Question 1
Which of the following is the hallmark imaging finding of panlobular emphysema?
A. Upper lobe-predominant bullae
B. Uniform destruction of the acinus
C. Honeycombing
D. Centrilobular lucencies
Answer: B. Uniform destruction of the acinus
Explanation: Panlobular emphysema is characterized by uniform destruction of alveoli throughout the acinus, with a preference for the lower lobes.
Reference:
Radiopaedia: Emphysema – Panlobular. “Uniform involvement of the acinus distinguishes it from centrilobular emphysema.”
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Question 2
What is the most common underlying cause of panlobular emphysema?
A. Chronic smoking
B. Alpha-1 antitrypsin deficiency
C. Pulmonary fibrosis
D. Asthma
Answer: B. Alpha-1 antitrypsin deficiency
Explanation: Alpha-1 antitrypsin deficiency leads to unregulated elastase activity, resulting in diffuse destruction of alveoli, especially in the lower lobes.
Reference:
PubMed: Alpha-1 Antitrypsin Deficiency and Lung Disease. “Panlobular emphysema is the characteristic lung manifestation of AAT deficiency.”
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Question 3
Which lobe is predominantly affected in panlobular emphysema?
A. Upper lobe
B. Middle lobe
C. Lower lobe
D. Diffuse without lobar predilection
Answer: C. Lower lobe
Explanation: Panlobular emphysema typically affects the lower lobes, unlike centrilobular emphysema, which is upper lobe predominant.
Reference:
Radiology Key: Panlobular Emphysema. “Lower lobe predominance is a hallmark feature of panlobular emphysema.”
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Question 4
Which pulmonary function test (PFT) finding is most characteristic of panlobular emphysema?
A. Increased FEV1/FVC ratio
B. Reduced DLCO
C. Normal total lung capacity
D. Restrictive pattern
Answer: B. Reduced DLCO
Explanation: Panlobular emphysema leads to destruction of alveolar walls and capillary beds, reducing diffusing capacity (DLCO).
Reference:
Radiographics: PFT Patterns in Emphysema. “Reduced DLCO is a characteristic finding in emphysema, reflecting alveolar and capillary destruction.”
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Question 5
What is the primary role of alpha-1 antitrypsin in the lungs?
A. Neutralize free radicals
B. Inhibit neutrophil elastase
C. Stimulate surfactant production
D. Promote alveolar repair
Answer: B. Inhibit neutrophil elastase
Explanation: Alpha-1 antitrypsin inhibits neutrophil elastase, preventing elastin degradation in alveolar walls.
Reference:
AJR: Pathogenesis of Panlobular Emphysema. “AAT deficiency leads to unchecked elastase activity, driving alveolar destruction.”
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Question 6
Which of the following is NOT a feature of panlobular emphysema on chest CT?
A. Lower lobe-predominant hypoattenuation
B. Uniform involvement of alveoli
C. Centrilobular nodules
D. Reduced vascular markings
Answer: C. Centrilobular nodules
Explanation: Centrilobular nodules are seen in centrilobular emphysema or other diseases, not in panlobular emphysema.
Reference:
Radiopaedia: CT Patterns in Emphysema. “Panlobular emphysema shows uniform hypoattenuation without nodularity.”
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Question 7
What genetic mutation is associated with alpha-1 antitrypsin deficiency?
A. CFTR gene mutation
B. SERPINA1 gene mutation
C. TGF-beta gene mutation
D. EGFR gene mutation
Answer: B. SERPINA1 gene mutation
Explanation: Mutations in the SERPINA1 gene lead to deficient or dysfunctional alpha-1 antitrypsin.
Reference:
PubMed: Genetics of Alpha-1 Antitrypsin Deficiency. “Mutations in the SERPINA1 gene underlie AAT deficiency.”
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Question 8
Which clinical feature is most commonly seen in individuals with panlobular emphysema due to AAT deficiency?
A. Productive cough
B. Progressive dyspnea
C. Recurrent hemoptysis
D. Night sweats
Answer: B. Progressive dyspnea
Explanation: Dyspnea is the most common symptom due to progressive alveolar destruction and airflow obstruction.
Reference:
Radiology Key: Clinical Features of Panlobular Emphysema. “Dyspnea is the hallmark symptom, especially in AATD-associated cases.”
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Question 9
What is the recommended first-line treatment for AAT deficiency-related panlobular emphysema?
A. Inhaled corticosteroids
B. Alpha-1 antitrypsin replacement therapy
C. Lung transplantation
D. Pulmonary rehabilitation
Answer: B. Alpha-1 antitrypsin replacement therapy
Explanation: Replacement therapy addresses the underlying deficiency and slows disease progression.
Reference:
ATS Guidelines: Management of AAT Deficiency. “AAT replacement is the cornerstone of treatment in AATD-associated lung disease.”
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Question 10
Which of the following imaging findings differentiates panlobular emphysema from centrilobular emphysema?
A. Hyperinflation
B. Diffuse vascular pruning
C. Predominant lower lobe involvement
D. Presence of bullae
Answer: C. Predominant lower lobe involvement
Explanation: Panlobular emphysema primarily involves the lower lobes, while centrilobular emphysema predominantly affects the upper lobes.
Reference:
Radiopaedia: Comparative Features of Emphysema Types. “Lower lobe involvement is a distinguishing feature of panlobular emphysema.”
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