Pulmonary Path Dr Bellot Part 2

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Pulmonary Quizzes & Trivia

Questions and Answers
  • 1. 

    The term "hypersensitivity pneumonitis" describes:

    • A.

      Pulmonary tuberculosis resulting from atypical mycobacteria

    • B.

      Immunologically mediated interstitial pneumonia related to occupational antigens

    • C.

      Bronchial asthma

    • D.

      A form of pneumonia exquisitely sensitive to treatment

    • E.

      A form of rapidly progressive peumonitis almost exclusively confined to AIDS patients

    Correct Answer
    B. Immunologically mediated interstitial pneumonia related to occupational antigens
    Explanation
    Hypersensitivity pneumonitis is a condition characterized by inflammation of the lung tissue due to an immune response triggered by exposure to certain occupational antigens. These antigens can include dust, mold, or chemicals present in the workplace. The immune response leads to interstitial pneumonia, which is inflammation of the tissue and spaces between the air sacs in the lungs. This condition is not related to pulmonary tuberculosis, bronchial asthma, or pneumonia exclusively seen in AIDS patients. It is also not described as being exquisitely sensitive to treatment, suggesting that it may require ongoing management and avoidance of the triggering antigens.

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  • 2. 

    One of the more impressive pathological differences between viral and bacterial pneumonias is  

    • A.

      The involvement of small vs large bronchi

    • B.

      Viral favors the right lobe, bacterial the left

    • C.

      Intra-alveolar versus interstitial inflammatory process

    • D.

      The severity of interstitial congestion

    • E.

      The extent of alveolar destruction

    Correct Answer
    C. Intra-alveolar versus interstitial inflammatory process
    Explanation
    The correct answer is the difference between viral and bacterial pneumonias lies in the type of inflammatory process that occurs. Viral pneumonia typically causes an interstitial inflammatory process, which means the inflammation primarily affects the spaces between the alveoli. On the other hand, bacterial pneumonia causes an intra-alveolar inflammatory process, where the inflammation occurs within the alveoli themselves. This distinction in the location of inflammation is one of the notable differences between viral and bacterial pneumonias.

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  • 3. 

    Following an episode of aspiration, a 60-year-old alcoholic developed severe respiratory distress. A lung biopsy is LIKELY to show

    • A.

      Hyaline membrane formation

    • B.

      Alveolar wall destruction

    • C.

      Extensive interstitial polymorphonuclear infiltrate

    • D.

      Replacement of alveolar lining cell by type 1 pneumonocytes

    • E.

      Interstitial hemorrhage

    Correct Answer
    A. Hyaline membrane formation
    Explanation
    Following an episode of aspiration, a 60-year-old alcoholic developing severe respiratory distress suggests the possibility of aspiration pneumonia. Hyaline membrane formation is a characteristic feature of acute respiratory distress syndrome (ARDS), which can occur as a complication of aspiration pneumonia. Hyaline membranes are formed by the accumulation of proteinaceous material and inflammatory cells in the alveoli, leading to impaired gas exchange and respiratory distress. Therefore, it is likely that a lung biopsy in this case would show hyaline membrane formation.

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  • 4. 

    A 16-year-old Dominican boy with a history of asthma presents to his family physician with a cough for the past two weeks that is not improving with simple over-the-counter medications. On examination the physician finds that there is an area of dullness over the right apex, and also hears coarse crackles. The physician suspects tuberculosis. What other physical sign is MOST LIKELY to be present?

    • A.

      Displacement of the trachea to the left

    • B.

      Absence of voice transmission over the right apex

    • C.

      Increased expansion on the right

    • D.

      Bronchial breathing over the right apex

    • E.

      In drawing of the lower ribs on inspiration

    Correct Answer
    D. Bronchial breathing over the right apex
    Explanation
    Bronchial breathing over the right apex is most likely to be present in this case because it indicates consolidation of lung tissue, which is a common finding in tuberculosis. The presence of bronchial breath sounds suggests that air is being conducted through a consolidated lung, rather than being diffusely distributed throughout the lung tissue. This finding, along with the area of dullness and coarse crackles, supports the suspicion of tuberculosis. The other options are less likely to be present in this case based on the given information.

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  • 5. 

    A 69-year-old man with a long history of smoking and recent weight loss is discovered to have a lung tumor that is confirmed by biopsy to be malignant. Routine blood investigation also reveals hypercalcemia. The lung lesion is LIKELY to be:

    • A.

      Large cell carcinoma

    • B.

      Alveolar cell carcinoma

    • C.

      Small cell ("Oat cell") carcinoma

    • D.

      Adenocarcinoma

    • E.

      Squamous cell carcinoma

    Correct Answer
    E. Squamous cell carcinoma
    Explanation
    Based on the information provided, the 69-year-old man with a long history of smoking and recent weight loss is at a higher risk for developing squamous cell carcinoma. Squamous cell carcinoma is strongly associated with smoking and is more common in older individuals. Additionally, hypercalcemia is often seen in squamous cell carcinoma due to the production of parathyroid hormone-related protein (PTHrP) by the tumor, which leads to increased calcium levels in the blood.

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  • 6. 

    Pulmonary infarcts do not occur frequently. One of the more reasonable explanations is that

    • A.

      The constant movement of the lungs prevents "lodgement" of the emboli in the pulmonary arterial system

    • B.

      The bronchial artery supply is an effective "back-up" of the pulmonary arterial system

    • C.

      Lung tissue is inherently resistant to ischemia

    • D.

      Pulmonary emboli only very rarely occur

    • E.

      A thromboembolus would need to be attached to the intimal surface of the artery to cause an infarct and this rarely occurs on the lung

    Correct Answer
    B. The bronchial artery supply is an effective "back-up" of the pulmonary arterial system
    Explanation
    The bronchial artery supply is an effective "back-up" of the pulmonary arterial system. This means that if there is a blockage in the pulmonary arteries, the bronchial arteries can provide an alternative blood supply to the lung tissue. This helps to prevent ischemia and infarction of the lung tissue, reducing the occurrence of pulmonary infarcts.

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  • 7. 

    A 73-year-old man has observed increasing shortness of breath, chest pain and marked loss of weight over the past, three months. He does not smoke but gives a history of having worked in a naval shipyard about 35 years ago at which time his duties included applying asbestos insulation to the ship's plumbing. At this point, his physician suspects

    • A.

      Hypersensitivity pneumonitis related to lead exposure

    • B.

      Bronchial asthma

    • C.

      Emphysema

    • D.

      Mesothelioma

    • E.

      Chronic bronchitis

    Correct Answer
    D. Mesothelioma
    Explanation
    The correct answer is mesothelioma. Mesothelioma is a type of cancer that affects the lining of the lungs, abdomen, or heart. The patient's history of working with asbestos insulation in the past suggests a potential link to mesothelioma, as asbestos exposure is a known risk factor for developing this type of cancer. The symptoms of increasing shortness of breath, chest pain, and weight loss are also consistent with mesothelioma.

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  • 8. 

    Hypersensitivity pneumonia is

    • A.

      A form of chronic bronchitis

    • B.

      Immunologically mediated interstitial pneumonia related to occupational antigens

    • C.

      Another name for bronchial asthma

    • D.

      A form of pneumonia exquisitely sensitive to antibiotic treatment

    • E.

      A form of rapidly progressive peumonitis almost exclusively confined to AIDS patients

    Correct Answer
    B. Immunologically mediated interstitial pneumonia related to occupational antigens
    Explanation
    Hypersensitivity pneumonia refers to a type of interstitial pneumonia that is caused by an immune response to occupational antigens. This means that individuals who are exposed to certain substances in their workplace, such as chemicals or dust, may develop this condition. It is not a form of chronic bronchitis, bronchial asthma, or pneumonia that is sensitive to antibiotic treatment. Additionally, it is not exclusively confined to AIDS patients, but can occur in anyone exposed to the relevant occupational antigens.

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  • 9. 

    A 65-year-old man with a long history of cigarette smoking died of cor pulmonale complicating severe emphysema. The type of emphysema is MOST LIKELY:

    • A.

      Irregular

    • B.

      Panacinar

    • C.

      Centriacinar

    • D.

      Paraseptal

    • E.

      Interstitial

    Correct Answer
    C. Centriacinar
    Explanation
    The correct answer is "Centriacinar." Centriacinar emphysema is the most common type of emphysema associated with cigarette smoking. It primarily affects the respiratory bronchioles and is characterized by destruction of the central or proximal portions of the acinus, while the distal portions remain relatively unaffected. This type of emphysema is typically seen in the upper lobes of the lungs. Given the patient's long history of cigarette smoking and the development of cor pulmonale, which is a complication of severe emphysema, centriacinar emphysema is the most likely type.

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  • 10. 

    All of the following are recognized causes of lung collapse (atelectasis) EXCEPT:

    • A.

      Aspiration of vomitus in unconscious patients

    • B.

      Sudden impaction of thromboemboli

    • C.

      Tension pneumothorax

    • D.

      Bronchial obstruction by a tumor

    • E.

      Massive pleural effusion

    Correct Answer
    B. Sudden impaction of thromboemboli
    Explanation
    Sudden impaction of thromboemboli refers to a blockage of a blood vessel in the lungs by a blood clot or other material. This condition is known as pulmonary embolism and can lead to serious complications, but it does not directly cause lung collapse or atelectasis. Lung collapse can occur due to various reasons such as aspiration of vomitus in unconscious patients, tension pneumothorax, bronchial obstruction by a tumor, or massive pleural effusion.

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  • 11. 

    A 28-year-old man complains of recurrent chest infections and chronic productive cough since early childhood. He also gives a history of chronic sinusitis and was discovered to have dextrocardia with situs inversus. He has been married for five years but has no children. His pulmonary disease is MOST LIKELY to be

    • A.

      Bronchiectasis

    • B.

      Bronchopneumonia

    • C.

      Bronchial asthma

    • D.

      Centriacinar emphysema

    • E.

      Tuberculosis

    Correct Answer
    A. Bronchiectasis
    Explanation
    The patient's history of recurrent chest infections, chronic productive cough since childhood, chronic sinusitis, and dextrocardia with situs inversus are all suggestive of Kartagener syndrome, a genetic disorder that affects the structure and function of cilia. This syndrome is commonly associated with bronchiectasis, which is characterized by the permanent dilation and destruction of the bronchi. Therefore, the patient's pulmonary disease is most likely to be bronchiectasis.

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  • 12. 

    A lung tumor which microscopically demonstrates cytologic features of malignancy as well as intercellular "bridges" and keratin "pearls" is LIKELY to be

    • A.

      Adenocarcinoma

    • B.

      Small cell carcinoma

    • C.

      Hamartoma

    • D.

      Large cell carcinoma

    • E.

      Squamous cell carcinoma

    Correct Answer
    E. Squamous cell carcinoma
    Explanation
    A lung tumor that demonstrates cytologic features of malignancy, as well as intercellular "bridges" and keratin "pearls," is likely to be squamous cell carcinoma. Squamous cell carcinoma is a type of lung cancer that arises from the squamous cells lining the airways. It is characterized by the presence of intercellular bridges and keratin pearls, which are histologic features commonly seen in squamous cell carcinoma. Adenocarcinoma, small cell carcinoma, large cell carcinoma, and hamartoma are other types of lung tumors that do not typically exhibit these specific features.

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  • 13. 

    An asymptomatic 10-year-old child is discovered though routine chest radiograph to have a small subpleural nodule in the middle lung zone and enlarged mediastinal lymph nodes. She has been living under poor hygienic conditions in a decaying neighborhood with her mother who is a drug addict and who herself had been hospitalized previously following a bout of hemoptysis. The child MOST PROBABLY has:

    • A.

      Primary tuberculosis

    • B.

      Primary atypical pneumonia

    • C.

      Bronchopulmonary sequestration

    • D.

      Lobar pneumonia

    • E.

      Fibrocavitory tuberculosis

    Correct Answer
    A. Primary tuberculosis
    Explanation
    The child is living in poor hygienic conditions and has a mother who is a drug addict, which increases the risk of exposure to tuberculosis. The presence of a small subpleural nodule and enlarged mediastinal lymph nodes on the chest radiograph are consistent with primary tuberculosis. Primary atypical pneumonia and lobar pneumonia typically present with different radiographic findings. Bronchopulmonary sequestration is a congenital abnormality and would not explain the symptoms in this case. Fibrocavitary tuberculosis typically occurs in older individuals with a history of previous tuberculosis infection.

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  • 14. 

    A 50-year-old pigeon-fancier complained of bouts of fever, shortness-of-breath, cough and chest tightness. He is a non­smoker. A lung biopsy revealed poorly formed epithelioid granulomas. Of the following, the MOST LIKELY diagnosis is:  

    • A.

      Pneumoconiosis

    • B.

      Chronic bronchitis

    • C.

      Lobar pneumonia

    • D.

      Hypersensitivity pneumonia

    • E.

      Bronchopneumonia

    Correct Answer
    D. Hypersensitivity pneumonia
    Explanation
    The symptoms of fever, shortness-of-breath, cough, and chest tightness, along with the presence of poorly formed epithelioid granulomas in the lung biopsy, suggest a hypersensitivity reaction. Hypersensitivity pneumonia is characterized by an immune response to inhaled antigens, leading to inflammation and granuloma formation in the lungs. Pneumoconiosis, chronic bronchitis, lobar pneumonia, and bronchopneumonia are less likely to present with these specific symptoms and histological findings.

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  • 15. 

    One of the commonest gross pathological findings in bronchial asthma is:

    • A.

      Upper lobe cavitation

    • B.

      Mucus plugs in bronchi

    • C.

      Pleural effusion

    • D.

      Pulmonary fibrosis

    • E.

      Pulmonary sequestration

    Correct Answer
    B. Mucus plugs in bronchi
    Explanation
    In bronchial asthma, mucus plugs in bronchi are a common gross pathological finding. This occurs due to the excessive production of mucus in the airways, which can lead to obstruction and difficulty in breathing. The mucus plugs can further contribute to bronchial inflammation and narrowing of the airways, resulting in symptoms such as wheezing, coughing, and shortness of breath. Therefore, the presence of mucus plugs in bronchi is a characteristic feature of bronchial asthma.

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  • 16. 

    A 75-year-old man who has lived in an overcrowded inner city neighborhood for 40 years complains of weight loss, hemoptysis and night sweats. His chest x-ray reveals numerous small opacities in both lungs and he has a positive PPD skin tests. He MOST LIKELY has:

    • A.

      Histoplasmosis

    • B.

      Fibrocavitary tuberculosis

    • C.

      Squamous cell carcinoma

    • D.

      Miliary tuberculosis

    • E.

      Adenocarcinoma

    Correct Answer
    D. Miliary tuberculosis
    Explanation
    The patient's symptoms of weight loss, hemoptysis, and night sweats, along with the presence of small opacities in both lungs and a positive PPD skin test, are consistent with miliary tuberculosis. Miliary tuberculosis occurs when Mycobacterium tuberculosis spreads through the bloodstream and affects multiple organs, including the lungs. This can result in the formation of numerous small opacities on a chest x-ray. Other conditions listed as answer choices, such as histoplasmosis, fibrocavitary tuberculosis, squamous cell carcinoma, and adenocarcinoma, do not typically present with the same combination of symptoms and radiographic findings as seen in this patient.

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  • 17. 

    Pancoast's Syndrome: (Select ALL that apply)

    • A.

      Specifically relates to a complication of small cell carcinoma

    • B.

      Is the result of tumor production of ACTH

    • C.

      Is often found in association with a pneumoconiosis

    • D.

      Is the result of thoracic inlet infiltration by tumor

    • E.

      Is the result of lung tumor metastases to the brain

    Correct Answer(s)
    B. Is the result of tumor production of ACTH
    D. Is the result of thoracic inlet infiltration by tumor
    Explanation
    Pancoast syndrome is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (stellate ganglion).[1, 2, 3] This is accompanied by the following:
    • Severe pain in the shoulder region radiating toward the axilla and scapula along the ulnar aspect of the muscles of the hand
    • Atrophy of hand and arm muscles
    • Horner syndrome (ptosis, miosis, hemianhidrosis, enophthalmos)
    • Compression of the blood vessels with edema


    Most Pancoast tumors are squamous cell carcinomas (SCCs) or adenocarcinomas; only 3-5% are small cell carcinomas. Squamous cell carcinoma occurs more frequently, although large cell and undifferentiated types are also common. Adenocarcinoma is sometimes found in this location and can even be metastatic. Involvement of the phrenic or recurrent laryngeal nerve or superior vena cava obstruction is not representative of the classic Pancoast tumor.

    A Pancoast tumour is an apical tumour that is typically found in conjunction with a smoking history. The clinical signs and symptoms can be confused with neurovascular compromise at the level of the superior thoracic aperture. The patient's smoking history, rapid onset of clinical signs and symptoms and pleuritic pain can suggest an apical tumour.
    A Pancoast tumor can give rise to both **** PANCOAST SYNDROME ***** and Horner's syndrome. When the brachial plexus roots are involved it will produce Pancoast syndrome; involvement of sympathetic fibres as they exit the cord at T1 and ascend to the superior cervical ganglion will produce Horner's syndrome.

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  • 18. 

    A 32-year-old woman on long-term steroid therapy for rheumatoid arthritis develops pneumonia within days of an upper respiratory influenza infection. A LIKELY pathological feature of this pneumonia is:

    • A.

      Multiple lung microabscesses

    • B.

      Hyaline membrane formation

    • C.

      Grey hepatization

    • D.

      Diffuse interstitial fibrosis

    • E.

      Interstitial calcifications

    Correct Answer
    B. Hyaline membrane formation
    Explanation
    Hyaline membrane formation is a likely pathological feature of pneumonia in a 32-year-old woman on long-term steroid therapy for rheumatoid arthritis. Hyaline membranes are formed due to the accumulation of proteinaceous material in the alveoli, leading to impaired gas exchange and respiratory distress. Steroid therapy can suppress the immune system, making individuals more susceptible to infections such as pneumonia. In this case, the patient developed pneumonia shortly after an upper respiratory influenza infection, suggesting an impaired immune response. The presence of hyaline membrane formation indicates the severity of the lung injury and the development of acute respiratory distress syndrome (ARDS), which can be seen in severe cases of pneumonia.

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