Mt4l4 Elhm Pathology Course (Exam 2)

The patient is most likely to have a lung abscess. The development of a non-productive cough and fever after aspirating gastric contents suggests the presence of an infection in the lung. The chest radiograph revealing a mass with an air-fluid level is consistent with a lung abscess. The sputum gram stain revealing mixed flora further supports the diagnosis of a lung abscess, as it indicates the presence of multiple bacteria in the respiratory tract. Squamous cell carcinoma, chronic bronchitis, and bronchiectasis are less likely in this case as they do not typically present with the specific findings described.

The patient's clinical presentation is consistent with emphysema, which is characterized by hyperresonance to percussion, increased lung volumes, and flattening of the diaphragmatic leaves. The prominent right heart border suggests pulmonary hypertension. The decreased attenuation on chest CT scan indicates loss of lung parenchyma. These findings are indicative of alpha-1-antitrypsin deficiency, a genetic disorder that predisposes individuals to the development of emphysema at a young age. Therefore, the patient is most likely to have decreased serum alpha-1-antitrypsin levels.

Atelectasis or collapse of the lungs can be caused by various conditions, including compression of bronchi by enlarged lymph nodes, pneumothorax, and bronchial tumors. However, alpha 1 antitrypsin deficiency is not a known cause of atelectasis or collapse.

Centriacinar emphysema is a type of emphysema that primarily affects the respiratory bronchioles and spares the alveoli. It is the main type of emphysema that occurs in smokers. This type of emphysema is characterized by the destruction of the walls of the respiratory bronchioles, leading to the enlargement of the air spaces. Although some degree of reversibility may be possible with treatment, centriacinar emphysema is generally considered irreversible.

The most likely diagnosis in this case is bronchial asthma. The patient's symptoms, such as acute onset of dyspnea, wheezing, and coughing up mucus plugs, are consistent with an asthma attack. The patient has a history of similar episodes for the past 7 years, further supporting the diagnosis of asthma. The physical examination findings, including decreased breath sounds and hyperinflation on chest radiograph, are also typical of asthma. The laboratory studies show an increased number of eosinophils, which is commonly seen in asthma. The other answer choices are less likely based on the given information.

The patient's presentation of fever, dyspnea, weight loss, reticulonodular pattern on chest radiograph, and prominent hilar lymphadenopathy is consistent with sarcoidosis. The negative findings on microscopic examination, including the absence of viral inclusions, fungi, acid-fast bacilli, and atypical cells, further support this diagnosis. Silicosis, TB, usual interstitial pneumonia, and asbestosis would typically have different clinical and radiographic findings.

Alphla 1 antitrypsin deficiency leads to emphysema because it leads to excessive destruction of elastic tissue by elastase enzymes. This deficiency impairs the ability of the body to inhibit the activity of elastase, an enzyme that breaks down elastic tissue in the lungs. As a result, there is an increased destruction of the elastic fibers, leading to the development of emphysema. This condition is characterized by the destruction of the alveoli and the loss of lung elasticity, resulting in difficulty breathing and other respiratory symptoms.

Emphysematous lungs are characterized by the destruction of the alveolar walls, leading to enlarged air spaces and reduced lung elasticity. This results in difficulty exhaling air and a decrease in lung function. Emphysematous lungs may show air pullae, which are small air-filled spaces within the lung tissue. They may also show rib indentations due to the enlarged air spaces pushing against the ribs. Additionally, emphysematous lungs are typically pale and dry due to the loss of blood vessels and decreased production of mucus. However, they do not rapidly collapse on opening the chest, as the destruction of the alveolar walls causes the lungs to lose their elastic recoil.

The most likely infectious agent causing the woman's pulmonary disease is Staphylococcus aureus. This is indicated by the presence of a high fever, productive cough with yellowish sputum, diffuse rales in all lung fields, and patchy infiltrates in all lung fields on chest radiograph. The presence of a 4 cm rounded area of consolidation in the left upper lobe with an air-fluid level further supports a bacterial infection. Staphylococcus aureus is a common cause of community-acquired pneumonia and can lead to severe lung infections.

Lobar pneumonia is not a suppurative lung disease because it is characterized by inflammation and consolidation of a lobe or lobes of the lung, but it does not typically involve the formation of pus. Suppurative lung diseases, on the other hand, are characterized by the presence of pus in the lung, such as in empyema, post pneumonic lung abscess, and septic bronchopneumonia. Bronchiectasis is also a suppurative lung disease, as it involves the permanent dilation of the bronchi and the accumulation of mucus and pus in the airways.

The correct answer is serum sodium of 113 mmol/L. This is likely due to the presence of a small cell lung carcinoma, which can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH leads to excess water retention and dilutional hyponatremia, resulting in low serum sodium levels. The patient's symptoms of coughing up blood, back pain, and the presence of lung nodules and bone metastases are consistent with advanced lung cancer, which can be associated with SIADH.