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 that are 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?
Caseous
Coagulative
Fat
Fibrinoid
Liquefactive
The Correct Answer is A
A. Caseous: A Ghon complex is characteristic of primary tuberculosis infection caused by Mycobacterium tuberculosis. The hallmark histologic feature is caseating granulomatous inflammation, with central caseous necrosis surrounded by epithelioid macrophages, Langhans giant cells, and lymphocytes. The necrotic center has a cheese-like appearance due to lipid-rich mycobacterial cell walls and immune-mediated tissue destruction.
B. Coagulative: Coagulative necrosis is typically seen in ischemic injury to solid organs such as the heart, kidneys, and spleen. Cellular architecture is preserved temporarily despite cell death, which differs from the amorphous, granular debris seen in caseous necrosis associated with tuberculosis.
C. Fat: Fat necrosis occurs in adipose tissue, commonly in acute pancreatitis or traumatic injury to fatty tissue. It involves enzymatic destruction of fat cells and formation of chalky calcium soaps, a process unrelated to granulomatous infections like tuberculosis.
D. Fibrinoid: Fibrinoid necrosis is associated with immune-mediated vascular damage, such as in vasculitis or malignant hypertension. It involves deposition of immune complexes and fibrin within vessel walls, not the granulomatous pattern typical of tuberculosis.
E. Liquefactive: Liquefactive necrosis is most commonly seen in brain infarctions and bacterial infections that produce pus. It results in complete digestion of dead cells into a liquid mass, which differs from the dry, cheese-like necrosis observed in tuberculosis.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Emphysema:Emphysema involves destruction of alveolar walls and airspace enlargement, leading to dyspnea and decreased gas exchange. While it may contribute to chronic cough, it rarely causes hemoptysis, especially in significant volumes, and is not typically a sudden cause of bloody sputum.
B. Hemothorax:Hemothorax is accumulation of blood in the pleural space, usually due to trauma or vascular injury. It presents with chest pain, hypotension, and respiratory compromise, but blood is not expectorated as sputum, distinguishing it from hemoptysis.
C. Lung cancer:In older smokers with chronic bronchitis, new-onset hemoptysis may indicate an underlying malignancy. Tumors can erode bronchial vessels, causing bleeding into the airway. This is a serious cause of hemoptysis and must be ruled out promptly with imaging and further diagnostic workup.
D. Pneumoconiosis:Pneumoconiosis refers to occupational lung diseases caused by inhalation of dust (e.g., silica, coal). It usually leads to fibrosis and chronic respiratory symptoms, but hemoptysis is uncommon and not typically acute or paroxysmal.
E. Pulmonary abscess:Pulmonary abscesses can cause hemoptysis due to necrosis of lung tissue and infection, but they are less common than lung cancer in older smokers and usually present with fever, purulent sputum, and systemic signs of infection.
Correct Answer is C
Explanation
A. Chronic inflammation:Chronic inflammation involves infiltration of tissues by lymphocytes and macrophages and is seen in conditions such as chronic infections or autoimmune disorders. It is not the primary feature of varicose veins, esophageal varices, hemorrhoids, or varicoceles, which are structural vascular abnormalities.
B. Cystic medial necrosis:Cystic medial necrosis involves degeneration of the elastic and muscular components of arterial walls and is typically associated with aortic aneurysms or Marfan syndrome. It does not describe venous dilatation or tortuosity seen in varicosities.
C. Enlarged and tortuous blood vessels:Varicose veins, esophageal varices, hemorrhoids, and varicoceles are all characterized by dilated, elongated, and tortuous veins. These changes result from increased venous pressure, valve incompetence, or venous obstruction, leading to the visible or palpable vascular abnormalities.
D. Hyaline arteriosclerosis:Hyaline arteriosclerosis involves deposition of homogeneous hyaline material in small arteries and arterioles, usually from chronic hypertension or diabetes. It affects arterial walls rather than veins and is unrelated to varicosities.
E. Severe atherosclerosis:Atherosclerosis is a disease of arterial walls involving lipid deposition, fibrosis, and plaque formation. It affects arteries rather than veins and does not produce the tortuous dilatation characteristic of varicose veins or other venous varicosities.
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