Pulmonology

Question 1

Disease?

Answer 1

Asthma

smooth muscle hypertrophy, mucus gland proliferation, prominent basement membrane (black arrows)

Question 2

Disease

Answer 2

Asthma

accumulation of mucus in lumen of bronchus (yellow star), smooth muscle hypertrophy (black arrow)

Question 3

Answer 3

squamous metaplasia in center area of epithelium

Question 4

Answer 4

squamous metaplasia of entire epithelium

Question 5

Answer 5

goblet cell hyperplasia

Question 6

Answer 6

centriacinar/centrilobar emphysema (most common, associated with smoking)

Question 7

Answer 7

panacinar emphysema (associated with alpha-1 anti-trypsin genetic insufficiency)

Question 8

Answer 8

centriacinar/centrilobar emphysema (most common, associated with smoking)

Question 9

Answer 9

panacinar emphysema (associated with alpha-1 anti-trypsin genetic insufficiency)

Question 10

Disease?

Answer 10

emphysema (alveolar changes)

Question 11

Disease?

Answer 11

chronic bronchitis (increased Reid index, >0.5)

Question 12

Disease?

Answer 12

chronic bronchitis (bronchus shows wall thickened by chronic inflammation)

Question 13

Disease?

Answer 13

chronic bronchitis (marked goblet cell hyperplasia)

Question 14

Answer 14

hyperinflated lungs in patient with emphysema

Question 15

Answer 15

increased lung markings in patient with chronic bronchitis

Question 16

Disease?

Answer 16

bronchiectasis

Question 17

Disease?

Answer 17

bronchiectasis (arrows show dilated bronchi)

Question 18

Disease?

Answer 18

bronchiectasis (dilation of bronchiole with a chronic inflammatory infiltrate in the lumen)

Question 19

Organism?

Answer 19

C. diphtheriae (gram positive rods)

Question 20

Organism?

Answer 20

S. pneumoniae (gram positive diplococci)

Question 21

Organism

Answer 21

Pseudomonas aeruginosa (gram negative rod; pyrocyanin/pyoverdin = conspicuous blue-green pigment)

Question 22

Pathology?

Answer 22

dense consolidation of lower lobe

Question 23

Pathology?

Answer 23

prominent vascular congestion of alveolar capillaries

Question 24

Pathology?

Answer 24

pulmonary edema: alveolar walls contain congested capillaries, plasma from the blood has moved into alveolar spaces

Question 25

Pathology?

Answer 25

red hepatization: lungs are heavy, red, and airless

Question 26

Pathology?

Answer 26

red hepatization: acute inflammatory cells and blood

Question 27

Pathology?

Answer 27

gray hepatization: gray-brown, dry surface

Question 28

Pathology?

Answer 28

gray hepatization micro: exudates of deteriorating WBC, fibrin, and RBC contracts, yielding clear zone adjacent to alveolar walls

Question 29

Pathology?

Answer 29

organizing pneumonia: virulent organism damaged basement membrane, leading to repair reaction - fibroblasts move in and secrete collagen

Question 30

Pathology?

Answer 30

organizing pneumonia (trichrome stain)

Question 31

Pathology?

Answer 31

bronchopneumonia (granular consolidation, often adjacent to major airways; pale-colored, firm nodules)

Question 32

Pathology?

Answer 32

bronchopneumonia micro (alveoli filled with edema fluid, extravasated RBC, bacteria, PMN, some alveolar macrophages)

Question 33

Pathology?

Answer 33

aspiration pneumonia (foreign material inside of foreign body giant cells and surrounding inflammatory cells)

Question 34

Viral pneumonia manifestation?

Answer 34

bronchiolitis (peribronchiolar collections of lymphocytes, epithelial damage and sloughing, squamous metaplasia, mucus plugging of bronchioles)

Question 35

Viral pneumonia manifestation?

Answer 35

interstitial pneumonia (lymphocytes and plasma cells within alveolar walls and around small airways; hyaline membranes may be present)

Question 36

Viral pneumonia manifestation

Answer 36

pneumonia associated with viral inclusions (CMV)

Question 37

Distribution of what fungi?

Answer 37

Histoplasma capsulatum (histoplasmosis); endemic in Ohio and Mississippi River valleys; growth in soil enhanced high in nitrogen content (bat and bird droppings)

Question 38

Distribution of what fungi?

Answer 38

Coccidioides immitis (coccidiomycosis); endemic to San Juaquin Valley, southwest US, Mexico, and parts of Central and South America

Question 39

Distribution of what fungi?

Answer 39

Blastomyces dermatitidis (blastomycosis); endemic east of Mississippi River

Question 40

Carcinoma precursor lesion type?

Answer 40

Atypical adenomatous hyperplasia subtle thickening of an area of lung parenchyma and some hyperplasia of the glandular epithelium

Question 41

Carcinoma precursor lesion type?

Answer 41

Adenocarcinoma in situ proliferation and tufting of glandular epithelium that also shows cellular atypia, but doesn't invade into alveolar wall can become invasive Adenocarcinoma

Question 42

Carcinoma precursor lesion type?

Answer 42

Squamous dysplasia and carcinoma in situ can become invasive squamous cell carcinoma

Question 43

Pathology?

Answer 43

squamous metaplasia

Question 44

Carcinoma type?

Answer 44

squamous cell carcinoma usually centrally located (coming from bronchus)

Question 45

Carcinoma type?

Answer 45

squamous cell carcinoma keratinization (squamous pears or individual cells with eosinophilic, dense cytoplasm)

Question 46

Carcinoma type?

Answer 46

adenocarcinoma

Question 47

Carcinoma type?

Answer 47

adenocarcinoma (acinar subtype)

Question 48

Carcinoma type?

Answer 48

adenocarcinoma (lepidic subtype)

Question 49

Carcinoma type?

Answer 49

small cell carcinoma (very little cytoplasm = blue appearance

Question 50

Tumor type?

Answer 50

carcinoid tumor (grows shows lesion covered in intact mucosa [might present with breathing obstruction/wheezing], micro shows carcinoid islands)

Question 51

Tumor type?

Answer 51

hamartoma (coin lesion); prominent cartilage and connective tissue with respiratory epithelium

Question 52

Tumor type?

Answer 52

malignant mesothelioma

Question 53

Answer 53

organizing pneumonia

Question 54

Disease?

Answer 54

pulmonary fibrosis

Question 55

Disease?

Answer 55

usual interstitial pneumonia

Question 56

Disease?

Answer 56

interstitial pulmonary fibrosis/ usual interstitial pneumonia

Question 57

Disease?

Answer 57

non-specific interstitial pneumonia

Question 58

Disease?

Answer 58

acute interstitial pneumonia (Hamman-Rich Syndrome); alveolar walls are lined with waxy hyaline membranes

Question 59

Disease?

Answer 59

desquamative interstitial pneumonia (accumulation of large numbers of macrophages within alveolar spaces and only mild fibrous thickening of the alveolar walls)

Question 60

Disease?

Answer 60

respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)

Question 61

Disease?

Answer 61

pulmonary Langerhans histiocytosis

Question 62

Disease?

Answer 62

pulmonary eosinophilia

Question 63

Disease?

Answer 63

pulmonary alveolar proteinosis