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Question 1

Which subtype of emphysema is most commonly associated with cigarette smoking?
A. Paraseptal emphysema
B. Panlobular emphysema
C. Centrilobular emphysema
D. Irregular emphysema

Correct Answer: C. Centrilobular emphysema
Explanation: Centrilobular emphysema primarily affects the respiratory bronchioles in the central portion of the secondary pulmonary lobule, commonly in the upper lobes. It is strongly associated with cigarette smoking, which causes inflammation and localized alveolar wall destruction.
References and Links:

  • Radiopaedia: Centrilobular Emphysema
  • AJR: Imaging features of emphysema subtypes emphasize the role of cigarette smoking.
  • ATS (American Thoracic Society): Smoking-induced emphysema and its distribution patterns.

Question 2

Which subtype of emphysema is predominantly found in the lung bases and is linked to alpha-1 antitrypsin (A1AT) deficiency?
A. Paraseptal emphysema
B. Panlobular emphysema
C. Centrilobular emphysema
D. Irregular emphysema

Correct Answer: B. Panlobular emphysema
Explanation: Panlobular emphysema uniformly affects the acini and is predominantly located in the lung bases. It is closely associated with A1AT deficiency, which leads to an imbalance between proteases and antiproteases, causing widespread alveolar wall destruction.
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Question 3

What is the most distinguishing radiologic feature of emphysema compared to cysts?
A. Thin walls in emphysema
B. Presence of internal structure in cysts
C. Presence of vascular markings and bronchovascular bundles in emphysema
D. Location near the pleura in cysts

Correct Answer: C. Presence of vascular markings and bronchovascular bundles in emphysema
Explanation:
The most distinguishing feature of emphysema is the preservation of internal structures, including the bronchovascular bundle and septal remnants of the secondary pulmonary lobule, even in areas of low attenuation. Cysts, in contrast, lack internal structure, which makes B incorrect.
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Question 4

Which subtype of emphysema is most closely associated with spontaneous pneumothorax?
A. Centrilobular emphysema
B. Paraseptal emphysema
C. Panlobular emphysema
D. Irregular emphysema

Correct Answer: B. Paraseptal emphysema
Explanation: Paraseptal emphysema predominantly affects the peripheral alveoli near the pleura and interlobular septa, predisposing patients to bullae formation. This makes it a common cause of spontaneous pneumothorax.
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Question 5

What is a typical finding on pulmonary function tests (PFTs) in emphysema?
A. Increased FEV1/FVC ratio
B. Increased residual volume (RV)
C. Increased diffusing capacity for carbon monoxide (DLCO)
D. Decreased total lung capacity (TLC)

Correct Answer: B. Increased residual volume (RV)
Explanation: In emphysema, airflow obstruction and loss of elastic recoil lead to air trapping, causing an increase in residual volume. A decreased DLCO and FEV1/FVC ratio are also hallmark findings.
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Question 6

What is the primary imaging modality used to detect emphysema subtypes?
A. Chest X-ray (CXR)
B. High-resolution computed tomography (HRCT)
C. MRI
D. Ultrasound

Correct Answer: B. High-resolution computed tomography (HRCT)
Explanation: HRCT is the imaging modality of choice for detecting emphysema, characterizing subtypes, and differentiating it from other conditions like cystic lung diseases.
References and Links:

  • Fleischner Society Guidelines: HRCT in the evaluation of COPD and emphysema.
  • RadiologyKey: Emphysema on CT
  • AJR: Role of HRCT in emphysema diagnosis and classification.

Question 7

What distinguishes centrilobular emphysema from panlobular emphysema on CT imaging?
A. Centrilobular affects the upper lobes; panlobular affects the lower lobes.
B. Centrilobular uniformly destroys the acini; panlobular spares the bronchioles.
C. Centrilobular occurs near the pleura; panlobular occurs centrally.
D. Centrilobular spares the upper lobes; panlobular spares the lower lobes.

Correct Answer: A. Centrilobular affects the upper lobes; panlobular affects the lower lobes.
Explanation: Centrilobular emphysema primarily affects the respiratory bronchioles and is found in the upper lobes, typically due to smoking. Panlobular emphysema involves uniform destruction of the acini, predominantly in the lower lobes, and is associated with A1AT deficiency.
References and Links:

  • Radiopaedia: Centrilobular Emphysema.
  • ATS Guidelines: Smoking-related COPD vs. genetic forms like A1AT deficiency.

Question 8

Which physical forces are thought to contribute to paraseptal emphysema?
A. Central airway obstruction
B. Inspiratory and expiratory stress near the pleura
C. Increased blood flow to the lower lobes
D. Smoking-related inflammation

Correct Answer: B. Inspiratory and expiratory stress near the pleura
Explanation: Paraseptal emphysema predominantly affects the alveoli near the pleura and septa, where physical stress during inspiration and expiration is greatest. This leads to localized destruction and formation of bullae.
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Question 9

Which subtype of emphysema is most strongly associated with bullae?
A. Centrilobular emphysema
B. Paraseptal emphysema
C. Panlobular emphysema
D. Irregular emphysema

Correct Answer: B. Paraseptal emphysema
Explanation: Paraseptal emphysema is characterized by its predilection for the periphery of the lung, particularly near the pleura, and is strongly associated with bullae formation.
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Question 10

What is the hallmark pathological process in emphysema?
A. Fibrosis of the lung parenchyma
B. Loss of elastic recoil and alveolar wall destruction
C. Airway inflammation and mucus hypersecretion
D. Smooth muscle hypertrophy and bronchial narrowing

Correct Answer: B. Loss of elastic recoil and alveolar wall destruction
Explanation: Emphysema is defined by abnormal, permanent enlargement of airspaces distal to the terminal bronchioles, with destruction of their walls and loss of elastic recoil, leading to airflow limitation.
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