Respiratory Pathology Practice Questions

Q: A 46-year-old woman presents with insidious onset of shortness of breath, chest pain, and fatigue. Chest X-ray films reveal bilateral pulmonary infiltrates and enlarged hilar lymph nodes. A biopsy of one of these lesions shows non-necrotizing granulomas. Special stains for fungi and mycobacteria are negative. The patient works as a secretary and has no history of occupational exposure to airborne minerals or organic dusts. Which of the following is the MOST likely diagnosis?

Sarcoidosis. **Explanation:** The clinical presentation of bilateral hilar lymphadenopathy and pulmonary infiltrates, combined with the histological finding of **non-necrotizing (non-caseating) granulomas**, is the classic triad for **Sarcoidosis**. Since special stains for acid-fast bacilli (AFB) and fungi are negative, and there is no history of occupational exposure, Sarcoidosis remains the diagnosis of exclusion [1]. **Why the other options are incorrect:** * **Asbestosis:** Characterized by interstitial fibrosis and the presence of "ferruginous bodies" (asbestos bodies). It does not typically present with non-caseating granulomas or isolated hilar lymphadenopathy. * **Berylliosis:** Histologically identical to sarcoidosis (non-caseating granulomas). However, it is strictly an occupational disease seen in workers in the aerospace, ceramics, or electronics industries. The patient’s history as a secretary makes this unlikely. * **Byssinosis:** An occupational lung disease caused by exposure to cotton, flax, or hemp dust ("Monday morning chest tightness"). It is a type of hypersensitivity pneumonitis/airway narrowing, not a granulomatous disease [2]. **NEET-PG High-Yield Pearls:** * **Schaumann bodies** (laminated calcium-protein concretions) and **Asteroid bodies** (stellate inclusions within giant cells) are characteristic histological findings in Sarcoidosis. * **Biochemical marker:** Elevated Serum ACE (Angiotensin-Converting Enzyme) levels. * **Kveim-Siltzbach Test:** Historically used for diagnosis (skin reaction to sarcoid tissue injection), though rarely used now. * **Staging:** Based on Chest X-ray (Stage I: Hilar lymphadenopathy alone; Stage II: Hilar nodes + Parenchymal infiltrates) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 701-702.

Q: What is true about bronchial adenoma?

It causes recurrent hemoptysis.. **Explanation:** **Bronchial Adenoma** is a historical (and somewhat misleading) term used to describe a group of low-grade malignant epithelial tumors, the most common being **Carcinoid tumors** (90%), followed by Adenoid cystic carcinoma and Mucoepidermoid carcinoma [1]. **Why Option C is correct:** Bronchial carcinoids are highly vascular tumors that typically grow as endobronchial polypoid masses [1]. Because they are covered by a fragile, highly vascularized mucosa, they frequently bleed into the airway, leading to **recurrent hemoptysis**. This is a classic clinical presentation alongside persistent cough and localized wheezing. **Why the other options are incorrect:** * **Option A:** Bronchial adenomas are rare, accounting for only **1–5%** of all primary lung tumors, not 10-15%. * **Option B:** While the term "adenoma" implies benignity, these are actually **low-grade malignant** neoplasms capable of local invasion and distant metastasis [1]. * **Option D:** Most (approx. 80%) bronchial carcinoids are **centrally located** in the mainstem or lobar bronchi. Peripheral locations are less common. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for a "Salt and Pepper" chromatin pattern and nests of uniform polygonal cells (Organoid pattern) [1]. * **Markers:** They are neuroendocrine tumors; positive for **Chromogranin A, Synaptophysin, and CD56** [1]. * **Carcinoid Syndrome:** Occurs in <10% of patients, usually only if liver metastasis is present (presents with flushing, diarrhea, and cyanosis). * **Age:** Unlike bronchogenic carcinoma, these often affect younger patients (mean age ~40 years) and have no strong association with smoking. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 725-727.

Q: Heart failure cells are found in which of the following organs?

Lungs. **Explanation:** **Heart failure cells** are **hemosiderin-laden alveolar macrophages**. They are a hallmark of **Chronic Passive Congestion (CPC) of the Lungs**, typically resulting from left-sided heart failure [1]. 1. **Why Lungs are correct:** In left-sided heart failure (e.g., mitral stenosis or post-MI), the left ventricle cannot pump blood efficiently, leading to increased pressure in the pulmonary veins [1]. This hydrostatic pressure causes pulmonary capillaries to rupture, releasing red blood cells (RBCs) into the alveolar spaces. Alveolar macrophages phagocytose these RBCs and break down the hemoglobin into **hemosiderin**, a golden-brown pigment. These pigment-filled macrophages are the "heart failure cells." 2. **Why other options are incorrect:** * **Myocardium:** While the pathology originates in the heart, the cells themselves are located in the lung parenchyma [1]. * **Liver:** Chronic congestion of the liver (right-sided heart failure) leads to a **"Nutmeg Liver"** appearance due to centrilobular necrosis, but not heart failure cells. * **Spleen:** Chronic congestion here leads to **Gamma-Gandy bodies** (siderofibrotic nodules), which are distinct from heart failure cells. **High-Yield NEET-PG Pearls:** * **Stain:** Heart failure cells (hemosiderin) are best visualized using **Prussian Blue (Perl’s) stain**, which highlights the iron content. * **Gross Appearance:** Long-standing congestion leads to **Brown Induration** of the lungs due to the combination of hemosiderin deposition and compensatory fibrosis. * **Clinical Correlation:** Their presence in sputum or bronchoalveolar lavage (BAL) is a diagnostic indicator of pulmonary edema secondary to heart failure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 536-538.

Q: Heart failure cells are seen in which organ?

Lungs. **Explanation:** **Heart Failure Cells** are hemosiderin-laden alveolar macrophages. Despite their name, they are found in the **Lungs**, specifically within the alveolar spaces. **Why Lungs is the correct answer:** In conditions like **Chronic Passive Congestion (CPC)** of the lungs—most commonly caused by Left-Sided Heart Failure—there is increased hydrostatic pressure in the pulmonary capillaries [1]. This causes red blood cells (RBCs) to leak into the alveolar spaces (diapedesis). Alveolar macrophages phagocytose these extravasated RBCs and break down the hemoglobin into **hemosiderin**, a golden-brown pigment. These pigment-filled macrophages are the hallmark of chronic pulmonary congestion. **Why other options are incorrect:** * **Heart:** While heart failure is the *cause*, the cells themselves are located in the pulmonary parenchyma, not the myocardium. * **Kidney:** Chronic congestion of the kidney leads to "cloudy swelling" or fatty change, but not the formation of specific heart failure cells. * **Brain:** Congestion in the brain leads to edema and herniation, but not hemosiderin-laden macrophages unless there is a localized primary hemorrhage. **High-Yield Facts for NEET-PG:** * **Stain:** Heart failure cells are best visualized using **Prussian Blue (Perl’s stain)**, which stains the iron in hemosiderin blue. * **Gross Appearance:** Chronic congestion leads to a condition called **Brown Induration** of the lungs (due to fibrosis and hemosiderin deposition). * **Nutmeg Liver:** This is the counterpart in the liver, caused by Right-Sided Heart Failure (congestion around central veins). * **Clinical Correlation:** Their presence in sputum or bronchoalveolar lavage (BAL) fluid is a diagnostic indicator of prior pulmonary edema or chronic heart failure [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 537-538.

Question 1

A 46-year-old woman presents with insidious onset of shortness of breath, chest pain, and fatigue. Chest X-ray films reveal bilateral pulmonary infiltrates and enlarged hilar lymph nodes. A biopsy of one of these lesions shows non-necrotizing granulomas. Special stains for fungi and mycobacteria are negative. The patient works as a secretary and has no history of occupational exposure to airborne minerals or organic dusts. Which of the following is the MOST likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Asbestosis

Answer

Berylliosis

Answer

Byssinosis

Question 2

Hypercalcemia is most commonly seen in which type of lung cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Small cell carcinoma

Answer

Large cell carcinoma

Question 3

What is true about bronchial adenoma?

Accepted Answer

It causes recurrent hemoptysis.

Answer

It accounts for 10-15% of all lung tumors.

Answer

It is mostly malignant.

Answer

It is typically peripherally located.

Question 4

Heart failure cells are found in which of the following organs?

Accepted Answer

Lungs

Answer

Myocardium

Answer

Liver

Answer

Spleen

Question 5

Which paraneoplastic syndrome is not seen with Small Cell Carcinoma of the Lung?

Accepted Answer

Parathyroid hormone (PTH) related hypercalcemia

Answer

Adrenocorticotropic hormone (ACTH) production

Answer

Syndrome of Inappropriate Antidiuretic Hormone (ADH) secretion

Answer

Carcinoid syndrome

Question 6

Asbestosis is usually related to which of the following malignancies?

Accepted Answer

Small cell carcinoma lung

Answer

Large cell carcinoma lung

Answer

Mesothelioma

Answer

Squamous cell carcinoma lung

Question 7

Hyperplasia of smooth muscle of the airway is seen in which of the following conditions?

Accepted Answer

Asthma

Answer

Emphysema

Answer

Alveolar proteinosis

Answer

Bronchiectasis

Question 8

A 65-year-old man with a history of working in a shipyard for 10 years and then for 5 years installing fire retardant insulation, presenting with 11 years of progressive dyspnea, respiratory failure, and hypoxemia, has a CT scan showing a large mass encasing the left lung. Which of the following findings is most likely to be seen on a chest radiograph in this patient?

Accepted Answer

Diaphragmatic pleural calcified plaques

Answer

Bilateral fluffy perihilar infiltrates

Answer

Bilateral upper lobe cavitation

Answer

Endobronchial mass with atelectasis

Question 9

As opposed to lobar pneumonia, bronchopneumonia is characterized grossly and microscopically by:

Accepted Answer

Patchy inflammatory distribution

Answer

Organization of alveolar exudate

Answer

A diffuse inflammatory distribution

Answer

Inflammation of the bronchus

Question 10

Heart failure cells are seen in which organ?

Accepted Answer

Lungs

Answer

Kidney

Answer

Heart

Answer

Brain

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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