PATHANATOMY EXAM 3RD COURSE 2016-17

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Quiz on Untitled, created by Mahesh Bishnoi on 11/06/2017.
Mahesh  Bishnoi
Quiz by Mahesh Bishnoi , updated more than 1 year ago
Mahesh  Bishnoi
Created by Mahesh Bishnoi almost 7 years ago
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Resource summary

Question 1

Question
Patient has complains on increasing of sizes of thyroid gland, shortness of breath & swallowing, torpidity, sleepiness. In physical examination: increasing of thyroid gland, brachycardia, hyperkeratosis, decreasing of basal metabolism. Operation thyroidectomy was done. In histological examination: replacement of tissue of thyroid gland by lymphoid elements. What kind of goiter was revealed?
Answer
  • riedel’s goiter
  • hashimoto’s goiter
  • grave’s disease
  • De Quervain's thyroiditis
  • macro-microfollicular goiter

Question 2

Question
Lungs in emphysema have following appearance
Answer
  • pale, dense
  • brown induration of lungs
  • dark red areas
  • increased airiness, malignization,
  • pale, increased, elasticity is decreased

Question 3

Question
Following changes in lungs were revealed in autopsy of girl of 2 y.o.: mononuclear infiltration of alveolar septi, hyperplasia of alveolar epithelium, large cells with intranuclear inclusions, serous liquid in lumens of alveoli. What is etiology of this disease?
Answer
  • mycoplasmic
  • pneumocyst
  • cytomegaloviral
  • chlamidia
  • rickettsia

Question 4

Question
In autopsy of the man of 53 y.o., lungs are with focal consolidation in low lobe of right lung, of the dark red color on the cut, there are granular grayish-red confluent foci up to 4 cm in diameter in low lobe of right lung. In pressing on lungs the mucous-purulent plugs are discharged from bronchi. Reddish foam liquid flows from the surface of the cut, lungs are congested. What complication has developed?
Answer
  • pleuritis
  • empyema
  • abscess formation
  • interstitial fibrosis
  • Carnification

Question 5

Question
Patient 54 y.o. was admitted in cardiac intensive care unit with complains on breathlessness, edema of low extremities, havieness in right hypochondrium. In anamnesis: transmural myocardium infarction. In examination: boundaries of heart are dilated; there is pulsating bulging formation in area of heart apex. Suddenly the right hemiplegia developed, patient lost conciseness & died. What changes is it possible to find in autopsy?
Answer
  • chronic heart aneurism with parietal thrombi, hemorrhagic brain infarction, concentric myocardial hypertrophy, brown induration of lungs, nutmeg liver
  • chronic heart aneurism with parietal thrombi, ischemic brain infarction, excentric myocardium hypertrophy, brown induration of lungs, nutmeg liver
  • chronic heart aneurism with parietal thrombi, ischemic brain infarction, excentric myocardium hypertrophy, brown atrophy of liver, emphysema of lungs
  • chronic heart aneurism with parietal thrombi, ischemic brain infarction, excentric myocardium hypertrophy, arteriolosclerotic kidney, lung’s athelectasis©
  • chronic heart aneurism with parietal thrombi, hemorrhagic brain infarction, excentric myocardium hypertrophy, steatosis of liver, lung’s cirrhosis

Question 6

Question
Patient 63 y.o., suffering from diabetes mellitus was admitted in hospital with complains on arrhythmia, dyspnoe. Suddenly the condition of patient became worse, reanimation measures are without effect. He died in reception ward. In autopsy: stenosed coronary arteries, yellowish color areas, surrounded by focal hemorrhages at apex & anterior wall of left ventricle. What is possible cause of myocardial lesion?
Answer
  • congenital anomaly of coronary arteries
  • arteritis
  • anemia©
  • atherosclerotic changes in coronary arteries
  • thromboembolism of coronary arteries©

Question 7

Question
Male, 51 y.o., was admitted in hospital with complains on breathlessness, cough with abundant sputum. At first time such symptoms appeared 30 years ago, all this time he continued to smoke. On X-ray examination: emphysema of lungs, saccular & cylindrical dilations of bronchi, cardiac borders are dilated by means of right ventricle. There are clubbed fingers. Symptoms of developing renal insufficiency have appeared. Patient has died from hyperazotemic uremia. What is pulmonary disease of this patient?
Answer
  • idiopathic fibrosing alveolitis
  • Hamman-Rich syndrome
  • lobular pneumonia
  • chronic obstructive bronchitis
  • bronchiectactic disease

Question 8

Question
Patient, 64 y.o. has diabetes mellitus during long period. Pains in abdomen, clinical picture of intestinal obstipation & surgical abdomen has suddenly appeared. All following is correct for this clinical situation, except of
Answer
  • patient has mesenterial variant of atherosclerosis
  • atherosclerosis & thrombosis of mesenterial vessels are revealed in surgery
  • loops of small intestine are dilated, of red-blackish color, serous membrane is smooth with glitter
  • patient has wet gangrene of intestine©
  • loops of small intestine are dilated, of red-blackish color, serous membrane is smooth , dull

Question 9

Question
Patient, 68 y.o., was admitted in neurological intensive care unit with acute developed paralysis. Blood wasn’t revealed in liquor. There is infarction of left hemisphere of brain in anamnesis. What are the morphological changes in brain?
Answer
  • ischemic infarction in left hemisphere
  • hemorrhagic infarction if left hemisphere
  • atherosclerosis if vessels of the base of the brain (up to 40%)
  • ischemic infarction in right hemisphere, cyst in left hemisphere
  • hemorrhagic infarction in right hemisphere, cyst in left hemisphere

Question 10

Question
Morphological changes of the knee joint of the patient P., 43 y.o. are presented by hypertrophy & hyperplasia of synovial cells with overgrowth of villi & formation of granulation tissue as a layer covered hyaline cartilage & subchondral bone. What extraarticular changes are possible to find at this patient?
Answer
  • purulent meningitis
  • secondary amyloidosis
  • hepatitis
  • gastritis
  • Pyelonephritis

Question 11

Question
Big white kidney was revealed at autopsy of woman of 47 y.o.There is deposition of amyloid in glomeruli, tubular basal membranes, wall of vessels & stroma in histological investigation. From anamnesis: woman had pathology of joints for a long period. This morphological picture is complication of following disease
Answer
  • rheumatic disease
  • Gout
  • postrheumatic arthritis
  • rheumatoid arthritis
  • arrhrosis

Question 12

Question
Patient has complains on bad sleeping, general weakness, soreness, protrusion of the eye-balls, heartbeats, tachycardia. There is diffuse increased thyroid gland in palpation. What are the typical microscopical changes
Answer
  • proliferation of high epithelium with formation of papillae, liquid colloid, lymphoid infiltrates in stroma
  • infiltration by polymorph-nuclear leucocytes, degenerative changes
  • replacement of tissue of gland by fibrous tissue
  • granulomatosis with giant cells of foreign bodies
  • abundant lymphocytic infiltration with formation of follicles with light centers

Question 13

Question
Male, 51 y.o., was admitted in hospital with complains on breathlessness, cough with abundant sputum. At first time such symptoms appeared 30 years ago, all this time he continued to smoke. On X-ray examination: emphysema of lungs, saccular & cylindrical dilations of bronchi, cardiac borders are dilated by means of right ventricle. There are clubbed fingers. Symptoms of developing renal insufficiency have appeared. Patient has died from hyperazotemic uremia. What is the cause of renal insufficiency?
Answer
  • chronic pyelonephritis
  • carbuncul of kidney
  • amyloidosis
  • kidneys’ tuberculosis
  • subacute mesangioprolipherative glomerulonephritis

Question 14

Question
Woman of 63 y.o. suffers from pain in knee joints, their stiffness & puffiness. There is crepitation in joints in physical examination. The reconstructive surgical operation was executed. There is destruction of articular cartilage & subchondral osteosclerosis with expressed thickening of cortical layer in dissected bone. What does better describe the etiology of this disease ?
Answer
  • wear & tear of articular cartilage
  • anti-IgG autoantibodies
  • disorder of metabolism of vitamin D
  • staphylococcus aureus
  • dysfunction of osteoclasts

Question 15

Question
Histological investigation of knee joint of patient of 22 y.o. revealed thinning of articular cartilage. What from predisposing conditions has place in appearance of these morphological changes in joint
Answer
  • significant obesity
  • hemopoetic tumors
  • diseases of adrenal glands
  • cachexy
  • congenital heart defects

Question 16

Question
Woman, suffering from atherosclerosis, was on treatment in neurological department with diagnosis: disorder of cerebral blood circulation in region of right hemisphere & brainstem. Clinically: paralysis of left extremities (hemiplegia), disorder of swallowing, often chocking. After regular meal the cough appeared, increasing of dyspnoe, body temperature increased up to 39?C., moist rale in right lung. What process in lungs may these symptoms be related with?
Answer
  • tuberculosis of lung
  • aspiration pneumonia
  • hemorragic infarction of lung
  • croupous pneumonia
  • pleuropleumonia

Question 17

Question
In chronic bronchitis like in bronchial asthma, there is direct dependence between expression of inflammation & reactivity of
Answer
  • Bronchi
  • Liver
  • Spleen
  • Trachea
  • Lungs

Question 18

Question
Male person, 60 y.o. suffered from hypertensive disease during 15 years, last time he has complains on weakness, fast fatigability, polyuria. In examination: proteinuria, significant increasing of creatinin in blood. He died from increasing renal insufficiency. What is the pathological process in kidney
Answer
  • embolic purulent nephritis
  • atherosclerotic nephrosis
  • arteriosclerotic kidney
  • hydronephrotic transformation
  • necronephrosis

Question 19

Question
Patient was admitted in hospital with complains on acute pains in abdomen, weakness. After several minutes after admission he lost the conciseness, thready pulse, patient was operated. About 1500 ml of blood was revealed in abdominal cavity. There is sacciform bulging of aorta in abdominal part, it’s wall is thin. Complication of what disease is described?
Answer
  • atherosclerosis of aorta
  • syphilitic mesarteritis
  • hypertensive disease
  • sclerodermia
  • periarteritis nodosa

Question 20

Question
Patient has suffered from rheumatic defect of mitral valve. Patient has died from chronic cardio-vascular insufficiency. In autopsy: leaflets of mitral valve are thickened, adherent, opaque, dense, of milky-white color. What pathological process is in the base of changes of mitral valve?
Answer
  • aschoff’s bodies
  • hyalinosis
  • mucoid swelling
  • fibrinoid swelling
  • mucoid & fibrinoid swelling

Question 21

Question
Patient, 67 y.o., left revisional meniscectomia was done. What morphological changes in organs are appearance of complications at this patient?
Answer
  • occlusion brown-reddish thrombi in pulmonary artery, firmly connected with intima, with dim rough surface
  • whitish foci of myocardium of flabby consistence of irregular shape
  • small-granular firm kidney, decreased in sizes
  • nutmeg liver
  • adrenal hypoplasia

Question 22

Question
Patient has complains on bad sleeping, general weakness, soreness, protrusion of the eye-balls, heartbeats, tachycardia. There is diffuse increased thyroid gland in palpation. What is disease at this patient?
Answer
  • riedel’s goiter
  • grave’s disease
  • hashimoto’s goiter
  • De Quervain's thyroiditis
  • macro-microfollicular goiter

Question 23

Question
Patient has complains on increasing of sizes of thyroid gland, shortness of breath & swallowing, torpidity, sleepiness. In physical examination: increasing of thyroid gland, brachycardia, hyperkeratosis, decreasing of basal metabolism. Operation thyroidectomy was done. In histological examination: replacement of tissue of thyroid gland by lymphoid elements. What kind of goiter was revealed ?
Answer
  • riedel’s goiter
  • hashimoto's goitre
  • Grave's disease
  • macro-microfollicular goiter
  • De Quervain's thyroiditis

Question 24

Question
Patient has complains on breathlessness in physical activity, heartbeat, pains & tightness in heart region. There is stable increasing of blood pressure during last 2 years. In examination: protein in urine, significant increasing of creatinin in blood. Patient has died in increasing autotoxication from chronic renal insufficiency. What clinic-morphological variant of hypertensive disease has place?
Answer
  • miscellaneous
  • renal
  • hypertrophy of muscular layer & elastic structures
  • hypertrophy of heart; left ventricle
  • arteriolosclerotic nephrosclerosis

Question 25

Question
Following changes were revealed in histological investigation of autopsic material: in lungs – edematic liquid, fibrin, massive accumulation of leucocytes are in alveoli; leuco-lymphocytic infiltration of interalveolar septi, in some areas septi are necrotized with formation of microabscesses. Capillaries are congested, some of them contain leucocytic thrombi. Walls of bronchi are thickened, sclerous. Masses of leucocytes, mucus, desquamated epithelium in limen of bronchi. What complication has developed?
Answer
  • Pleuritis
  • Carnification
  • Empyema
  • Abscess formation
  • interstitial fibrosis

Question 26

Question
Bronchial asthma is accompanied by predominant eosinophilic infiltration of bronchial wall, but chronic bronchitis is characterized by predominance of neutrophils in infiltrate and presence of
Answer
  • hyperplasia of goblet cells
  • peribronchial fibrosis
  • Chemokins
  • Reed's index
  • Endopeptidase

Question 27

Question
Pathological process, which is characterized by fibrosis, destruction, rebuilding & deformation of lungs
Answer
  • lobular pneumonia
  • pneumocirrhosis
  • Croupous pneumonia
  • interstitial pneumonia
  • gangrene of lungs

Question 28

Question
Patient, 32 y.o. was admitted in clinics with complains on dyspnoae, pains in left part of chest, temperature up to 39?C. He became sick suddenly after overcooling. In examination: dulling of sound above low lobe, pleural rub. In spite of conducted treatment after 4 weeks the cough was kept, dullness and absence of conducting of breathing sounds in projection of low lobe of left lung. What complication does develop at this patient?
Answer
  • Carnification
  • Gangrene
  • Abscess
  • Caverna formation
  • growth of granulation tissue©

Question 29

Question
Patient, 35 y.o., has suffered from hypertensive disease during 2 years. Level of diastolic pressure is constantly more than 120 mm Hg. What morphological changes of vessels is it possible to find at this patient?
Answer
  • malignant lipoidosis
  • hyalinosis, sclerosis, fibrinoid necrosis©
  • plasmorrhagia in arteriols’ walls
  • hyalinosis, sclerosis, hemorrhage
  • hyalinosis, sclerosis, thrombosis

Question 30

Question
A 19-year-old female presents with urticaria that developed after she took aspirin for a headache. She has a history of chronic rhinitis, and physical examination reveals the presence of nasal polyps. This patient is at an increased risk of developing which one of the following pulmonary diseases following the ingestion of aspirin?
Answer
  • Chronic emphysema
  • Bronchitis
  • Bronchial Asthma
  • pulmonary hypertension
  • interstitial fibrosis

Question 31

Question
Long time patient has suffered by chronic bronchitis & bronchiolitis, which later complicated by emphysema of lungs. Emphysema became to dominate in clinical picture. Patient has died. What kind of emphysema had place in this case?
Answer
  • chronic obstructive emphysema
  • Focal emphysema
  • Vicarious emphysema
  • Senile emphysema
  • Bullous emphysema

Question 32

Question
What diseases may lead to the development of acquired heart defects
Answer
  • rheumatic fever, chronic bronchitis, leucemia, sepsis, tuberculosis
  • rheumatic fever, тромбоцитопения, аневризма аорты,атеросклероз
  • rheumatic fever, meningitis, atherosclerosis, septic endocarditis, brucellosis, syphilis
  • rheumatic fever, hemophilia, reactive arthritis, liver cirrhosism, aortitis
  • rheumatic fever, systemic lupus erythematosus, ischemic heart disease, hemorrhagic vasculitis

Question 33

Question
Large depositions of urate crystals, surrounded by accumulation of macrophages, lymphocytes & giant cells of foreign bodies were revealed in articular cartilage, periarticular ligaments, tendons & soft tissues in histological investigation. What complications are possible in kidneys?
Answer
  • nephropathy
  • amyloidosis of kidneys
  • kidney’s infarction nephrotic syndrome© acute glomerulonephritis
  • acute glomerulonephritis
  • nephrotic syndrome

Question 34

Question
The yellow color foci with violet-reddish collar were revealed in autopsy. What changes is it possible to find at histological investigation?
Answer
  • development of granulation tissue around necrosis
  • caseous necrosis, epithelioid cells, Pirogov-Langhans cells
  • aschoff’s bodies
  • zone of necrosis with leucocytic infiltration
  • beginning of fibrosis development

Question 35

Question
What are most common heart defects
Answer
  • Mitral , pulmonary
  • Tricuspidal, aortal
  • Mitral, aortal
  • Aortal, pulmonary
  • Tricuspidal , pulmonary

Question 36

Question
Following changes are present in bronchial wall in acute period of bronchial asthma
Answer
  • acute congestion of vessels of microcirculation & increasing of their permeability, edema of mucous membrane, thickening of the basal membrane of bronchi, hypersecretion of mucous glands
  • acute congestion of vessels of microcirculation & increasing of their permeability
  • edema of mucous membrane thickening of the basal membrane of bronchi© hypersecretion of mucous glands
  • thickening of the basal membrane of bronchi
  • hypersecretion of mucous glands

Question 37

Question
Big white kidney was revealed at autopsy of woman of 47 y.o.There is deposition of amyloid in glomeruli, tubular basal membranes, wall of vessels & stroma in histological investigation. From anamnesis: woman had pathology of joints for a long period. This morphological picture is complication of following disease
Answer
  • gout
  • rheumatoid arthritis
  • post rheumatic arthritis
  • arthrosis
  • rheumatic disease

Question 38

Question
Patient has suffered from rheumatic defect of mitral valve. Patient has died from chronic cardio-vascular insufficiency. In autopsy: leaflets of mitral valve are thickened, adherit, opaque, dense, of milky-white color. What pathological process is in the base of changes of mitral valve?
Answer
  • hyalinosis
  • mucoid swelling
  • mucoid & fibrinoid swelling
  • aschoff’s bodies
  • fibrinoid swelling

Question 39

Question
Patient has complains on increasing of sizes of thyroid gland, shortness of breath & swallowing, torpidity, sleepiness. In physical examination: increasing of thyroid gland, brachycardia, hyperkeratosis, decreasing of basal metabolism. Operation thyroidectomy was done. In histological examination: replacement of tissue of thyroid gland by lymphoid elements. What is pathogenesis of this disease?
Answer
  • autoimmune disease
  • congenital malformation
  • disorder of regulating influence of pituitary gland
  • disorder of regulating influence of hypothalamus
  • iodine deficiency

Question 40

Question
Patient has complains on bad sleeping, general weakness, soreness, protruded eye-balls, heartbeats, tachycardia. There is diffuse increased thyroid gland in palpation. What are the typical microscopical changes
Answer
  • proliferation of high epithelium with formation of papillae, liquid colloid, lymphoid infiltrates in stroma
  • infiltration by polymorph-nuclear leucocytes, degenerative changes
  • granulomatosis with giant cells of foreign bodies
  • replacement of tissue of gland by fibrous tissue
  • abundant lymphocytic infiltration with formation of follicles with light centers

Question 41

Question
Patient, 64 y.o., has used antibiotics during 2 weeks due to acute respiratory disease. Death from progressing respiratory insufficiency. Polymorph picture were revealed in lungs: walls of alveoli with irregular lymphohistiocytic infiltration, giant mononuclear cells in alveolar epithelium, squamous metaplasia of bronchiolar epithelium are in some areas, destructive purulent bronchiolitis is present in many areas, surrounded alveoli are filled by serous-leucocytic exudates, there are foci of abscesses. What is etiology of this disease?
Answer
  • mycoplasmic
  • viral & bacterial
  • viral
  • friedlander’s pneumonia
  • pneumocyst

Question 42

Question
Following changes are present at the surface of the cut of the lungs of the patients, died due to the attack of bronchial asthma
Answer
  • all bronchi up to terminal bronchiols are filled with viscous mucus
  • destructive changes of the alveolar walls
  • thickening of the basal membrane neutrophilic infiltration© hyperplasia of vessels of mucous layer
  • neutrophilic infiltration
  • hyperplasia of vessels of mucous layer

Question 43

Question
Woman, 62 y.o., on 7th day after cholecystectomia due to calculous cholecystitis following symptoms appeared: body temperature 38,5°C, cough & dyspnoea. After 4 weeks of massive antibiotic therapy temperature decreased, but X-ray examination revealed one round-shaped cloud. What histological changes is it possible to find in lung?
Answer
  • foci of caseous snecrosis, surrounded by collar of lymphocytes & epithelioid cells, solitary giant cells of Pirogov-Langhans
  • Lympholeucocytic infiltration of interalveolar septi
  • serous-leucocytic exudate in alveoli, inflammation of bronchi & bronchioles, focus of abscess
  • fibrin & leucocytes in alveoli
  • erythrocytes, leucocytes, fibrin in alveoli

Question 44

Question
Acute destructive processes in lungs
Answer
  • abscess of lung
  • chronic bronchitis
  • bronchial asthma interstitial pneumonia© pneumosclerosis
  • interstitial pneumonia
  • pneumosclerosis

Question 45

Question
Long time patient has suffered by chronic bronchitis & bronchiolitis, which later complicated by emphysema of lungs. Emphysema became to dominate in clinical picture. Patient has died. What is the cause of death?
Answer
  • pulmonary bleeding
  • acute cardiac-pulmonary insufficiency
  • amyloidosis
  • chronic cardiac-pulmonary insufficiency
  • asthmatic status

Question 46

Question
Patient, 57 y.o., was admitted in hospital with attack of heart angina. In anamnesis: hypertensive disease during 20 years. On ECG: no changes, which are typical for myocardial infarction. After 15 minutes patient died from ventricular fibrillation. What changes were revealed in autopsy?
Answer
  • atherosclerosis of all branches of coronary arteries (up to 40%), brown atrophy of myocardium
  • thrombosis of coronary arteries
  • chronic aneurism with parietal thrombosis©
  • atherosclerosis of all branches of coronary arteries (up to 90%), myocardial hypertrophy
  • dilatation of ventricles

Question 47

Question
Patient has complains on breathlessness in physical activity, heartbeat, pains & tightness in heart region. There is periodic increasing of blood pressure during last several years. In examination diseases, which maybe connected with arterial hypertension were not revealed. Diagnose of hypertensive disease was established. What clinic-morphological variant of hypertensive disease is described?
Answer
  • miscellaneous
  • hypertrophy of heart; left ventricle
  • hypertrophy of muscular layer & elastic structures
  • renal
  • arteriolosclerotic nephrosclerosis

Question 48

Question
Histological investigation of knee joint of patient of 22 y.o. revealed thinning of articular cartilage. What from predisposing conditions has place in appearance of these morphological changes in joint
Answer
  • cachexy
  • congenital heart defects
  • diseases of adrenal glands hemopoetic tumors© +significant obesity
  • hemopoetic tumors
  • significant obesity

Question 49

Question
What are the main microscopic changes in valve in case of acquired heart defects
Answer
  • sclerosis of valve with it’s deformation, hyperplasia, smallcellular infiltration
  • sclerosis of valve with it’s deformation, hyalinosis, calcification, vascularization of valves
  • calcification, proliferation, vascularization of valves, hyperplasia
  • sclerosis of valve with it’s deformation, meta plasma
  • sclerosis of valve with it’s deformation, proliferation, hyalinosis

Question 50

Question
Patient C., 50 y.o., died in the ambulance car, which was called because of appearance of severe retrosternal pain & fear of death. In autopsy: very liquid blood, features of increased angiostaxis, edema of lungs. Patient has died from
Answer
  • Septic shock
  • Allergic shock
  • Cardiogenic shock
  • Traumatic shock
  • Hypovolemic shock

Question 51

Question
Patient, 68 y.o., was admitted in neurological intensive care unit with acute developed paralysis. Blood wasn’t revealed in liquor. There is infarction of left hemisphere of brain in anamnesis. What are the morphological changes in brain?
Answer
  • ischemic infarction in left hemisphere
  • hemorrhagic infarction if left hemisphere
  • atherosclerosis if vessels of the base of the brain (up to 40%)
  • ischemic infarction in right hemisphere, cyst in left hemisphere
  • hemorrhagic infarction in right hemisphere, cyst in left hemisphere

Question 52

Question
Male, 49 y.o., was admitted in hospital with complains on breathlessness, cough with abundant sputum. At first time such symptoms appeared 30 years ago, all this time he continued to smoke. On X-ray examination: emphysema of lungs, saccular & cylindrical dilations of bronchi, cardiac borders are dilated by means of right ventricle. There are clubbed fingers. Symptoms of developing renal insufficiency have appeared. Patient has died from hyperazotemic uremia. What is pulmonary disease of this patient?
Answer
  • chronic obstructive bronchitis
  • idiopathic fibrosing alveolitis
  • Hamman-Rich syndrome
  • lobular pneumonia
  • bronchiectactic disease
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