Mt4l4 Elhm Pathology Course (Exam 2)
Respiratory chapter
Questions and Answers
- 1.
A 55-year-old woman has had fever and dyspnea for a month along with a 2 kg weight loss. On physical examination her temperature is 37.7 C. A chest radiograph shows a reticulonodular pattern along with prominent hilar lymphadenopathy. A transbronchial lung biopsy is performed, and microscopic examination shows no viral inclusions, no fungi, no acid fast bacilli, and no atypical cells. Which of the following diseases is she most likely to have?
- A.
Silicosis
- B.
Sarcoidosis
- C.
TB
- D.
Usual interstitial pneumonia
- E.
Asbestosis
Correct Answer
B. SarcoidosisExplanation
The patient's presentation of fever, dyspnea, weight loss, reticulonodular pattern on chest radiograph, and prominent hilar lymphadenopathy is consistent with sarcoidosis. The negative findings on microscopic examination, including the absence of viral inclusions, fungi, acid-fast bacilli, and atypical cells, further support this diagnosis. Silicosis, TB, usual interstitial pneumonia, and asbestosis would typically have different clinical and radiographic findings.Rate this question:
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- 2.
A 55-year-old man has been a cigarette smoker for the past 39 years. He has noted some blood-streaked sputum on coughing during the past week. He also has back pain. A chest radiograph shows a small 3 cm right hilar mass with several 1 to 2 cm peripheral lung nodules. A bone scan reveals multiple areas of increased uptake in the vertebrae, ribs, and pelvis. A sputum cytology reveals the presence of clusters of small cells having hyperchromatic nuclei and almost no cytoplasm. Which of the following laboratory test findings is he most likely to have as a consequence of his lung disease?
- A.
Positive antinuclear antibody
- B.
Platelet count of 55,000/microliter
- C.
Plasma cortisol at 8 am of 5 microgm/dL (N= 10-20 micrigram/dL)
- D.
Serum sodium of 113 mmol/L
- E.
Hyperuricemia
Correct Answer
D. Serum sodium of 113 mmol/LExplanation
The correct answer is serum sodium of 113 mmol/L. This is likely due to the presence of a small cell lung carcinoma, which can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH leads to excess water retention and dilutional hyponatremia, resulting in low serum sodium levels. The patient's symptoms of coughing up blood, back pain, and the presence of lung nodules and bone metastases are consistent with advanced lung cancer, which can be associated with SIADH.Rate this question:
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- 3.
A 40-year-old woman has had a high fever for a week, accompanied by a cough productive of yellowish sputum. On physical examination her temperature is 38.2 C. There are diffuse rales in all lung fields. Her chest radiograph reveals patchy infiltrates in all lung fields, and there is a 4 cm rounded area of consolidation in the left upper lobe that has an air-fluid level. Examination of her sputum reveals numerous neutrophils. Which of the following infectious agents is most likely causing her pulmonary disease?
- A.
Staphylococcus aureus
- B.
Aspergillus niger
- C.
Mycoplasma pneumoniae
- D.
Adenovirus
- E.
Mycobacterium tuberculosis
Correct Answer
A. StapHylococcus aureusExplanation
The most likely infectious agent causing the woman's pulmonary disease is Staphylococcus aureus. This is indicated by the presence of a high fever, productive cough with yellowish sputum, diffuse rales in all lung fields, and patchy infiltrates in all lung fields on chest radiograph. The presence of a 4 cm rounded area of consolidation in the left upper lobe with an air-fluid level further supports a bacterial infection. Staphylococcus aureus is a common cause of community-acquired pneumonia and can lead to severe lung infections.Rate this question:
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- 4.
A 12-year-old girl has the acute onset of dyspnea and wheezing. She coughs up a large, thick mucus plug. She has experienced similar previous episodes for the past 7 years, all of which lasted 1 to 6 hours. On physical examination her vital signs include T 37.1 C, P 109/minute, RR 27/minute, and BP 90/60 mm Hg. There are decreased breath sounds in all lung fields. A chest radiograph reveals hyperinflation but no infiltrates. Laboratory studies show WBC count of 8300/microliter with differential count of 60 segs, 3 bands, 16 lymphs, 10 monos, and 11 eosinophils. A sputum sample examined microscopically has increased numbers of eosinophils. Which of the following is the most likely diagnosis?
- A.
Hypersensitivity pneumonitis
- B.
Mycoplasma pneumonia infection
- C.
Cystic fibrosis
- D.
Bronchial asthma
- E.
Aspiration of gastric contents
Correct Answer
D. Bronchial asthmaExplanation
The most likely diagnosis in this case is bronchial asthma. The patient's symptoms, such as acute onset of dyspnea, wheezing, and coughing up mucus plugs, are consistent with an asthma attack. The patient has a history of similar episodes for the past 7 years, further supporting the diagnosis of asthma. The physical examination findings, including decreased breath sounds and hyperinflation on chest radiograph, are also typical of asthma. The laboratory studies show an increased number of eosinophils, which is commonly seen in asthma. The other answer choices are less likely based on the given information.Rate this question:
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- 5.
A 36-year-old woman has had increasing dyspnea for 8 years. She has no cough or increased sputum production. On physical examination there is hyperresonance to percussion. A chest radiograph reveals increased lung volumes with flattening of the diaphragmatic leaves bilaterally. The right heart border is prominent. A chest CT scan demonstrates decreased attenuation (broncho vascular marking) in all lung fields. Which of the following laboratory findings is she most likely to have?
- A.
Decreased serum ceruloplasmin
- B.
Increased sweat chloride
- C.
Elevated blood ethanol
- D.
Decreased serum alpha-1-antitrypsin
- E.
Positive antinuclear antibody test
Correct Answer
D. Decreased serum alpHa-1-antitrypsinExplanation
The patient's clinical presentation is consistent with emphysema, which is characterized by hyperresonance to percussion, increased lung volumes, and flattening of the diaphragmatic leaves. The prominent right heart border suggests pulmonary hypertension. The decreased attenuation on chest CT scan indicates loss of lung parenchyma. These findings are indicative of alpha-1-antitrypsin deficiency, a genetic disorder that predisposes individuals to the development of emphysema at a young age. Therefore, the patient is most likely to have decreased serum alpha-1-antitrypsin levels.Rate this question:
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- 6.
During a cardiac arrest, a 58-year-old man, a non-smoker, receives cardiopulmonary resuscitative measures and is brought to the hospital, where he is intubated. During the intubation procedure he suffers aspiration of gastric contents (pasta with mushrooms and peas). Over the next 10 days he develops a non-productive cough along with a fever to 37.9 C. A chest radiograph reveals a 4 cm diameter mass with an air-fluid level in the right lung. A sputum gram stain reveals mixed flora. Which of the following conditions is he most likely to have?
- A.
Squamous cell carcinoma
- B.
Lung abscess
- C.
Chronic bronchitis
- D.
Bronchiectasis
Correct Answer
B. Lung abscessExplanation
The patient is most likely to have a lung abscess. The development of a non-productive cough and fever after aspirating gastric contents suggests the presence of an infection in the lung. The chest radiograph revealing a mass with an air-fluid level is consistent with a lung abscess. The sputum gram stain revealing mixed flora further supports the diagnosis of a lung abscess, as it indicates the presence of multiple bacteria in the respiratory tract. Squamous cell carcinoma, chronic bronchitis, and bronchiectasis are less likely in this case as they do not typically present with the specific findings described.Rate this question:
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- 7.
All of the following conditions can cause atelectasis or collapse except:
- A.
Compression of bronchi by enlarged lymph nodes.
- B.
Alphla 1 antitrypsin deficiency
- C.
Pneumothorax
- D.
Bronchial tumors
Correct Answer
B. AlpHla 1 antitrypsin deficiencyExplanation
Atelectasis or collapse of the lungs can be caused by various conditions, including compression of bronchi by enlarged lymph nodes, pneumothorax, and bronchial tumors. However, alpha 1 antitrypsin deficiency is not a known cause of atelectasis or collapse.Rate this question:
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- 8.
Which of the following is true about centriacinar emphysema:
- A.
It affects the alveoli and spares the broncioles
- B.
It's the main type occurring in smokers
- C.
It is reversible
- D.
Non of the above
- E.
All of the above
Correct Answer
B. It's the main type occurring in smokersExplanation
Centriacinar emphysema is a type of emphysema that primarily affects the respiratory bronchioles and spares the alveoli. It is the main type of emphysema that occurs in smokers. This type of emphysema is characterized by the destruction of the walls of the respiratory bronchioles, leading to the enlargement of the air spaces. Although some degree of reversibility may be possible with treatment, centriacinar emphysema is generally considered irreversible.Rate this question:
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- 9.
Alphla 1 antitrypsin deficiency leads to emphysema because:
- A.
Lt leads to deficient formation of pulmonary elastic tissue
- B.
It leads to excessive destruction of elastic tissue by elastase enzymes
- C.
Lt predisposes to Bronchial inflammation and obstruction.
- D.
All of the above
- E.
Non of the above
Correct Answer
B. It leads to excessive destruction of elastic tissue by elastase enzymesExplanation
Alphla 1 antitrypsin deficiency leads to emphysema because it leads to excessive destruction of elastic tissue by elastase enzymes. This deficiency impairs the ability of the body to inhibit the activity of elastase, an enzyme that breaks down elastic tissue in the lungs. As a result, there is an increased destruction of the elastic fibers, leading to the development of emphysema. This condition is characterized by the destruction of the alveoli and the loss of lung elasticity, resulting in difficulty breathing and other respiratory symptoms.Rate this question:
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- 10.
Emphysematous lungs are characterised by all the following except
- A.
They rapidly collapse on opining the chest
- B.
They may show air pullae
- C.
They may show rib indentations
- D.
They are pale and dry
Correct Answer
A. They rapidly collapse on opining the chestExplanation
Emphysematous lungs are characterized by the destruction of the alveolar walls, leading to enlarged air spaces and reduced lung elasticity. This results in difficulty exhaling air and a decrease in lung function. Emphysematous lungs may show air pullae, which are small air-filled spaces within the lung tissue. They may also show rib indentations due to the enlarged air spaces pushing against the ribs. Additionally, emphysematous lungs are typically pale and dry due to the loss of blood vessels and decreased production of mucus. However, they do not rapidly collapse on opening the chest, as the destruction of the alveolar walls causes the lungs to lose their elastic recoil.Rate this question:
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- 11.
Which of the following is not a suppurative lung disease
- A.
Empyema
- B.
Post pneumonic lung abscess
- C.
Septic bronchopneumonia
- D.
Lobar pneumonia
- E.
Bronchiectasis
Correct Answer
D. Lobar pneumoniaExplanation
Lobar pneumonia is not a suppurative lung disease because it is characterized by inflammation and consolidation of a lobe or lobes of the lung, but it does not typically involve the formation of pus. Suppurative lung diseases, on the other hand, are characterized by the presence of pus in the lung, such as in empyema, post pneumonic lung abscess, and septic bronchopneumonia. Bronchiectasis is also a suppurative lung disease, as it involves the permanent dilation of the bronchi and the accumulation of mucus and pus in the airways.Rate this question:
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Mar 21, 2023Quiz Edited by
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Feb 21, 2019Quiz Created by
Ali Amin
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