Diseases of the Bronchi and Bronchioles

Question 1

A patient dies and the surface of his airway is fiery red. What is the likely infectious agent?

Answer 1

Influenza

Question 2

A patient is infected with a microorganism, begins to recover and dies. On autopsy, the bronchioles show signs of obliterative bronchiolitis. What is the Dx?

Answer 2

Adenovirus infection

Question 3

A child acquires a respiratory infection from a nursery. What is the likely infectious agent?

Answer 3

Respiratory Syncytial virus

Question 4

A patient is admitted to the hospital with bouts of coughing followed by a whooping inspiration. What is your Dx? What portions of the respiratory tract would be inflamed?

Answer 4

Bordetella Pertussis (Whooping Cough); Bronchi and bronchioles

Question 5

A patient working at a welding factory and grain silo goes home for the weekend and begins to experience dyspnea and cough late Saturday evening. The cough and dyspnea resolve. What is your Dx? What is a more serious complication of this disease?

Answer 5

Silo-filler disease caused by NO2 inhalation; Bronchiolitis obliterans and death due to respiratory failure

Question 6

From what source is SO2 produced?

Answer 6

Burning fossil fuels

Question 7

A biopsy of a patients bronchiole is shown below with necrosis, ulceration, and granulomatous inflammation. What is the Dx?

Answer 7

Bronchocentric granulomatosis

Question 8

What two groups of patients does bronchocentric granulomatosis predominate? What complicates the condition in each patient subtype?

Answer 8

Asthmatic - allergic bronchopulmonary aspergillosis

Non-asthmatic - Infection, especially with tuberculosis or fungi (such as Histoplasma capsulatum)

Question 9

A patient presents with dyspnea and wheezing. The patient recently had a bone marrow transplant. The biopsy of the patients bhronchiole is shown below. What is the Dx? What other conditions is this disease associated with? What is the pathologic progression of this condition?

Answer 9

Constrictive bronchiolitis;

1. Lung transplantation
2. Collgen vascular diseases
3. Postinfectious disorders
4. Inhalation of toxins
5. Ingestion of certain drugs

Infalmmation, bronchiolar scarring, fibrosis, progressive narrowing, obliterative bronchiolitis

Question 10

What does bronchial obstruction often lead to?

Answer 10

Atelectasis

Question 11

Describe the pathophysiology leading to atelectasis

Answer 11

1. If air supply is obstructed, air in the alveoli will transfer to the blood causing collapse of the lung. The mediastinum will move toward the affected side.
2. IF compression occurs and is severe enough the lung may compress and the mediastinum will shift away from the affected side

Question 12

What is Right middle lobe syndrome?

Answer 12

Atelectasis due to obstruction of the bronchus to the right middle lobe. This particular lobe is susceptible to external compression because it is long and slender and surrounded by lymph nodes

Question 13

What is bronchiectasis? What is it caused by?

Answer 13

Irreversible dilation of bronchi caused by destruction of bronchial wall muscle and elastic elements

Question 14

What are the subtypes of bronchiectasis?

Answer 14

1. Obstructive
2. Localized Nonobstructive
3. Generalized Nonobstructive

Question 15

What is obstructive bronchiectasis?

Answer 15

Localized bronchiectasis that occurs to a mechanical obstruction (tumors, inhaled objects, etc)

Question 16

What is Localized Nonobstructive bronchiectasis?

Answer 16

Bronchiectasis usually following childhood bronchopulmonary infections with measles (uncommon in industrialized countries)

Question 17

What is generalized nonobstructive bronchiectasis?

Answer 17

Bronchiectasis that is secondary to inherited impairment in host defense mechanisms or acquired conditions that permit introduction of infectious organisms into the airways

Question 18

What are the main inherited conditions that predispose a person to generalized nonobstructive bronchiectasis?

Answer 18

CF, Dyskinetic ciliary syndromes, Hypogammaglobulinemias, and deficiencies of IgG subclasses

Question 19

A patient presents with dextrocardia, bronchiectasis and sinusitis. What is your Dx?

Answer 19

Kartagener Syndrome

Question 20

A patient is found to have an absence of cilia throughout the body. The patient is sterile. The patient experiences recurrent upper and lower respiratory tract infections. What is the Dx?

Answer 20

Radial Spoke Deficiency (Sturgess Syndrome)

Question 21

What are the three classifications of bronchiectasis on gross examination of the lung?

Answer 21

1. Saccular
2. Cylindrical
3. Varicose

Question 22

A patient with a Hx of chronic lung problems expires. The patient had chronic productive cough with several mL of mucopurulent sputum a day. The patient often had hemoptysis. The patient’s lung is shown below. What is the Dx? How would this condition be Dx in a living patient?

Answer 22

Bronchiectasis; CT Scan