A 45-year-old sandblaster presents with progressive exertional dyspnoea and a chest X-ray showing bilateral upper-zone nodular shadows with 'eggshell calcification' of hilar lymph nodes. His FEV1/FVC ratio is 0.65. The MOST likely diagnosis and the occupational exposure responsible are:
- A Asbestosis — asbestos fibres in shipyard workers
- B Coal worker's pneumoconiosis — coal dust in miners
- C Silicosis — free crystalline silica (SiO₂) in sandblasters/quarry workers ✓
- D Byssinosis — cotton dust in textile workers
Explanation
Silicosis is caused by inhalation of free crystalline silica (SiO₂) and is the most common occupational lung disease. Classic features: bilateral upper-lobe nodular opacities on CXR, 'eggshell calcification' of hilar lymph nodes (highly specific), and progressive massive fibrosis. Occupational exposure includes sandblasting, quarrying, grinding granite, and tunnelling. Spirometry typically shows a restrictive or mixed pattern. Silicosis predisposes to TB (silicotuberculosis). Asbestosis causes lower-zone fibrosis with pleural plaques; CWP (coal workers' pneumoconiosis) lacks eggshell calcification. Byssinosis causes Monday morning chest tightness.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.