pulmonary//renal case questions
Silica - ANSWER-A 63-year-old man has had progressively worsening dyspnea over the past 10 years. He
has noticed a 5-kg weight loss in the past 2 years. He has a chronic cough with minimal sputum
production and no chest pain. On physical examination, he is afebrile and normotensive. A chest
radiograph shows extensive interstitial disease. Pulmonary function tests show low FVC and normal
FEV1/FVC ratio. Increased exposure to which of the following pollutants is most likely to produce these
findings?
Chronic bronchitis with asthmatic bronchitis - ANSWER-A 45-year-old man has smoked two packs of
cigarettes per day for 20 years. For the past 4 years, he has had a chronic cough with copious mucoid
expectoration. During the past year, he has had several episodes of respiratory tract infections that were
diagnosed as "viral flu," and he developed difficulty breathing, tightness of the chest, and audible
wheezing. His breathing difficulty was relieved by inhalation of a β-adrenergic agonist and disappeared
after the chest infection had resolved. Which of the following pathologic conditions best describes these
clinical findings?
Pulmonary hypertension - ANSWER-A 75-year-old woman has had worsening lower leg edema and
dyspnea for the past 5 years. On physical examination, her temperature is 36.9°C, pulse is 74/min,
respirations are 19/min, and blood pressure is 110/75 mm Hg. There is dullness to percussion at the lung
bases. A low rumbling heart murmur is present. An echocardiogram shows a large (4 cm) atrial septal
defect. Which of the following pulmonary conditions is most likely to be present?
AIDS - ANSWER-A 40-year-old woman has had malaise and an 11-kg weight loss over the past 3 years.
She has had fever and a nonproductive cough with increasing dyspnea for the past 3 days. On physical
examination, her temperature is 37.8°C, pulse is 82/min, respirations are 22/min, and blood pressure is
100/60 mm Hg. There is dullness to percussion over the lungs and diffuse crackles on auscultation. A
chest radiograph shows extensive bilateral infiltrates. Bronchoalveolar lavage is done, and the fluid is
stained with Gomori methenamine silver. The high-power microscopic appearance is shown in the figure.
Which of the following underlying conditions is most likely present?
Bronchial asthma - ANSWER-A 34-year-old man suddenly develops severe dyspnea with wheezing and is
taken to the emergency department. On physical examination, his vital signs are temperature, 37°C;
pulse, 95/min; respirations, 15/min; and blood pressure, 130/80 mm Hg. A chest radiograph shows
increased lucency in all lung fields. A sputum cytologic specimen shows Curschmann spirals, Charcot-
Leyden crystals, and acute inflammatory cells in a background of abundant mucus. Many of the
inflammatory cells are eosinophils. What is the most likely diagnosis?
Release of elastase from neutrophils - ANSWER-A 50-year-old man comes to the physician with gradually
increasing dyspnea and a 4-kg weight loss over the past 2 years. He admits to smoking two packs of
cigarettes per day for 20 years, but states that he has not smoked for the past year. Physical examination
shows an increase in the anteroposterior diameter of the chest ("barrel chest"). Auscultation of the chest
shows decreased lung sounds. A chest radiograph shows bilateral hyperlucent lungs; the lucency is
especially marked in the upper lobes. Pulmonary function tests show that the FEV, is markedly
Silica - ANSWER-A 63-year-old man has had progressively worsening dyspnea over the past 10 years. He
has noticed a 5-kg weight loss in the past 2 years. He has a chronic cough with minimal sputum
production and no chest pain. On physical examination, he is afebrile and normotensive. A chest
radiograph shows extensive interstitial disease. Pulmonary function tests show low FVC and normal
FEV1/FVC ratio. Increased exposure to which of the following pollutants is most likely to produce these
findings?
Chronic bronchitis with asthmatic bronchitis - ANSWER-A 45-year-old man has smoked two packs of
cigarettes per day for 20 years. For the past 4 years, he has had a chronic cough with copious mucoid
expectoration. During the past year, he has had several episodes of respiratory tract infections that were
diagnosed as "viral flu," and he developed difficulty breathing, tightness of the chest, and audible
wheezing. His breathing difficulty was relieved by inhalation of a β-adrenergic agonist and disappeared
after the chest infection had resolved. Which of the following pathologic conditions best describes these
clinical findings?
Pulmonary hypertension - ANSWER-A 75-year-old woman has had worsening lower leg edema and
dyspnea for the past 5 years. On physical examination, her temperature is 36.9°C, pulse is 74/min,
respirations are 19/min, and blood pressure is 110/75 mm Hg. There is dullness to percussion at the lung
bases. A low rumbling heart murmur is present. An echocardiogram shows a large (4 cm) atrial septal
defect. Which of the following pulmonary conditions is most likely to be present?
AIDS - ANSWER-A 40-year-old woman has had malaise and an 11-kg weight loss over the past 3 years.
She has had fever and a nonproductive cough with increasing dyspnea for the past 3 days. On physical
examination, her temperature is 37.8°C, pulse is 82/min, respirations are 22/min, and blood pressure is
100/60 mm Hg. There is dullness to percussion over the lungs and diffuse crackles on auscultation. A
chest radiograph shows extensive bilateral infiltrates. Bronchoalveolar lavage is done, and the fluid is
stained with Gomori methenamine silver. The high-power microscopic appearance is shown in the figure.
Which of the following underlying conditions is most likely present?
Bronchial asthma - ANSWER-A 34-year-old man suddenly develops severe dyspnea with wheezing and is
taken to the emergency department. On physical examination, his vital signs are temperature, 37°C;
pulse, 95/min; respirations, 15/min; and blood pressure, 130/80 mm Hg. A chest radiograph shows
increased lucency in all lung fields. A sputum cytologic specimen shows Curschmann spirals, Charcot-
Leyden crystals, and acute inflammatory cells in a background of abundant mucus. Many of the
inflammatory cells are eosinophils. What is the most likely diagnosis?
Release of elastase from neutrophils - ANSWER-A 50-year-old man comes to the physician with gradually
increasing dyspnea and a 4-kg weight loss over the past 2 years. He admits to smoking two packs of
cigarettes per day for 20 years, but states that he has not smoked for the past year. Physical examination
shows an increase in the anteroposterior diameter of the chest ("barrel chest"). Auscultation of the chest
shows decreased lung sounds. A chest radiograph shows bilateral hyperlucent lungs; the lucency is
especially marked in the upper lobes. Pulmonary function tests show that the FEV, is markedly
