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Multiple Choice Questions (MCQs) on Centrilobular Emphysema (CLE)

Incorporating References with Paraphrased Comments

  1. What is the primary site of lung involvement in centrilobular emphysema?
    • A) Entire alveolus
    • B) Respiratory bronchioles
    • C) Interlobular septa
    • D) Pleura
      Answer: B) Respiratory bronchioles
      Comment: CLE primarily affects the respiratory bronchioles, sparing distal alveoli. This unique pattern is discussed in detail on Radiopaedia, which highlights CLE’s typical distribution and pathological changes.
  1. Which imaging finding is most characteristic of centrilobular emphysema on CT?
    • A) Uniformly enlarged alveoli
    • B) Small, focal areas of low attenuation without visible walls
    • C) Thickened bronchial walls
    • D) Mosaic attenuation pattern
      Answer: B) Small, focal areas of low attenuation without visible walls
      Comment: According to Radiopaedia, CLE’s hallmark finding is small areas of decreased attenuation, often in the upper lobes, representing destruction around respiratory bronchioles.
  1. How does centrilobular emphysema differ from chronic bronchitis in its pathology?
    • A) CLE involves mucus hypersecretion; chronic bronchitis does not.
    • B) CLE involves alveolar destruction; chronic bronchitis involves airway inflammation.
    • C) CLE affects the lower lobes; chronic bronchitis affects the upper lobes.
    • D) CLE is not associated with smoking; chronic bronchitis is.
      Answer: B) CLE involves alveolar destruction; chronic bronchitis involves airway inflammation.
      Comment: Radiology Key elaborates on the distinction, describing CLE as bronchiole-focused alveolar destruction, while chronic bronchitis involves mucus hypersecretion and larger airway inflammation.
  1. What is the typical lobe distribution of centrilobular emphysema?
    • A) Upper lobes
    • B) Lower lobes
    • C) Middle lobe and lingula
    • D) Diffuse involvement
      Answer: A) Upper lobes
      Comment: CLE is predominantly upper lobe-centric, which is attributed to smoking-related damage, as highlighted in studies available on PubMed.
  1. How does centrilobular emphysema contribute to the pathophysiology of COPD?
    • A) Restrictive lung disease with reduced lung compliance
    • B) Airway obstruction and air trapping due to loss of alveolar attachments
    • C) Impaired diffusion due to pleural thickening
    • D) Increased airway resistance from mucus plugging
      Answer: B) Airway obstruction and air trapping due to loss of alveolar attachments
      Comment: Radiopaedia discusses how CLE causes airflow limitation by reducing elastic recoil, a key feature of COPD pathophysiology.
  1. Which factor is most strongly associated with centrilobular emphysema?
    • A) Alpha-1 antitrypsin deficiency
    • B) Smoking
    • C) Air pollution
    • D) Chronic infections
      Answer: B) Smoking
      Comment: Smoking remains the most significant risk factor for CLE, as described in detail by Radiology Key, which also notes the additive role of environmental pollutants.
  1. Which PFT finding distinguishes centrilobular emphysema from chronic bronchitis?
    • A) Increased FEV1/FVC ratio in CLE
    • B) Decreased DLCO in CLE
    • C) Increased TLC in chronic bronchitis
    • D) Decreased RV in CLE
      Answer: B) Decreased DLCO in CLE
      Comment: CLE’s alveolar destruction reduces DLCO, whereas chronic bronchitis primarily affects airways without significantly impairing diffusion. This distinction is well-documented in Radiology Key and related PFT studies on PubMed.
  1. On CT, how can centrilobular emphysema be distinguished from chronic bronchitis?
    • A) CLE shows thickened bronchial walls, while chronic bronchitis shows low attenuation.
    • B) CLE shows low attenuation areas, while chronic bronchitis shows thickened bronchial walls.
    • C) CLE involves lower lobes; chronic bronchitis involves upper lobes.
    • D) CLE is associated with pleural effusion; chronic bronchitis is not.
      Answer: B) CLE shows low attenuation areas, while chronic bronchitis shows thickened bronchial walls.
      Comment: As detailed by Radiopaedia, chronic bronchitis primarily involves bronchial wall thickening, whereas CLE is characterized by low attenuation areas on CT.
  1. What is a common clinical manifestation of centrilobular emphysema in COPD patients?
    • A) Chronic productive cough
    • B) Progressive dyspnea on exertion
    • C) Recurrent hemoptysis
    • D) Clubbing of fingers
      Answer: B) Progressive dyspnea on exertion
      Comment: CLE contributes to hyperinflation and airflow limitation, causing progressive dyspnea, a hallmark of COPD as discussed on PubMed.
  1. Which treatment recommendation is most appropriate for patients with centrilobular emphysema in COPD?
  • A) Long-term corticosteroids as the first-line treatment
  • B) Smoking cessation and pulmonary rehabilitation
  • C) Immediate lung transplantation
  • D) Antibiotics for all exacerbations
    Answer: B) Smoking cessation and pulmonary rehabilitation
    Comment: Smoking cessation is critical for slowing disease progression, and pulmonary rehabilitation improves exercise tolerance, as emphasized in guidelines from Radiopaedia.

Recommendations

  • CT of the chest is the gold standard for identifying CLE and distinguishing it from other COPD subtypes.
  • Encourage smoking cessation as the most effective intervention to slow disease progression.
  • Consider pulmonary rehabilitation programs to improve dyspnea and exercise capacity.
  • Use PFTs, particularly DLCO, to assess functional impairment and differentiate CLE from other COPD phenotypes.