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 FEV, 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?
Asbestos
Cigarette smoke
Coal
Beryllium
The Correct Answer is A
A. Asbestos: Asbestos exposure is strongly associated with pleural diseases, including pleural plaques, pleural thickening, and malignant mesothelioma. Inhaled asbestos fibers cause chronic inflammation and fibrosis, leading to interstitial lung disease with alveolar septal fibrosis and honeycomb changes, as described in this patient. Occupational exposure in mining or construction is a classic risk factor.
B. Cigarette smoke: Cigarette smoke is primarily linked to chronic bronchitis, emphysema, and lung carcinoma. While it can exacerbate lung damage in combination with asbestos, it does not cause pleural plaques or diffuse pleural encasement.
C. Coal: Coal dust exposure causes coal workers’ pneumoconiosis, which leads to nodular lung fibrosis, mainly in the upper lobes. It does not typically cause pleural plaques or mesothelioma, nor does it produce honeycomb changes throughout the lung.
D. Beryllium: Chronic beryllium disease leads to noncaseating granulomatous inflammation and interstitial fibrosis. It is not associated with pleural plaques or mesothelioma, making asbestos the more likely causal agent in this scenario.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is E
Explanation
A. Asthma:Asthma is a chronic inflammatory airway disorder usually triggered by allergens or atopy. While inhaled irritants may exacerbate asthma symptoms, it is not caused by chronic silica exposure and does not produce the fibrotic changes seen in occupational lung diseases.
B. Atelectasis:Atelectasis refers to the collapse of alveoli, usually secondary to obstruction, compression, or surfactant deficiency. It is not a primary disease caused by chronic inhalation of silica dust and does not explain the progressive dyspnea over years in this patient.
C. Bronchiectasis:Bronchiectasis involves permanent dilation of bronchi, often following repeated infections or severe airway obstruction. Chronic silica exposure typically causes interstitial fibrosis rather than bronchial dilation, making bronchiectasis less likely in this occupational scenario.
D. Emphysema:Emphysema is characterized by alveolar wall destruction and airspace enlargement, most commonly due to smoking or alpha-1 antitrypsin deficiency. While dust exposure may contribute to obstructive changes, the fibrotic response from silica inhalation leads to a restrictive pattern rather than classic emphysema.
E. Pneumoconiosis:Pneumoconiosis is a fibrotic lung disease caused by chronic inhalation of mineral dusts, including silica. Inhaled quartz particles trigger macrophage-mediated inflammation, collagen deposition, and nodular fibrosis, leading to progressive dyspnea, reduced lung compliance, and radiographic changes typical of silicosis in stone workers.
Correct Answer is B
Explanation
A. Bronchial asthma:Asthma is characterized by episodic wheezing, reversible airway obstruction, and airway hyperresponsiveness. It usually presents with intermittent symptoms rather than a chronic productive cough and persistent hypoxia with CO₂ retention, making it less consistent with this patient’s history.
B. Chronic bronchitis:Chronic bronchitis, a form of chronic obstructive pulmonary disease (COPD), is defined by a productive cough lasting at least three months per year for two consecutive years. Heavy smoking is the primary risk factor. The patient’s chronic cough, sputum production, frequent infections, hypoxia, and CO₂ retention are classic features of chronic bronchitis, reflecting chronic airway inflammation and airflow obstruction.
C. Diffuse alveolar damage (ARDS):ARDS presents acutely with severe hypoxemia and bilateral pulmonary infiltrates following trauma, sepsis, or inhalation injury. It does not produce a 3-year history of chronic cough or sputum production and is not a chronic condition.
D. Goodpasture syndrome:Goodpasture syndrome is an autoimmune disorder targeting the lungs and kidneys, causing hemoptysis and rapidly progressive glomerulonephritis. It does not typically present with chronic productive cough or CO₂ retention from chronic airway disease.
E. Usual interstitial pneumonia:Usual interstitial pneumonia, seen in idiopathic pulmonary fibrosis, causes progressive dyspnea and dry cough, not productive cough. It also leads to restrictive lung disease rather than the obstructive pattern and CO₂ retention seen in chronic bronchitis.
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