Lung pathology

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jaz_walker
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270174
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Lung pathology
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2014-04-11 05:48:20
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pathology
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pathology
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Lung pathology cases
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  1. 1. A 81 year old female has worked with coal all her life.. A biopsy shows coal macules, dust-laden macrophages and collagen fibres throughout the macules. The upper zones are more involved. There is some evidence of centrilobular emphysema. What disease is she likely to have, and what may this progress to?
    Simple coal worker's pneumoconiosis - progressive massive fibrosis
  2. 2. A 71 year old man has developed a cough and haemoptysis.. A bronchial lavage shows atypical cells.. What is the most likely cause?
    Squamous cell carcinoma -
  3. 3. A 62 year old woman presents with increased sputum production, which is slightly blood-streaked. She is a lifelong smoker.. A bronchoscopy shows complete obliteration of some of the bronchioles and mucous plugging and inflammation in others.. What disease does she have?
    Chronic bronchiolitis - with bronchiolitis obliterans
  4. 4. A 62 year old woman presents with increased sputum production, which is slightly blood-streaked. She is a lifelong smoker.. A bronchoscopy shows the larger airways are hyperemic and swollen, covered by mucus. A biopsy shows hyperplasia of mucus secreting glands. There are also macrophages and a few neutrophils.. What disease does she have?
    Chronic bronchitis -
  5. 5. A 73 year old woman presents with haemoptysis and a muculopurulent sputum. A CXR shows a cavitated lesion located centrally in the major bronchi. Biopsy shows a well differentiated lesion showing keratin pearls and evidence of dysplasia.. What is the most likely cause and what has caused the muculopurulent sputum?
    Squamous cell carcinoma - atelectesis and infection.
  6. 6. A 27 year old female presents with sudden onset of dyspnoea.. A CXR shows a pleural line, with no lun markings beyond the line. A lung biopsy taken at a later date shows involvements is most noticeable close to the pleura, and along septa. A chest x ray shows bullae.. What is the most likely disease process, and what is the cause?
    Paraseptal emphysema - Unknown cause, but often seen with spontaneous pneumothorax in young adults.
  7. 7. A 71 year old man with a lifelong smoking history presents with dyspnea - he is hunched over and struggles to breathe out.. ABG is normal. What is the most likely disease process, and what is the cause?
    Centrilobular emphysema - Smoking
  8. 8. A 75 year old man presents with a chronic cough for the past 4 months.. ABG shows hypercapnia, hypoxaemia.. What disease does he have and what complications might you expect?
    Chronic bronchitis - Pulmonary hypertension, cardiac failure, recurrent infections, respiratory failure.
  9. 9. A 80 year old woman presents with acute onset of dyspnea.. ABG shows hypoxemia and CXR shows bilateral pulmonary edema. There is no evidence of heart failure.. What classification of disease does she have, and what are the 4 most common causes (2 direct, 2 indirect)?
    Acute lung injury - pneumonia, aspiration, sepsis, trauma with shock.
  10. 10. A 52 year old woman presents with acute SOB.. ABG shows hypoxia, pulmonary hypertension. D dimer is positive.. What should you consider?
    Pulmonary embolism -
  11. 11. A 71 year old man presents with life-threatening respiratory insufficiency and cyanosis.. ABG shows hypoxia, which is refractory to oxygen therapy. Histology shows diffuse alveolar damage. What problem does this man have?
    Acute respiratory distress syndrome -
  12. 12. A 51 year old woman presents with acute SOB and left to right shunting.. ABG shows hypoxia.. What should you consider and what may be long term effects?
    Pulmonary embolism - Pulmonary hypertension
  13. 13. A 25 year old man has a sudden death alone in the night.. At autopsy, the bronchi are occluded with mucous plugs. Histologically, the plugs contain Curschmann spirals, and Charcot-Leyden crystals.. What was the likely cause and what are the crystals formed from?
    Status asthmaticus - Eosinophil proteins
  14. 14. A 35 year old female with ascites presents with shortness of breath.. Atelectesis is present. What kind of atelectesis is likely to be present?
    Compression atelectesis at base of lungs. - secondary to ascites
  15. 15. A 91 year old man dies of type II respiratory failure. He is overweight, little is known of his life history.. Autopsy shows deep pink lungs which are not voluminous. The upper two thirds of the lungs are most severely affected. There is destruction of the alveolar walls without fibrosis.. What is the most likely disease process, and what is the cause?
    Centrilobular emphysema - Smoking
  16. 16. A 37 year old woman presents with peripheral painless lymphadenopathy. The nodes are not adherent.. Biopsy shows asteroid bodies.. What is the likely diagnosis and which cells are chiefly involved?
    Sarcoidosis - CD4+ T cells
  17. 17. A 4 year old boy presents with a wheeze which is worse on excersize. Biopsy shows chronic bronchial inflammation with eosinophils, bronchial smooth muscle cell hypertrophy and hyperreactivity, increased mucus secretion.. What is likely to be causing his symptoms and what kinds of T cells are involved?
    Asthma - T2 helper cells
  18. 18. A 71 year old woman presents with insiduous onset of a cough and dyspnea for the past 3 months. She has a considerable smoking history.. Biopsy shows findings consistent with usual interstitial pneumonia. There are also beaded golden brown rods present. The pleura show plaques of dense collagen.. What should you consider and what 2 major complications should you check for?
    Asbestosis - Malignant mesothelioma, lung carcinoma
  19. 19. A farmer is chronically exposed to moldy pressed sugar cane.. Biopsy shows interstitial noncaseating granulomas. What might this predispose her to and what is the causative particle?
    Bagassosis - Thermophilic actinomycetes
  20. 20. A 73 year old man has been a lifelong smoker. He presents with shortness of breath.. Biopsy shows macrophages with a dusty brown pigment, and mild interstitial fibrosis. Pulmonary function is mildly restrictive.. What is the diagnosis and what is treatment?
    Desquamative interstitial pneumonia - Steroid therapy and smoking cessation
  21. 21. A 73 year old man has been a lifelong smoker. He presents with shortness of breath and a dry cough.. Biopsy shows pigmented intraluminal macrophages in a 'bronchiolocentric' pattern, with mild peribronchiolar fibrosis.. What is the diagnosis and what is treatment?
    Respiratory bronchiolitis - Cessation of smoking.
  22. 22. An ex-miner has been asked to undertake some routine screening.. Biopsy shows silicotic nodules, with concentrically arranged hyalinized collagen fibres around an abnormal centre. Polarised microscopy shows weakly birefringent silica.. What disease is he likely to have and what may he be susceptible to?
    Silicosis - tuberculosis
  23. 23. A 34 year old male notices periodic shortness of breath.. Blood tests show eosinophilia, biopsy shows alveolar septa are thickened by an infiltrate containing eosinophils.. What syndrome is this and what is it classically caused by?
    Loeffler syndrome - Hookworm
  24. 24. A 80 year old man presents with hemoptysis.. Bloods show anaemia, CXR shows diffuse pulmonary infiltrate.. What group of diseases might this man have?
    Primary diffuse alveolar haemrrhage syndrome. -
  25. 25. A 46 year old man presents with a fever, cough and shortness of breath after visiting a friend's farm in Dorset. This clears in 3 days.. Bronchoalveolar lavage shows CD4+ and CD8+ T cells.. What is the most likely cause?
    Hypersensitivity Pneumonitis -
  26. 26. A 3 year old child presents having swallowed a button 6 hours ago.. Chest X ray shows mediastinal shift towards the right. There is also a small area of increased opacity on the right, and right upwards displacement of the hemidiaphragm.. What is the most likely cause?
    Resorption atelectasis -
  27. 27. A 58 year old woman presents shortness of breath. She has no smoking history.. CXR shows a peripherally located lesion with a central scar. On histopathology it is acinar in structure.. What is the most likely cause, what is its precursor and what mutation is commonly found?
    Adenocarcinoma - atypical adenomatous hyperplasia, k-ras mutations
  28. 28. A 79 year old man with known emphysema presents with acute onset shortness of breath.. CXR shows a pleural line with no lung markings beyond.. What was the most likely cause for his shortness of breath?
    Pneumothorax - due to bullous emphysema
  29. 29. A 35 year old woman presents with a cough and weight loss.. CXR shows bilateral hilar lymphadenopathy. Biopsy shows noncaseating epithelioid granuloma., containing Schaumann bodies and asteroid bodies.. What is the likely diagnosis and what is the possible lung sequelae
    Sarcoidosis - Diffuse interstitial fibrosis resulting in a honeycomb lung
  30. 30. A 29 year old man presents with shortness of breath which has been getting worse over the past 2 months.. CXR shows bilateral lymphadenopathy. Sputum culture is negative.. What classification of lung difficulty is he likely to experience?
    Sarcoidosis - Chronic restrictive.
  31. 31. An 81 year old woman with a history of congestive heart failure presents with shortness of breath. The base of her left lung is dull to percussion.. CXR shows blunting of the costophrenic angle. There is also atelectesis.. What kind of atelectesis is likely to be present?
    Compression atelectesis - secondary to pleural effusion.
  32. 32. A 46 year old male has a rapid onset of fever, dyspnea, hypoxia.. CXR shows diffuse pulmonary infiltrate. Lavage shows more than 25% eosinophils.. What is the most likely disease and how should it be treated?
    Acute eosinophilic pneumonia - Steroids
  33. 33. A 83 year old woman had a severe episode of atypical pneumonia 3 years before she died.. CXR shows irregular radiolucency. Patholoy shows irregular involvement of the acinus, with scarring.. What is the most likely disease process, and what is the cause?
    Irregular emphysema - Healed inflammatory disease.
  34. 34. A 39 year old male presents with hypovolaemic shock secondary to trauma from a road traffic accident. 12 hours later they develop dyspnea.. CXR shows non specific opacity. Lung biopsy shows neutrophil invasion and epithelial necrosis.. What classification of lung difficulty is he likely to experience?
    ARDS - acute restrictive disorder
  35. 35. A 71 year old female presents with a cough and dyspnnea. There is no apparent cause.. CXR shows subplerural pachy areas of air space consolidation. Biopsy shows polypoid plugs of loose organising connective tissue.. What is the diagnosis and prognosis?
    Cryptogenic organizing pneumonia - Recovery either spontaneously or with steroids.
  36. 36. A 45 year old woman with HIV presents with a high respiratory rate and a fever and presumed bacterial illness. 48 hours later she develops dyspnea, which is refractory to oxygen therapy.. CXR: bilateral opacities which are non specific. ABG: type I respiratory failure. Lung biopsy shows hyaline membranes lining the alveolar ducts.. What was the likely cause and what may be the future complications?
    Acute respiratory distress syndrome - Intra-alveolar fibrosis
  37. 37. a 45 year old man presents with sudden onset of shortness of breath.. CXR: Visceral pleural line is visible, with no lung markings beyond this line. Atelectesis is also present.. What kind of atelectesis is likely to be present?
    Compression atelectesis - secondary to pneumothorax.
  38. 38. A 32 year old woman has a fractured rib after a rugby match. She begins to vomit, and then begins to blow up 'like a balloon', with her head and neck swelling quickly.. Examination shows crepitations throughout the chest.. What is the most likely cause for these symptoms?
    Mediastinal emphysema -
  39. 39. A 42 year old woman presents with intermittent attacks of diarrhoea, flushing and cyanosis. She also has an insiduous cough.. Excised 'collar-button' lesion shows 'salt and pepper' chromatin.. What should you consider?
    Carcinoid tumour. -
  40. 40. A mass is excised from the lungs of a 71 year old man.. Histology shows a pale gray, centrally located mass with extension into the lun parenchyma. There is involvement of the hilar and mediastinal nodes. Cells are round, with scant cytoplasm and finely granular chronatin. Mitotic fiures are present. There is. What is this and what is the prognosis?
    Small cell carcinoma - Poor
  41. 41. A 65 year old man persents with an insiduous onset of a non-productive cough and progressive dyspnea. On examination, he has dry inspiratory crackles. There is no apparent cause. Histology shows mild/moderate chronic interstitial inflammation, without heterogeneity.. What should you consider? What is the prognosis?
    Nonspecific interstitial pneumonia - Better than IPF
  42. 42. In the pathology lab, you receive a lung specimen of a 68 year old female, with the clinical details 'dyspnea'. Histology shows neutrophil invasion in vascular space, interstitium and alveoli.. What is the most likely cause and which interleukin is the main mediator
    Acute respiratory distress syndrome - IL-8
  43. 43. A 23 year old man with a history of cystic fibrosis has developed muculopurulent sputum and haemoptysis.. Hypoxemia, hypercapnea, cor pulmonale.. What is the most likely cause of this?
    Bronchiectasis -
  44. 44. A 34 year old woman is recovering from her Klebsiella infection. She has developed a severe, persistent cough with mucopurulent sputum.. Hypoxemia, hypercapnea, CXR shows tramtrack opacities.. What is the most likely cause of this?
    Bronchiectasis -
  45. 45. Presentation. Investigations. Question
    Disease - Further information
  46. 46. A 55 year old smoker is noticed to be hypoxic. Later in his life he has a pneumectomy.. Investigations show a ventilation-perfusion imbalance. The pathology report comments on collabse of part of the lobe, with a mucous plug at the bronchiolar level.. What does this describe and what are 3 common causes in adults?
    Resorption atelectasis - Postoperative, bronchial asthma, bronchiectasis, chronic bronchitis.
  47. 47. A nodule is excised from the lung of a 61 year old man.. It is 2.5cm in size, grows in a monolayer along alveolar septa and preserves alveolar architecture.. What is this?
    Adenocarcinoma in situ. -
  48. 48. A 49 year old man presents with shortness of breath, particularly on exertation. He smokes about 1 pack/week.. Lung biopsy shows acini are mainly affected at the central and proximal parts ot the acini.. What is the most likely disease process, and what is the cause?
    Centrilobular emphysema - Smoking
  49. 49. A 49 year old man presents with shortness of breath, particularly on exertation. He smokes about 1 pack/week.. Lung biopsy shows acini are uniformly enlarged, with damage mainly in the lower lung zones.. What is the most likely disease process, and what is the cause?
    Panacinar emphysema - Smoking + alpha-1 antitrypsin deficiency
  50. 50. A 52 year old man presents with dyspnea, which is refractory to oxygen treatment. He recovers and a biopsy is taken a week later.. Lung biopsy shows type II pneumocytes proliferating vigorously.. What was the likely cause and what may be the future complications?
    Organisation stage of Acute respiratory distress syndrome - Intra-alveolar fibrosis
  51. 51. A 43 year old man dies of liver failure. Cause of death is uncertain, so autopsy is performed.. Lungs are pale and voluminous, obscuring the heart when the chest wall is removed.. What is the most likely disease process, and what is the cause?
    Panacinar emphysema - alpha-1 antitrypsin deficiency
  52. 52. A 58 year old man presents with dehydration, haematuria and shortness of breath. He dies rapidly.. On autopsy, the lungs are heavy with areas of red-brown consolidation. Microscopy shows focal necrosis. Hemosiderin is present. There is a linear pattern of immunolobulin deposition in both the kidneys and alveoli.. What should you consider?
    Goodpasture syndrome. -
  53. 53. A 13 year old boy presents with shortness of breath.. On autopsy, the lungs are heavy with areas of red-brown consolidation. Microscopy shows focal necrosis. Hemosiderin is present. There is a linear pattern of immunolobulin deposition in the alveoli. Kidney biopsy is normal.. What should you consider?
    Idiopathic pulmonary hemosiderosis -
  54. 54. A 91 year old man dies of heart failure.. On autopsy, there are atheromas of the main pulmonary arterites, proliferation of smooth muscle in medium sized arteries. There is thickening of walls in small arteries.. What are the likely causes of this?
    Pulmonary hypertension -
  55. 55. A 38 year old man presents with chronic sinusitis, epistaxis, haemoptysis.. P-ANCA is positive. Lung biopsy shows necrotising vasculitis and parenchymal necrotizing granulomatios inflammation. What is the likely diagnosis?
    Pulmonary angiitis -
  56. 56. A 81 year old man with lung fibrosis secondary to chemotherapy, dies of hypoxia.. Pathology report notes atelectesis.. What kind of atelectesis is likely to be present?
    Contraction atelectesis - Secondary to fibrosis.
  57. 57. A 5 year old girl presents with a wheeze and shortness of breath.. She has a wheal and flare reaction to pollen.. What is the likely cause and what kind of hypersensitivity reaction is this?
    Atopic asthma - Type I hypersensitivity reaction
  58. 58. A 65 year old man persents with an insiduous onset of a non-productive cough and progressive dyspnea. On examination, he has dry inspiratory crackles. There is no apparent cause. Spirometry shows reduced compliance, CXR shows patchy areas of ground glass shadows in the periphery, consistent with Usual Interstitial Pneumonia'. What is the most likely cause of this? What is the prognosis?
    Idiopathic pulmonary fibrosis - Median survival is 3 years.
  59. 59. In the pathology lab, you receive a lung specimen of a 61 year old female, with the clinical details 'dyspnea'. The lungs are dark red, firm, airless and heavy. Microscopic examination shows capillary congestion, necrosis of epithelial cells, interstitial oedema and harmorrhage, and neutrophils. There are hyaline membranes around the alveolar ducts.. What is the likely cause and which stage is this patient in?
    Acute respiratory distress syndrome - acute phase (particularly characteristic are hyaline membranes)
  60. 60. A mass is excised from the lungs of a 71 year old man.. This is an undifferntiated malignant epithelial tumour, lacking the cytological features of small cell carcinoma. Thare are large prominent nucleoli, moderate cytoplasm.. What is this?
    Large cell carcinoma -
  61. 61. A 15 year old girl has lived in lived in the city all her life. Since having a cold last week, she has noticed a wheese.. Wheal and flare tests are negative, there is no family history. What is the most likely cause of this?
    Non-Atopic Asthma -
  62. 62. You are in the pathology lab. You are sent a biopsy labelled 'dyspnea, smoker'.. You note air space enlargement, wall destruction. What is the most likely disease process, and what is the cause?
    Centrilobular emphysema - Dyspnea
  63. 63. You are in the pathology lab. You are sent a biopsy labelled 'purulent sputum, smoker'.. You note airway dilation and scarring. What is the most likely disease process, and what is the cause?
    Bronchiectasis - chronic or severe infection
  64. 64. You are in the pathology lab. You are sent a biopsy labelled 'dyspnea, smoker'.. You note inflammatory scarring, partial obliteration of bronchioles. What is the most likely disease process, and what is the cause?
    Bronchiolitis - Smoking
  65. 65. You are in the pathology lab. You are sent a biopsy labelled 'sputum production, smoker'.. You note mucous gland hypertrophy and hyperplasia, hypersecretion.. What is the most likely disease process, and what is the cause?
    Chronic bronchitis - smoking
  66. 66. You are in the pathology lab. You are sent a biopsy labelled 'wheeze, smoker'.. You note smooth muscle hypertrophy and hyperplasia, excessive mucus, inflammation. What is the most likely disease process, and what is the cause?
    Asthma - Immunologic
  67. 67. . . What are the 3 types of atelectesis?
    Resorption atelectasis, compression atelectasis, contraction atelectasis -
  68. 68. . . What 2 properties identify Acute Respiratory Distress Syndrome?
    Diffuse alveolar capillary and epithelial damage. -
  69. 69. . . What are the 4 major diffuse obstructive disorders?
    Emphysema, chronic bronchitis, bronchiectasis, asthma -
  70. 70. . . How is obstructive disorder defined?
    Decreased FEV:FVC -
  71. 71. A 43 year old woman presents with hip numbness which is spreading to her toes, and an onset of breathing difficulties.. . What classification of lung difficulty is she likely to experience
    Guillain-Barre syndrome. - Restrictive disorder
  72. 72. A 31 year old woman presents with sleep apnoea. You note that she is extremely obese.. . What classification of lung difficulty is she likely to experience?
    Obesity - Restrictive disorder
  73. 73. . . What 3 types of lung disease most commonly cause chronic restrictive lung disease?
    Pneumoconiosis, cryptogenic interstitial fibrosis, infiltrative conditions -
  74. 74. A 57 year old woman has a lobectomy due to carcinoma. Her doctor comments that her other lobes may now be suspect to emphysema.. . What is the doctor referring to?
    Compensatory emphysema. -
  75. 75. A 54 year old woman is discharged to the community from a lifethreatening admission due to lung overinflation.. . What are you now concerned about?
    Tumour causing lung overinflation. -
  76. 76. A 71 year old woman has been a smoker all her life. She presents in the community with a persistent productive cough for the past 3 months. She has also noticed increased sputum production and a slight wheeze.. . What disease does she have?
    Chronic bronchitis -
  77. 77. A 19 year old boy presents with rhinitis, urticaria and a wheeze.. . Which drug is the most likely cause for this?
    Aspirin -
  78. 78. . . Which 3 heriditary conditions predispose to bronchiectasis?
    cystic fibrosis, immunodeficiencies, kartagener syndrome -
  79. 79. . . Overall, what are the 2 main causes of bronchiectasis?
    Cystic fibrosis, post-infectious -
  80. 80. A 43 year old man is diagnosed with an interstitial lung disease. . What kind of lung disease is this?
    Restrictive -
  81. 81. A 61 year old factory worker is told he has a pneumoconiosis. . What are the 3 most common types of pneumoconioses?
    Coal worker's, silicosis, asbestosis -
  82. 82. A 58 year old woman has worked in an asbestos factory for most of her life. She now has asbestosis.. . Which cell is most involved in the process of injury and fibrosis?
    Pulmonary alveolar macrophage - These induce IL-1 production.
  83. 83. A 76 year old man has coal worker's lung.. . What is his chance of lung carcinoma?
    The same as the normal population. -
  84. 84. An ex-miner with a history of silicosis presents with acute shortness of breath and a fever.. . What infectious disease may she have?
    Tuberculosis -
  85. 85. . . Which cancer drug is associated with fibrosis?
    Bleomycin -
  86. 86. . . Which antiarrhythmic is associated with fibrosis?
    Amiodarone -
  87. 87. A 32 year old woman presents with raised, red tender nodules on the anterior aspects of the legs. She also has had an iritis and dry eyes.. . What is the likely diagnosis and what is the possible lung sequelae
    Sarcoidosis - Diffuse interstitial fibrosis resulting in a honeycomb lung
  88. 88. A 31 year old woman presents with painful enlarged parotid glands and a dry mouth. She has a previous diagnosis of sarcoidosis.. . What syndrome does she have?
    Mikulicz syndrome -
  89. 89. A farmer is chronically exposed to moldy hay.. . What might this predispose her to and what is the causative particle?
    Farmer's lung - Micropolyspora faeni
  90. 90. . . What are the three main causes of pulmonary hypertension?
    Chronic obstructive or interstitial lung disease, precurrent PE, congestive heart failure. -
  91. 91. . . What are the 3 types of primary diffuse alveolar haemorrhage syndromes?
    Goodpasture syndrome, idiopathic pulmonary haemosiderosis, Wegener granulomatosis -
  92. 92. What are the 4 main types of lung cancer?
    adenocarcinoma, squamous cell cancer, small cell lung cancer, large cell carcinoma -
  93. 93. A 52 year old woman is diagnosed with lung adenocarcinoma.. . What is the most common mutation in the cancer genome?
    EGFR -
  94. 94. A 61 year old man has just stopped smoking and wants to know which cancers he is at risk for.. . Which 2 lung cancers have the strongest association with tobacco smoking?
    Squamous and small cell carcinoma. -
  95. 95. A 64 year old female has been a smoker all her life. She presents with ptosis, and blurry vision, and a dry eye.. . What is this and what might you expect to find?
    Pancoast tumour - An apical neoplasm.

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