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Old 10-31-2012
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Arrow Gyrus Daily Questions: Internal Medicine #62

A 56 -year - old man is admitted to the hospital because of worsening shortness of breath. He has a past medical history of significant for coronary artery disease, hypertension and episodes of ventricular tachycardia for which he was placed on amiodarone several months ago.Physical examination is significant for decreased breath sounds bilaterally. Echocardiogram reveals a stable ejection fraction and pulmonary function testing results are consistent with restrictive disease. Amiodarone - induced pulmonary toxicity is suspected and broncoscopy and bronchoalveolar lavage is performed.Which of the following findings is consistent with amiodarone - induced lung disease ?


A. Foamy macrophages.
B. Increased eosinophils
c. Increased lymphocytes
d. Increased neutrophils
e. Langerhans cells
f. Turbid PAS positive materials
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Originally Posted by cingulate.gyrus View Post
A 56 -year - old man is admitted to the hospital because of worsening shortness of breath. He has a past medical history of significant for coronary artery disease, hypertension and episodes of ventricular tachycardia for which he was placed on amiodarone several months ago.Physical examination is significant for decreased breath sounds bilaterally. Echocardiogram reveals a stable ejection fraction and pulmonary function testing results are consistent with restrictive disease. Amiodarone - induced pulmonary toxicity is suspected and broncoscopy and bronchoalveolar lavage is performed.Which of the following findings is consistent with amiodarone - induced lung disease ?


A. Foamy macrophages.
B. Increased eosinophils
c. Increased lymphocytes
d. Increased neutrophils
e. Langerhans cells
f. Turbid PAS positive materials
By exclusion is the only one that can be correct
B would be like asthma, eosinophilic pneumonia and stuff like that.
C autoimmune causes
D any cause of pyogenic pneumonia
E whatever
F havent heard of that in the lung
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wait a sec...is this a CK question.....??? at first instance i thot its step1 territory.........c'mon do they ask this stuff again in CK....
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yes its A...........
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A. Foamy macrophages.
Quote:
Several forms of pulmonary disease occur among patients treated with amiodarone, including chronic interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, and a solitary pulmonary mass. The incidence of pulmonary toxicity from amiodarone is not precisely known but is likely to be approximately 5 percent.
A characteristic finding in all patients exposed to amiodarone is the presence of numerous foamy macrophages in the air spaces, which are filled with amiodarone-phospholipid complexes. Like other amphiphilic compounds, amiodarone can cause an accumulation of phospholipids within lysosomes in the lungs and other tissues due to the inhibition of phospholipase A. Ultrastructural studies show myelinoid inclusion bodies in the affected tissue.
Chronic interstitial pneumonitis — Chronic interstitial pneumonitis is the most common presentation of amiodarone-induced pulmonary disease. It is characterized by the insidious onset of nonproductive cough, dyspnea, and weight loss. The chest radiograph reveals focal or diffuse interstitial opacities. Interstitial pneumonitis is usually recognized after two or more months of therapy, especially in patients in whom the dose of amiodarone exceeds 400 mg per day. These manifestations are due to a nonspecific interstitial pneumonitis predominantly composed of mononuclear cells, foamy alveolar macrophages, type II cell hyperplasia, and fibrosis.
E
Quote:
Pulmonary Langerhans cell histiocytosis (PLCH) is a unique form of LCH in that it occurs almost exclusively in cigarette smokers. It is now considered a form of smoking-related interstitial lung disease. Some patients recover completely after they stop smoking, but others develop long-term complications such as pulmonary fibrosis and pulmonary hypertension.
F
Quote:
Pulmonary alveolar proteinosis
Microscopically, the distal air spaces are filled with a granular, eosinophilic material that is positive with the PAS stain and the PAS diastase stain. The main histomorphologic differential diagnosis is pulmonary edema, which does not have dense bodies.Pulmonary alveolar proteinosis (PAP) is a rare condition which is characterised by the abnormal accumulation of proteinaceous material in the alveolar spaces, with resulting impairment in oxygen exchange across the involved alveoli. The diagnosis of PAP can be established by the classic ‘milky’ effluent bronchoalveolar lavage fluid (BALF). The current effective treatment for PAP is whole-lung lavage (WLL).
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Last edited by Novobiocin; 10-31-2012 at 05:54 PM.
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A. Foamy macrophages.

Well explained Thanks..
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