#3 Zaman - Lung Pathology - 1

Question 1

A 35 year old patient comes in with a 70 pack year history. What exacerbating factors of injury will likely be present?

Answer 1

Injury to mucociliary apparatus

Decreased phagocytic activity

Decreased protective mechanisms

Question 2

Would you see pleural effusion in a patient with 40 years of exposure to asbestos?

Answer 2

No. Pleural effusion is seen early on in the disease.

Question 3

What imaging would you order to confirm asbestosis?

Answer 3

Radiologic imaging

Question 4

Which pulmonary lesions are required for a diagnosis of Asbestosis?

Answer 4

Pulmonary Fibrosis and Pulmonary Plaques (10-20 years)

Pleural calcification (end stage)

Question 5

On the radiological imaging of the asbestosis patient, where would you expect to find the neoplasm?

Answer 5

The Malignant Mesothelioma is a neoplasm in the pleura of the lung.

Question 6

Identify

Answer 6

Type 1 pneumocyte

Squamous pneumocyte

Thin area for gas exchange

susceptible to inhaled agents

Question 7

Identify

Answer 7

Type II pneumocytes

Granular pneumocyte

Surfactant secreting alveolar epithelial cell

Question 8

Identify

Answer 8

Asbestos exposure

Discrete fibrocalcific plaques on the pleural surface of the diaphragm.

Question 9

Identify

Answer 9

Asbestos Body

Typical beading and knobbed ends

Ferrugenous body

Metaplasia of type I to type II pneumocytes

Question 10

Identify

Answer 10

Silicosis

Fibrotic lesion of black

Hard coal miners

excessive release of fibrogenic cytokines

Question 11

Identify

Answer 11

Coal worker’s pneumoconiosis

large blackened scars primarily in upper lobe

Question 12

Identify

Answer 12

Hypersensitivity pneumonitis

Cough

Dyspnea

Fever

Rales

Non-caseating granulomas

Question 13

A lawyer calls you up and asks about the mechanism of injury for his client who has mesothelioma. What would you say was the cause?

Answer 13

Asbestos fibers are inhaled and are not easily removed via the mucociliary route. As a result they impale the epithelial cells, the interstitium, the lymphatics and the lymph nodes. The person then gets a fibrotic response leading to pulmonary fibrosis.

Question 14

One of your clients is in Egypt working on the restoration of the pyramids. What disease will likely be in his future?

Answer 14

Silicosis

Occupational Lung Disease (OLD)

Also seen in hard coal miners due to silicon dioxide

Silica is toxic to macrophages resulting in excessive release of fibrogenic cytokines.

Question 15

You identify a noncaseating granuloma in the lung with hilar lymphadenopathy. What do you suspect?

Answer 15

Berylliosis

Increased risk of lung cancer

Not sarcoidosis

Question 16

Patient’s culture just came back positive for actinomyces. What disorders could he have?

Answer 16

Farmer’s lung (chronic hypersensitivity/granulomas)

Bagassosis - hypersensitivity pneumonitis (actinomyces, sugar cane, hemp)

Bagasse is the leftover pulp from sugracane production.

Question 17

Patient works at the local cotton gin and comes in wheezing and coughing with SOB. You diagnose him with Byssinosis. What is causing the reaction?

Answer 17

Probably due to interleukins produced by endotoxin exposure

Also known as “brown lung disease”

reversible allergic-type reaction

Question 18

You originally diagnosed your patient with Farmer’s lung becuase he had recently stored a bunch of hay in his barn loft. He has not gotten better. His labs came back and MHb levels are increased due to NO2 inhalation. What is your new Ddx?

Answer 18

Silofiller’s lung