View source for WBR0394

{{WBRQuestion
|QuestionAuthor={{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|SubCategory=Pulmonology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Pulmonology
|Prompt=A 72-year-old man presents to the pulmonary clinic for chronic cough and recent onset dyspnea on exertion. He reports that he has been admitted to the hospital at least 4 times in the past 60 days for the treatment of pneumonia. After initial work-up is unrevealing, the physician decides to perform a bronchoscopy with bronchoalveolar lavage (BAL). A centrifuged sample of the BAL specimen is shown below. Which of the following conditions are associated with this patient's findings?

[[Image:WBR0394.jpg|500px]]
|Explanation=Curschmann's spirals are spiral shaped mucus plugs found in the sputum of patients who suffer from asthma or chronic bronchitis or those who have been chronic smokers. They are associated with excess sputum production and are composed mainly of glycoproteins. Although they have little diagnostic significance, they are a classic sign of obstructive lung diseases. In asthma, they are usually seen with Charcot-Leyden crystals.
|AnswerA=Fungal colonization of the lung
|AnswerAExp=Fungal colonization of the lung would show mold or yeast species on microscopy.
|AnswerB=Chronic obstructive lung disease
|AnswerBExp=Patients with chronic obstructive lung diseases usually have excess sputum production with  Curschmann's spirals often seen on sputum microscopy.
|AnswerC=Helminth infection in the lungs
|AnswerCExp=Helminth infection in the lungs is not associated with Curschmann's spirals. Eosinophils are usually abundant on BAL.
|AnswerD=Small cell lung carcinoma
|AnswerDExp=Small cell lung carcinoma does not produce Curschmann's spirals that can be seen on BAL examination.
|AnswerE=Chronic asbestos exposure
|AnswerEExp=Chronic asbestos exposure is associated with Asbestos bodies on BAL that are golden-brown structures resembling dumbbells.
|EducationalObjectives=Curschmann's spirals are spiral shaped mucus plugs found in the sputum of patients who suffer from asthma or chronic bronchitis or in chronic smokers.
|References=Antonakopoulos GN, Lambrinaki E, Kyrkou KA. Curschmann's spirals in sputum: Histochemical evidence of bronchial gland ductal origin. Diagn. Cytopathol. 1987;3(4):291-294.
|RightAnswer=B
|WBRKeyword=COPD, Curschmann's spirals, Asthma
|Approved=Yes
}}