Respiratory Pathology — MCQs

Respiratory Pathology Indian Medical PG Practice Questions and MCQs

Question 441: Radiotherapy induced radiation pneumonitis is mediated by all of the following cytokines and factors except -

A. PAF (Correct Answer)
B. NF-kB
C. TNF-α
D. TGF-β

Explanation: ***PAF*** - **Platelet-activating factor (PAF)** is primarily involved in **anaphylaxis**, **asthma**, and **allergic responses**, mediating inflammation through platelet aggregation and smooth muscle contraction. - While it has pro-inflammatory effects, it is **not a primary mediator** of the specific inflammatory cascade seen in radiotherapy-induced radiation pneumonitis. *TNF-α* - **Tumor Necrosis Factor-alpha (TNF-α)** is a crucial **pro-inflammatory cytokine** that plays a significant role in the initial acute phase of radiation pneumonitis. - It induces **cytotoxicity**, **apoptosis**, and the production of other inflammatory mediators, contributing to lung tissue damage. *TGF-β* - **Transforming Growth Factor-beta (TGF-β)** is a key cytokine involved in the **fibrotic phase** of radiation pneumonitis. - It promotes **fibroblast proliferation**, collagen synthesis, and extracellular matrix deposition, leading to lung scarring. *NF-kB* - **Nuclear Factor kappa-light-chain-enhancer of activated B cells (NF-kB)** is a master **transcription factor** that regulates the expression of numerous genes involved in inflammation and immune responses. - Radiation exposure **activates NF-kB**, leading to the transcription of various pro-inflammatory cytokines, including TNF-α, which contribute to radiation pneumonitis.

Question 442: Curschmann's spirals are seen in which condition?

A. Bronchiectasis
B. Chronic bronchitis
C. Wegener's granulomatosis
D. Bronchial asthma (Correct Answer)

Explanation: ***Bronchial asthma*** - **Curschmann's spirals** are spiral-shaped mucus plugs found in the sputum of patients with **bronchial asthma**. - They represent casts from small bronchi and are formed from **mucus and cellular debris** within the airways during an asthmatic exacerbation. *Bronchiectasis* - Characterized by **permanent abnormal dilation** of the bronchi due to chronic inflammation and infection, leading to productive cough and recurrent respiratory infections. - While it involves mucous production, it is typically associated with **purulent sputum** due to bacterial colonization, not necessarily Curschmann's spirals. *Chronic bronchitis* - Defined clinically by a **chronic productive cough** for at least three months in each of two successive years, without other causes. - Involves mucus hypersecretion and inflammation, but **Curschmann's spirals are not a characteristic finding** compared to asthma. *Wegener's granulomatosis (Granulomatosis with Polyangiitis)* - This is a systemic **vasculitis** affecting small to medium-sized blood vessels, typically involving the upper and lower respiratory tracts and kidneys. - Its pulmonary manifestations include **nodules, cavities, and diffuse alveolar hemorrhage**, and sputum findings are related to inflammation and bleeding, not Curschmann's spirals.

Question 443: Which of the following statements is MOST accurate regarding adenocarcinoma of the lung?

A. Smoking is associated with adenocarcinoma
B. Typically presents with central cavitations
C. Most commonly found in peripheral lung tissue (Correct Answer)
D. Relatively more common in non-smokers compared to other lung cancer types

Explanation: ***More common in female*** - Adenocarcinoma of the lung has a higher incidence in **female** patients compared to other types of lung cancer. - This is especially relevant in **non-smokers** where adenocarcinoma is often more prevalent among women. *Upper lobe involvement is most common* - Typically, adenocarcinoma is often found in the **peripheral** regions of the lung [1] and not specifically in the upper lobes. - Upper lobe predominance is more characteristic of **squamous cell carcinoma** rather than adenocarcinoma [2]. *Central cavitations* - Adenocarcinoma generally presents as **solid masses** and **nodules** rather than central lesions with cavitations. - Cavitary lesions are more commonly associated with **squamous cell carcinoma** [2] or certain infections like **tuberculosis**. *Smoking is not associated with* - In fact, smoking is a significant risk factor for adenocarcinoma [3], although it is often considered less directly related compared to **squamous cell carcinoma**. - The incidence in smokers is notable, but adenocarcinoma can also occur in **non-smokers**, complicating this association. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-336. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 721-723.

Question 444: Hypersensitivity pneumonitis due to prolonged inhalation of dust is a characteristic feature of Maltworker's lung, which is caused by:

A. Aspergillus clavatus (Correct Answer)
B. Pseudomonas
C. Micropolyspora faeni
D. Aspergillus fumigatus

Explanation: ***Aspergillus clavatus*** - **Maltworker's lung** is a specific type of hypersensitivity pneumonitis caused by repeated inhalation of dust from moldy barley, which often contains **Aspergillus clavatus**. - This leads to an **immunological reaction** in the lungs, manifesting as granulomatous inflammation [4]. *Aspergillus fumigatus* - While **Aspergillus fumigatus** is a common cause of lung infections, it is primarily associated with conditions like **allergic bronchopulmonary aspergillosis (ABPA)** and invasive aspergillosis, not specifically Maltworker's lung [1]. - ABPA involves type I and type III hypersensitivity reactions to *A. fumigatus* colonization in the airways, distinct from the hypersensitivity pneumonitis seen in Maltworker's lung [2]. *Pseudomonas* - **Pseudomonas** species are gram-negative bacteria, primarily known for causing opportunistic infections, particularly in immunocompromised individuals or those with cystic fibrosis. - They are not a fungal organism and are not associated with hypersensitivity pneumonitis like Maltworker's lung; rather, they cause acute and chronic bacterial pneumonia. *Micropolyspora faeni* - **Micropolyspora faeni** (now *Saccharopolyspora rectivirgula*) is the causative agent of **Farmer's lung**, another form of hypersensitivity pneumonitis [3]. - **Farmer's lung** is distinct from Maltworker's lung, occurring due to exposure to moldy hay rather than moldy barley [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 396-397. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 329-330. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 332-333. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 701-702.

Question 445: Ferruginous bodies are seen in:

A. Silicosis
B. Asbestosis (Correct Answer)
C. Byssinosis
D. Bagassosis

Explanation: ***Asbestosis*** - Ferruginous bodies are specifically associated with **exposure to asbestos**, which leads to asbestosis [1]. - These bodies are seen as **siderophilic structures** resembling a "dumbbell" shape under the microscope, which are indicative of this condition [1]. *Bagassosis* - Caused by exposure to **bagasse dust**, primarily from sugarcane, leading to allergic alveolitis rather than ferruginous bodies [1]. - Histopathology typically shows **lymphocytic infiltration** and non-caseating granulomas, not ferruginous bodies. *Byssinosis* - This is associated with inhalation of **cotton dust** and primarily results in **bronchoconstriction** and respiratory symptoms rather than ferruginous bodies. - Characterized by a **respiratory illness** that worsens at the beginning of the work week, missing the key features of asbestosis. *Silicosis* - Resulting from exposure to **silica dust**, this condition leads to macules and nodules in the lungs instead of ferruginous bodies [1]. - The hallmark findings are **hyaline nodules** on imaging and not the abnormal iron-containing structures seen in asbestosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 695, 698-699.

Question 446: The earliest lesion seen in asbestosis is:

A. Mesothelioma
B. Hilar lymphadenopathy
C. Adenoma of the lung
D. Pleural plaques (Correct Answer)

Explanation: ***Pleura plaques*** - The earliest lesion in asbestosis is characterized by the development of **pleural plaques**, which are indicative of asbestos exposure [1]. - These plaques are often asymptomatic but are a strong marker for previous exposure to **asbestos fibers** [1]. *Mesothelioma* - While **mesothelioma** is associated with asbestos exposure, it is a malignant tumor that typically arises years after the initial exposure and isn't the earliest lesion [1,3]. - This condition usually presents with pleuritic symptoms and effusions, occurring much later than pleural plaques [2]. *Hilar lymphadenopathy* - Hilar lymphadenopathy may indicate lung disease, but it is not a direct lesion associated with asbestosis and does not present as the earliest finding. - Commonly seen in various conditions like **sarcoidosis**, it signifies **lymph node enlargement** rather than a direct effect of asbestos. *Adenoma lung* - Lung adenomas are benign lesions that are not directly tied to asbestosis exposure and occur independently of asbestos-related diseases. - This option fails to recognize that the characteristic **asbestos-related lesions** develop much differently than a lung adenoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 698-699. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Question 447: Which of the following features is NOT typically seen in viral pneumonia?

A. Bronchiolitis
B. Multinucleate giant cells in the bronchiolar wall
C. Predominance of alveolar exudate (Correct Answer)
D. Presence of interstitial inflammation

Explanation: ### Predominance of alveolar exudate - Viral pneumonia typically involves the **interstitium**, leading to interstitial inflammation, rather than a significant accumulation of **exudate** within the alveoli [3]. - **Alveolar exudate** is more characteristic of **bacterial pneumonia**, where neutrophils and fibrin fill the alveolar spaces [1], [2], [3]. ### Presence of interstitial inflammation - This is a **hallmark pathological feature** of viral pneumonia, where inflammatory cells infiltrate the alveolar septa and peribronchial tissues [3]. - The inflammation primarily involves the **walls of the alveoli** and the **surrounding connective tissue**, not the alveolar lumen. ### Bronchiolitis - Viral infections, especially in children, often affect the **small airways (bronchioles)**, causing inflammation and obstruction. - This can lead to symptoms such as **wheezing** and **dyspnea** in viral pneumonia. ### Multinucleate giant cells in the bronchiolar wall - The presence of **multinucleate giant cells** is a specific histological finding associated with certain viral pneumonias, particularly those caused by **measles** and **respiratory syncytial virus (RSV)**. - These cells arise from the fusion of infected cells and are found within the bronchiolar epithelium and lumen. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 711-712. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 715.

Question 448: What is the terminal stage of pneumonia?

A. Resolution (Correct Answer)
B. Congestive stage
C. Red hepatization
D. Gray hepatization

Explanation: ***Resolution*** - The **terminal stage of pneumonia** involves the body's response leading to resolution, characterized by the clearing of exudate and repair of lung tissue [1][3]. - Successful resolution signifies that **inflammation** has subsided, and lung function can begin to return to normal [3]. *Gray hepatization* - This stage occurs during the inflammatory process of pneumonia and is characterized by **pulmonary consolidation**, not the final stage [1]. - In gray hepatization, the lung tissue appears **gray and firm** due to the accumulation of fibrin and cellular debris, indicating ongoing infection [1]. *Congestion* - Congestion is an early stage in pneumonia marked by **vascular engorgement** and **edema of lung tissue**, preceding the inflammatory response [1]. - It's not a terminal stage, as it indicates the onset of pneumonia rather than an end stage where resolution occurs [1]. *Red hepatization* - This form represents another intermediate stage where the lungs become **reddened and firm** due to the influx of **red blood cells** and neutrophils [1]. - Like gray hepatization, it indicates active inflammation rather than recovery, which occurs later in the pneumonia process [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 711-712. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 193-194. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318.

Question 449: Small deposits of neuroendocrine cell hyperplasia in scarred lungs are known as:

A. Teratoma
B. Tumorlet (Correct Answer)
C. Carcinoid
D. Hamartoma

Explanation: ***Tumorlet*** - Small deposits of **neuroendocrine cell hyperplasia** in scarred lungs are specifically referred to as tumorlets, which can be associated with various lung diseases. - Tumorlets are typically benign, comprising **small clusters of neuroendocrine cells** that are usually found in pulmonary scars. *Teratoma* - Teratomas are **germ cell tumors** that typically contain tissue from all three embryonic layers and are not associated with neuroendocrine cell hyperplasia. - They usually occur in **gonadal** sites or mediastinum and do not relate to scarring in lung tissue. *Carcinoid* - Carcinoids are **neuroendocrine tumors** but larger and more defined than tumorlets, often causing obstruction or symptoms. - Unlike tumorlets, carcinoids present as **solitary masses**, typically found in the gastrointestinal tract or lungs but not as small deposits in scarred tissue. *Hamartoma* - Hamartomas are benign tumors made of **disorganized tissue** native to the organ in which they arise, but they do not involve neuroendocrine cells specifically [1]. - They are generally characterized as **well-circumscribed** nodules and do not correlate with neuroendocrine hyperplasia in scarred lungs [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 727-728.

Practice by Chapter

Congenital Anomalies

Practice Questions

Atelectasis and Acute Lung Injury

Practice Questions

Obstructive Pulmonary Diseases

Practice Questions

Restrictive Pulmonary Diseases

Practice Questions

Lung Infections

Practice Questions

Pulmonary Vascular Diseases

Practice Questions

Lung Tumors

Practice Questions

Pleural Diseases

Practice Questions

Interstitial Lung Diseases

Practice Questions

Occupational Lung Diseases

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free