Obstructive and Restrictive Lung Diseases MCQs

Eosinophils are key inflammatory cells found in almost all subtypes of asthma; eosinophil products (such as major basic protein) are responsible for airway damage. An increase in size of the sub mucosal glands and goblet cell metaplasia of the airway epithelium Hypertrophy and/or hyperplasia of the bronchial muscle are seen. The most striking finding is occlusion of bronchi and bronchioles by thick, tenacious mucous plugs containing whorls of shed epithelium (Curschmann spirals). Numerous eosinophils and Charcot-Leyden crystals (crystalloids made up of the eosinophil protein galectin-10) also are present. Reference: Robbins Basic Pathology, 10 th ed, Pg-505

Emphysema is characterized by permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without significant fibrosis. Reference: Robbins Basic Pathology, 10 th ed, Pg-498

Desquamative interstitial pneumonitis is one form of restrictive lung disease and can present with a slowly developing chronic cough and dyspnea on exertion. It is strongly associated with tobacco use, and the histologic feature is alveolar airspaces filled with pigment-laden macrophages (the pigment being carbonaceous material from the tobacco use). Respiratory bronchiolitis with interstitial lung disease occurs under a similar clinical scenario (i.e., a tobacco user presenting with dyspnea on exertion and chronic cough), but has patchy involvement of the pulmonary parenchyma and not diffuse involvement. Reference: Robbins Basic Pathology, 10 th ed, Pg-507

With in the phagocytes, the following reaction takes place: The initiating enzyme for this process is NADPH oxidase(also called respiratory burst oxidase). Glutathione peroxidase, glutathione reductase and superoxide dismutase are antioxidants. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, chapter 3, pg 78

Asbestos is a family of crystalline hydrated silicates with a fibrous geometry. On the basis of epidemiologic studies, occupational exposure to asbestos is linked to parenchymal interstitial fibrosis (asbestosis); localized fibrous plaques, or, rarely, diffuse fibrosis in the pleura; pleural effusions; lung carcinoma; malignant pleural and peritoneal mesothelioma; laryngeal carcinoma. Reference: Robbins Basic Pathology, 10 th ed, Pg-511

Churg-Strauss syndrome (also called allergic granulomatosis and angiitis) is a small-vessel necrotizing vasculitis classically associated with asthma, allergic rhinitis, lung infiltrates, peripheral eosinophilia, extravascular necrotizing granulomas, and a striking eosinophilic infiltration of vessels and tissues. (b, d) The vasculitis histologically resembles the lesions of polyarteritis nodosa (choice d) and Wegener granulomatosis (choice c), but these diseases do not typically present with an asthmatic syndrome. Reference : Robbins 10th Ed pg 515

Answer- B. Lymphoma Chylothorax is a pleural collection of a milky lymphatic fluid containing micro globules of lipid. It results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct. The total volume of fluid may not be large, but chylothorax is always significant because it implies obstruction of the major lymph ducts, usually by intrathoracic cancer like primary or secondary mediastinal neoplasm, such as lymphoma.

Answer- D. Pleural effusion and lymphedema, associated with discolored nails Yellow nail syndrome is a rare disorder of the nail, which is usually accompanied by Lymphoedema It may also be associated with : Recurrent pleural effusions Bronchiectasis