Pulmonary - Part 1

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  • 1/20 Questions

    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 in all lung fields. Which of the following laboratory findings is she most likely to have?

    • Decreased serum ceruloplasmin
    • Increased sweat chloride
    • Elevated blood ethanol
    • Decreased serum alpha-1-antitrypsin
    • Positive urine opiates
    • Positive antinuclear antibody test
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Pulmonary - Part 1 - Quiz
About This Quiz

This Pulmonary - Part 1 quiz assesses knowledge in identifying and managing various pulmonary conditions such as bronchiectasis, pneumonia, tuberculosis, thromboembolism, sarcoidosis, and alpha-1-antitrypsin deficiency. It is designed for medical students and professionals to enhance their diagnostic and clinical skills.

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  • 2. 

    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?

    • Squamous cell carcinoma

    • Lung abscess

    • Chronic bronchitis

    • Bronchiectasis

    • Bronchopulmonary sequestration

    Correct Answer
    A. Lung abscess
    Explanation
    (B) CORRECT. A Lung abscesses can result from aspiration of oropharyngeal or nasopharyageal contents, where bacterial organisms as part of normal flora can be picked up and transported to the lungs. The straighter bronchus to the right lung is more likely to conduct aspirated material. With septicemia, multiple abscesses are more likely to be present.
    (D) Incorrect. Bronchiectasis can occur from chronic bronchial inflammation and destruction following obstruction and/or infection; cystic fibrosis is the best known disease to produce a widespread pattern of bronchiectasis. With obstruction, it depends upon the cause for the obstruction where the focus of bronchiectasis will be.
    (E) Incorrect. Sequestrations are masses of lung tissue without a normal connection to the airways. They act as space occupying lesions and can cause obstruction.

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  • 3. 

    A 9-year-old boy was identified in childhood as having an elevated sweat chloride. Though he appeared to be a normal term baby, his neontal course was complicated by the development of meconium ileus. Throughout childhood he has experienced multiple increasingly severe bouts of pneumonia with a productive cough, often with Pseudomonas aeruginosa, and later Burkholderia cepacea, cultured from sputum. Based upon these findings, he is at greatest risk for development of which of the following pulmonary abnormalities?

    • Adenocarcinoma

    • Bronchiectasis

    • Lymphangiectasis

    • Pleural fibrous plaques

    • Pneumocystis carinii (jiroveci) pneumonia

    • Pneumothorax

    Correct Answer
    A. Bronchiectasis
    Explanation
    (B) CORRECT. The chronic lung disease of cystic fibrosis often includes bronchiectasis, a disease characterized by inflammation with obstruction and dilation and destruction of bronchi. This process is diffuse throughout the lungs. The loss of pulmonary vascular bed with progressive bronchiectasis can lead to pulmonary hypertension and cor pulmonale.
    (A) Incorrect. The incidence of lung cancer is not increased with cystic fibrosis.
    (C) Incorrect. Dilation of lymphatics is an infrequent occurrence with mediastinal masses such as lymphomas.
    (D) Incorrect. Pleural plaques are most frequently seen with pneumoconioses.
    (E) Incorrect. Patients with cystic fibrosis usually have lung infections with bacteria such
    as Pseudomonas.
    (F) Incorrect. Pneumonias with cystic fibrosis are unlikely to produce pneumothorax. No bullae form.

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  • 4. 

    On the 11th postoperative day following a radical prostatectomy for adenocarcinoma of the prostate, a 70-year-old man is recovering uneventfully. He then ambulates to the bathroom, but upon returning to his bed he suddenly becomes extremely dyspneic and diaphoretic, with chest pain, palpitations, and a feeling of panic. Which of the following post-operative complications has he most likely developed?

    • Pulmonary edema

    • Pleural effusion

    • Atelectasis

    • Thromboembolus

    • Diffuse alveolar damage

    Correct Answer
    A. Thromboembolus
    Explanation
    (D) CORRECT. The activity of ambulation resulted in sudden movement of a thrombus that formed during his period of immobilization in the leg or pelvic veins. The thrombus became an embolus and traveled to the lungs.
    (B) Incorrect. An effusion would take days to weeks to form. There could be dyspnea.
    (C) Incorrect. Post-operative changes should have resolved after a week or so and would have a course of gradual improvement.

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  • 5. 

    A 50-year-old woman has lived in Oslo, Norway all her life and worked as a seamstress. She is a non-smoker, but she has had increasing shortness of breath, fever, weight loss, and night sweats for the past 4 months. On physical examination her temperature is 37.6 C. There are fine rales auscultated in all lung fields. A chest radiograph reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. She demonstrates anergy by skin testing to mumps and Candida antigens. A transbronchial biopsy is performed that microscopically shows numerous small pulmonary interstitial non-caseating granulomas. Which of the following is the most likely diagnosis?

    • Histoplasmosis

    • Adenocarcinoma

    • Sarcoidosis

    • Usual interstitial pneumonitis

    • Berylliosis

    • Tuberculosis

    • Extrinsic allergic alveolitis

    Correct Answer
    A. Sarcoidosis
    Explanation
    (C) CORRECT. Sarcoidosis is typified by non-caseating granulomas. However, culture of the tissue and a careful search histologically should be made for organisms.
    (A) Incorrect. Histoplasmosis is most common in the Mississippi and Ohio river valleys in the US. The dimorphic fungi tend to mimic tuberculosis and can have granulomas with central caseation.
    (B) Incorrect. Adenocarcinoma should yield malignant cells, not granulomas, on biopsy.
    (D) Incorrect. UIP is the end result of a diffuse fibrosing alveolitis. Many cases are idiopathic. The end stage is a honeycomb lung. No granulomas are seen.
    (E) Incorrect. Though berylliosis can produce sarcoid-like granulomas, it is very uncommon. An environmental history would be helpful.

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  • 6. 

    A 70-year-old woman has been at an extended care facility for the past two years because of her increasing inability to attend to activities of daily living. She can no longer recognize family members. She has no movement disorder, but is lethargic and spends most of her days in a wheelchair or in bed. She develops an acute febrile illness and is noted to be coughing up increasing quantities of yellowish sputum. Her temperature is 38.2 C. A chest radiograph shows infiltrates that nearly fill the left lower lobe. Her family elects not to treat her acute illness, and she dies 4 days later. At autopsy, there is extensive consolidation of the left lower lobe, with numerous neutrophils within alveoli. Which of the following infectious agents is most likely to cause her pulmonary disease?

    • Pneumocystis carinii (jiroveci)

    • Listeria monocytogenes

    • Cryptococcus neoformans

    • Mycobacterium tuberculosis

    • Legionella pneumophila

    • Staphylococcus aureus

    • Streptococcus pneumoniae

    • Influenza A virus

    Correct Answer
    A. Streptococcus pneumoniae
    Explanation
    (G) CORRECT. She has a lobar pneumonia, which is most often a community aquired pneumonia (the nursing home counts as a community venue), following a debilitating course of Alzheimer disease. The most common organism is Streptococcus pneumoniae (pneumococcus).
    (B) Incorrect. Listeriosis is infrequent. Some cases occur in immune compromised persons. It can be a congenital infection.
    (F) Incorrect. S. aureus is more likely to be a nosocomial infection and more likely to produce a bronchopneumonia with patchy infiltrates.

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  • 7. 

    A 58-year-old man has been a smoker for 40 years. He has had an 8 kg weight loss over the past 6 months accompanied by a chronic cough and malaise. He reports no fever, nausea, or vomiting. He had a recent episode of hemoptysis. A chest radiograph reveals a 5 cm diameter mass in the medial left upper lobe. Bronchoscopy reveals a mass lesion involving the left superior segmental bronchus. Which of the following cytologic findings is most likely to be present in this man?

    • Cysts staining with GMS in a bronchoalveolar lavage fluid

    • Pleural fluid with atypical mesothelial cells

    • Epthelioid cells with necrotic debris in a fine needle aspirate

    • Malignant appearing squamous cells in sputum

    • Intranuclear inclusions in large epithelial cells in bronchoalveolar lavage fluid

    Correct Answer
    A. Malignant appearing squamous cells in sputum
    Explanation
    (D) CORRECT. The large central mass is consistent with a squamous cell carcinoma, which is seen mainly in smokers.
    (E) Incorrect. Cytomegalovirus infections occur in immunocompromised patients. No mass is present.
    (B) Incorrect. Mesothelioma is rare; it is characterized by a bulky pleural mass in a person with prior asbestos exposure.
    (C) Incorrect. Granulomatous inflammation is typical for mycobacterial and fungal infections; though a solitary granuloma may be present, it is usually not larger than 2 to 3 cm in size.

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  • 8. 

    A 66-year-old woman has had a worsening non-productive cough with malaise for the past week. Her temperature increases to 37.4 C. A chest radiograph reveals diffuse bilateral pulmonary interstitial infiltrates in all lung fields. A sputum gram stain reveals normal flora and few neutrophils. She recovers over the course of the next two weeks without sequelae. Infection with which of the following organisms most likely caused her illness?

    • Mycobacterium tuberculosis

    • Streptococcus pneumoniae

    • Influenza A virus

    • Cryptococcus neoformans

    • Mycobacterium avium-complex

    Correct Answer
    A. Influenza A virus
    Explanation
    (C) CORRECT. The typical appearance of a viral lung infection is chronic interstitial inflammation.
    (A) Incorrect. TB most often produces a granulomatous pattern of inflammation with reticulonodular densities, particularly in the upper lobes.
    (B) Incorrect. Pneumococcus leads to alveolar filling with neutrophils.
    (D) Incorrect. Cryptococcus leads to granulomatous disease.
    (E) Incorrect. MAI may produce poorly-formed granulomas.

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  • 9. 

    A 55-year-old man with a 55 pack year history of smoking cigarettes has recently experienced an episode of hemoptysis along with his usual cough. On physical examination there are no abnormal findings. He has a sputum cytology examination performed that on microscopic examination shows atypical cells with hyperchromatic nuclei and orange-pink cytoplasm. Labortory studies show a serum calcium of 11.3 mg/dL, with phosphorus 2.1 mg/dL. Which of the following chest radiographic findings is this man most likely to have?

    • Large hilar mass

    • Pneumonia-like consolidation

    • Peripheral nodule

    • Carinal compression

    • Left pleural thickening

    Correct Answer
    A. Large hilar mass
    Explanation
    (A) CORRECT. Both squamous cell and oat cell carcinomas tend to be central in location. Squamous cell carcinomas of the lung are associated with hypercalcemia, though overall the oat cell carcinomas are best known for paraneoplastic syndromes.
    (B) Incorrect. This is more typical of a bronchioloalveolar carcinoma.
    (C) Incorrect. Such a peripheral mass would more likely be a granuloma, an adenocarcinoma or a hamartoma.
    (D) Incorrect. The carina is an unusual site for a primary tumor.
    (E) Incorrect. The findings do not suggest a mesothelioma.

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  • 10. 

    A 58-year-old man has developed a non-productive cough worsening over the past 2 months. Last week he noted the appearance of blood-streaked sputum. On physical examination there are some expiratory wheezes auscultated over the left lung. A chest radiograph reveals a 5 cm mass near the left lung hilum. A sputum cytology reveals the presence of small clusters of very hyperchromatic, pleomorphic cells with scant cytoplasm. Which of the following is the most likely predisposing factor to development of his pulmonary disease?

    • Silicosis

    • Radon gas exposure

    • Smoking

    • Asbestosis

    • Passive smoking

    Correct Answer
    A. Smoking
    Explanation
    (C) CORRECT. Smoking remains the most frequent cause of lung cancer. Lung cancer does, however, occur in nonsmokers. A small cell anaplastic carcinoma, as in this patient, is virtually always seen in smokers.
    (A) Incorrect. Silicosis increases the risk for lung cancer slightly by about 2 fold.
    (B) Incorrect. Radon is probably the second leading cause of lung cancer. However, most cases of lung cancer in which exposure to radon gas has been identified also occur in smokers.
    (D) Incorrect. However, asbestos exposure increases the risk for lung cancer in smokers even more.
    (E) Incorrect. Passive smoking could probably be right behind radon exposure as the second leading cause for lung cancer.

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  • 11. 

    A 66-year-old man has had increasing dyspnea for the past year. He is a smoker. He is retired from the construction business. There are some rales auscultated in both lungs on physical examination. A chest radiograph reveals bilateral diaphragmatic pleural plaques with focal calcification as well as diffuse interstitial lung disease. A sputum cytology shows no atypical cells. Pulmonary function studies reveal a low FVC and a normal FEV1/FVC ratio. These findings are most likely to suggest prior exposure to which of the following environmental agents?

    • Cotton fibers

    • Silica dust

    • Fumes with iron particles

    • Asbestos crystals

    • Beryllium

    • Mold spores

    Correct Answer
    A. Asbestos crystals
    Explanation
    (D) CORRECT. These findings are classic for exposure to asbestos. Pleural plaques are more frequent in this condition than in other pneumonconioses, particularly with calcification. Asbestosis is a form of pneumoconiosis that can lead to restrictive lung disease. In smokers, there is an increased risk for development of bronchogenic carcinomas.
    (B) Incorrect. Silicosis more typically produces a pattern of silicotic nodules in lung. Inorganic dusts often produce interstitial fibrosis.

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  • 12. 

    Following a vehicular accident with blood loss leading to prolonged, severe hypotension, a 30-year-old man is intubated and placed on a mechanical ventilator. He has progressively decreasing oxygen saturations despite increasing PEEP and FI02 of 100%. He remains afebrile. He dies 3 days later. At autopsy, the distal lungs show pink hyaline membranes, thickened interstitium, and many macrophages but few neutrophils. Which of the following pulmonary diseases most likely complicated his course?

    • Bronchopneumonia

    • Chronic bronchitis

    • Bronchiectasis

    • Viral pneumonia

    • Diffuse alveolar damage

    Correct Answer
    A. Diffuse alveolar damage
    Explanation
    (E) CORRECT. Diffuse alveolar damage (or ARDS as it is known clinically) is the final event following lung injury from a variety of serious illnesses or accidents. In this case, it was probably initiated by the hypotension ('shock lung') and potentiated by the 100% oxygen.
    (A) Incorrect. A bacterial pneumonia, as a nosocomial infection, is likely to be accompanied by signs of sepsis.
    (B) Incorrect. Chronic bronchitis develops and continues over months to years, probably from environmental agents.
    (C) Incorrect. This is a process that takes at least weeks to months and is due to obstruction of airways in one or more parts of lung.
    (D) Incorrect. Viral pneumonias are not likely to be acquired in hospital. They are often complicated by bacterial pneumonia.

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  • 13. 

    A 9-year-old girl has complained of difficulty breathing for the past week. Her vital signs include T 37.9 C, P 80/minute, RR 25/minute, and BP 110/60 mm Hg. On physical examination, her lung fields are clear to auscultation. Her heart rate is regular and no murmurs or gallops are heard. A chest radiograph shows prominent hilar lymphadenopathy along with a 1 cm peripheral right lung nodule in the middle lobe. No infiltrates or masses are present. A sputum gram stain shows normal flora and routine bacterial culture reveals no pathogens. Which of the following conditions is she most likely to have?

    • Hypersensitivity pneumonitis

    • Mycobacterium tuberculosis infection

    • Bronchial carcinoid tumor

    • Infective endocarditis

    • Goodpasture syndrome

    Correct Answer
    A. Mycobacterium tuberculosis infection
    Explanation
    (B) CORRECT. This is a description of the typical 'Ghon complex' of an initial, or primary, TB infection. The peripheral granuloma does not produce symptoms, but the enlarged lymph nodes may impinge upon airways. Most persons with a primary infection, however, are asymptomatic and the infection goes unnoticed.
    (C) Incorrect. A carcinoid tumor could produce focal obstruction with a pneumonia, but pulmonary neoplasms in children are rare. Most bronchial carcinoids act in a benign fashion without metastases.

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  • 14. 

    A 51-year-old man complains of a slight cough he has had for a week. He is a non-smoker. On auscultation of the chest his lung fields are clear. A chest radiograph shows a subpleural "coin lesion" 2 cm in diameter in the right upper lobe. Which of the following is the most likely diagnosis?

    • Small cell anaplastic carcinoma

    • Granuloma

    • Bronchiectasis

    • Exogenous lipid pneumonia

    • Silicosis

    Correct Answer
    A. Granuloma
    Explanation
    (B) CORRECT. The differential diagnosis of a solitary coin lesion most often includes lung cancer (adenocarcinoma most likely), granuloma, or hamartoma.
    (A) Incorrect. An 'oat cell' carcinoma tends to spread very quickly and not remain localized. Moreover, it virtually always appears in persons with a history of smoking.
    (D) Incorrect. An exogenous lipid pneumonia from aspiration of a substance that is oily or contains much lipid is not typically localized.

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  • 15. 

    A 60-year-old man has a 90 pack year history of smoking. For the past 5 years, he has had a cough productive of copious amounts of mucoid sputum for months at a time. He has had episodes of pneumonia with Streptococcus pneumoniae and E. coli cultured. His last episode of pneumonia is complicated by septicemia and brain abscess and he dies. At autopsy, his bronchi microscopically demonstrate mucus gland hypertrophy. Which of the following conditions is most likely to explain his clinical course?

    • Squamous cell carcinoma

    • Congestive heart failure

    • Chronic bronchitis

    • Bronchial asthma

    • Centrilobular emphysema

    • Panlobular emphysema

    • Bronchiectasis

    Correct Answer
    A. Chronic bronchitis
    Explanation
    (C) CORRECT. Chronic bronchitis is defined clinically as a person who has persistent cough with sputum production for at least 3 months in at least 2 consecutive years. Air pollution and smoking are key causes for chronic bronchitis.
    (A) Incorrect. Though lung cancers are more common in persons who smoke, his findings are not explained by a mass lesion, and his symptoms have persisted for years.
    (B) Incorrect. Congestive heart failure will produce pulmonary edema, if it is primarily left heart failure. If severe, there can be 'rusty' colored sputum.
    (E) Incorrect. As a smoker, he is at risk for development of emphysema, but this does not explain his sputum production. Sometimes, smokers have elements of both emphysema and chronic bronchitis.
    (G) Incorrect. Bronchiectasis is not a typically complication of smoking.

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  • 16. 

    A 60-year-old man has had a cough without production of much sputum for the past week. On physical examination he is afebrile. There are decreased breath sounds at the right lung base. A chest x-ray reveals an area of consolidation in the right lower lobe. He is given antibiotic therapy, but a month later the radiographic picture has not changed, and his cough continues. A bronchoalveolar lavage is performed and yields atypical cells along with scattered alveolar macrophages. Which of the following is the most likely diagnosis?

    • Mycoplasma pneumonia

    • Bronchioloalveolar carcinoma

    • Sarcoidosis

    • Pulmonary infarction

    • Silicosis

    Correct Answer
    A. Bronchioloalveolar carcinoma
    Explanation
    (B) CORRECT. This tumor can spread in a pneumonia-like pattern. The lack of a change over time and the absence of a response to antibiotics should suggest a non-infectious process.
    (D) Incorrect. An infarct is unlikely to yield - ATYPICAL CELLS.
    (A) Incorrect. An atypical pneumonia with Mycoplasma is unlikely to be confined to just the right lower lobe, and it would not yield - ATYPICAL CELLS.

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  • 17. 

    A 25-year-old man receives a bone marrow transplant for treatment of acute myelogenous leukemia. He develops increasing dyspnea 3 weeks later, along with fever and cough. On physical examination his temperature is 37.8 C. A chest radiograph shows irregular interstitial infiltrates. A bronchoalveolar lavage is performed an on cytologic examination shows cells that are enlarged and have prominent intranuclear inclusions. He is most likely to have an infection with which of the following organisms?

    • Toxoplasma gondii

    • Candida albicans

    • Cytomegalovirus

    • Pneumocystis carinii (jirovecii)

    • Mycobacterium tuberculosis

    • Influenza B virus

    • Respiratory syncytial virus

    Correct Answer
    A. Cytomegalovirus
    Explanation
    C) CORRECT. CMV produces a cytopathic effect with enlarged cells having prominent intranuclear inclusions.
    (A) Incorrect. Toxo is not common in lung. Toxo cysts contain bradyzoites, which are about 2 microns in size. There may be surrounding free tachyzoites of the same size as bradyzoites.
    (B) Incorrect. Candida yields budding cells and pseudohyphae.
    (D) Incorrect. PCP yields foamy material that appears acellular with H&E and Pap stains.
    (E) Incorrect. TB produces a granulomatous reaction. There may be giant cells of the Langhans variety, but a BAL will probably not have much that is diagnostic without an AFB stain or culture.
    (F) Incorrect. Influenza virus infections are not characteristic for immunocompromised patients. No characteristic inclusions can be seen in specimens.
    (G) Incorrect. Respiratory syncytial virus infections are most common in young children and infants. They are not characteristic for immunocompromised patients. Inclusions are in the cytoplasm with this RNA virus.

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  • 18. 

    A 44-year-old man with a history of chronic alcohol abuse has lost 6 kg in the past five months. He has had a cough with hemoptysis along with pleuritic chest pain for the past 2 weeks. On physical examination his temperature is 37.5 C. A chest radiograph reveals a bilateral reticulonodular pattern of infiltrates. A transbronchial biopsy is performed and on microscopic examination shows epithelioid cells with necrotic debris. Laboratory studies show a WBC count of 5890/microliter with 78% granulocytes, 15% lymphocytes, and 7% monocytes. Which of the following additional histologic findings is most likely to be present on his biopsy?

    • Branching, septated hyphae

    • Pleomorphic cells with dark, angular nuclei

    • Clusters of small RBC-sized cysts staining with GMS

    • Small, rounded hyperchromatic cells with a high N/C ratio

    • Acid fast bacilli

    Correct Answer
    A. Acid fast bacilli
    Explanation
    (E) CORRECT. The hemoptysis suggests that the granulomas have eroded enough parenchyma and involved a bronchus. A granulomatous reaction is typical for Mycobacterium tuberculosis.
    (A) Incorrect. Aspergillus infection is not common. It is more likely to produce a fungus ball. Persons who are neutropenic are at greatest risk. The inflammatory reaction could vary from acute to mixed to granulomatous.
    (B) Incorrect. A squamous cell carcinoma is usually a central mass lesion. It is unlikely that epithelioid cells would appear on biopsy
    (C) Incorrect. PCP in rare cases has a granulomatous pattern, but the granulomas would be small and unlikely to lead to hemoptysis.
    (D) Incorrect. Small cell anaplastic carcinomas are centrally located. They are unlikely to be found with epithelioid cells.

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  • 19. 

    A 20-year-old man falls to the ground while jogging along a city street early one morning. He suffers a minor abrasion to his left hand. However, within minutes he is very dyspneic and has right-sided chest pain. He walks into a nearby store, and the manager calls for an ambulance. On arrival at the hospital, he has tachypnea and tachycardia. On physical examination breath sounds are absent over the right lung fields. A chest radiograph shows that the mediastinum is shifted to the left, and there are no fractures. A thoracentesis on the right yields a rush of air. Which of the following conditions is most likely to have given rise to these events?

    • Bronchopleural fistula

    • Paraseptal emphysema

    • Foreign body aspiration

    • Intrinsic asthma

    • Pulmonary atherosclerosis

    Correct Answer
    A. Paraseptal emphysema
    Explanation
    B) CORRECT. Paraseptal emphysema is not common, but does account for a significant number of cases of spontaneous pneumothorax in young persons. It is not related to smoking. There are subpleural bullae that can burst, even with minimal trauma.
    (A) Incorrect. A bronchopleural fistula typically occurs in the setting of a severe lung infection, not in a healthy person.
    (E) Incorrect. Both chronic restrictive and obstructive lung diseases can reduce the pulmonary vascular bed to increase pulmonary arterial pressures that promote pulmonary atherosclerosis. The vessels do not rupture.

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  • 20. 

    A 41-year-old man with a 6 kg weight loss over the past 3 months now has had worsening fever, non-productive cough, and dyspnea for the past 3 days. His temperature is 38.2 C and there are diffuse rales in both lungs on auscultation. A chest radiograph shows patchy infiltrates in both lungs. Laboratory studies show a WBC count of 3250/microliter with differential of 78 segs, 3 bands, 5 lymphs, 11 monos, 2 eosinophils, and 1 basophil, Hgb 13.8 g/dL, Hct 41.4%, MCV 91 fL, and platelet count 317,000/microliter. His CD4 lymphocyte count is 79/microliter. Cryptosporidium parvum organisms are found in a stool specimen. A bronchoalveolar lavage is performed, yielding fluid that microscopically demonstrates pink, foamy exudate with little inflammation. Which of the following additional findings on microscopic examination is he most likely to have in the BAL specimen?

    • Acid fast bacilli

    • Branching septate hyphae

    • Multiple cysts with GMS stain

    • Hemosiderin-laden macrophages

    • Short gram positive rods

    Correct Answer
    A. Multiple cysts with GMS stain
    Explanation
    (C) CORRECT. He is most likely to have Pneumocystis carinii (jirovecii) pneumonia in association with the acquired immunodeficiency syndrome. PCP has an exudate composed of the Pneumocystis cysts and trophozoites with little accompanying inflammation. The clinical findings in this case are typical as well.
    (B) Incorrect. Aspergillus often produces a fungus ball, or a defined mass, rather than infiltrates. It does not produce an acellular exudate.
    (D) Incorrect. Pulmonary hemorrhage in the setting of AIDS is not common. The clinical features suggest an acute infection.

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  • Mar 21, 2023
    Quiz Edited by
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  • Jul 26, 2012
    Quiz Created by
    Chachelly

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