Pulmonary block 3 answers

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don't look 'till you finish the exam. it's tempting to look, but it will offset your real % if you see answers to the other questions, good luck.










92 (C) Match on 92. Aspirin sensitivity is a cause for asthma with bronchospasm.
93 (A) Match with 93. Asbestosis can, as other pneumoconioses, produce fibrous pleural plaques. With asbestosis, they are mainly diaphragmatic. Interstitial fibrosis may also be present.
94 (B) Match on 94. The nodular pattern and the upper airway involvement suggest the diagnosis of Wegener's granulomatosis.
95 (E) Match with 95. The multiple emboli reach small peripheral arteries and then organize, eventually leading to pulmonary hypertension.
96 (E) Match on 96. A bronchioloalveolar carcinoma may mimic pneumonia.
97 (C) Match with 97. A pulmonary hamartoma is a solitary benign lesion.
98 (E) Match on 98. There are no real characteristic pathologic features of chronic bronchitis -- it is defined clinically.
99 (B) Match with 99. Moldy hay contains thermophilic actinomycetes which produce the allergic alveolitis.
100 (D) Match on 100. PCP is seen in immunocompromised persons.
101 (E) Match with 101. Secondary TB is most often seen in adults and the granulomas are caseating and tend to cavitate when large.
102 (A) Match on 102. The desert southwest of the U.S. is the endemic location for Coccidioides immitis.
103 (D) Match with 103. Histoplasma capsulatum is endemic to the Mississippi and Ohio river regions of the U.S.
104 (D) Match on 104. Fat embolism syndrome typically includes fat droplets in pulmonary and brain vasculature. The ORO stain helps to highlight them.
105 (C) Match with 105. The alveolar exudates of pulmonary alveolar proteinosis, an uncommon idiopathic disease, are PAS positive.
106 (B) Match on 106. In Goodpasture's syndrome, there is IgG directed against the basement membrane, with complement activation. This is a form of type II hypersensitivity reaction.
107 (A) Match with 107. Bronchial asthma is an allergic response. Sensitization to an antigen leads to fixation of IgE on mast cells, and when the allergen is again encountered, the mast cells degranulate, releasing vasoactive substances to produce a localized form of type I hypersensitivity reaction.
108 (D) Match on 108. Streptococcus pneumoniae (pneumococcus) typically produces a community acquired lobar pneumonia.
109 (B) Match with 109. Nocardia asteroides and Actinomyces israeli tend to produce chronic abscessing pneumonias, particularly in immunocompromised patients.
110 (C) Match on 110. H. influenzae can produce an acute epiglottitis.
111 (E) Match with 111. N. meningitidis starts as a pharyngitis. It may become a meningitis. A few people become carriers and harbor this organism in the pharynx.
112 (B) Match on 112. A bronchial adenoma, of which a carcinoid tumor is one form, could produce localized bronchial obstruction leading to localized bronchiectasis.
113 (A) Match with 113. A peripheral 'coin lesion' could be a granuloma, carcinoma, or hamartoma. The most likely primary malignancy in a non-smoker would be adenocarcinoma.
114 (C) Match on 114. Chronic berylliosis mimics sarcoidosis but is extremely rare.
115 (A) Match with 115. The silica crystals are polarizable and can be found throughout the lung of a patient with silicosis.
116 (D) Match on 116. Pleural metastases are associated with serosanguineous effusions. Tuberculosis and fungal infections can do the same.
117 (B) Match with 117. Rheumatic heart disease leads to congestive heart failure, which leads to pleural effusions that are transudates and pulmonary edema.
118 (A) CORRECT. Emphysema is characterized by destruction with loss of lung parenchyma. There may be scarring secondarily from infection, but the pathogenesis does not involve fibrosis.
119 (E) CORRECT. The greenish staining should alert you to potential meconium aspiration, which may occur near term when there is fetal distress and meconium is released into the amniotic fluid. Gasping reflexes by the fetus result in aspiration.
120 (C) CORRECT. Eosinophilic granuloma is a localized lesion that is part of the spectrum of Langerhans cell histiocytosis, seen in children as histiocytosis X. In adults, the lesions tend to form small scars and resolve with time. This uncommon condition has a mean age of 30, with a 2:1 F:M predominance. The Langerhans cells are the key to the diagnosis.
121 (E) CORRECT. The BAL is a good means for diagnosing infections, particularly Pneumocystis and bacterial infections. The lungs are sampled widely, reducing sampling error. The technique does not have the morbidity or mortality of thoracic surgery.
122 (D) CORRECT. These findings are most typical for infection with RSV, which can occur in epidemics. RSV affects young children more than adults.
123 (C) CORRECT. Bloody effusions should suggest a neoplasm, metastases more often than primary. Infectious agents such as M. tuberculosis may also produce serosanguinous effusions.
124 (B) CORRECT. These are findings with chronic passive pulmonary congestion. Left heart failure would be suspected.
125 (B) CORRECT. Hospitalized, immobile patients are at risk for deep vein thrombosis and pulmonary embolism. Patients with pre-existing heart or lung disease are at risk for pulmonary infarction with a medium-sized embolus.