Respiratory Pathology Practice Questions

Q: A patient underwent lung transplantation. Below is the gross appearance of the post-mortem lung. What is the most likely diagnosis?

Miliary tuberculosis. ***Miliary tuberculosis*** - In **immunocompromised patients** (lung transplant recipients), tuberculosis can disseminate and present as **millet-seed sized nodules** scattered throughout both lungs on gross examination. - The **post-mortem lung** appearance with multiple small, uniform nodules is classic for **miliary TB**, especially in the setting of immunosuppression following transplantation. *Bronchiectasis* - Characterized by **abnormally dilated and thickened airways** with a "tram-track" appearance on imaging, not multiple small nodules. - Gross examination would show **cystic dilatation of bronchi** and bronchioles, often filled with purulent secretions. *Lung abscess* - Presents as a **single or few large cavitary lesions** filled with pus, not multiple small nodules. - Gross appearance would show **thick-walled cavities** with necrotic centers, typically larger than millet seeds. *Lung carcinoma* - Typically appears as **discrete mass lesions** or **irregular nodules** of varying sizes, not uniform small nodules. - Gross examination would reveal **heterogeneous tissue** with possible necrosis, hemorrhage, or calcification, distinct from the uniform miliary pattern.

Q: Infraclavicular lesion of tuberculosis is known as?

Assman's focus. **Explanation:** The correct answer is **Assman’s focus**. This question tests the nomenclature of specific lesions in Pulmonary Tuberculosis based on their stage and anatomical location. **1. Why Assman’s focus is correct:** Assman’s focus refers to the initial area of consolidation seen in **Secondary (Reactivation) Tuberculosis**. Unlike primary TB, secondary TB typically involves the apex of the lungs (due to high oxygen tension). Specifically, an early localized area of tuberculous bronchopneumonia located in the **infraclavicular region** is termed Assman’s focus. **2. Why other options are incorrect:** * **Ghon’s focus:** This is the hallmark of **Primary Tuberculosis** [1]. It is a 1–1.5 cm area of gray-white inflammation/consolidation located typically in the lower part of the upper lobe or upper part of the lower lobe, usually close to the pleura [1]. (Ghon’s focus + Lymph node involvement = Ghon’s Complex) [1]. * **Puhl’s focus:** This refers to a specific lesion in the **apex** of the lung in secondary TB. While Assman’s is infraclavicular, Puhl’s is strictly apical. **3. NEET-PG High-Yield Pearls:** * **Ranke Complex:** A healed, radiologically visible calcified Ghon’s complex [1]. * **Simmond’s focus:** Another term for apical nodules in secondary TB (similar to Puhl's). * **Rich Focus:** A subpial or subependymal focus in the brain that ruptures into the subarachnoid space, leading to TB Meningitis. * **Weigert’s Law:** Refers to the mechanism of miliary TB where a tubercle erodes into a pulmonary vein, spreading bacilli throughout the systemic circulation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 383-384.

Question 1

A patient underwent lung transplantation. Below is the gross appearance of the post-mortem lung. What is the most likely diagnosis?

Accepted Answer

Miliary tuberculosis

Answer

Bronchiectasis

Answer

Lung abscess

Answer

Lung carcinoma

Question 2

What is the causative particle in asbestosis?

Accepted Answer

Amphibole

Answer

Chrysotile

Answer

Tridymite

Answer

Cristobalite

Question 3

Infraclavicular lesion of tuberculosis is known as?

Accepted Answer

Assman's focus

Answer

Ghon's focus

Answer

Puhl's focus

Answer

None of the above

Question 4

Which condition is characterized by alveolar hemorrhage and hemosiderin-laden macrophages?

Accepted Answer

Goodpasture syndrome

Answer

Sarcoidosis

Answer

Bronchial pneumonia

Answer

Bronchiectasis

Question 5

Alpha-1-antitrypsin deficiency is associated with which type of emphysema?

Accepted Answer

Panacinar emphysema

Answer

Centriacinar emphysema

Answer

Paraseptal emphysema

Answer

Irregular emphysema

Question 6

Which of the following is a finding in biopsy of mesothelioma of pleura?

Accepted Answer

Intense fibrosis

Answer

Myelin figures

Answer

Desmosomes

Answer

Weibel-Palade bodies

Question 7

The alveoli are filled with exudate and the air is displaced, converting the lung into a solid organ. This description suggests:

Accepted Answer

Lobar pneumonia

Answer

Chronic bronchitis

Answer

Bronchial asthma

Answer

Bronchiectasis

Question 8

Lymphangitis carcinomatosa is a typical feature of which of the following?

Accepted Answer

Carcinoma of the bronchus

Answer

Carcinoma of the thyroid

Answer

Hepatoma

Answer

None of the above

Question 9

What is the synonym for shock lung?

Accepted Answer

ARDS

Answer

COPD

Answer

Alveolar proteinosis

Answer

Hyaline Membrane Disease (HMD)

Question 10

Clubbing is the least common in which of the following conditions?

Accepted Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Mesothelioma

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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