Obstructive And Restrictive Lung Disease

Approved & Edited by ProProfs Editorial Team
The editorial team at ProProfs Quizzes consists of a select group of subject experts, trivia writers, and quiz masters who have authored over 10,000 quizzes taken by more than 100 million users. This team includes our in-house seasoned quiz moderators and subject matter experts. Our editorial experts, spread across the world, are rigorously trained using our comprehensive guidelines to ensure that you receive the highest quality quizzes.
Learn about Our Editorial Process
| By Chachelly
C
Chachelly
Community Contributor
Quizzes Created: 513 | Total Attempts: 606,197
Questions: 11 | Attempts: 2,200

SettingsSettingsSettings
Obstructive And Restrictive Lung Disease - Quiz

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.


Questions and Answers
  • 1. 

    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?

    • A.

      Alveolar proteinosis

    • B.

      Carcinomatosis

    • C.

      Sarcoidosis

    • D.

      Silicosis

    • E.

      Tuberculosis

    Correct Answer
    C. Sarcoidosis
    Explanation
    SARCOIDOSIS
    A. Systemic disease characterized by noncaseating granulomas in multiple organs;
    classically seen in African American females
    B. Etiology is unknown; likely due to CD4 • helper T-cell response to an unknown antigen
    C. Granulomas most commonly involve the hilar lymph nodes and lung (Fig. 9.15A),
    leading to restrictive lung disease.
    l. Characteristic stellate inclusions ('asteroid bodies') are often seen within giant
    cells of the granulomas .
    D. Other commonly involved tissues include the uvea (uveitis), skin (cutaneous
    nodules or erythema nodosum), and salivary and lacrimal glands (mimics Sjogren
    syndrome); almost any t issue can be involved.
    E. Clinical features
    l. Dyspnea or cough (most common presenting symptom)
    2. Elevated serum ACE
    3. Hypercalcemia (1-alpha hydroxylase activity of epithelioid histiocytes converts
    vitamin D to its active form)
    4. Treatment is steroids; often resolves spontaneously without treatment.

    Rate this question:

  • 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?

    • A.

      Inhaled albuterol

    • B.

      Inhaled beclomethasone

    • C.

      Oral zileuton

    • D.

      Inhaled cromolyn

    • E.

      SC omalizumab

    • F.

      Oral zafirlukast

    Correct Answer
    E. SC omalizumab
    Explanation
    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:

  • 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?

    • A.

      Hypertrophy of the submucosal glands and edema of the mucosa

    • B.

      Dilation of the respiratory bronchioli and of alveolar ducts and sacs

    • C.

      Constriction of the respiratory bronchioli and dilation of alveolar ducts and sacs

    • D.

      Thickening and sclerosis of the mucosal basement membrane

    Correct Answer
    B. Dilation of the respiratory bronchioli and of alveolar ducts and sacs
    Explanation
    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:

  • 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?

    • A.

      Decreased Reid Index, hyperplasia of mucus glands and goblet cell dysplasia

    • B.

      Increased Reid Index, hypertrophy of mucus glands, and squamous metaplasia

    • C.

      Decreased Reid Index, hyperplasia of goblet cells and mucus gland, intestinal metaplasia

    • D.

      Increased Reid Index, hypertrophy of goblet cells with squamous cell carcinoma

    Correct Answer
    B. Increased Reid Index, hypertrophy of mucus glands, and squamous metaplasia
    Explanation
    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:

  • 5. 

    This gross and microscopic image was most likely taken from a patient with:

    • A.

      A patient with obstructive lung disease and difficulty with expiratory deflation of lungs

    • B.

      A patient with restrictive lung disease and difficulty with expiratory deflation of lungs

    • C.

      A patient with obstructive lung disease and difficulty with inspiratory expansion of lungs

    • D.

      A patient with restrictive lung disease and difficulty with inspiratory expansion of lungs

    Correct Answer
    D. A patient with restrictive lung disease and difficulty with inspiratory expansion of lungs
    Explanation
    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.
    ___________________________________________________
    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 factor

    Rate this question:

  • 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?

    • A.

      “pink puffer” appearance, tachypnea, reduced FEV1/FVC normoxia, and normocapnia

    • B.

      “blue bloater” appearance, polycytemia, reduced FEV1/FVC, normoxia (pO2 > 70 mm Hg), normocapnia (pCO2 < 45 mm Hg)

    • C.

      “pink puffer” appearance, polycytemia, reduced FEV1/FVC, hypoxia, hypercapnia

    • D.

      “blue bloater” appearance, polycytemia, reduced FEV1/FVC, hypoxia, hypercapnia

    Correct Answer
    A. “pink puffer” appearance, tachypnea, reduced FEV1/FVC normoxia, and normocapnia
    Explanation
    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:

  • 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?

    • A.

      Congo red stain

    • B.

      Serum ACE level

    • C.

      Ziehl-Neelsen stain

    • D.

      Polarized microscopy

    Correct Answer
    D. Polarized microscopy
    Explanation
    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:

  • 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?

    • A.

      Honeycomb lung

    • B.

      Panacinar emphysema

    • C.

      Bronchial asthma

    • D.

      Centroacinar emphysema

    Correct Answer
    B. Panacinar emphysema
    Explanation
    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 lobes

    Rate this question:

  • 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?

    • A.

      Bronchial asthma

    • B.

      Bronchiectasis

    • C.

      Chronic bronchitis

    • D.

      Bronchopulmonary dysplasia

    Correct Answer
    B. Bronchiectasis
    Explanation
    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:

  • 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?

    • A.

      Decreased serum ceruloplasmin

    • B.

      Increased sweat chloride

    • C.

      Positive antinuclear antibody test

    • D.

      Decreased serum alpha-1-antitrypsin

    Correct Answer
    D. Decreased serum alpha-1-antitrypsin
    Explanation
    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:

  • 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?

    • A.

      Pulmonary consolidation

    • B.

      Irreversibly dilated bronchioles

    • C.

      Mucus gland hyperplasia

    • D.

      Destroyed alveolar walls

    • E.

      Asbestos bodies

    Correct Answer
    D. Destroyed alveolar walls
    Explanation
    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:

Quiz Review Timeline +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 19, 2012
    Quiz Created by
    Chachelly

Related Topics

Back to Top Back to top
Advertisement
×

Wait!
Here's an interesting quiz for you.

We have other quizzes matching your interest.