Restrictive lung diseases

Question 1

Determine the histopathological patterns and features of indeterminate usual interstitial pneumonia (UIP) or an alternative diagnosis.

Predominant subpleural or paraseptal distribution of fibrosis

Histologic findings indicative of hypersensitivity pneumonitis

Dense fibrosis with architectural distortion and honeycombing

Absence of features that suggest an alternative diagnosis

Answer 1

Histologic findings indicative of hypersensitivity pneumonitis

Question 2

Identify one of the most frequent and common symptoms of all DPLDs.

Shock

Fever

Hemoptysis

Dry cough and chest pain

Answer 2

Dry cough and chest pain

Question 3

Pathophysiology is of great importance for the practice of medicine because it facilitates an understanding of the mechanisms that cause diseases. Identify the correct statement regarding the pathophysiology of sarcoidosis.

Sarcoidosis is related to an occupational tumor caused by exposure to any type of inorganic fiber.

Sarcoidosis is a disease of unknown cause characterized by inflammation of the lymph nodes, lungs, liver, eyes, skin, and other tissues.

Sarcoidosis is a consequence of the proliferation of micro-organisms at the alveolar level and the response against them triggered by the host.

Sarcoidosis is a disease characterized by increasing inflammation and mucus (phlegm or sputum) in the airways.

Answer 3

Sarcoidosis is a disease of unknown cause characterized by inflammation of the lymph nodes, lungs, liver, eyes, skin, and other tissues.

Question 4

Identify the pathology that is associated with diffuse interstitial lung disease on a chest X-ray.

Pulmonary infarction

Fibrosis

Vascular malformation

Pneumonia

Answer 4

Fibrosis

Question 5

Select the statement that best describes restrictive lung disease.

There are limited data on the epidemiology of interstitial diseases, and the data about their incidence and prevalence vary greatly.

This disease occurs due to the accumulation of fluid in the pleural space, which usually results from disorders that promote transudation or exudation from capillaries underlying the pleura. However, it also occasionally results from a blockage or injury that causes the lymphatic vessels to drain into the pleural space.

This disease occurs due to the accumulation of air in the pleural space and can be caused by the spontaneous rupture of the weakened areas of the pleura.

This disease involves the passage of fluid and solid particles into the lung, usually from impaired swallowing and coughing. It frequently results in pneumonitis and pulmonary infection.

Answer 5

There are limited data on the epidemiology of interstitial diseases, and the data about their incidence and prevalence vary greatly.

Question 6

A patient presents with dyspnea, PaO2 59 mm Hg while breathing air, and 65 mm Hg with 40% O2 (FiO2 0.4). The patient’s PaCO2 is 40 mm Hg. Determine the diagnosis that is the least likely for this patient.

Cardiogenic pulmonary edema

Idiopathic pulmonary fibrosis

Atelectasis

Pneumonia

Answer 6

Idiopathic pulmonary fibrosis

Question 7

Determine the correct statement about malignant mesotheliomas.

Patients with benign mesotheliomas may have hypoglycemia.

They are usually multifocal.

One of their common causes is erionite because it is a very carcinogenic mineral fiber used in gravel roads.

They are usually unifocal.

Answer 7

One of their common causes is erionite because it is a very carcinogenic mineral fiber used in gravel roads.

Question 8

Diffuse parenchymal lung disease includes more than 200 entities that are classified into groups. Identify a condition that is related to idiopathic interstitial pneumonia.

Acute interstitial pneumonia

Drug-induced and radiation therapy

Pneumoconiosis

Pulmonary eosinophilia

Answer 8

Acute interstitial pneumonia

Question 9

Determine the histopathological patterns and features of definitive usual interstitial pneumonia (UIP).

Patchy involvement of lung parenchyma by fibrosis

Absence of fibroblastic foci or loose fibrosis

Fibrosis without architectural distortion

Histologic findings indicative of hypersensitivity pneumonitis

Answer 9

Patchy involvement of lung parenchyma by fibrosis

Question 10

A 55-year-old man presents for dysphonia. In his medical history, he refers to asthenia and unquantified weight loss. His chest radiograph shows an increase in density in the upper left lobe and occupation of the aortopulmonary window, and his bronchoscopy shows a paralysis of the left vocal cord with no endoscopic image suggestive of neoplasia. Determine the most likely diagnosis.

Silicosis

Sarcoidosis

Asbestosis

Lung carcinoma

Answer 10

Lung carcinoma

Question 11

Based on the pathophysiology of diffuse parenchymal lung disease, select the correct match of the processes and causative agents.

Process: host factors that result in aberrant healing; causes: aging lung

Process: harmful stimuli to the lung that produce microscopic lung injuries over time; causes: aging lung

Process: host factors that result in aberrant healing; causes: infection, radiation, aspiration

Process: host factors that result in aberrant healing; causes: drugs, cigarettes, and fumes

Answer 11

Process: host factors that result in aberrant healing; causes: aging lung

Question 12

Determine the factor that can be correctly diagnosed by bronchoscopy and transbronchial lung biopsy.

Fibrosis

Bleomycin pulmonary toxicity

Asbestosis

Bronchiolitis obliterans with organized pneumonia

Answer 12

Fibrosis

Question 13

Identify the pathology that is associated with diffuse interstitial lung disease on a chest X-ray.

Bacterial abscess

Pulmonary fibrosis

Vascular malformation

Pneumonia

Answer 13

Pulmonary fibrosis

Question 14

Identify one of the most frequent and common symptoms of all DPLDs.

Excessive sputum

Cyanosis (bluish discoloration of the hands or lips)

Hemoptysis

Shock

Answer 14

Cyanosis (bluish discoloration of the hands or lips)

Question 15

Based on the pathophysiology of diffuse parenchymal lung disease, select the correct match of the processes and causative agents.

Process: host factors that result in aberrant healing; causes: infection, radiation, aspiration

Process: harmful stimuli to the lung that produce microscopic lung injuries in a short period of time; causes: drugs, cigarettes, fumes

Process: harmful stimuli to the lung that produce microscopic lung injuries over time; causes: drugs, cigarettes, fumes

Process: host factors that result in aberrant healing; causes: drugs, cigarettes, and fumes

Answer 15

Process: harmful stimuli to the lung that produce microscopic lung injuries in a short period of time; causes: drugs, cigarettes, fumes

Question 16

Diffuse parenchymal lung disease includes more than 200 entities that are classified into groups. Identify a condition that is related to idiopathic interstitial pneumonia.

Acute interstitial pneumonia

Pneumoconiosis

Drug-induced and radiation therapy

Pulmonary eosinophilia

Answer 16

Acute interstitial pneumonia

Question 17

Determine the most accurate statement about sarcoidosis in the elderly.

In relation to the results of bronchoalveolar lavage and of gallium scintigraphy, there are multiple differences in the elderly compared with the other age populations.

The evolution of this disease is predictable, and all cases have a spontaneous resolution.

Elderly-onset sarcoidosis(EOS) is defined as the onset of sarcoidosis in people over 65 years of age.

The less typical radiological findings include the existence of adenopathies and pulmonary micronodules of perilymphatic distribution.

Answer 17

Elderly-onset sarcoidosis(EOS) is defined as the onset of sarcoidosis in people over 65 years of age.

Question 18

Determine an incorrect statement about benign mesotheliomas.

They are usually related to asbestos exposure.

Hypertrophic osteoarthropathy is common in patients with benign mesotheliomas.

Patients with benign mesotheliomas may have hypoglycemia.

They are usually multifocal.

Answer 18

They are usually related to asbestos exposure.

Question 19

Identify a restrictive pathological condition that must be referred to a pulmonary rehabilitation program.

COPD

Conditions of the thoracic wall

Cystic fibrosis

Diffuse bronchiectasis

Answer 19

Conditions of the thoracic wall

Question 20

Identify the spirometry alteration that does not indicate an obstructive bronchial pathology.

Increase in pulmonary residual volume

Depression of the FEF25–75%

Decrease in vital capacity

Decrease in total lung capacity

Answer 20

Decrease in total lung capacity

Question 21

Determine the correct statement about malignant mesotheliomas.

Hypertrophic osteoarthropathy is common in patients with benign mesotheliomas.

They are usually multifocal.

They are usually unifocal.

They are usually related to asbestos exposure.

Answer 21

They are usually related to asbestos exposure.

Question 22

A patient who is a former smoker and was previously diagnosed with COPD presents to the office. Upon physical examination, the existence of digital clubbing of recent appearance is detected. Identify the most acceptable explanation for this finding in the clinical context described.

Malignancy

Bronchiectasis

Cyanotic heart disease

Tuberculosis

Answer 22

Malignancy

Question 23

Identify the spirometry alteration that does not indicate an obstructive bronchial pathology.

FVC reduced (<80% of the predicted normal)

Depression of the FEF25–75%

Increase in pulmonary residual volume

Decrease in FEV 1/FVC ratio

Answer 23

FVC reduced (<80% of the predicted normal)

Question 24

Identify the pathology that is associated with diffuse interstitial lung disease on a chest X-ray.

Pneumonia

Bacterial abscess

Pulmonary infarction

Pulmonary fibrosis

Answer 24

Pulmonary fibrosis

Question 25

Determine the histopathological patterns and features of indeterminate usual interstitial pneumonia (UIP) or an alternative diagnosis.

Fibrosis without architectural distortion

Absence of features that suggest an alternative diagnosis

Dense fibrosis with architectural distortion and honeycombing

Patchy involvement of lung parenchyma by fibrosis

Answer 25

Fibrosis without architectural distortion

Question 26

Determine the histopathological patterns and features of definitive usual interstitial pneumonia (UIP).

Absence of features that suggest an alternative diagnosis

Histologic findings indicative of hypersensitivity pneumonitis

Fibrosis without architectural distortion

Absence of fibroblastic foci or loose fibrosis

Answer 26

Absence of features that suggest an alternative diagnosis

Question 27

Pathophysiology is of great importance for the practice of medicine because it facilitates an understanding of the mechanisms that cause diseases. Identify the correct statement regarding the pathophysiology of sarcoidosis.

Sarcoidosis is a consequence of the proliferation of micro-organisms at the alveolar level and the response against them triggered by the host.

Sarcoidosis is a disease characterized by increasing inflammation and mucus (phlegm or sputum) in the airways.

In sarcoidosis, a certain inflammation usually decreases within days alongside the harmful element. Inflammation decrease that does not occur in people with sarcoidosis, due to a group of cells of the immune system, which form masses called granulomasin different organs of the body.

The carcinogenicity of sarcoidosis is given because inhaled fibers cannot be eliminated by macrophages and travel to the pleura via the lymphatic route, where they produce a persistent inflammatory reaction.

Answer 27

In sarcoidosis, a certain inflammation usually decreases within days alongside the harmful element. Inflammation decrease that does not occur in people with sarcoidosis, due to a group of cells of the immune system, which form masses called granulomasin different organs of the body.

Question 28

A 75-year-old man is evaluated for a year’s history of cough and dyspnea. He has no other medical problems and does not take medications. He has smoked 40 packs of cigarettes a year for 40 years. He has no animals at home. He has worked in a bank branch. Upon physical examination, his blood pressure is 135/75 mm Hg, pulse 88 bpm, respiratory rate 24 rpm, and SpO2 88% while breathing ambient air. He has no jugular distention. Cardiac auscultation is normal. Upon pulmonary auscultation, bilateral inspiratory crackles are heard on bases. Patient has finger clubbing. No edema in lower limbs. Respiratory function tests are performed, showing a decrease in FEV1 (57% of predicted), a decrease in FVC (67% of predicted), an FEV1/FVC ratio 0.91, and a decrease in diffusion capacity (42 % of predicted). The thoracic CT scan is shown in the following image:

Determine the most likely diagnosis.

Fibrotic diseases of the lungs

Peeling pneumonitis

COPD with bronchitis

Lung cancer

Answer 28

Fibrotic diseases of the lungs

Question 29

Diffuse parenchymal lung disease includes more than 200 entities that are classified into groups. Identify a condition that is related to idiopathic interstitial pneumonia.

Sarcoidosis

Pulmonary eosinophilia

Peeling interstitial pneumonia

Pneumoconiosis

Answer 29

Peeling interstitial pneumonia

Question 30

Pathophysiology is of great importance for the practice of medicine because it facilitates an understanding of the mechanisms that cause diseases. Identify the correct statement regarding the pathophysiology of sarcoidosis.

Sarcoidosis is related to an occupational tumor caused by exposure to any type of inorganic fiber.

Special cells release chemicals that in turn attract other cells, which try to isolate and destroy the substance that causes the damage.

Sarcoidosis is a consequence of the proliferation of micro-organisms at the alveolar level and the response against them triggered by the host.

The carcinogenicity of sarcoidosis is given because inhaled fibers cannot be eliminated by macrophages and travel to the pleura via the lymphatic route, where they produce a persistent inflammatory reaction.

Answer 30

Special cells release chemicals that in turn attract other cells, which try to isolate and destroy the substance that causes the damage.

Question 31

A 55-year-old man presents for dysphonia. In his medical history, he refers to asthenia and unquantified weight loss. His chest radiograph shows an increase in density in the upper left lobe and occupation of the aortopulmonary window, and his bronchoscopy shows a paralysis of the left vocal cord with no endoscopic image suggestive of neoplasia. Determine the most likely diagnosis.

Tuberculosis

Silicosis

Sarcoidosis

Lung cancer

Answer 31

Lung cancer

Question 32

Identify a restrictive pathological condition that must be referred to a pulmonary rehabilitation program.

COPD

Ankylosing spondylitis

Asthma

Cystic fibrosis

Answer 32

Ankylosing spondylitis

Question 33

Identify one of the most frequent and common symptoms of all DPLDs.

Hemoptysis

Excessive sputum

Fever

Fatigue or asthenia

Answer 33

Fatigue or asthenia

Question 34

Based on the pathophysiology of diffuse parenchymal lung disease, select the correct match of the processes and causative agents.

Process: harmful stimuli to the lung that produce microscopic lung injuries in a short period of time; causes: drugs, cigarettes, fumes

Process: host factors that result in aberrant healing; causes: genetic factors, autoimmune disease

Process: harmful stimuli to the lung that produce microscopic lung injuries over time; causes: aging lung

Process: host factors that result in aberrant healing; causes: infection, radiation, aspiration

Answer 34

Process: host factors that result in aberrant healing; causes: genetic factors, autoimmune disease

Question 35

Select the statement that best describes restrictive lung disease.

This disease occurs due to the accumulation of fluid in the pleural space, which usually results from disorders that promote transudation or exudation from capillaries underlying the pleura. However, it also occasionally results from a blockage or injury that causes the lymphatic vessels to drain into the pleural space.

This disease can also be called diffuse parenchymal lung disease(DPLD).

This disease involves the passage of fluid and solid particles into the lung, usually from impaired swallowing and coughing. It frequently results in pneumonitis and pulmonary infection.

This disease occurs due to the presence of pus in the pleural space (infected pleural effusion). The source of the pus is usually lymphatic drainage from sites of bacterial pneumonia.

Answer 35

This disease can also be called diffuse parenchymal lung disease(DPLD).