307.2 🩺 國考版

307.2.1 高頻考點

307.2.1.1 Silicosis

  • Crystalline silica (quartz)
  • Mining, sandblasting, ENGINEERED STONE (2010s-2020s epidemic)
  • Acute, accelerated, chronic forms
  • HRCT: upper lobe nodules, eggshell calcification of LN
  • TB risk significantly ↑
  • Associated autoimmune (scleroderma, RA, SLE — Caplan)

307.2.1.2 Asbestosis

  • Asbestos fibers
  • 20-40 year latency
  • Pleural plaques (calcified often, asymptomatic marker)
  • Basilar fibrosis
  • BAL: ferruginous bodies
  • Mesothelioma (even low exposure)
  • Lung cancer + smoking → multiplicative

307.2.1.3 Mesothelioma

  • Pleural > peritoneal
  • Asbestos most common
  • Median survival 12-24 months untreated
  • Treatment: chemotherapy (cisplatin + pemetrexed); immunotherapy (nivolumab + ipilimumab, CheckMate 743 — first immunotherapy approved)

307.2.1.4 CWP

  • Coal dust + silica
  • Simple → complicated PMF
  • Caplan syndrome: CWP + RA + rheumatoid nodules

307.2.1.5 Berylliosis (Chronic Beryllium Disease)

  • Aerospace, electronics, ceramics, nuclear
  • HLA-DPB1 association
  • Granulomatous (mimics sarcoid)
  • BeLPT positive
  • Steroids + exposure cessation

307.2.1.6 Engineered Stone Silicosis

  • New epidemic (Caesarstone, Silestone)
  • Rapid progression
  • Young workers
  • High silica content (95%+)
  • Many cases globally 2010s-2020s

307.2.1.7 Acute Irritant Exposures

  • Chlorine
  • Ammonia
  • Sulfur dioxide
  • Nitrogen dioxide (silo filler’s)
  • Phosgene (delayed pulmonary edema 6-24h)

307.2.1.8 Air Pollution

  • PM2.5 + PM10 + ozone + NOx + SO2
  • ↑ Asthma + COPD + CV + lung cancer
  • 6% ↑ CV mortality per 10 ÎŒg/m³ PM2.5

307.2.1.9 Radon

  • 2nd cause of lung cancer (after smoking)
  • Test + mitigate
  • Geographic variability

307.2.1.10 EVALI

  • Vitamin E acetate in THC vapes
  • Lipoid pneumonia pattern
  • Acute respiratory failure
  • Steroids + cessation

307.2.2 易混淆比范

Disease Etiology Imaging Treatment
Silicosis Quartz Upper nodules, eggshell LN Cessation, TB screen
Asbestosis Asbestos Pleural plaques + basilar fibrosis Cessation, LDCT
CWP Coal dust Simple/PMF Cessation
Berylliosis Beryllium Granulomas Cessation + steroids
Hard-metal Cobalt + WC Giant cell IP Cessation + steroids
Talcosis Talc Variable Cessation
Stannosis Tin Nodular Reversible (benign)
Siderosis Iron Nodular Reversible

307.2.3 Special Topics

307.2.3.1 Engineered Stone Silicosis

  • Quartz content 90%+
  • Cutting + grinding releases silica
  • 2010s-2020s global epidemic
  • Younger patients
  • Rapid progression
  • OSHA + WHO action

307.2.3.2 Silicosis + TB

  • Silica impairs alveolar macrophage function
  • Latent TB reactivates more
  • All silicosis patients should be TB screened
  • IGRA / TST + treat latent

307.2.3.3 Mesothelioma Treatment Advances

  • CheckMate 743: nivolumab + ipilimumab > chemo (median OS 18.1 vs 14.1 months)
  • First immunotherapy approval
  • Pemetrexed + cisplatin chemo
  • Surgery (extended pleurectomy, pneumonectomy)
  • Trimodality (surgery + chemo + radiation) controversial