Respiratory Pathology Practice Questions

Q: In small cell carcinoma of the lung, where do the DNA of the necrotic cells get deposited on vessels?

Azzopardi effect. ### Explanation **Correct Answer: B. Azzopardi effect** **The Concept:** Small cell carcinoma of the lung (SCLC) is characterized by extremely high mitotic activity and extensive necrosis. The **Azzopardi effect** refers to the encrustation of blood vessel walls by basophilic DNA material released from necrotic tumor cells [1]. Because SCLC cells have a very high nuclear-to-cytoplasmic ratio and are fragile, they easily rupture, releasing DNA that adheres to the walls of intrinsic pulmonary vessels [1]. On H&E staining, this appears as intense, fuzzy blue/purple staining of the vessel walls [1]. **Analysis of Incorrect Options:** * **A. Psammoma body:** These are laminated, concentric calcifications. While seen in some lung cancers (like Adenocarcinoma or Mesothelioma), they are not related to DNA deposition on vessels. * **C. Button collar lesion:** This is a gross morphological description sometimes used for **Carcinoid tumors** of the lung, which often grow as a mass penetrating the bronchial wall like a "collar stud." * **D. Necrotic diathesis:** This is a cytological term referring to the background of necrotic debris, blood, and inflammatory cells seen in invasive carcinomas on a Pap smear or FNA, but it does not specifically describe DNA deposition on vessel walls. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** SCLC arises from **Kulchitsky cells** (neuroendocrine cells). * **Markers:** Positive for **Chromogranin A, Synaptophysin, and CD56** [1]. * **Genetics:** Nearly 100% association with **TP53 and RB1** mutations. * **Paraneoplastic Syndromes:** Most commonly associated with **SIADH** and **ACTH** (Cushing syndrome), and **Lambert-Eaton Myasthenic Syndrome**. * **Histology:** Look for "Salt and pepper" chromatin and nuclear molding [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-338.

Q: Bronchogenic carcinoma commonly metastasizes to which endocrine organ?

Adrenals. **Explanation:** **Correct Answer: D. Adrenals** Bronchogenic carcinoma is notorious for its aggressive metastatic potential. The **adrenal glands** are the most common site of endocrine metastasis for lung cancer, with involvement seen in approximately 40% of cases at autopsy [1]. The underlying medical concept involves the rich vascular supply of the adrenal glands (specifically the cortex), which facilitates the hematogenous seeding of malignant cells. While lung cancer frequently spreads to the liver, brain, and bones, the adrenals are the classic "high-yield" endocrine destination [1]. Interestingly, despite extensive bilateral involvement, these metastases rarely cause clinical adrenal insufficiency (Addison’s disease) because more than 90% of the gland must be destroyed before symptoms manifest. **Why other options are incorrect:** * **Ovaries (A):** While the ovaries are common sites for "Krukenberg tumors" (typically from gastric or colonic primaries), they are rare sites for lung cancer metastasis. * **Testes (B):** Metastasis to the testes is extremely rare from any primary site; most testicular tumors are primary germ cell tumors. * **Thyroid (C):** Although the thyroid is highly vascular, it is an infrequent site for clinically significant metastasis from the lungs compared to the adrenals. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of distant metastasis:** Liver [1]. * **Most common endocrine site:** Adrenals [1]. * **Imaging Tip:** In a patient with a known lung mass, an incidental adrenal mass on CT is highly suspicious for metastasis and often requires PET-CT or biopsy for staging. * **Small Cell Carcinoma:** This subtype is the most likely to present with early, widespread metastasis to the adrenals and brain. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725.

Question 1

What is the dominant cell type in the grey hepatization stage of community-acquired pneumonia?

Accepted Answer

Neutrophils

Answer

Eosinophils

Answer

Macrophages

Answer

Monocytes

Question 2

In small cell carcinoma of the lung, where do the DNA of the necrotic cells get deposited on vessels?

Accepted Answer

Azzopardi effect

Answer

Psammoma body

Answer

Button collar lesion

Answer

Necrotic diathesis

Question 3

Histologic examination of lung tissue reveals multiple suppurative, neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces only. The majority of lung tissue is not involved in this inflammatory process. Hyaline membranes are not found. This histologic appearance best describes which of the following conditions?

Accepted Answer

Bronchopneumonia

Answer

Bronchiectasis

Answer

Lobar pneumonia

Answer

Interstitial pneumonitis

Question 4

Bronchogenic carcinoma commonly metastasizes to which endocrine organ?

Accepted Answer

Adrenals

Answer

Ovaries

Answer

Testes

Answer

Thyroid

Question 5

Diffuse mesothelioma is associated with which exposure?

Accepted Answer

Asbestos

Answer

Arsenic

Answer

Tobacco use

Answer

Tuberculosis (TB)

Question 6

Gray hepatization of lungs is typically seen on which day of pneumonia?

Accepted Answer

Day 7

Answer

Day 1

Answer

Day 3

Answer

Day 5

Question 7

Bronchus is the site of pathological changes for all of the following diseases, except:

Accepted Answer

Emphysema

Answer

Chronic bronchitis

Answer

Asthma

Answer

Bronchiectasis

Question 8

What is the lung pathology occurring in persons working in cotton-wool industries?

Accepted Answer

Asthma like features

Answer

Hypersensitivity pneumonitis

Answer

Lung cancer

Answer

Chronic bronchitis

Question 9

Alpha-1 antitrypsin deficiency is associated with which of the following conditions?

Accepted Answer

Emphysema

Answer

Bronchiectasis

Answer

Empyema

Answer

Bronchogenic carcinoma

Question 10

Which of the following conditions is NOT associated with bronchiectasis?

Accepted Answer

Lung cancer

Answer

Pericarditis

Answer

Amyloidosis

Answer

Hemoptysis

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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