Respiratory Pathology Practice Questions

Q: What are heart failure cells?

Macrophages. **Explanation:** **Heart failure cells** are **hemosiderin-laden alveolar macrophages**. They are a classic histopathological hallmark of **Chronic Passive Congestion (CPC) of the lungs**, typically resulting from Left-Sided Heart Failure. **Why Macrophages are the correct answer:** In left-sided heart failure, the left ventricle cannot pump blood efficiently, leading to increased pressure in the pulmonary capillaries. This causes red blood cells (RBCs) to leak into the alveolar spaces (micro-hemorrhages). Alveolar macrophages phagocytose these RBCs and break down the hemoglobin into **hemosiderin**, a golden-brown pigment. These pigment-filled macrophages are then termed "heart failure cells." They can be visualized using a **Prussian Blue stain**, which highlights the iron (hemosiderin) in bright blue. **Why other options are incorrect:** * **Polymorphonuclear cells (Neutrophils):** These are markers of acute inflammation (e.g., bacterial pneumonia), not chronic congestion. * **Stem cells:** These are undifferentiated cells involved in tissue repair and do not play a role in the phagocytosis of extravasated blood. * **Fibroblasts:** While chronic congestion can eventually lead to "Brown Induration" of the lungs due to secondary fibrosis, fibroblasts themselves do not ingest hemoglobin or form heart failure cells. **High-Yield NEET-PG Pearls:** * **Brown Induration:** The combination of pulmonary fibrosis and hemosiderin deposition gives the lung a firm, brown appearance. * **Stain of Choice:** Prussian Blue (Perl’s) reaction. * **Clinical Correlation:** Their presence in sputum or bronchoalveolar lavage (BAL) fluid is a diagnostic clue for occult heart failure or pulmonary hemorrhage.

Q: A 45-year-old man with a 15-year history of working in a construction factory presents with a 6-month history of cough. What is the probable diagnosis based on his chest X-ray findings and occupational history?

Asbestosis. ***Asbestosis*** - **Construction factory** work for 15 years provides significant **asbestos exposure** risk, as asbestos was commonly used in building materials until the 1980s. - Chronic cough developing after prolonged exposure is consistent with **asbestos-induced pulmonary fibrosis**, typically showing **bilateral lower lobe reticular opacities** and **pleural plaques** on chest X-ray. *Silicosis* - Associated with **silica dust exposure** from occupations like **mining**, **sandblasting**, or **quarrying**, not typical construction work. - Chest X-ray characteristically shows **upper lobe nodular opacities** and **progressive massive fibrosis**, contrasting with lower lobe involvement in asbestosis. *Anthracosis* - Results from **coal dust exposure** in **coal miners** or workers in coal-processing industries, not construction factories. - Presents with **black lung** appearance on imaging with **coal macules** and **progressive massive fibrosis**, typically in upper zones. *Mesothelioma* - While associated with **asbestos exposure**, it is a **pleural malignancy** that typically presents with **chest pain** and **dyspnea** rather than just cough. - Chest imaging shows **pleural thickening** and **pleural effusion** rather than the **pulmonary fibrosis** pattern seen in pneumoconioses.

Question 1

Which of the following pulmonary conditions is associated with the widespread formation of hyaline membranes in the alveolar cavities?

Accepted Answer

Diffuse alveolar damage

Answer

Asthma

Answer

Bacterial pneumonia

Answer

Desquamative interstitial pneumonitis

Question 2

In centrilobular (centriacinar) emphysema, there is an abnormal, permanent enlargement of which structure?

Accepted Answer

Respiratory bronchioles

Answer

Alveolar ducts

Answer

Small bronchi

Answer

Bronchioles

Question 3

Which of the following is NOT seen in a Pancoast tumor?

Accepted Answer

Hemoptysis

Answer

Horner's syndrome

Answer

Rib erosion

Answer

Pain in shoulder and arm

Question 4

What are heart failure cells?

Accepted Answer

Macrophages

Answer

Polymorphonuclear cells

Answer

Stem cells

Answer

Fibroblasts

Question 5

All of the following statements are true regarding silicosis, except?

Accepted Answer

Phagocytosed silica crystals activate the inflammasome, leading to the release of inflammatory mediators, particularly IL-1 and TNF.

Answer

Crystalline forms are much more fibrogenic.

Answer

As the disease progresses, nodules coalesce into hard, collagenous scars.

Answer

Histologic examination reveals the hallmark lesion characterized by a central area of whorled collagen fibers with a more peripheral zone of dust-laden macrophages.

Question 6

Smoking is most strongly associated with which type of lung cancer?

Accepted Answer

Small cell cancer

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Carcinoid tumor

Question 7

The histologic entity that has the worst prognosis in interstitial lung disease is?

Accepted Answer

Acute interstitial pneumonia

Answer

Non-specific interstitial pneumonia

Answer

Desquamative interstitial pneumonia

Answer

Usual interstitial pneumonia

Question 8

A 45-year-old man with a 15-year history of working in a construction factory presents with a 6-month history of cough. What is the probable diagnosis based on his chest X-ray findings and occupational history?

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Anthracosis

Answer

Mesothelioma

Question 9

What is the most common type of emphysema associated with alpha-1 antitrypsin deficiency?

Accepted Answer

Panlobular

Answer

Centriacinar

Answer

Paraseptal

Answer

Distal acinar

Question 10

Bilateral lymphadenopathy, along with non-caseating granulomas, is a characteristic feature of which condition?

Accepted Answer

Sarcoidosis

Answer

Scleroderma

Answer

SLE

Answer

Stein-Leventhal syndrome

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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