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?

Interstitial Pneumonia


  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?

Honeycomb lung


  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?

Interstitial pneumonia CXR


  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?

Nodular Silicosis


  Panlobular emphysema

  

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 ?

  Nodular silicosis

  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?

Centrolobular emphysema


  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?

Centrilobular emphysema


  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?

Bronchopneumonia with abscess


  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?

Mucous gland hyperplasia


  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?

Panacinar emphysema


  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:

Panacinar emphysema

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?

Bronchopneumonia


  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?

Candida in sputum


  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?

Streptococcus Pneumoniae in sputum


  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


  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?

Sputum - gram-negative bacilli (Klebsiella)


  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?

Miliary Tuberculosos


  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?

Bronchopneumonia


  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?

Bullous emphysema


  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.