WBR0013

Author	PageAuthor::Ogheneochuko Ajari MB.BS, MS
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Pulmonology
Prompt	[[Prompt::A 7-year-old boy with a long history of constipation was found to have an infiltrate in his right lower lobe on a chest radiograph obtained during evaluation for developmental delay. The parents reported daily use of mineral oil for him, resulting in occasional bouts of coughing and choking. At presentation, he was not symptomatic and physical examination was unremarkable. The parents were advised to stop the administration of the mineral oil and he was treated with antibiotics during an 8-week period. At follow-up examination, the patient continued to cough and there was the radiological persistence of the infiltrate. Diagnostic bronchoscopy with bronchoalveolar lavage (BAL) would reveal with of the following cytologic changes?]]
Answer A	AnswerA::Creola Bodies
Answer A Explanation	AnswerAExp::Creola Bodies are columnar ciliated hyperplastic cells that are often seen in asthmatics.
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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