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102 Cards in this Set

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63 year old man with worsening dyspnea over 10 years. 5kg weight loss in 2 years. Chronic cough with minimal sputum production. Afebrile and normotensive. CXR extensive interstitial disease. Low FVC and normal FEV1/FVC ratio. Increased exposure to what pollutant will produce these findings
Silica. Crystals incite a fibrogenic response after ingestion by macrophages. The greater the exposure, the greater is the lung injury. Tobacco smoke will lead to loss of lung tissue and emphysema, not to fibrosis
50 year old alcoholic found stuporous after 3 days of binging. 39.2C. A few crackels are heard in the right lung base. CXR 3cm lesions with an air-fluid level in the right lower lobe. What two organisms may be detected
Staphylococcus aureus and Bacteroides fragilis. This patient has a lung abscess that most likely resulted from aspiration, which can occur in persons with a depressed cough reflex or in neurologically impaired persons (alcohol). Aspiration in the the right lower lung lobe is common. S aureus and Bacteroides are in the oral cavity and are easily aspirated. The purulent, liquefied center of the abscess can produce the radiographic appearance of an air-fluid level.
45 year old smoker. 4 years chronic cough with copious mucoid expectoration. During the past year, he has had several episodes of respiratory tract infections that were diagnosed as viral flu, and he developed difficulty breathing, tightness of the chest, and audible wheezing. Breathing difficulty relieved by inhalation of an Beta-adrenergic agonist and disappeared after the chest infection had resolved. Diagnosis?
Chronic bronchitis with asthmatic bronchitis. This case meets the clinical definition of bronchitis: cough with sputum for at least 3 months in 2 consecutive years. Chronic bronchitis is a disease of smokers and persons living in areas of poor air quality, which explains the chronic cough with mucoid sputum production. Bronchoconstriction set off by viral infections suggest a superimposed element of nonatopic asthma
75 year old woman with worsening lower leg edema and dyspnea for 5 years. 36.9C, pulse 74, resp 19, BP 110/75. Dullness to percussion at the lung bases. Low rumbling heart murmur. Large (4cm) atrial septal defect. Diagnosis?
Pulmonary hypertension. L to R shunt leads to increased pulmonary arterial pressure with thickening of the pulmonary arteries, and increased pulmonary vascular resistance. Shunt may eventually reverse (Eisenmenger complex)
Phlebothrombosis. The figure shows a red infarct typical of pulmonary thromboembolism that affects persons who are immobilized in the hospital, such as those with CHF. Source is pelvic or leg veins. Bronchial arterial supply of blood is sufficient to produce hemorrhage but not to prevent infarction. Persons with underlying cardiac or respiratory diseases that compromise pulmonary circulation are at greater risk of infarction if thromboembolism does occur
60 year old man had MI 1 year ago and now has CHF. Over the past 24 hours has developed right-sided chest pain. Lower lobe rales. Afebrile, pulse 70, resp 17 and shallow, BP 130/85. Right lower lobe shown. What preceded this lesion
Streptococcus pneumoniae. The productive cough suggests an alveolar exudate with neutrophils, and the course is compatible with an acute infection---think bacteria. Pneumococcus is the most likely agent to be cultured in persons acquirign a pneumonia outside of the hostpital, particularly when a lobar pneumonic pattern is present
52 year old woman with increasingly severe cough productive of yellowish sputum for several days. 38.9C, diffuse crackles are heard in the LLlung. CXR shows LLlung consolidation WBC 11990, 72% seg neut, 8% band, 16% lymph, 4% mono. What pathogen will most likely be cultured from the sputum
44 year old woman has 4 month history of mild but persistent right chest pain. CXR right pleural mass, no pleural effusions. CT shows 3x7cm mass attached to visceral pleura; lungs and chest wall normal. Mass is composed of spindle cells resembling fibroblasts with abundant collagenous stroma. Spindle cells mark for CD34 but are cytokeratin negative. No recurrence of the lesion. Nonsmoker. Research biologist specializing in manatees. Diagnosis?
Solitary fibrous tumor, or localized benign mesothelioma of pleura, a rare neoplasm that appears as a pedunculated mass. No relationship to environmental pathogens
34 year old man suddenly develops dyspnea with wheezing and is taken to the ER. 37C, pulse 95, resp 15, BP 130. CXR increased lucency in all lung fields. Sputum shows Curschmann spirals, Charcot-Leyden crystals, and acute inflammatory cells (eosinophils) in a background of abundant mucus. Diagnosis?
Bronchial asthma. Asthma, particularly extrinsic (atopic) asthma, is driven by a type 1 hypersensitivity response. Charcot-Leyden crystals represent the breakdown products of eosinophil granules. Curschmann spirals represent the whorls of sloughed surface epithelium in the mucin.
50 year old man with gradually increasing dyspnea and 4kg weight loss over 2 years. Smoker. Barrel chest. Decreased lung sounds. CXR bilateral hyperlucent lungs; lucency is especially marked in the upper lobes. FEV1 decreased, FVC normal, FEV1/FVC decreased. Diagnosis
Release of elastase from neutrophils, resulting in emphysema with a centrilobular pattern of predominantly upper lobe involvment. Inflammation that can accompany smoking leads to increased neutrophil elaboration of elastase, as well as elaboration of macrophage elastase that is not inhibited by the antiprotease action of alpha1-antitrypsin. Alpha1-antitrypsin deficiency is uncommonon and leads to panlobular pattern of emphysema
10 year old girl developed a 10mm area of induration on the left forearm 3 days after a PPD test. She appears healthy. What will be seen on a CXR
No abnormal findings. Most mycobacterium tuberculosis infections are asymptomatic and subclinical. Active disease is uncommon, although a preceding illness or poor living conditions increase the risk. Abnormal findings are more likely in adults, primary tuberculosis, miliary tuberculosis, or mycobacterial disease
63 year old man worked for 20 years in sandblasting, no respiratory precautions. 7 years increasing dyspnea without fever, cough, or chest pain. What inflammatory cell is most crucial to the development of his underlying disease
Macrophages. Small silica crystals are inhaled, and their buoyancy allows them to be carried to the alveoli. They are ingested by macrophages which then secrete cytokines that recruit other inflammatory cells and promote fibrogenesis
Granulocyte macrophage colony stimulating factor. The patient has the acquired form of pulmonary alveolar proteinosis (PAP). PAP has impaired surfactant clearance by alveolar macrophages
33 year old woman with increasing dyspnea and cough for 10 days. Over past two days, her cough has become productive of chunks of gelatinous sputum. Afebrile. Extensive dullness to percussion over all lung fields. CXR diffuse opacification bilaterally. Electron micro shows many lamellar bodies. Antibody against what is causing this?
What will be seen in CXR after reinfection or reactivation of tuberculosis infections in adults
Calcifications and cavitation
Lymphadenopathy or subpleural granuloma formation is more frequent in what type of TB infection
Primary TB infections
A diffuse reticulonodular pattern suggests what type of TB
Miliary TB
What does alpha1-antitrypsin deficiency lead to
Panlobular emphysema
What does CFTR gene mutation lead to
Cystic fibrosis and widespread bronchiectasis
When are Anti-DNA topoisomerase I antibodies seen
Diffuse scleroderma, which produces interstitial fibrosis
When is anti-glomerular basement membrane antibody present
Goodpasture syndrome with extensive alveolar hemorrhage
Neutrophilic myeloperoxidase is a form of anti-neutrophil cytoplasmic autoantibody seen in what
Wegener granulomatosis
50 year old man develops truncal obesity, back pain, and easily bruisable skin over 5 months. Afebrile, BP 160/95. CXR ill defined 4cm mass involving the left hilum of the lung. Round cells that have the appearance of lymphocytes but are somewhat larger. Surgical treatment is unlikely to be curative. Told to stop smoking. Diagnosis
Small cell carcinoma. This patient has the features of Cushing syndrome, a paraneoplastic syndrome resulting from ectopic corticotropin production, most often from small cell carcinoma. Small cell carcinomas are aggressive tumors that tend to metastasize early, cure is uncommon
Adenocarcinomas and large cell carcinomas tend to be where on the lungs
They tend to be peripheral neoplasms in the lung. They do not usually cause paraneoplastic syndromes
What size are Bronchial carcinoids typically
Small. They are not likely to produce paraneoplastic effects, but rarely they produce carcinoid syndrome
What abnormal lab value are squamous cell carcinomas likely to produce
After hemicolectomy to remove a colon carcinoma, a 53 year old man develops respiratory distress. Intubated and receives 100% O2. Three days later, arterial oxygen saturation decreases. CXR shows increasing opacification in all lung fields. Hyaline membranes lining distended alveolar ducts and sacs. What is causing this?
Leukocyte-mediated injury to alveolar capillary endothelium. The patient has ARDS, characterized by diffuse alveolar damage, which is initiated in most cases by injury to capillary endothelium by neutrophils and macrophages. Leukocytes aggregate in alveolar capillaries and release toxic oxygen metabolites, cytokines, and eicosanoids. The damage to the capillary endothelium allows leakage of protein-rich fluids. Eventually, the overlying alveolar epithelium is also damaged
What does reduced surfactant production in newborns cause
Respiratory distress syndrome with hyaline membrane disease
What does aspiration of bacteria cause
Release of fibrogenic cytokines in the lungs is an important cause of what
Chronic diffuse pulmonary fibrosis
Previously healthy 29 year old man experiences acute onset of hemoptysis. 37C, pulse 83, resp 23, BP 150/95. CXR bilateral fluffy infiltrates. Biopsy shows focal necrosis of alveolar walls associated with prominent intra-alveolar hemorrhage. Two days later oliguria. Creatinine 2.9 urea nitro 31. What is causing this
Anti-glomerular basement membrane antibody. The patient has Goodpasture syndrome. Renal and pulmonayr lesions are produced by an antibody directed against an antigen common to the basement membrane in glomeruli and alveoli. Leads to typeII hypersensitivity reaction.
C-ANCA and P-ANCA are best known as markers for various forms of what
Systemic vasculitis
Anti-DNA topoisomerase I antibody is a marker for what
Antimitochondrial antibody is associated with what
Primary biliary cirrhosis
ANA is used as a general screen test for what
A variety of autoimmune conditions, typically collage vascular diseases such as SLE
49 year old man has increasing dyspnea for 4 years. Occasional cough with minimal sputum production. Lungs hyperresonant with expiratory wheezes. Increased TLC with slightly increased FVC, decreased FEV1 and decreased FEV1/FVC. Arterial blood gas ph7.35, PO2 65, PCO2 45. Diagnosis
Centrilobular emphysema. These findings point to an obstructive lung disease, such as emphysema, that occurs from airway narrowing or from loss of elastic recoil.
Diffuse alveolar damage is what type of lung disease
Acute restrictive lung disease
Sarcoidosis is what form of lung disease
Chronic restrictive lung disease
Pneumoconioses produce what pattern of lung disease
Restrictive pattern with all lung volumes decreased, low FVC and normal FEV1/FVC ratio
70 year old woman has difficulty with right eye and pain in right upper chest. Findings include enophthalmos, meiosis, anhibrosis, and ptosis. CXR right upper lobe opacification and bony destruction of the right first rib. What is causing this
Bronchogenic carcinoma. This patient has Horner syndrome as a result of cervical sympathetic ganglion involvement by invasive carcinoma. Such a tumor in this location with these associated findings is called a Pancoast tumor
Previously healthy 20 year old woman has low grade fever for two weeks. What is seen in the picture
These findings represent the so-called Ghon (or primary) complex seen in tuberculosis, consisting of a small subpleural granuloma with extensive hilar nodal caseating granulomas. The Ghon complex is a feature of primary tuberculosis which is most often a subclinical disease of younger persons
What is anticentromeric antibody characteristic of
Limited scleroderma, which does not have significant pulmonary involvement, unlike diffuse scleroderma
60 year old farmer has 15 year history of increasing dyspnea. 37.6C. CXR bilateral increase in linear markings. Reduced FVC with normal FEV1. Interstitial infiltrates of lymphocytes and plasma cells, minimal interstitial fibrosis, and small granulomas. Diagnosis
The patient has "farmer's lung," a form of hypersensitivity pneumonitis caused by inhalation of actinomycete spores. Spores contain antigen that incites the hypersensitivity reaction. Because type III (early) and type IV immune hypersensitivity reactions are involved, granuloma formation can occur. Disease abates when antigen is gone, but chronic exposure can lead to more extensive interstitial lung disease.
A local epidemic occurs among children at summer camp, and they all develop upper respiratory tract infections manifested by coryze, pharyngitis, and tracheobronchitis. Fever and malaise, but minimal sputum. Total leukocytes not elevated. Mycoplasma pneumoniae is cultured. What histologic pattern will be found in the lungs
Interstitial mononuclear cell infiltrates. Primary atypical pneumonia may result from a variety of infectious agents, including viruses, chlamydiae, and rickettsiae, although mycoplasmal infections are most common in children and young adults
Neutrophilic exudates are typical of what type of pneumonia
Bacterial pneumonias
6 year old aspirates a peanut. Next day slight dyspnea. 36.8C, pulse 70, resp 17, BP 90/60. Decreased breath sounds and increased tympany over the right lower lung posteriorly. Chest CT shows hemicircular area of density. Hgb 13.6, WBC 6175. What complication has developed
Resporption atelectasis. Complete obstruction of a bronchus can result in resorption of air and localized atelectasis
49 year old with sudden lower ab pain with hematuria. Passes ureteral calculus, composed of calcium oxalate. Serum calcium 10.2, ser phos 2.9, ser alb 4.6. CXR 7cm hilar mass in the right lung. CT shows prominent central necrosis. What type of neoplasm is this
Squamous cell carcinoma. Most paraneoplastic syndromex involving lung carcinomas are associated with small cell anaplastic (oat cell) carcinomas, but hypercalcemia is an exception. Most commonly, it is caused by squamous cell carcinoma
What type of lung cancers are strongly associated with smoking
Small cell anaplastic (oat cell) carcinoma of the lung
What do fluffy infiltrates on CXR suggest
Infectious process
What type of TB infection does upper lobe cavitation on CXR suggest
Secondary TB
Diaphragmatic pleural plaques can be a feature of what
Pneumoconioses, particularly asbestosis
What is a subpleural nodule with hilar adenopathy
The classic Ghon complex of primary tuberculosis
What does an air-fluid level in the lungs suggest
Liquefaction with an abscess
64 year old smoker with cough and weight loss for three months. Clubbing of the fingers. Afebrile. CXR no hilar adenopathy, but cavitation within a 3cm lesion near the right hilum. Calc 12.3, phos 2.4, alb 3.9. Lesion almost occluding the right main stem bronchus. Surgical procedure will be attempted. What neoplasm does the patient have
Squamous cell carcinoma, which is most likely to produce hypercalcemia, and has a strong association with smoking. Can undergo central necrosis, hence a cavity may form. Can be cured by surgery.
3 year old boy with pneumonia caused by respiratory syncytial virus. How will the CXR appear
Interstial infiltrates
Viral, chlamydial, and mycoplasmal pneumonias appear as what on CXR
Interstial infiltrates. Neutrophilic alveolar exudates will be absent
Bacterial pneumonia will show what on CXR
Lobar consolidation, such as seen in Streptococcus pneumoniae infection
Secondary TB will show what on CXR
35 year old man has wheezing and coughing during the winter after minor respiratory tract infections. No history of asthma or allergies. Everything looks normal. What is causing the problem
Bronchial hyperreactivity to virus-induced inflammation. This history is typical of nonatopic, or intrinsic, asthma. The fundamental abnormality in such cases is bronchial hyperresponsiveness. When airway inflammation occurs after viral infections, the bronchial muscles spasm, and an asthmatic attack occurs. This can also be triggered by inhalation of air pollutants such as ozone, sulfur dioxide, and nitrogen dioxide
78 year old man with dyspnea without cough or increased sputum for 4 months. Afebrile. Breath sounds reduced in all fields. Chest CT shows dense, bright, right pleural mass encasing most of the left lung. Spindle and cuboidal cells that invade adipose tissue are present. What caused this
Inhalation of Asbestos. The patient has a malignant mesothelioma. This is a rare tumor even in persons with a history of asbestos exposure. The tumor appears decades after exposure. Bronchogenic carcinoma is more common in persons with asbestos exposure, particularly when there is a history of smoking
How is silicosis typified
Interstitial fibrosis. It causes a slight increase in the risk of bronchogenic carcinoma
Two groups with chronic lung disease. Group 1 normal FEV1, decreased FVC, normal PCO2. Group 2 FEV1 decreased more than FVC, and the FEV1/FVC ratio is 65%, and PCO2 is increased. What morphologic change will be seen in both groups?
Marked medial thickening of pulmonary arterioles. Changes associated with pulmonary hypertension are characteristic of both restrictive and obstructive lung diseases. This explains cor pulmonale and right-sided congestive heart failure in person with COPDs (like emphysema) or pneumoconiosis.
Destruction of elastic lung tissue is seen in what
Fibrosis of alveolar walls occurs in what
Restrictive lung diseases
Diffuse alveolar damage (acute respiratory distress syndrome), will have what type of alveolar membranes
Hyaline membranes
35 year old woman has multiple bouts of severe necrotizing pneumonia with various microbes. Now suffers for weeks at a time with a cough productive of large amounts of purulent sputum. Dullness to percussion with decreased breath sounds over the right mid to lower lung fields. CXR right lower lobe consolidation. Bronchogram shows marked dilation of RL lobe bronchi. What is the most likely cause of airspace dilation in this patient
Destruction of bronchial walls by recurrent inflammation. This patient has a typical history of bronchiectasis. In this condition, irreversible dilation of bronchi results from inflammation and destruction of bronchial walls after prolonged infections or obstruction. Serious bouts of pneumonia can predispose to bronchiectasis.
56 year old man has heart surgery. Two days later experiences increasing respiratory difficulty with decreasing arterial oxygen saturation. Afebrile, vitals normal, Hgb normal. After he coughs up a large amount of mucoid sputum, his condition improves. What can explain this?
Resorption atelectasis, which is most often the result of a mucous or mucopurulent plug obstructing a bronchus. It can occur postoperatively, or it may complicate bronchial asthma
24 year old man has had increasing dyspnea for the past 10 weeks. Afebrile. Dullness to percussion over the lungs posteriorly and decreased breath sounds. CXR large bilateral pleural effusions and widening of the mediastinum. Thoracentesis yields 500 ml milky-white fluid. High protein content, many lymphocytes and fat globules. Diagnosis?
Non-Hodgkin lymphoma. The pleural fluid findings are typical of chylothorax, which is uncommon but distinctive. High-grade non-Hodgkin lymphomas can disrupt the thoracic duct.
42 year old woman suffers from chronic sinusitis for several months. Now has malaise and mild fever that persisted for 3 weeks. A few crackles are heard over the lungs. 37.9C, urea nitro 35, creatinine 4.3, ALT 167, AST 154, tbili 1.1, C-ANCA 1:256. Necrotizing capillaritis with mild intra-alveolar hemorrhage. Granuloma is seen within the wall of a necrotic small artery. Diagnosis?
Wegener granulomatosis. Vasculitis is a key feature of Wegener granulomatosis. Although multiple organs can be affected, the lung and kidney are most often involved. C-ANCA is positive--P-ANCA suggests microscopic polyangiitis.
For the past 6 years a 45 year old woman has had increasing respiratory difficulties. Afebrile and normotensive. Lungs hyperresonant. CXR shows flattening of the diaphragmatic leaves. PiZZ phenotype of alpha1-antitrypsin deficiency. What is present in the lungs
Panacinar emphysema. Lack of antielastase activity of alpha1-antitrypsin promotes damage to the pulmonary elastic tissue, resulting in loss of structures throughout lung acini and causing panacinar emphysema. Irreversible dilation of respiratory bronchioles to terminal alveoli. Pronounced in the lower lobes of the lung, where greater perfusion occurs.
45 year old man with 3 month weight loss after losing his job. Developed low-grade fever and cough with mucoid sputum production, and after 1 week, he noticed blood-streaked sputum. 37.7C. Bilateral crackles in the upper lobe. CXR bilateral upper lobe consolidations and focal cavitations. What microorganism is causing this
Upper lobe cavitation suggests reactivation or reinfection of Mycobacterium tuberculosis infection in adults. Acid-fast staining should be done.
In a person with emphysema, what structure in the lung will most likely be affected
The respiratory bronchioles
40 year old man has increasing cough with hemoptysis for 2 weeks. 38.2C. CXR consolidation in the right upper lobe. Condition improves with antibiotics, but cough and hemoptysis persist for 2 more weeks. Chest CT shows right upper lung atelectasis. Exam shows obstructive mass filling the bronchus of the RU lobe. What neoplasm is this
Carcinoid tumor. Most pulmonary carcinoids are central obstructing masses involving a bronchus. These neuroendocrine tumors have somewhat unpredictable behavior, but many are resectable and follow a benign course. They typically manifest with hemoptysis and the consequenes of bronchial obstruction. In this case, pneumonia in the RU lobe probably resulted from obstruction to drainage caused by the tumor.
Where are hamartomas typically located in the lung
Where are adenocarcinomas typically located in the lungs
12 year old with atopic asthma. What will the lung look like histologically
Thickening of bronchial epithelial basement membrane and hypertrophy of bronchial smooth muscle. Atopic asthma is a type I hypersensitivity reaction in which there are presensitized, IgE-coated mast cells in mucosal surfaces and submucosa of airways. Contact with an allergen results in degranulation of the mast cells, with release of mediators, such as leukotrienes, histamine, and prostaglandins, that attract leukocytes, particularly eosinophils, and promote bronchoconstriction. The characteristic histologic changes in the bronchi result from inflammation
Dilation of the respiratory bronchiole is a feature of what
Centrilobular emphysema
Bronchial dilation with inflammatory destruction is a feature of what
Hyaline membranes in the lungs are seen with what
Acute diffuse alveolar damage.
When are neutrophilic exudates with consolidation in the lung seen
Pneumonic processes, typically from bacterial infections
40 year old man with 6 year history of increasing shortness of breath and weakness. Afebrile and normotensive. CXR diffuse interstitial markings. Diminished FVC, decreased diffusing capacity, and normal FEV1/FVC ratio. What pathologic change will be found in the lung
Honeycomb lung with widespread alveolar septal fibrosis and hyperplasia of type II pneumocytes. The spirometric data suggest a restrictive lung disease process. The progressive pulmonary interstitial fibrosis of a restrictive lung disease such as pneumoconiosis can eventually lead to dilation of remaining airspaces, giving a honeycomb appearance
In hospitalized patients, a subset is found who have abnormal ultrasound results suggestive of thrombosis, blood gas parameters with a lower PO2, and pulmonary perfusion defects. What will likely be observed in the majority of these patients?
No symptoms. Most pulmonary emboli are small and clinically silent
55 year old man with increasing respiratory difficulty for the past 18 months. Can no longer pass yearly physical as an airline pilot. No remarkable findings on PE. FEV1 normal, FVC diminished. CXR diffuse interstitial disease but no masses and no hilar adenopathy. ANA and anti-DNA topoisomerase I antibody are negative. Diagnosis?
Idiopathic pulmonary fibrosis. This patient has chronic restrictive lung disease. The cause of many slowly progressive cases of restrictive lung disease is unknown. Cases must be distinguished from identifiable causes such as infection, collagen vascular disease, drug use, and pneumoconioses
54 year old woman has mild fever with cough for a week. Symptoms gradually improve for the next ten days. Then has increasing fever, cough, shortness of breath, and malaise. 37.9C Inspiratory crackles. CXR bilateral patchy small alveolar opacities. CT small, scattered, ground-glass and nodular opacities. Polypoid plugs of loose fibrous tissue and granulation tissue filling bronchioles, along with a surrounding interstitial infiltrate of mononuclear cells. Receives corticosteroids and improves. Diagnosis?
Bronchiolitis obliterans with organizing pneumonia (Cryptogenic organizing pneumonia). This is an uncommon, nonspecific reaction to a lung injury such as infection or toxic exposure
What is Desquamative interstitial pneumonitis (DIP)
An uncommon smoking-related interstitial disease in which monocytes gather together to form intra-alveolar macrophages. DIP is not related to idiopathic pulmonary fibrosis
What is diffuse alveolar damage
An acute condition complicating an underlying lung injury; there is damage to alveolar capillary walls, followed by exudate with hyaline membrane formation
57 year old woman with cough and pleuritic chest pain for the past three weeks. Afebrile. Crackles audible over the left lower lung. CXR ill-defined area of opacification in the left upper lobe. Antibiotics don't help. What does this patient most likely have
Bronchioloalveolar carcinoma. This is a peripheral tumor that can mimic pneumonia. Most are well differentiated.
What are some characteristics of large cell carcinoma
Peripheral in the lungs. Cells are large and pleomorphic and form sheets
Mesotheliomas almost always occur in what setting
Prior asbestos exposure. They are large pleural masses
What are some characteristics of squamous cell carcinomas of the lungs
Can occasionally be peripheral, but most are central. Composed of pink, polygonal cells that have intercellular bridges. If well differentiated, squamous cell carcinomas show keratin pearls
65 year old man exposed to asbestos. At autopsy, a firm, tan mass encased the left lung. Many ferruginous bodies were identified on microscopic exam. What would be seen on CXR
Diaphragmatic pleural calcified plaques. The inhaled asbestos fibers become encrusted with iron and appear as the characteristic ferruginous bodies with iron stain. The firm, tan mass encasing the pleura is most likely a malignant mesothelioma. Asbestosis more commonly gives rise to pleural fibrosis and interstitial lung disease, like other pneumoconioses. It can also give rise to bronchogenic carcinoma, especially in smokers
What should be suspected when an endobronchial mass is found
Carcinoid tumor
37 year old woman with nonproductive cough for 4 months. Non smoker, lost weight. Afebrile. CXR right peripheral subpleural mass. Symptom free after lobectomy. Diagnosis
Adenocarcinoma. The most common primary lung malignancy in women and in nonsmokers is adenocarcinoma. Primary adenocarcinomas in the lung tend to be small, peripheral masses that are amenable to surgical excision and have a better overall prognosis than other forms of lung cancer
How do Haratomas present in the lungs
They are small, peripheral masses that contain benign epithelial and connective tissue elements.
What is the most likely mechanism for sudden death in a patient with a saddle pulmonary thromboembolism
Acute right-sided heart failure. Sudden death occurs from hypoxemia or from acute cor pulmonale with right-sided heart failure
61 year old woman with increasing dyspnea and nonproductive cough for 5 months. 37.7C. CXR prominent hilar lymphadenopathy with reticulonodular infiltrates bilaterally. Interstitial fibrosis and small, noncaseating granulomas. One granuloma contains an asteroid body in a giant cell. Previous smoker. What is causing her illness
Delayed hypersensitivity response to an unknown antigen. The clinical and morphologic features strongly suggest sarcoidosis. This granulomatous disease has an unknown cause, but the presence of granulomas and activated T cells in the lungs indicates a delayed hypersensitivity response to some inhaled antigen. Lung involvement may be asymptomatic or may lead to restrictive lung disease
What type of granulomas do Atypical mycobacteria, such as mycobacterium tuberculosis, cause
Caseating granulomas
62 year old smoker with 10 year cough productive of copious mucopurulent sputum. Over 6 months develops dyspnea. Bilateral pedal edema and a soft but enlarged liver. CXR bilateral pleural effusions and a prominent heart border on the right side. PO2 60, PCO2 55, pH 7.31, HCO3 28. What microscopic finding will be characteristic of his underlying pulmonary disease
Hypertrophy of bronchial submucosal glands. The patient had chronic bronchitis complicated by pulmonary hypertension and cor pulmonale. There are few characteristic microscopic features of chronic bronchitis, so it is mainly defined clinically by the presence of a persistent cough with sputum production for at least 3 months in at least 2 consecutive years.
25 year old woman has progressive dyspnea and fatigue for the past 2 years. Pedal edema, jugular venous distension, hepatomegaly. Lung fields clear. Right heart enlargement. Pulmonary arterial pressure increased, without gradients across the pulmonic valve, and no shunts are noted. Plexiform lesions of peripheral pulmonary arteries, with striking smooth muscle hypertrophy causing marked luminal narrowing. A mutation in a gene encoding for what will cause her pulmonary disease
Bone morphogenic receptor 2 (BMPR2), a cell-surface protein belonging to the TGF-Beta receptor superfamily. It causes inhibition of vascular smooth muscle cell proliferation and favors apoptosis. In the absence of BMPR2 signaling, smooth muscle proliferation occurs and pulmonary hypertension ensues. This can lead to primary pulmonary hypertension
A drug is being designed to treat the recurent bronchospasms characteristic of bronchial asthma. An antagonist of what mediators is most likely to be effective in the early, acute phase of bronchial asthma
Leukotrienes C4, D4 and E4. The early, acute phase of bronchial asthma is triggered by release of chemical mediators, whereas the late phase is mediated by recruited inflammatory cells and the cytokines they release. Leukotrienes C4, D4, and E4 promote intense bronchoconstriction and mucin production. Montelukast binds to CysLT receptors on mast cells and eosinophils to block the lipoxygenase pathway of arachidonic acid metabolism, which generates the leukotrienes
59 year old woman with SOB worsening over 2 months. Afebrile. Diffuse rales, dullness to percussion up to the mid-lung fields. CXR bilateral pleural effusions, greater on the right than the left. Thoracentesis 700ml fluid from right side. Clear and slightly yellow tinged. WBC 1, RBC 12. What has probably caused these findings
Congestive heart failure. The cell count and appearance indicate a transudate
40 year woman with no smoking exposure. CXR 3cm sharply demarcated mass in the left upper lobe of the lung. Too hard to obtain fine needle aspirate. Mass has a firm, glistening, bluish white cut surface. No culture growth. What is the mass
A hamartoma. These are uncommon benign peripheral lesions of the lung. They are composed of benign-appearing epithelial cells and connective tissue, typically with a large component of cartilage. They are induced in the differential diagnosis of a "coin lesion" that also includes carcinoma and granuloma.
25 year old in a new apartment experiences acute onset of fever, cough, dyspnea, headache, and malaise. Subsidex when he leaves. CXR normal. What produced these symptoms
Antigen-antibody complex formation. The patient has hypersensitivity pneumonitis, with acute symptoms that occur soon after exposure to an antigen, often actinomycetes or fungi (molds). Sometimes called farmer's lung. Mainly a type III hypersensitivity reaction, but with more chronic exposure to the antigen, there may be a component of type IV hypersensitivity with granulomatous inflammation
63 year old man with worsening dyspnea with a nonproductive cough for the past 9 months. Afebrile and normotensive Diffuse dry crackles are heard in all lung fields. CXR irregular opacifications throughout both lungs. Negative ANA, anti-DNA-topoisomerase I, ANCA, anticentromere antibody. Dies despite glucocorticoid therapy. Diagnosis
Idiopathic pulmonary fibrosis, which leads to progressive restrictive lung disease. The antigen that incites the inflammatory process with activated macrophage release of cytokines such as fibroblast growth factor is unknown