Respiratory Pathology Practice Questions

Q: Which of the following classifications is used for pulmonary adenocarcinoma?

Noguchi's classification. **Explanation:** **Noguchi’s Classification** is a histopathological classification used specifically for **small peripheral pulmonary adenocarcinomas** (specifically those $\leq$ 2 cm in diameter). It categorizes these tumors into six types (A to F) based on their growth patterns and degree of alveolar wall thickening. * **Types A, B, and C** represent "localized bronchioloalveolar carcinoma" (now largely termed Adenocarcinoma In Situ) and carry a very high 5-year survival rate (nearly 100%) [1]. * **Types D, E, and F** represent invasive adenocarcinoma and carry a significantly poorer prognosis. **Analysis of Incorrect Options:** * **A. Parkland Classification:** Used in surgery to grade the severity of **acute cholecystitis** based on gallbladder inflammation and adhesions. * **B. Waterston’s Classification:** A historical risk-stratification system for **Esophageal Atresia**, based on birth weight and the presence of pneumonia or associated anomalies. * **C. Chicago Classification:** The gold standard for interpreting **high-resolution esophageal manometry** to diagnose motility disorders like Achalasia Cardia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common lung cancer:** Adenocarcinoma is now the most common histological subtype in both smokers and non-smokers [1]. * **Driver Mutations:** Adenocarcinoma is frequently associated with **EGFR** mutations (common in Asian non-smoking females), **ALK** rearrangements, and **KRAS** mutations [1]. * **Staining:** Adenocarcinomas are typically positive for **TTF-1** (Thyroid Transcription Factor-1) and **Napsin A**. * **Lepidic Growth:** This term refers to tumor cells "crawling" along the pre-existing alveolar walls without stromal invasion, a hallmark of early-stage adenocarcinoma [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-337.

Q: What condition is indicated by the presence of Creola bodies in sputum?

Bronchial Asthma. **Bronchial Asthma** is the correct answer. **Creola bodies** are compact, multi-layered clusters of desquamated ciliated columnar epithelial cells found in the sputum of asthmatic patients. They result from the intense airway inflammation and mechanical sloughing of the bronchial mucosa characteristic of an asthma exacerbation [1]. **Analysis of Options:** * **Bronchial Asthma (Correct):** In addition to Creola bodies, asthma is associated with other classic sputum findings: **Curschmann spirals** (coiled mucus plugs from small airways) and **Charcot-Leyden crystals** (eosinophil-derived galectin-10) [1]. * **Chronic Bronchitis:** While this involves mucus hypersecretion and goblet cell hyperplasia, the characteristic finding is an increased **Reid Index** (>0.4) on histopathology, not Creola bodies. * **Bronchogenic Carcinoma:** Sputum cytology here would typically show malignant cells with nuclear pleomorphism, hyperchromasia, and keratin pearls (in squamous cell carcinoma), rather than organized clusters of benign ciliated cells. * **Pulmonary Tuberculosis:** This is characterized by **caseating granulomas** and the presence of Acid-Fast Bacilli (AFB) on Ziehl-Neelsen staining. **NEET-PG High-Yield Pearls:** * **Creola Bodies:** Ciliated epithelial cell clusters (Asthma). * **Curschmann Spirals:** Whorled mucus plugs (Asthma) [1]. * **Charcot-Leyden Crystals:** Rhomboid-shaped crystals from eosinophil breakdown (Asthma/Eosinophilic conditions). * **Reid Index:** Ratio of bronchial gland thickness to total wall thickness (Increased in Chronic Bronchitis). * **Ferruginous Bodies:** Asbestos fibers coated with iron (Asbestosis). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 688-690.

Question 1

Which type of lung carcinoma is most commonly associated with causing Superior Vena Cava (SVC) syndrome?

Accepted Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Anaplastic carcinoma

Question 2

Which of the following classifications is used for pulmonary adenocarcinoma?

Accepted Answer

Noguchi's classification

Answer

Parkland classification

Answer

Waterston's classification

Answer

Chicago classification

Question 3

Ghons focus is seen in?

Accepted Answer

Primary Tuberculosis

Answer

Amoebiasis

Answer

Lepromatous Leprosy

Answer

Syphilis

Question 4

Panacinar emphysema is typically seen in which condition?

Accepted Answer

Alpha-1 antitrypsin deficiency

Answer

Smoking

Answer

Chronic bronchitis

Answer

Spontaneous pneumothorax

Question 5

Which of the following is a feature of small cell carcinoma?

Accepted Answer

It is associated with paraneoplastic syndromes.

Answer

It is the commonest malignancy of the lung.

Answer

It does not cause Superior Vena Cava (SVC) syndrome.

Answer

None of the above.

Question 6

Which of the following is NOT a typical histological feature of Hypersensitivity Pneumonitis?

Accepted Answer

Eosinophilic abscess

Answer

Interstitial pneumonitis

Answer

Non-caseating granuloma

Answer

Interstitial fibrosis

Question 7

Which of the following statements about lung carcinoma is true?

Accepted Answer

Oat cell variant is typically associated with hilar adenopathy.

Answer

Squamous cell variant accounts for 70% of all lung cancer.

Answer

Oat cell variant typically presents with cavitation.

Answer

Adenocarcinoma variant is typically central in location.

Question 8

What condition is indicated by the presence of Creola bodies in sputum?

Accepted Answer

Bronchial Asthma

Answer

Chronic Bronchitis

Answer

Bronchogenic Carcinoma

Answer

Pulmonary Tuberculosis

Question 9

Which paraneoplastic syndrome is not associated with small cell carcinoma of the lung?

Accepted Answer

Immune thrombocytopenic purpura

Answer

Ectopic ACTH production

Answer

Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer

Carcinoid syndrome

Question 10

A Ghon complex of the lung typically undergoes which of the following changes?

Accepted Answer

Calcification

Answer

Cavitation

Answer

Progression to tuberculous pneumonia

Answer

Progression to miliary tuberculosis

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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