Respiratory Pathology Practice Questions

Q: A 65-year-old chronic smoker presents with a rapidly enlarging large hilar mass on a chest film associated with significant adenopathy. He also experiences recurrent hypoglycemic spells. Which of the following lung carcinoma subtypes will most commonly lead to this spectrum?

Small cell carcinoma. **Explanation:** The clinical presentation of a **rapidly enlarging hilar mass** with significant **adenopathy** in a chronic smoker is highly characteristic of **Small Cell Lung Carcinoma (SCLC)** [1]. SCLC is a neuroendocrine tumor known for its aggressive growth and early mediastinal involvement. **Why Small Cell Carcinoma is correct:** The "recurrent hypoglycemic spells" point toward a **Paraneoplastic Syndrome**. While SCLC is most famously associated with SIADH (hyponatremia) and ectopic ACTH (Cushing’s syndrome) [1], it can also cause hypoglycemia through the secretion of **Insulin-like Growth Factor (IGF)** or, rarely, insulin-like substances. Furthermore, SCLC is the lung cancer most strongly associated with central/hilar locations and smoking [2]. **Analysis of Incorrect Options:** * **Squamous Cell Carcinoma:** Also central and smoking-related, but typically associated with **Hypercalcemia** (due to PTHrP secretion), not hypoglycemia [1]. * **Adenocarcinoma:** The most common lung cancer overall; however, it is usually **peripheral** in location and more common in non-smokers. It is associated with hypertrophic osteoarthropathy (clubbing) [1]. * **Large Cell Carcinoma:** A diagnosis of exclusion that presents as a large peripheral mass with early metastasis, but it is not the classic cause of the described paraneoplastic endocrine features. **NEET-PG High-Yield Pearls:** * **SCLC Markers:** Positive for Chromogranin A, Synaptophysin, and CD56. * **Paraneoplastic Associations:** * **SCLC:** SIADH, Ectopic ACTH, Lambert-Eaton Myasthenic Syndrome [1]. * **Squamous Cell:** Hypercalcemia (PTHrP) [1]. * **Adenocarcinoma:** Trousseau syndrome (thrombophlebitis), Marantic endocarditis. * **Rule of "S":** **S**mall cell and **S**quamous cell are **S**moking-related and **S**entral [2].

Question 1

A 60-year-old male with a 30-year history of occupational asbestos exposure presents with progressive dyspnea and massive right-sided pleural effusion. CT scan reveals a circumferential pleural-based mass encasing the right lung. A pleural biopsy is performed. The IHC panel (Image 1) shows: Panel A — strong diffuse nuclear and cytoplasmic positivity for Calretinin in tumor cells; Panel B — strong nuclear positivity for WT-1 in tumor cells; Panel C — negativity for CEA in tumor cells; Panel D — negativity for TTF-1 in tumor cells. Based on this IHC pattern, which of the following best explains why this result is diagnostically significant in distinguishing this lesion from its closest morphological mimic?

Accepted Answer

A. Strong diffuse positivity for Calretinin and WT-1 with negativity for CEA and TTF-1 confirms mesothelial lineage and excludes pulmonary adenocarcinoma metastasis

Answer

B. Positivity for CEA and TTF-1 with negativity for Calretinin confirms glandular differentiation consistent with primary lung adenocarcinoma invading the pleura

Answer

C. Negativity for both Calretinin and WT-1 with positivity for CK7 and CK20 is characteristic of metastatic colonic adenocarcinoma involving the pleura

Answer

D. Diffuse positivity for S100 and CD34 with negativity for CEA confirms a solitary fibrous tumor of the pleura with mesenchymal differentiation

Question 2

A 65-year-old chronic smoker presents with a rapidly enlarging large hilar mass on a chest film associated with significant adenopathy. He also experiences recurrent hypoglycemic spells. Which of the following lung carcinoma subtypes will most commonly lead to this spectrum?

Accepted Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Large cell carcinoma

Question 3

Which of the following is NOT typically seen in ARDS?

Accepted Answer

Dilated bronchioles

Answer

Edema

Answer

Fibrosis

Answer

Alveolar damage

Question 4

A 46-year-old woman presents with fever, hemoptysis, weight loss, and night sweats. She has never smoked and recently returned from a month-long trip to Asia. A chest radiograph reveals apical lesions with cavitation in the left lung. A purified protein derivative (PPD) test is placed, and 48 hours later an 18-mm wheal develops. Sputum cultures reveal numerous acid-fast organisms. This patient is placed on contact precautions, and a regimen for tuberculosis is started. Which of the following disorders does this patient most likely have?

Accepted Answer

Secondary tuberculosis, resulting from activation of a prior Ghon complex, with spread to a new pulmonary site

Answer

Acquired immunodeficiency syndrome

Answer

Congenital immunodeficiency

Answer

Miliary tuberculosis, with seeding of distal organs with innumerable small millet seed-like lesions

Question 5

A specimen from a lung biopsy reveals occasional plexiform lesions within pulmonary arterioles. Which of the following conditions is most characteristic of this finding?

Accepted Answer

Pulmonary hypertension

Answer

Churg-Strauss syndrome

Answer

Adult respiratory distress syndrome

Answer

Wegener's granulomatosis

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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