaced by fiberglass and slag wool. Workers in many occupations had significant exposure and
often did not use protective equipment. There are several pulmonary manifestations of asbestos
exposure in the lungs, the most important of which are pleural plaques, benign asbestos pleural
effusions, asbestosis, lung cancer, and mesothelioma. Pleural plaques, which appear as calcifications or
thickening along the parietal pleura, simply suggest exposure and not pulmonary impairment. Benign
pleural effusions can occur and are often bloody. They may regress or progress spontaneously.
Asbestosis refers to interstitial lung disease, generally with fibrosis, seen in the lower lung fields of a
chest radiogram or chest CT and an associated restrictive ventilatory defect. This patient does not have
interstitial changes on chest radiography and has no restriction on pulmonary function tests; therefore,
he does not have asbestosis. The risk of lung cancer, including squamous cell cancer and
adenocarcinoma, is elevated in all patients with asbestos exposure but is amplified furtherby cigarette
smoking. In contrast, mesothelioma risk, though elevated in patients with asbestos exposure, is not
increased by cigarette smoking. Interestingly, despite the high risk of malignancies in this group of
patients, no benefit has been ascribed to screening techniques, including biannual chest radiograms.