Pulmonary Path Dr Bellot Part 3
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Questions and Answers
- 1.
A 34‑year‑old man from Chicago presents to his family doctor with fever and chest pain with greeny‑yellow sputum. On examination of the chest, you hear a coarse rasping sound on deep inspiration at the left base, which does not disappear on coughing. The diagnosis is MOST LIKELY to be
- A.
Carcinoma of bronchus
- B.
Pericarditis
- C.
Pleurisy
- D.
Asthma
- E.
Pneumothoroax
Correct Answer
C. PleurisyExplanation
The patient's symptoms of fever, chest pain, and greeny-yellow sputum, along with the findings of a coarse rasping sound on deep inspiration at the left base that does not disappear on coughing, are consistent with pleurisy. Pleurisy is an inflammation of the pleura, the lining of the lungs, which can cause chest pain and a characteristic rubbing or rasping sound known as a pleural friction rub. Carcinoma of the bronchus, pericarditis, asthma, and pneumothorax may also present with chest symptoms, but the specific findings described in this case are most indicative of pleurisy.Rate this question:
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- 2.
A 45‑year‑old farmer had been using paraquat for weed control. He suddenly became short of breath, was unresponsive to the usual supportive measures and died of respiratory failure. Sections of his lungs will probably demonstrate:
- A.
Lipid pneumonia
- B.
Multiple abscesses
- C.
Caseating graulomas
- D.
Hyaline membranes
- E.
Birefringent foreign bodies
Correct Answer
D. Hyaline membranesExplanation
– aerolized gases cause microvascular injury→ARDSRate this question:
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- 3.
A 35‑year‑old woman with a history of dyspnea and chest pain is shown by x‑ray to have right ventricular enlargement and is clinically going into right heart failure. Primary pulmonary hypertension is suspected. A pathologic characteristic of this disease is:
- A.
Absence of pulmonary arterioles
- B.
Plexogenic pulmonary arteriopathy
- C.
Bullae formation
- D.
Alveolar fibrosis
- E.
Destruction of alveolar septa
Correct Answer
B. Plexogenic pulmonary arteriopathyExplanation
Plexogenic pulmonary arteriopathy = plexus of capillary channels w/I dilated arteryRate this question:
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- 4.
Which is TRUE regarding Coal Workers Pneumoconiosis?
- A.
The earliest stage, anthracosis, is not clinically significant
- B.
Caplan's syndrome indicates a malignant complication
- C.
Patients typically suffer obstructive lung disease
- D.
Progressive massive fibrosis(PMP) is the usual outcome
- E.
The lower lobes are usually most severely effected
Correct Answer
A. The earliest stage, anthracosis, is not clinically significantExplanation
The correct answer is that the earliest stage of Coal Workers Pneumoconiosis, anthracosis, is not clinically significant. Anthracosis refers to the accumulation of carbon deposits in the lungs due to inhalation of coal dust. Although it is a common finding in coal miners, it does not typically cause any symptoms or functional impairment. It is considered a benign condition and does not progress to more severe forms of the disease.Rate this question:
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- 5.
A 21‑year‑old Black woman observes gradually worsening shortness of breath, night sweats and weight loss. Chest x‑ray reveals bilateral hilar adenopathy as well as early pulmonary interstitial fibrosis. Bronchial biopsy revealed many small "noncaseating granulomas". Her diagnosis MOST LIKELY is:
- A.
Asbestosis
- B.
Hypersensitivity pneumonitis
- C.
Sarcoidosis
- D.
Tuberculosis
- E.
Atypical (viral) pneumonia
Correct Answer
C. SarcoidosisExplanation
The patient's symptoms of shortness of breath, night sweats, weight loss, and the presence of bilateral hilar adenopathy and pulmonary interstitial fibrosis on chest x-ray are consistent with sarcoidosis. Sarcoidosis is a systemic inflammatory disease characterized by the formation of non-caseating granulomas in various organs, including the lungs. It predominantly affects young adults, especially Black individuals. This explanation aligns with the given information and is supported by the clinical presentation and diagnostic findings.Rate this question:
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- 6.
All of the following features may be associated with chronic bronchitis EXCEPT:
- A.
Hypertrophy of mucus glands
- B.
Chronic productive cough with excessive mucus secretion
- C.
Epithelioid granulomas in the bronchial mucosa
- D.
Increased resistance to air flow
- E.
Squamous metaplasia of the respiratory epithelium
Correct Answer
C. Epithelioid granulomas in the bronchial mucosaExplanation
Chronic bronchitis is a condition characterized by inflammation and excessive mucus production in the bronchial tubes. This leads to symptoms such as chronic productive cough with excessive mucus secretion, hypertrophy of mucus glands, and increased resistance to air flow. Squamous metaplasia of the respiratory epithelium can also occur in chronic bronchitis. However, the presence of epithelioid granulomas in the bronchial mucosa is not typically associated with chronic bronchitis. Epithelioid granulomas are more commonly seen in conditions such as tuberculosis or sarcoidosis.Rate this question:
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- 7.
A mother brings her previously healthy three‑year‑old child to the clinic with a history of cough for one month and blood tinged sputum for one day. The child is afebrile. A chest x‑ray reveals increased density of the right lower lobe, and slight shift of the mediastinum to the right. The child PROBABLY has:
- A.
Bacterial bronchopneumonia
- B.
Bronchial asthma
- C.
Hemorrhagic infarct of the lung
- D.
Acute viral pneumonia
- E.
Foreign body in the right lower lobe bronchus
Correct Answer
E. Foreign body in the right lower lobe bronchusExplanation
Based on the given information, the child has a history of cough for one month and blood tinged sputum for one day. The chest x-ray reveals increased density of the right lower lobe and a slight shift of the mediastinum to the right. These findings suggest that there is a foreign body in the right lower lobe bronchus. Bacterial bronchopneumonia and acute viral pneumonia would typically present with fever, which is not seen in this case. Bronchial asthma would not cause the radiographic findings described. Hemorrhagic infarct of the lung is less likely given the history and radiographic findings. Therefore, the most probable diagnosis is a foreign body in the right lower lobe bronchus.Rate this question:
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- 8.
An child with cystic fibrosis is at particular risk of developing which of the following?
- A.
Bronchiectasis
- B.
Pleural mesothelioma
- C.
Bronchial asthma
- D.
Hypersensitivity pneumonitis
- E.
Panacinar emphysema
Correct Answer
A. BronchiectasisExplanation
Cystic fibrosis is a genetic disorder that affects the lungs and causes the production of thick mucus. This mucus can block the airways and lead to recurrent infections and inflammation. Bronchiectasis is a condition characterized by the widening and scarring of the airways, which can result from chronic inflammation and infection. Therefore, a child with cystic fibrosis is at particular risk of developing bronchiectasis due to the ongoing damage to the airways caused by the disease.Rate this question:
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- 9.
The major physiologic abnormality in emphysema is
- A.
Decreased elastic recoil of lung
- B.
Increased airway resistance
- C.
Increased vital capacity
- D.
Atelectasis
- E.
Reduced total lung capacity
Correct Answer
A. Decreased elastic recoil of lungExplanation
In emphysema, the major physiologic abnormality is the decreased elastic recoil of the lung. This means that the lung tissue loses its ability to recoil or bounce back after inhalation, leading to air trapping in the lungs. This results in the characteristic symptoms of emphysema, such as shortness of breath and difficulty exhaling. The other options, such as increased airway resistance, increased vital capacity, atelectasis, and reduced total lung capacity, are not the primary abnormalities seen in emphysema.Rate this question:
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- 10.
After 20 years as a rock crusher, a man has shortness of breath, conglomerate nodular shadows on chest x-ray, a restrictive ventilatory defect, and pleural nodules which show whorls of fibrous tissue containing birefringent particles. He has
- A.
Sarcoidosis
- B.
Silicosis
- C.
Asbestosis
- D.
Bagassosis
- E.
Tuberculosis
Correct Answer
B. SilicosisExplanation
The man's symptoms and findings suggest silicosis. Silicosis is a lung disease caused by inhaling silica dust, typically from occupations like rock crushing. The shortness of breath, restrictive ventilatory defect, and nodular shadows on chest x-ray are consistent with silicosis. The presence of pleural nodules containing whorls of fibrous tissue containing birefringent particles is a characteristic finding of silicosis. Sarcoidosis is a systemic disease that can affect the lungs but typically presents with non-nodular shadows on chest x-ray. Asbestosis is caused by asbestos exposure and would have different radiographic findings. Bagassosis is caused by exposure to moldy sugar cane and tuberculosis presents differently with cavities and infiltrates on chest x-ray.Rate this question:
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- 11.
Pulmonary abscesses are particularly prone to develop in the right lung, rather than the left, when they follow
- A.
Chest trauma
- B.
Pneumonia
- C.
Pulmonary embolism
- D.
Cancer of the lung
- E.
Aspiration of foreign material
Correct Answer
E. Aspiration of foreign materialExplanation
Pulmonary abscesses are more likely to develop in the right lung when they occur after the aspiration of foreign material. This is because the right main bronchus is wider, shorter, and more vertical compared to the left main bronchus. As a result, foreign material is more likely to enter and get lodged in the right lung, leading to the formation of abscesses.Rate this question:
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- 12.
Cavitary disease at the apex of the lung suggests a diagnosis of
- A.
Pneumococcal pneumonia
- B.
Hypersensitivity pneumonia
- C.
Secondary tuberculosis
- D.
Pancoast tumor
- E.
Sarcoidosis
Correct Answer
C. Secondary tuberculosisExplanation
Cavitary disease at the apex of the lung is a characteristic finding in secondary tuberculosis. Secondary tuberculosis occurs when a person who has previously been exposed to tuberculosis becomes re-infected with the bacteria. The bacteria can cause the formation of cavities in the lung tissue, particularly in the upper lobes or apex of the lung. This is a common pattern seen in secondary tuberculosis, making it the most likely diagnosis in this case.Rate this question:
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- 13.
A patient's chest radiograph shows diffuse interstitial disease and hilar adenopathy. Biopsy of a skin lesion and a lymph node show non-caseating granulomas with no necrosis. The BEST diagnosis is
- A.
Sarcoidosis
- B.
Silicosis
- C.
Alveolar proteinosis
- D.
Carcinomatosis
- E.
Tuberculosis
Correct Answer
A. SarcoidosisExplanation
The presence of diffuse interstitial disease and hilar adenopathy, along with non-caseating granulomas with no necrosis in both the skin lesion and lymph node biopsy, strongly suggests sarcoidosis. Sarcoidosis is a systemic disease characterized by the formation of non-caseating granulomas in various organs, including the lungs, lymph nodes, and skin. This disease commonly presents with chest radiograph abnormalities and hilar adenopathy. Silicosis, alveolar proteinosis, carcinomatosis, and tuberculosis do not typically exhibit the same pattern of granulomas seen in sarcoidosis.Rate this question:
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- 14.
A 30-year-old physician has a positive skin test for tuberculosis (PPD or purified protein derivative). Imaging studies of the chest are performed, and there is a 1.5 cm subpleural parenchymal lesion just above the interlobar fissure between the upper and lower lobes on the left and enlarged lymph nodes in the left hilum. This MOST LIKELY represents
- A.
Reactivation pulmonary tuberculosis
- B.
Miliary tuberculosis
- C.
Primary pulmonary tuberculosis
- D.
Progressive pulmonary tuberculosis
- E.
Tuberculous pneumonia
Correct Answer
C. Primary pulmonary tuberculosisExplanation
The presence of a positive skin test for tuberculosis and imaging findings of a subpleural parenchymal lesion and enlarged lymph nodes in the left hilum suggests primary pulmonary tuberculosis. Primary tuberculosis occurs when a person is first exposed to the Mycobacterium tuberculosis bacteria. The bacteria enter the lungs and cause an initial infection, typically in the upper lobes. The subpleural parenchymal lesion and enlarged lymph nodes are characteristic findings of primary tuberculosis. Reactivation tuberculosis occurs when a latent infection becomes active again, miliary tuberculosis is characterized by widespread dissemination of the bacteria, progressive tuberculosis refers to a worsening of the disease, and tuberculous pneumonia specifically refers to infection of the lung tissue.Rate this question:
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- 15.
A 55-year-old man presents with malaise and right chest pain for the past two weeks. He has a long history of alcoholism, advanced dental caries, fever, and a cough producing foul, purulent sputum. A chest x-ray reveals a fluid-filled cavity in the upper right lobe. The MOST LIKELY diagnosis is
- A.
Adenocarcinoma
- B.
Bronchiectasis
- C.
Infarct
- D.
Abscess
- E.
Mycoplasma pneumonia
Correct Answer
D. AbscessExplanation
The patient's history of alcoholism, advanced dental caries, and symptoms such as fever, cough producing foul, purulent sputum, and a fluid-filled cavity on chest x-ray suggest the presence of a lung abscess. Lung abscess is commonly seen in individuals with poor oral hygiene and alcoholism, as aspiration of oral bacteria is a common cause. The symptoms and imaging findings are consistent with this diagnosis. Adenocarcinoma and bronchiectasis are less likely given the patient's history and presentation. Infarct would typically present with different symptoms and imaging findings. Mycoplasma pneumonia is unlikely to cause a fluid-filled cavity.Rate this question:
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- 16.
A predominantly interstitial reaction in the lung is MOST LIKELY associated with
- A.
Asbestosis
- B.
Bronchopneumonia
- C.
Lobar pneumonia
- D.
Fungal infection
- E.
Viral infection
Correct Answer
E. Viral infectionExplanation
A predominantly interstitial reaction in the lung is MOST LIKELY associated with viral infection. Interstitial lung disease refers to a group of lung disorders that affect the interstitium, the tissue and space around the air sacs of the lungs. Viral infections, such as influenza or respiratory syncytial virus (RSV), can cause inflammation and damage to the interstitium, leading to interstitial lung disease. This can result in symptoms such as cough, shortness of breath, and decreased lung function. Other conditions listed, such as asbestosis, bronchopneumonia, lobar pneumonia, and fungal infection, may also cause lung damage but are less commonly associated with predominantly interstitial reactions.Rate this question:
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- 17.
Pulmonary embolism is MOST LIKELY to result in pulmonary infarction if the patient has
- A.
Atrial fibrillation
- B.
Multiple small emboli
- C.
Large saddle embolus
- D.
Pre-existing cardio-pulmonary disease
- E.
Systemic hypertension
Correct Answer
D. Pre-existing cardio-pulmonary diseaseExplanation
Pre-existing cardio-pulmonary disease increases the risk of pulmonary infarction in patients with pulmonary embolism. This is because individuals with pre-existing cardio-pulmonary disease already have compromised lung function and reduced blood flow to the lungs. When a pulmonary embolism occurs in these patients, it further restricts blood flow to the affected area, leading to tissue damage and infarction. Therefore, patients with pre-existing cardio-pulmonary disease are more susceptible to developing pulmonary infarction in the presence of a pulmonary embolism.Rate this question:
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- 18.
A 25-year-old man has bronchiectasis, sinusitis, situs inversus, and infertility. A defect in which of the following is MOST LIKELY responsible for his bronchiectasis?
- A.
Alveolar macrophages
- B.
Ciliary motility
- C.
Pores of Kohn
- D.
Alpha-1 antitrypsin
- E.
Type II pneumocytes
Correct Answer
B. Ciliary motilityExplanation
Ciliary motility is most likely responsible for the man's bronchiectasis. Cilia in the respiratory tract help to move mucus and trapped particles out of the airways. In bronchiectasis, there is a loss of ciliary function, leading to impaired clearance of mucus and increased susceptibility to infection. This can result in the dilation and damage of the bronchi, leading to bronchiectasis. The presence of sinusitis and situs inversus (a condition in which the organs are reversed from their normal positions) further supports the involvement of ciliary motility, as cilia are also responsible for the movement of mucus in the sinuses and the positioning of organs during development.Rate this question:
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- 19.
You see a 48-year-old overweight woman who complains of a dry cough lasting 2 months. Physical examination, including chest x-ray and sputum culture, is unrevealing. Your attending physician thinks there might be an iatrogenic cause for the cough. So you ask her about current treatment she might be receiving. What is the MOST LIKELY condition for which she might be receiving treatment? (Choose all that apply)
- A.
Asthma
- B.
Hypertension
- C.
Gastroesophageal reflux disease
- D.
Tuberculosis
- E.
Arthritis
Correct Answer(s)
A. Asthma
B. HypertensionExplanation
The most likely condition for which the woman might be receiving treatment is asthma and hypertension. This is because both asthma and hypertension can be associated with a chronic dry cough. Asthma is a respiratory condition that can cause inflammation and narrowing of the airways, leading to symptoms such as coughing. Hypertension, or high blood pressure, can also cause a chronic cough due to the side effects of certain medications used to treat it. The other conditions listed, such as gastroesophageal reflux disease, tuberculosis, and arthritis, are less likely to be associated with a dry cough in this case.Rate this question:
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Mar 14, 2023Quiz Edited by
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Aug 04, 2012Quiz Created by
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