Respiratory Pathology Practice Questions

Q: Bronchoalveolar carcinoma presents as:

All of the above. **Explanation:** Bronchoalveolar Carcinoma (BAC), now classified under the spectrum of **Adenocarcinoma in situ (AIS)** and **Minimally Invasive Adenocarcinoma (MIA)**, is a unique subtype of lung cancer that grows along the alveolar walls without invading the stroma (lepidic growth pattern) [1]. **Why "All of the Above" is correct:** BAC can present in three distinct patterns: a solitary peripheral nodule, a multinodular form, or a diffuse pneumonic-type consolidation. 1. **Hemoptysis:** Like all bronchogenic carcinomas, erosion into small vessels or irritation of the airway can lead to blood-streaked sputum. 2. **Collapse (Atelectasis):** Although BAC typically spreads along alveolar walls, the diffuse or multinodular forms can lead to significant airway obstruction or replacement of air spaces with mucin/tumor cells, resulting in segmental or lobar collapse [1]. 3. **Effusion:** BAC has a high propensity for pleural involvement. The peripheral location of the tumor often leads to malignant pleural effusions due to direct extension or lymphatic spread [1]. **Clinical Pearls for NEET-PG:** * **Lepidic Growth:** The hallmark histological feature where tumor cells "crawl" along pre-existing alveolar structures [1]. * **Bronchorrhea:** A classic, high-yield clinical sign where the patient produces massive amounts of watery, mucoid sputum (seen in the mucinous subtype). * **Radiology:** Often mimics **lobar pneumonia** on a chest X-ray (consolidation that does not resolve with antibiotics). * **Driver Mutations:** Frequently associated with **EGFR mutations**, making it more common in non-smokers, females, and Asians. * **Prognosis:** It generally has a better prognosis than other bronchogenic carcinomas if detected in the solitary nodule stage. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-337.

Question 1

Basophilic staining of vascular walls due to encrustation by DNA from necrotic tumour cells is seen in which of the following variants of lung cancer?

Accepted Answer

Small cell variant

Answer

Squamous cell variant

Answer

Adenocarcinoma variant

Answer

Large cell variant

Question 2

A 25-year-old woman presents with progressive dyspnea and fatigue over the past 2 years. Physical examination reveals pedal edema, jugular venous distention, and hepatomegaly. Lung auscultation is clear. A chest CT scan shows right heart enlargement. Cardiac catheterization demonstrates increased pulmonary arterial pressure without pulmonic valve gradients and no shunts. A transbronchial biopsy reveals plexiform lesions. A mutation in a gene encoding for which of the following is most likely responsible for her pulmonary disease?

Accepted Answer

Bone morphogenetic receptor 2 (BMPR2)

Answer

B-type natriuretic peptide (BNP)

Answer

Endothelial nitric oxide synthetase (eNOS)

Answer

Fibrillin-1

Question 3

Which of the following is NOT a feature of bronchial asthma?

Accepted Answer

Thickening of bronchial wall

Answer

Increase in number of goblet glands

Answer

Hypertrophy of smooth muscle

Answer

Increased IgE

Question 4

Charcot-Leyden crystals and Curshmann's spirals are seen in which of the following conditions?

Accepted Answer

Bronchial asthma

Answer

Chronic bronchitis

Answer

Bronchiectasis

Answer

Emphysema

Question 5

How is pulmonary infarction differentiated from pulmonary edema?

Accepted Answer

Heart failure cells

Answer

Necrotizing alveolar sac

Answer

Capillary congestion

Answer

Pulmonary wedge pressure

Question 6

Bronchoalveolar carcinoma presents as:

Accepted Answer

All of the above

Answer

Hemoptysis

Answer

Collapse

Answer

Effusion

Question 7

A 30-year-old man undergoes a lung biopsy, which shows multiple nodular lesions consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts. There is an area of necrosis in the center of some nodules. Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells. Silver stains for fungi are negative. Which of the following is the MOST likely condition that predisposed the patient to this pulmonary disease?

Accepted Answer

Acquired immunodeficiency syndrome (AIDS)

Answer

Common variable immunodeficiency

Answer

Cystic fibrosis

Answer

Depressed level of consciousness

Question 8

What is the primary site of involvement in congenital tuberculosis?

Accepted Answer

Liver

Answer

Lungs

Answer

Lymph nodes

Answer

Stomach

Question 9

A 64-year-old man with a history of occupational exposure presents with an 8-month history of chest discomfort, malaise, fever, night sweats, and weight loss. Imaging reveals a pleural effusion and a pleural mass encasing the lung. The patient died of cardiorespiratory failure. Histologic examination of the pleural mass shows a biphasic pattern of epithelial and sarcomatous elements. What is the most likely diagnosis?

Accepted Answer

Malignant mesothelioma

Answer

Carcinoid tumor

Answer

Large cell carcinoma

Answer

Malignant melanoma

Question 10

Few RBCs, raised neutrophils with some hemorrhage in alveoli is seen in which stage of pneumonia?

Accepted Answer

Red hepatization

Answer

Gray hepatization

Answer

Viral pneumonia

Answer

Resolving phase of lobar pneumonia

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?