JCU MB4 Term 1 Week 5 (Pneumonia/Asthma/Restrictive Lung Disease)
1
39-year-old male, history of dyspnoea and non-productive cough for 6 weeks. Lung biopsy shown. What is the diagnosis?
Lobar pneumonia
Bronchopneumonia
Interstitial pneumonia
Fungal pneumonia
Carcinomatous pneumonia
Note heavy inflammation and widening in alveloar septa, but alveolar themselves are mostly clear. KFP questions:
- What is the pattern/type of inflammation?
- What infectious agents are most likely to cause this? (many viruses, Mycoplasma, Klebsiella)
- Briefly comment on the prognosis?
2
Which of the following is useful in assessing the severity of COPD?
Total lung capacity
Response to bronchodilators
Forced vital capacity
Force expiratory volume in 1st second
Diffusing capacity
The FEV1/FVC ratio is used to asses COPD. Typically, obstruction causes a reduction in FEV1 and therefore a reduction in the ratio, and is used to assess the progression of COPD.
3
32-year-old female presented with "recurrent bronchitis". You suspect bronchial asthma, though there are no rhonchi. Which of the following would be the most appropriate test to diagnose it?
Plain CXR
Peripheral blood eosinophil count
Sputum for Curschmann spirals
Bronchoscopic biopsy
Methacholine challenge test on spirometry
4
42-year-old, chronic smoker with COPD for 20 years presents with worsening dyspnoea and right-sided heart failure since 3 months. Lung gross specimen shown. What is the diagnosis?
Chronic bronchitis
Honeycomb lung
Emphysema
Bronchiectasis
Lung abscess
6
39-year-old male, history of dyspnoea and non-productive cough for 6 weeks. CXR shown. What is the diagnosis?
What is the pattern of the CXR?
Lobar pneumonia
Bronchopneumonia
D e s c r i b e
m i c r o s c o p y
e x p e c t e d
i n
t h e s e
l e s i o n s ?
Interstitial pneumonia
Fungal pneumonia
Lung abscess
The characteristic pattern of interstitial pneumonia is a reticulated (lined) appearance with "extra dots". Although diffuse opacity is also seen in bronchopneumonia it does exhibit this reticular appearance. The arrow actually points to a malignancy - small opacities like this may also be a small foci of lobar pneumonia which can make radiological differentiation of the different types of pneumonia difficult. KFP questions:
7
58-year-old mining worker with history of chronic dyspnoea. Lung gross specimen shown. What is the diagnosis?
Panlobular emphysema
Nodular silicosis
D e s c r i b e
m i c r o s c o p y
e x p e c t e d
i n
t h e s e
l e s i o n s ?
Diffuse fibrosis
Centrilobular emphysema
Smoker - chronic bronchitis
The primary diagnosis is nodular silicosis due to the prominent nodules seen in central region. Note the darkening caused by deposits of carbon and silica. There is some evidence of fibrosis and emphysema is the more distal portions of the lung.
8
42-year-old male smoker, history of dyspnoea. Lung gross specimen shown. What are the arrows pointing to?
Emphysematous bullae
Panlobular emphysema
Centrilobular emphysema
Chronic bronchitis and emphysema
Diffuse pulmonary fibrosis
The lesions are well within the lung parenchyma despite their proximity to the lung border, excluding emphysematous bullae. Note also the plentiful normal lung parenchyema between visible lesions which is characteristic of centrilobular emphysema. There are bullae in the lower right of the picture (lingular lobe).
9
42-year-old male chronic smoker, history of dyspnoea. Lung gross specimen shown. What is the diagnosis?
Emphysematous bullae
Panlobular emphysema
Centrilobular emphysema
Chronic bronchitis
Anthracotic pigmentation
Anthracotic pigmentation (carbon deposits) are visible, but this is not a diagnosis. The large spaces interspersed by normal lung parenchyma is characteristic of centrilobular emphysema.
10
42-year-old male smoker, history of fever for 2 weeks with dyspnoea. Lung gross specimen is shown. What is the diagnosis?
Cavitary tuberculosis
Panlobular emphysema
Centrilobular emphysema
Chronic bronchitis and abscess
Bronchopneumonia and abscess
Note abscess with fibrotic wall, and surrounding lung with consolidation.
11
45-year-old male with history of dysponea. Bronchial biopsy shown. What is indicated between the arrows?
Congested blood vessels
Mucous gland hyperplasia
Inflammation
Goblet cell hyperplasia
Smooth muscle hyperplasia
The ratio of the thickness of mucosal glands and bronchial wall is known as the Reid index. A ratio of 2:1 is considered diagnostic of mucosal gland hyperplasia.
12
28-year-old male, history of chronic dyspnoea. Close-up lung gross specimen shown. What is the diagnosis?
Panlobular emphysema
Nodular silicosis
Diffuse fibrosis
Centrilobular emphysema
Smoker - chronic bronchitis
Typical panacinar emphysema - there is no normal lung parenchyma visible; all acinar appear to be dilated. Gross specimen might typically appear as:
13
Blue discolouration in a "blue bloater" is due to...
Cyan Meth-Hb
Deoxy-Hb
Hypercapnoea
Carbon pigment (smoking)
Excess pCO2
14
34-year-old male, smoker, history of fever for 6 days. Lung biopsy shown. What is the diagnosis?
Chronic bronchitis
Bronchopneumonia
Interstitial pneumonia
Lung abscess
Emphysema and pneumonia
15
34-year-old male AIDS patient, recent fever, chest infection not responding to usual antibiotics. Sputum microscopy shown. What is the pathogen?
Mycobacterium spp.
Candida spp.
Streptococcus pneumoniae
Staphylococcus aureus
Streptococcus pyogenes
Candida infection is more likely in immunocompromised patients.
16
29-year-old male, high fever, cough, dyspnoea. Sputum gram stain shown. What is the probably type of pneumonia?
Lobar pneumonia
Bronchopneumonia
Interstitial pneumonia
Aspiration pneumonia
Viral pneumonia
17
Peter is a 58-year-old and is a non-smoker. He suffers aspiration of gastric contents during cardiac resuscitation. Over the next 10 days he develops a non-productive cough and fever. A chest radiograph reveals a 4cm diameter mass with an air-fluid level in the right lung. A sputum gram stain reveals mixed flora. What is the most likely diagnosis?
Lobar pneumonia
Lung abscess
Interstitial pneumonia
Fungal pneumonia
Bronchopneumonia
18
34-year-old male, high fever. Gross lung specimen shown. What is the diagnosis?
Lobar pneumonia
Bronchopneumonia
Interstitial pneumonia
Fungal pneumonia
Carcinomatous pneumonia
Note well-demarcated border of consolidation along anatomical border.
19
54-year-old male, on ventilator in ICU. Develops fever and chest infiltrates. Sputum gram stain shown. What is the diagnosis?
Streptococcus pneumoniae
Candida albicans
Klebsiella pneumoniae
Staphylococcus aureus
Influenza type A
20
28-year-old smoker, history of fever for 6 weeks with weight loss and haemoptysis. Lung gross specimen shown. What is the diagnosis?
Centrilobular emphysema
Adenocarcinmoa
Metastatic deposits
Lung abscesses
Miliary tuberculosis
Note the diffuse nodules indicated by the arrows. Metastatic cancer is unlikely given the age.
21
A 54-year-old woman which chronic emphysema presents with cough and dyspnoea. Her BP is 126/64mmHg, pulse 82/min and RR 24/min. On lung examination, there are loud expiratory wheezes and rhonchi. The CVS examination is normal. Which of the following results would most likely be expected if arterial blood gas analysed?
pH of 7.20, pCO2 of 60, PO2 of 46
pH of 7.30, pCO2 of 50, PO2 of 94
pH of 7.35, pCO2 of 45, pO2 of 60
pH of 7.46, pCO2 of 25, pO2 of 76
pH of 7.52, pCO2 of 30, pO2 of 82
Symptoms of mild acidosis, typically seen in chronic COPD.
22
39-year-old male, chronic smoker, high fever. Gross lung specimen shown. What is the type of pneumonia?
Lobar pneumonia
Interstitial pneumonia
Bronchopneumonia
Fungal pneumonia
Carcinomatous pneumonia
Specimen shows patchy consolidation with areas of confluence seen in the lower zone. There are some areas of intervening normal lung.
23
56-year-old male with decreased lung capacity develops sudden severe dyspnoea. Close-up of gross specimen shown. What is the most likely cause?
Pumonary embolism
Pulmonary infarction
Myocardial infarction
Right ventricular failure
Spontaneous pneumothorax
The picture shows bullous emphysema at the lung border. A complication of this condition is detachment from the pleura and subsequent lung collapse.