Transcript 1. Interpret the CXR.

Pulmonary Pathology
Situational Analysis
Part I
Rosella L. Montano, MD
Emmanuel R. Dela Fuente, MD
Alejandro E. Arevalo, MD
Situation no. 1 (Case I-A)
FJ, a 36 year old male, a market vendor, had
moderate to high grade fever, cough
productive of yellowish and occasionally
rusty colored phlegm, and progressive
dyspnea of 1 week duration. He is a known
diabetic and takes medications irregularly.
Situation no. 1 (Case 1-A)
On PE, FJ was awake, BP 110/70, PR was
129/min, RR was 29/min, T 38.9 C. She
preferred the upright position. There were
intercostal and subcostal retractions. There
was symmetrical chest expansion, increase
fremiti, dullness and bronchial breath sounds
on the left lower lung fields. There were
also scattered crackles over both lung fields.
1. Interpret the CXR.
2. Shown below are 2 gross specimens of the lungs.
Which of the following is more characteristic for
this particular patient?
A
B
3. Based on the microscopic section of the bronchus
and bronchiole, explain the mechanism of
productive cough.
4. Which of the following histologic pictures is more
compatible with the physical finding of crackles /
rales ?
A
B
5. Based on the microscopic section of the alveolus,
explain the mechanism of dyspnea, increased
fremiti and lung dullness on percussion.
Situation no. 1 (Case I-B)
His son, mikey, 2 year old, also developed
cough and cold 4 days ago. This was
accompanied by moderate grade fever
temporarily relieved by Paracetamol. One
day prior to admission, he was noted to
refuse to eat his food, and to have rapid
breathing. Mikey was restless, and was
noted to have alar flaring.
Situation no. 1 (Case I-B)
His CR was 108 beats/min, RR 47/min and
temperature was 39.4 C. PE of the chest
revealed intercostals and subcostal
retractions, equal tactile and vocal fremiti,
resonance on percussion with scattered
fine crackles over both lung fields.
1. With this particular patient, which of the
following gross pictures of the lungs is more
characteristic?
A
B
2. Based on the microscopic section of the lung
parenchyma, explain the mechanism of dyspnea,
equal tactile and vocal fremiti and resonance on
percussion.
3. Give the Pathophysiology of this
complication
Low Power
High Power
4. Summarize the main histologic differences
between bacterial pneumonia and viral
pneumonia and its complications
Situation no. 2
Mina, a 47 year old laundry woman complained
of afternoon rises in temperature
accompanied by cough, back pains, and
“unquantifiable” weight loss. A consult and a
subsequent CXR showed a “spot” in the LUL.
1. Interpret the CXR
2. With the signs and symptoms, which of the
following pictures is more compatible with
the patient’s history? Explain.
A
B
3. Interpret the Sputum exam
4. This is a microscopic section from the lung
parenchyma. Discuss the evolution (formation)
of this characteristic lesion, as well as the
predisposing factors that would favor these
lesions to develop.
Two weeks after, she experienced at least 2-4
episodes of coughing out blood streaked
sputum per day. This was accompanied by
progressive dyspnea and a sharp pain along
the left subcostal region, which is worsened
by coughing. During the past few days, she
also needed to prop herself up on 3 pillows
so as to sleep without feeling dyspneic.
5. Explain the pathophysiology of hemoptysis.
6. The 2nd CXR revealed this changes. Explain the
pathoophysiology of dyspnea and pleuritic chest
pain.
Pulmonary Pathology
Situational Analysis
Part II
Rosella L. Montano, MD
Emmanuel R. Dela Fuente, MD
Alejandro E. Arevalo, MD
Situation no. 1-1
Albert, a 59 year old businessman
complained of chronic cough and
exertional dyspnea for 3 years. He has a
70 pack-year smoking history.
1-A. Interpret the following CXR. Which is
more compatible with the patient
symptoms?
A
B
1-B. These are two gross specimens of the
lung in relation to the CXRs shown earlier.
Describe the pathology and explain the
etiopathogenesis of each.
A
B
1-C. These are the microscopic findings of
the lungs shown previously. Discussion
should include the following:
i. morphological changes in the lungs
ii. Clinical manifestions of the patient
iii. Outcome and Complications
A
B
Situation no. 1-2
He claims that he used to have blood
streaks in his sputum 2 months ago, but in
the past week, he has been coughing up
to 1-2 tsps of blood daily.
2. Arrange the sequence of events from
normal to dysplasia to carcinoma.
Explain the etiopathogenesis as well as
the predisposing factors/risk factors.
4
1
2
3
Situation no. 1-3
Albert also has a 1 x 1 cm hard, fixed lymph
node on the right supraclavicular area.
3-A. Shown are sections from the right
supraclavicular node. Which of the
following is more compatible with this
patient? Describe the gross findings in
the lymph nodes.
A
B
3-B. The following are the respective histologic
findings in the nodes. Discuss according to:
i. Morphology
ii. Etiopathogenesis
iii. Outcome
A
B
4. Chest X-ray and CT scan were done.
Interpret the results.
CXR
CT
5. This is a section from the right hilar mass.
Describe the gross findings and explain the
pathogenesis of hemoptysis.
6. This is the histologic section. Classify the tumor
according to its behaviour (Benign or
Malignant), origin (Epithelial, Mesenchymal or
Lymphoid) and differentiation ( Well-, mod.or poorly differentiated).