A 62-year-old woman, previously in good health, complains of mild chest pain and dyspnea. Chest x-ray reveals multiple "coin lesions in both lung fields. CT-guided biopsy of a pulmonary lesion would most likely demonstrate which of the following lung diseases?
Diffuse alveolar damage
Metastatic cancer
Nodular silicosis
Primary lung cancer
Pulmonary abscess
The Correct Answer is B
A. Diffuse alveolar damage: Diffuse alveolar damage (DAD) presents with widespread interstitial involvement, alveolar edema, and hyaline membrane formation, typically causing diffuse infiltrates rather than discrete “coin lesions.” It does not manifest as multiple nodules on imaging.
B. Metastatic cancer: Multiple “coin lesions” on chest x-ray are characteristic of hematogenous spread of metastatic tumors to the lungs. CT-guided biopsy would likely reveal malignant cells consistent with secondary pulmonary involvement, making metastatic cancer the most probable diagnosis in a patient with multiple discrete nodules.
C. Nodular silicosis: Nodular silicosis presents with upper lobe nodules and may calcify, but it usually occurs in individuals with long-term occupational silica exposure and produces a more diffuse nodular pattern rather than well-circumscribed coin lesions.
D. Primary lung cancer: Primary lung cancer usually presents as a single mass or nodule rather than multiple discrete coin-shaped lesions. While it can metastasize, the primary presentation of multiple coin lesions is more consistent with secondary metastases.
E. Pulmonary abscess: Pulmonary abscesses are localized collections of pus that usually appear as cavitary lesions, often with air-fluid levels, rather than multiple well-circumscribed coin lesions. They are typically unilateral and associated with infection, fever, and purulent sputum.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Atelectasis:Atelectasis is collapse of lung tissue due to obstruction, compression, or surfactant deficiency. It results in decreased lung volume rather than hyperinflation and does not produce enlarged, irregular air spaces as seen in this patient.
B. Bronchiectasis:Bronchiectasis involves permanent dilation of bronchi due to chronic infection or obstruction, often associated with copious purulent sputum. It primarily affects the airways rather than alveolar structures and does not cause the centriacinar destruction or “sponge-like” hyperinflated lungs described.
C. Chronic bronchitis:Chronic bronchitis is characterized by chronic productive cough due to hyperplasia of mucus-secreting glands and airway inflammation. While it may coexist with emphysema, it does not produce enlarged alveolar air spaces or the characteristic upper-lobe centriacinar pattern.
D. Emphysema:Emphysema is a chronic obstructive pulmonary disease marked by irreversible enlargement of alveoli and destruction of alveolar walls. Centriacinar (centrilobular) emphysema predominantly is strongly associated with heavy smoking. The “sponge-like,” hyperinflated lungs with irregular air spaces are classic features.
E. Pneumonia:Pneumonia is an acute infection causing alveolar consolidation, inflammation, and exudate accumulation. It does not lead to permanent alveolar enlargement or centriacinar destruction and is inconsistent with the chronic “sponge-like” changes observed in this patient.
Correct Answer is D
Explanation
A. Congestive heart failure:Congestive heart failure can cause dyspnea and pulmonary congestion, but hemoptysis and sudden pleuritic chest pain are not classic presenting features. CHF-related pulmonary edema usually produces pink, frothy sputum rather than frank blood and develops in the context of volume overload rather than acute embolic events.
B. Cor pulmonale:Cor pulmonale refers to right ventricular hypertrophy and failure secondary to chronic pulmonary hypertension. It develops gradually in patients with chronic lung disease and presents with peripheral edema and fatigue, not sudden chest pain and hemoptysis.
C. Phlebothrombosis:Phlebothrombosis refers to thrombus formation in a vein, often in the lower extremities, especially in patients with varicose veins. While it is the underlying source of emboli, it does not directly cause chest pain or hemoptysis unless a clot dislodges and travels to the lungs.
D. Pulmonary thromboembolism:Pulmonary thromboembolism occurs when a thrombus, often originating from deep leg veins, embolizes to the pulmonary arteries. Sudden chest pain and hemoptysis result from pulmonary infarction and pleural irritation. Varicose veins increase venous stasis, predisposing to thrombosis and subsequent embolism.
E. Pulmonary edema:Pulmonary edema involves fluid accumulation in the alveoli, most commonly due to left-sided heart failure. It causes dyspnea and crackles but does not typically present with sudden pleuritic chest pain and hemoptysis linked to venous thromboembolic risk factors.
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