WBR0013

Author	[[PageAuthor::Ogheneochuko Ajari, MB.BS, MS [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Pulmonology
Prompt	[[Prompt::A 5-year-old boy with a history significant for chronic constipation is found to have a right upper lobe focal infiltrate on a chest radiograph obtained during evaluation for developmental delay and tonic-clonic seizures. The parents report daily ingestion of mineral oil laxatives to relieve his constipation, and explain that he had recently been complaining of occasional episodes of coughing and choking during intake of food. At presentation, he is completely asmyptomatic. His vital signs and physical examination are unremarkable. The pediatrician advises to stop the ingestion of mineral oil and to give oral antibiotics for 10 days. At follow-up examination, the patient continues to cough. Persistence of the infiltrate is noted on chest xray. Diagnostic bronchoscopy with bronchoalveolar lavage (BAL) is scheduled to identify the etiology of the patient's symptoms. What is the most likely BAL finding associated with this patient's condition?]]
Answer A	AnswerA::Creola Bodies
Answer A Explanation	AnswerAExp::Creola bodies (CrBs) are clusters of columnar ciliated hyperplastic cells often observed in sputum of patients with bronchial asthma. They are suggestive of bronchial injury.
Answer B	AnswerB::Reserve cell hyperplasia
Answer B Explanation	AnswerBExp::These are tight clusters of uniform small cells with hyperchromatic nuclei, they are the earliest changes seen in squamous metaplasia and are commonly found in cigarette and marijuana smokers.
Answer C	AnswerC::Hemosiderin-Laden Macrophages
Answer C Explanation	[[AnswerCExp::The presence of hemosiderin-laden alveolar macrophages in bronchoalveolar lavage fluid is a useful tool for diagnosing diffuse lung bleeding. However, many diffuse interstitial pulmonary diseases also reveal evidence of these cells in aspirates.]]
Answer D	AnswerD::Lipid-Laden Macrophages
Answer D Explanation	[[AnswerDExp::They are commonly seen whenever there is aspiration of mineral oil. Lipid-Laden Macrophages in bronchial lavage are clinically associated with tracheal aspiration in children with gastro-esophageal reflux (GER) or lobular consolidation distal to an obstructed bronchus.]]
Answer E	AnswerE::Ferruginous Bodies
Answer E Explanation	AnswerEExp::Ferruginous Bodies (also called Asbestos bodies) are clear central fibers within a golden brown iron-protein complex. They are indicative of occupational asbestos exposure.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Lipid-Laden Macrophages in Bronchial Lavage are clinically associated with tracheal aspiration in children with gastro-esophageal reflux (GER) or lobular consolidation distal to an obstructed bronchus. They are commonly seen whenever there is aspiration of mineral oil. The hypothesis is that the amount of lipids in alveolar macrophages, quantitated as the lipid-laden index (LLI), would correlate with lung inflammation in pediatric patients. Educational Objective: References: ]]
Approved	Approved::Yes
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