Question 1

A 56-year-old woman has worked in a photography shop developing film for the past 20 years.She has a long history of shortness of breath and chronic cough,which have progressively become worse.Her forced expiratory volume in 1 second (FEV₁)and forced vital capacity (FVC)values were reduced,but the FEV₁/FVC ratio was within the normal range.Her diffusion capacity,as measured with diffusion of carbon monoxide in the lungs (DLco),was low,at 15 mL/minute/mm Hg.Bronchoalveolar lavage and tissue biopsy were performed.The lavage sample revealed high numbers of abnormal-appearing macrophages and high numbers of dead macrophages. What type of lung disease do you suspect?

A)Restrictive disease
B)Obstructive disease
C)Infectious disease
D)Lung cancer
E)Genetically inherited disease

A

Accepted Answer

The patient's history of working in a photography shop and the presence of abnormal-appearing macrophages in the lavage sample suggest an occupational lung disease called lipoid pneumonia. This is caused by the inhalation of lipid substances, such as the mineral oil used in developing film, which can accumulate in the lung tissue and cause a granuloma-like lesion in the terminal bronchioles with interstitial fibrosis and large foamy macrophages. This is the most likely pathologic process in this case. Peribronchial inflammation with eosinophils would suggest asthma or allergic bronchopulmonary aspergillosis, which is not supported by the patient's history or test results. Interstitial edema fluid accumulation with neutrophil infiltrate would suggest acute interstitial pneumonia or acute respiratory distress syndrome, which does not fit with the chronicity of the patient's symptoms. Emphysema would cause destruction of alveolar walls and enlargement of air spaces, which is not consistent with the low diffusion capacity seen in this case.

Question 2

A 56-year-old woman has worked in a photography shop developing film for the past 20 years.She has a long history of shortness of breath and chronic cough,which have progressively become worse.Her forced expiratory volume in 1 second (FEV₁)and forced vital capacity (FVC)values were reduced,but the FEV₁/FVC ratio was within the normal range.Her diffusion capacity,as measured with diffusion of carbon monoxide in the lungs (DLco),was low,at 15 mL/minute/mm Hg.Bronchoalveolar lavage and tissue biopsy were performed.The lavage sample revealed high numbers of abnormal-appearing macrophages and high numbers of dead macrophages. What type of lung disease do you suspect?

A)Restrictive disease
B)Obstructive disease
C)Infectious disease
D)Lung cancer
E)Genetically inherited disease

Accepted Answer

The patient's symptoms, reduced forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) with a normal FEV1/FVC ratio, along with a low diffusion capacity (DLco) and the presence of abnormal-appearing macrophages in the bronchoalveolar lavage, suggest a restrictive lung disease. This pattern is indicative of a disease that restricts lung expansion, leading to reduced lung volumes.

Question 3

A 56-year-old woman has worked in a photography shop developing film for the past 20 years.She has a long history of shortness of breath and chronic cough,which have progressively become worse.Her FEV₁ and FVC values were reduced,but the FEV₁/FVC ratio was within the normal range.Her diffusion capacity,as measured by DLco,was low,at 15 mL/min/mm Hg.Bronchoalveolar lavage and tissue biopsy were performed.The lavage sample revealed high numbers of abnormal-appearing macrophages and high numbers of dead macrophages. What is the specific diagnosis?

A)Allergic airway disease
B)Chronic bronchitis
C)Silicosis
D)Pneumoconiosis
E)Tuberculosis

Accepted Answer

The patient's history of exposure to photography chemicals suggest occupational exposure to silica, which is commonly used in developing agents. The symptoms of shortness of breath and chronic cough, along with the abnormal macrophages seen in the lavage sample, are consistent with silicosis. The decreased DLco also supports this diagnosis. Allergic airway disease and tuberculosis would have different symptoms and imaging findings. Chronic bronchitis is a possibility, but the abnormal macrophages suggest a more specific diagnosis. Pneumoconiosis is a general term describing lung diseases caused by mineral dust exposure, of which silicosis is a type.

Question 4

A 50-year-old male coal miner has a long history of lung disease.Where in the lung would you expect to find the greatest deposition of inhaled coal dust?&#10;A)Terminal bronchioles&#10;B)Bronchi&#10;C)Nonrespiratory bronchioles&#10;D)Alveolus&#10;E)Trachea

Accepted Answer

The answer of A 50-year-old male coal miner has a...

Question 5

A 16-year-old girl develops shortness of breath,runny nose,wheezing,and chest tightening with no fever.A spirometry test is performed and reveals that her FEV₁ is reduced and the ratio of FEV₁ to FVC is abnormal.Her FEV₁ improves by 15% after bronchodilator use.A chest radiograph is also obtained.The family mentions that they purchased a cat several weeks ago.You suspect allergic asthma. Increased levels of what type of serum antibody would you like to see to confirm your diagnosis?

A)Immunoglobulin A (IgA)
B)IgG
C)IgM
D)IgE
E)IgD

Accepted Answer

Allergic asthma is a type of asthma triggered by an immune response to an allergen. In this case, the cat may be the allergen responsible for triggering the asthma symptoms. IgE is the serum antibody responsible for allergic reactions, including allergic asthma. Increased levels of IgE would support the diagnosis of allergic asthma.

Question 6

The four cell types that contribute to the quantity and composition of mucus include:&#10;A)Type II epithelial cells,mucous and serous cells within the submucosal tracheobronchial glands,and Clara cells&#10;B)Type II epithelial cells,mucous cells within the submucosal tracheobronchial glands,goblet cells,and Clara cells&#10;C)Type II epithelial cells,mucous and serous cells within the submucosal tracheobronchial glands,and goblet cells&#10;D)Goblet cells,mucous and serous cells within the submucosal tracheobronchial glands,and Clara cells

Accepted Answer

Goblet cells, mucous and serous cells within the submucosal tracheobronchial glands, and Clara cells are the correct cell types that contribute to the quantity and composition of mucus. Goblet cells and mucous cells within glands produce mucus, serous cells contribute to the liquid component, and Clara cells, found in the bronchioles, have a secretory function that contributes to the airway lining fluid. Type II epithelial cells are primarily involved in surfactant production in the alveoli, not mucus production in the airways.

Deck 26: Non-Physiologic Functions of the Lung: Host Defense and Metabolism