NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University
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Free NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University Questions
A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. An x-ray film of the chest reveals findings described as "consistent with a Ghon complex." Sputum cultures grow acid-fast bacilli. Biopsy of a hilar lymph node in this patient would most likely demonstrate which of the following morphological patterns of necrosis?
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Caseous
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Coagulative
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Fat
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Fibrinoid
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Liquifactive
Explanation
Correct Answer: A) Caseous.
This patient's presentation — persistent cough, night sweats, low-grade fever, malaise, acid-fast bacilli in sputum, and a Ghon complex on chest x-ray — is classic for primary pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis. The Ghon complex consists of a peripheral lung lesion combined with hilar lymph node involvement, representing the primary infection site.
The pathognomonic histological finding in tuberculosis is caseous necrosis, a distinctive form of necrosis that appears grossly as soft, white, cheese-like material. Microscopically, it is characterized by granulomas with central areas of acellular, eosinophilic necrotic debris surrounded by epithelioid macrophages, Langhans giant cells, and a rim of lymphocytes.
Unlike coagulative necrosis (seen in ischemic infarcts where cell outlines are preserved) or liquefactive necrosis (seen in brain infarcts and bacterial abscesses), caseous necrosis completely destroys the tissue architecture. Fat necrosis occurs in pancreatitis and breast trauma, while fibrinoid necrosis is seen in immune-mediated vascular conditions. Caseous necrosis is virtually pathognomonic for mycobacterial and fungal granulomatous infections.
A 36-year-old man with AIDS presents with fever, dry cough, and dyspnea. A chest x-ray shows bilateral and diffuse infiltrates. Laboratory studies reveal a low CD4+ cell count. A lung biopsy discloses a chronic interstitial pneumonitis and an intra-alveolar foamy exudate. A silver stain of a bronchoalveolar lavage is shown. Which of the following organisms is the most likely responsible for these pulmonary findings?
[IMAGE_4]
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Cryptococcus neoformans
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Mycoplasma pneumoniae
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Pneumocystis jiroveci
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Streptococcus pyogenes
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Streptococcus viridans
Explanation
Correct Answer: C) Pneumocystis jiroveci.
Pneumocystis jiroveci pneumonia (PCP) is the most common opportunistic lung infection in AIDS patients with severely low CD4+ counts (typically below 200 cells/µL). The classic presentation includes dry cough, progressive dyspnea, fever, and bilateral diffuse infiltrates on chest x-ray. The hallmark pathological finding is a foamy intra-alveolar exudate, and the silver stain (Gomori methenamine silver) highlights the characteristic cup-shaped or crescent-shaped cysts of Pneumocystis. This combination of clinical, radiological, and histological features is diagnostic of PCP.
A sputum sample obtained from a 68-year-old former construction worker reveals needle-like inert minerals (shown). This patient is at increased risk of developing which of the following malignant neoplasms?
[IMAGE_2]
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B cell lymphoma
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Carcinoid tumor
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Mesothelioma
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Teratocarcinoma
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Transitional cell carcinoma
Explanation
Correct Answer: C) Mesothelioma.
The needle-like inert minerals visible in the sputum sample are asbestos fibers, specifically asbestos bodies (also called ferruginous bodies), which appear as golden-brown, dumbbell-shaped or beaded rods with a protein-iron coat around a central fiber.
Their presence in a former construction worker is consistent with occupational asbestos exposure, which was extremely common in construction, shipbuilding, insulation, and manufacturing industries before the widespread recognition of its dangers. Asbestos exposure is the leading cause of malignant mesothelioma, a rare and aggressive cancer of the pleural, peritoneal, or pericardial mesothelium.
The latency period between asbestos exposure and mesothelioma development is characteristically very long — often 20 to 40 years — which explains the presentation in a 68-year-old former worker. Asbestos also significantly increases the risk of lung adenocarcinoma, especially in smokers (synergistic effect). B cell lymphoma, carcinoid tumors, teratocarcinomas, and transitional cell carcinomas are not associated with asbestos exposure.
A 67-year-old smoker with long-standing bronchitis expectorates blood during a paroxysm of coughing. What is a possible serious cause of hemoptysis in this patient that should be considered?
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Emphysema
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Hemothorax
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Lung cancer
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Pneumoconiosis
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Pulmonary abscess
Explanation
Correct Answer: C) Lung cancer.
In a long-term smoker with chronic bronchitis who develops hemoptysis, lung cancer must always be seriously considered and ruled out. Cigarette smoking is the single greatest risk factor for lung cancer, particularly squamous cell carcinoma and small cell carcinoma. Hemoptysis in this context can result from tumor erosion into bronchial blood vessels. While chronic bronchitis itself can occasionally cause blood-streaked sputum, new-onset hemoptysis in a chronic smoker warrants immediate investigation with imaging and bronchoscopy.
A 64-year-old woman with bilateral varicose veins of her legs developed sudden onset chest pain, and expectorated blood the next day (hemoptysis). What could have caused the patient's symptoms?
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Congestive heart failure
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Cor pulmonale
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Phlebothrombosis
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Pulmonary thromboembolism
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Pulmonary edema
Explanation
Correct Answer: D) Pulmonary thromboembolism.
This patient's varicose veins predispose her to venous stasis and deep vein thrombosis. A clot forming in the leg veins can dislodge and travel to the pulmonary vasculature, causing pulmonary thromboembolism. This presents with sudden chest pain followed by hemoptysis when pulmonary infarction occurs, causing necrosis and bleeding into the airways. While phlebothrombosis describes the leg clot itself, the pulmonary thromboembolism is what directly causes the chest pain and hemoptysis. Congestive heart failure and pulmonary edema do not typically cause hemoptysis in this pattern.
A neonate is rushed to the hospital in acute respiratory distress and expires. The lungs are examined at autopsy. This pulmonary condition is termed:
[IMAGE_6]
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Atelectasis
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Bronchiectasis
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Emphysema
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Pneumonia
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Pulmonary aplasia
Explanation
Correct Answer: A) Atelectasis.
The autopsy image shows collapsed, airless, dark red lungs that have failed to expand — consistent with neonatal atelectasis, most commonly caused by surfactant deficiency in premature infants (hyaline membrane disease/neonatal respiratory distress syndrome). Without adequate surfactant, alveolar surface tension remains high, causing alveoli to collapse after each breath. The lungs appear dark and liver-like rather than the expected spongy, air-filled appearance. This is a leading cause of respiratory failure and death in premature neonates.
A 70-year-old woman with progressive dyspnea dies in her sleep. The lungs are examined at autopsy. What was the most likely cause of this patient's lung pathology?
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Bacterial endocarditis
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Bronchial asthma
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Congestive heart failure
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Myocardial infarction
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Pulmonary thromboembolism
Explanation
Correct Answer: C) Congestive heart failure.
The autopsy image shows lungs with pink, frothy fluid-filled alveoli consistent with pulmonary edema, which is the hallmark of congestive heart failure. In CHF, elevated left-sided filling pressures cause fluid to back up into the pulmonary capillaries and leak into the alveolar spaces, severely impairing gas exchange and causing progressive dyspnea. The gradual progression of symptoms and the microscopic appearance of fluid-filled alveoli are characteristic of chronic cardiac failure rather than the other listed conditions.
A 55-year-old stone worker presents with a 5-year history of increasing shortness of breath. Chronic inhalation of quartz (silicon dioxide) in this patient most likely caused which of the following lung diseases?
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Asthma
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Atelectasis
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Bronchiectasis
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Emphysema
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Pneumoconiosis
Explanation
Correct Answer: E) Pneumoconiosis.
Pneumoconiosis is a group of occupational lung diseases caused by chronic inhalation of inorganic dust particles. Silicosis, caused specifically by quartz (silicon dioxide) inhalation, is the most common form seen in stone workers, miners, and sandblasters. Inhaled silica particles are engulfed by alveolar macrophages, which die and release fibrogenic factors, leading to progressive pulmonary fibrosis and nodule formation. The gradual onset of dyspnea over years is characteristic. The other conditions listed are not caused by occupational dust inhalation.
A 72-year-old man who works for a mine in Libby, Montana, has a clinical history of pulmonary function tests that show a decreased FEV1 and FVC, with a normal FEV1/FVC ratio. He dies and an autopsy is performed. The autopsy reveals a tumor in the right pleural cavity, which completely encases the lung. He also has tan-white pleural plaques in the right pleural cavity. Upon histologic examination of the lung, prominent alveolar septal fibrosis with honeycomb change is identified. This patient was most likely exposed to which of the following agents?
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Asbestos
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Cigarette smoke
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Coal
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Beryllium
Explanation
Correct Answer: A) Asbestos.
Libby, Montana is well known for widespread asbestos contamination from vermiculite mining. Asbestos exposure causes a distinctive triad of findings: pleural plaques (tan-white calcified deposits on the pleura), pulmonary fibrosis with honeycomb change (asbestosis), and malignant mesothelioma — a pleural tumor that encases the lung. The restrictive pattern on pulmonary function tests (decreased FEV1 and FVC with normal ratio) is consistent with pulmonary fibrosis. No other listed agent produces this combination of pleural and parenchymal findings.
The left ventricle of the heart from a 70-year-old man is examined at autopsy (shown). What was the most likely cause of the patient's death?
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Cardiac tamponade
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Congestive heart failure
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Hypovolemic shock
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Mycardial infarction
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Pulmonary thromboembolism
Explanation
Correct Answer: B) Congestive heart failure
The autopsy image shows a markedly dilated left ventricle with thinned walls, which is the classic gross pathology of dilated cardiomyopathy leading to congestive heart failure. In CHF, the ventricle becomes enlarged and weakened, losing its ability to pump blood effectively. The cavity dilation with wall thinning distinguishes this from hypertrophic changes seen in hypertension or other conditions.
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