Obstructive And Restrictive Lung Disease
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A patient's chest radiograph shows diffuse interstitial disease and hilar adenopathy. Endoscopic examination shows a few slightly irregular areas on the bronchial mucosal surface and this is biopsied. Sections reveal several small granulomas within the bronchial mucosa but none is associated with central caseous necrosis. What is the best diagnosis?
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Alveolar proteinosis
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Carcinomatosis
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Sarcoidosis
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Silicosis
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Tuberculosis
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Knowing the early warning signs of lung disease can help you receive treatment before the disease becomes serious or even life threatening. There are different types of lung diseases and we have just covered obstructive and restrictive lung diseases. Take up the quiz below and test your on how to diagnose them.
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- 2.
A 14-year-old boy with a 10 year history of asthma was admitted to the hospital for evaluation. He reported symptoms consistent with those of severe asthma, including awakening from sleep five to seven times per night. Present medications were high dose inhaled fluticasone and salmeterol. Lab exams showed total serum IgE level of 615 UI/mL (normal > 120). Which of the following treatments would be appropriate for this patient?
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Inhaled albuterol
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Inhaled beclomethasone
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Oral zileuton
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Inhaled cromolyn
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SC omalizumab
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Oral zafirlukast
Correct Answer
A. SC omalizumabExplanation
Omalizumab (Xolair®)
•Chemistry
o IgG monoclonal antibody
• Pharmacokinetics
o Parenteral administration **************
Administration of large doses should be divided over more than one injection site
o Slow absorption
o Bioavailability ~62%
o Undergoes hepatic metabolism, and degradation via the reticuloendothelial system and endothelial cells
o t1/2 ~26 days
o Elimination is primarily through hepatic degradation and bile secretion of intact antibody
• Pharmacodynamics
o Mechanism of Action
Binds IgE antibodies and inhibits their binding to the high-affinity IgE receptor on mast cells and basophils
o Pharmacological Actions/Effects
Inhibits IgE-mediated effects ********
• Inhibits release of early and late phase allergic response mediators
• DECREASES serum IgE levels and expression of high-affinity IgE receptors *******
•Clinical Pharmacology
o Clinical Uses
Therapy of moderate-to-severe, persistent allergic asthma not adequately controlled with ICS
• Lessens asthma severity and reduces corticosteroid requirement
• Reduces the frequency and severity of asthma exacerbations
• Not used to control acute asthmatic attacks
Improvement of symptoms of perennial and seasonal allergic rhinitis
o ADVERSE EFFECTS/TOXICITY
Serious reactions
• Hypersensitivity reactions/anaphylaxis can occur within 2-24 hrs following administration, and > 1 year after initiation of regular treatment (very rare)
• Malignancy, severe thrombocytopenia, severe injection site reactions
Common reactions
• Injection site reaction, viral infection, URI, sinusitis, headache, pharyngitis, helminth infection, arthralgia, pain, fatigue, dizziness, pruritus, dermatitis, earache, fractures
Carries a Black Box Warning regarding ANAPHYLAXIS RISK
o Contraindications
Acute bronchospasm, status asthmaticus, parasitic infections (infection risk may be increased)
Pregnancy/Lactation—Category B/precaution (safety unknown)Rate this question:
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- 3.
A 76-year-male with a 70-pack-year history of smoking was admitted to the hospital with complaints of severe dyspnea and unproductive cough. Chest x-ray revealed barrel chest, small heart and overinflated lungs. No immunologic abnormalities were detected. Despite of adequate treatment, the patient expired of respiratory failure twelve hours after admission. Postmortem examination revealed over distended lungs that cover the front surface of the heart. Microscopic evaluation of the lung would most likely reveal which of the following changes?
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Hypertrophy of the submucosal glands and edema of the mucosa
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Dilation of the respiratory bronchioli and of alveolar ducts and sacs
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Constriction of the respiratory bronchioli and dilation of alveolar ducts and sacs
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Thickening and sclerosis of the mucosal basement membrane
Correct Answer
A. Dilation of the respiratory bronchioli and of alveolar ducts and sacsExplanation
The correct answer is dilation of the respiratory bronchioles and alveolar ducts and sacs. This is because the patient's history of smoking and the presence of barrel chest, small heart, and overinflated lungs on chest x-ray suggest the development of chronic obstructive pulmonary disease (COPD). In COPD, the airways become narrowed and the alveoli become overinflated, leading to the dilation of respiratory bronchioles and alveolar ducts and sacs. This can result in severe dyspnea and respiratory failure, as seen in this patient.Rate this question:
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- 4.
A 50-year old man comes to your office complaining of a chronic cough productive. His cough began four months ago and has not improved despite taking over- the-counter cough medicine. He reports a 50-pack a year smoking history. Physical examination reveals a thin cyanotic man with tachypnea and tachycardia. Which of the following will most likely be seen in this case?
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Decreased Reid Index, hyperplasia of mucus glands and goblet cell dysplasia
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Increased Reid Index, hypertrophy of mucus glands, and squamous metaplasia
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Decreased Reid Index, hyperplasia of goblet cells and mucus gland, intestinal metaplasia
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Increased Reid Index, hypertrophy of goblet cells with squamous cell carcinoma
Correct Answer
A. Increased Reid Index, hypertrophy of mucus glands, and squamous metaplasiaExplanation
The patient's history of chronic cough, smoking, and physical examination findings of thin cyanotic man with tachypnea and tachycardia suggest a diagnosis of chronic obstructive pulmonary disease (COPD). Increased Reid Index, hypertrophy of mucus glands, and squamous metaplasia are characteristic histological findings seen in COPD. The Reid Index is the ratio of the thickness of the submucosal gland layer to the thickness of the bronchial wall, and an increased Reid Index indicates hypertrophy of mucus glands. Squamous metaplasia is a common histological finding in COPD due to chronic irritation and inflammation of the airways.Rate this question:
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- 5.
This gross and microscopic image was most likely taken from a patient with:
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A patient with obstructive lung disease and difficulty with expiratory deflation of lungs
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A patient with restrictive lung disease and difficulty with expiratory deflation of lungs
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A patient with obstructive lung disease and difficulty with inspiratory expansion of lungs
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A patient with restrictive lung disease and difficulty with inspiratory expansion of lungs
Correct Answer
A. A patient with restrictive lung disease and difficulty with inspiratory expansion of lungsExplanation
The ferruginous bodies shown in the figure are long, thin crystals of asbestos that have become encrusted with iron and calcium. The inflammatory reaction incited by these crystals promotes fibrogenesis and resultant pneumoconiosis.
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Obstructive disease -”COPD” = difficulty with expiratory deflation of the lungs due to anatomic narrowing of airways or reduced elastic recoil
Restrictive disease = difficulty with inspiratory expansion of the lungs due to reduced total lung capacity---eg. chest wall disorders or interstitial or infiltrative lung diseases(acute or chronic) eg pneumoconiosis. Fibrosis often a factorRate this question:
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- 6.
Postmortem examination of a 75-old man with a 60-pack-years history of smoking reveals severe atherosclerosis and lung changes shown below. Which of the following sets of clinicolaboratory data could most likely be found in this case?
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“pink puffer” appearance, tachypnea, reduced FEV1/FVC normoxia, and normocapnia
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“blue bloater” appearance, polycytemia, reduced FEV1/FVC, normoxia (pO2 > 70 mm Hg), normocapnia (pCO2 < 45 mm Hg)
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“pink puffer” appearance, polycytemia, reduced FEV1/FVC, hypoxia, hypercapnia
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“blue bloater” appearance, polycytemia, reduced FEV1/FVC, hypoxia, hypercapnia
Correct Answer
A. “pink puffer” appearance, tachypnea, reduced FEV1/FVC normoxia, and normocapniaExplanation
The given answer is the most likely set of clinicolaboratory data that would be found in this case because it is consistent with the patient's history of smoking and the findings of severe atherosclerosis and lung changes. The "pink puffer" appearance, tachypnea, and reduced FEV1/FVC are indicative of chronic obstructive pulmonary disease (COPD), which is commonly seen in smokers. The presence of normoxia (normal oxygen levels) and normocapnia (normal carbon dioxide levels) suggests that the patient's respiratory function is still relatively preserved despite the lung changes. This combination of symptoms and laboratory findings is consistent with a "pink puffer" phenotype of COPD.Rate this question:
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- 7.
Postmortem examination of an 81-year-old man, a former construction worker, reveals the lung changes shown for your evaluation. Application of which of the following technique would be confirmatory in this case?
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Congo red stain
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Serum ACE level
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Ziehl-Neelsen stain
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Polarized microscopy
Correct Answer
A. Polarized microscopyExplanation
Polarized microscopy would be confirmatory in this case because it is used to identify and evaluate lung changes, such as fibrosis and inflammation, which can be seen in individuals with a history of occupational exposure, such as construction workers. It allows for the visualization of tissue structures and can help identify specific patterns associated with certain lung diseases. The other options, Congo red stain, Serum ACE level, and Ziehl-Neelsen stain, are not specific to evaluating lung changes and would not provide confirmatory evidence in this case.Rate this question:
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- 8.
Postmortem examination of a 60 year-old man, who died of combined respiratory and right-sided heart failure, reveals the shown gross and microscopic pulmonary changes. Which of the following is the most likely diagnosis?
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Honeycomb lung
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Panacinar emphysema
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Bronchial asthma
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Centroacinar emphysema
Correct Answer
A. Panacinar emphysemaExplanation
Panacinar (or panlobular) emphysema: The entire respiratory acinus, from respiratory bronchiole to alveoli, has expanded. Occurs more commonly in the lower lobes (especially basal segments) and in the anterior margins of the lungs.
Centriacinar (or centrilobular) emphysema: The respiratory bronchiole (proximal and central part of the acinus) has expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobesRate this question:
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- 9.
A chest radiograph shows an area of right middle lobe consolidation in a 40 year old woman who has had bouts of pneumonia with purulent sputum production for many years. The gross appearance of her right middle lobe is shown here. Which of the following conditions best accounts for these findings?
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Bronchial asthma
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Bronchiectasis
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Chronic bronchitis
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Bronchopulmonary dysplasia
Correct Answer
A. BronchiectasisExplanation
Bronchiectasis:
= Infection + permanent dilatation of bronchi. Causes: infections and bronchial obstruction (FB, mucus plugs, tumors, intralobar sequestrations, cystic fibrosis, immotile cilia (Kartagener’s synd.)
Infection destroys the elastic tissue in the wall of bronchi; and persistent obstruction --> collapse & fibrosis of alveoli --> increased negativity of the intrathoracic pressure ---> dilatation of weakened bronchi (cylindrical, fusiform or saccular).
Clinically: chronic cough, productive of purulent sputum; may progress to obstructive respiratory insufficiency & cor-pulmonale.Rate this question:
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- 10.
A 36-year-old man has had increasing dyspnea for 8 years. He has no cough or increased sputum production. On physical examination there is hyper-resonance to percussion. A chest radiograph and the gross appearance of the lung are shown. Which of the following laboratory findings is he most likely to have?
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Decreased serum ceruloplasmin
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Increased sweat chloride
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Positive antinuclear antibody test
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Decreased serum alpha-1-antitrypsin
Correct Answer
A. Decreased serum alpha-1-antitrypsinExplanation
The patient's symptoms of dyspnea and hyper-resonance to percussion suggest the presence of emphysema, a condition characterized by destruction of lung tissue. Decreased serum alpha-1-antitrypsin is the most likely laboratory finding in this case because alpha-1-antitrypsin is a protein that helps protect the lungs from damage caused by enzymes released during inflammation. Deficiency of alpha-1-antitrypsin can lead to the development of emphysema at an early age. The other options are not associated with emphysema.Rate this question:
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- 11.
A 68-year -old man who has been a 2-pack-a-day smoker for more than 40 years has been suffering from shortness of breath and a dry cough for the past year and both are getting worse. Examination reveals a barrel-chested man with who is quite thin. He in not cyanosed but has an obviously increased respiratory rate and is using his accessory muscles of respiration. Which of the following pathologic descriptions best fits his disease?
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Pulmonary consolidation
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Irreversibly dilated bronchioles
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Mucus gland hyperplasia
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Destroyed alveolar walls
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Asbestos bodies
Correct Answer
A. Destroyed alveolar wallsExplanation
EMPHYSEMA
A. Destruction of alveolar air sacs ******************
1. Loss of elastic recoil and collapse of airways during exhalation results in obstruction and air trapping.
B. Due to imbalance of proteases and antiproteases
1. Inflammation in the lung normally leads to release of proteases by neutrophils
and macrophages.
2. a1-antitrypsin (AlAT) neutralizes proteases.
3. Excessive inflammation or lack of AlAT leads to destruction of the alveolar air sacs.
C. Smoking is the most common cause of emphysema.
1. Pollutants in smoke lead to excessive inflammation and protease-mediated damage.
2. Results in centriacinar emphysema that is most severe in the upper lobes
E. Clinical features of emphysema include
1. Dyspnea and cough with mini mal sputum*****************
2. Prolonged expiration with pursed lips ('pink-puffer')
3. Weight loss***********************
4. Increased anterior-posterior diameter of chest ('barrel-chest) ****************
5. Hypoxemia (due to destruction of capillaries in the alveolar sac) and cor pulmonale are late complications.Rate this question:
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.JPG "This gross and microscopic image was most likely taken from a patient with:")
.JPG "Postmortem examination of a 75-old man with a 60-pack-years history of smoking reveals severe atherosclerosis and lung changes shown below.
Which of the following sets of clinicolaboratory data could most likely be found in this case?")
.JPG "Postmortem examination of an 81-year-old man, a former construction worker, reveals the lung changes shown for your evaluation.
Application of which of the following technique would be confirmatory in this case?")
.JPG "Postmortem examination of a 60 year-old man, who died of combined respiratory and right-sided heart failure, reveals the shown gross and microscopic pulmonary changes.
Which of the following is the most likely diagnosis?")
.JPG "A chest radiograph shows an area of right middle lobe consolidation in a 40 year old woman who has had bouts of pneumonia with purulent sputum production for many years. The gross appearance of her right middle lobe is shown here. Which of the following conditions best accounts for these findings?")
.JPG "A 36-year-old man has had increasing dyspnea for 8 years. He has no cough or increased sputum production. On physical examination there is hyper-resonance to percussion. A chest radiograph and the gross appearance of the lung are shown. Which of the following laboratory findings is he most likely to have?")
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Current Version
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Mar 21, 2023Quiz Edited by
ProProfs Editorial Team -
Jul 19, 2012Quiz Created by
Chachelly
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