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Week 19

 

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Quiz 19 Context:

You are continuing to evaluate a 60-year-old female with chronic exercise related dyspnea and chronic dry cough, in the setting of a history of previous smoking. There is no history of environmental exposure, infectious exposure, cardiac disease, connective tissue disease, exposure to medications or drugs with adverse effects. Physical examination revealed dry rales at the bases of the lung fields as well as clubbing.

A CT of the chest is obtained, it shows subpleural fibrosis with honeycombing and traction bronchiectasis.

The patient subsequently opts to undergo diagnostic biopsy. The results of the biopsy are shown above.

These pathology specimens are most consistent with which of the following?

  1. Patchy and temporally variegated fibrosis, with fibroblastic focus. Dx: usual interstitial pneumonitis (UIP)
  2. Uniform appearance of interstitial inflammation in all areas of the biopsy. Dx: nonspecific interstitial pneumonitis (NSIP)
  3. Organizing pneumonia within the alveolar ducts & bronchioles. Dx: bronchiolitis obliterans-organizing pneumonia (BOOP)
  4. Focal bronchiolar pigmented macrophage accumulation. Dx: respiratory bronchiolitis associated interstitial lung disease (RB-ILD)
  5. Diffuse interstitial infiltration of T lymphocytes grouped into germinal centers. Dx: lymphocytic interstitial pneumonitis (LIP)

 

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Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195