Respiratory Pathology Practice Questions

Q: All are features of sarcoidosis except:

Schaumann and asteroid bodies are pathognomic. **Explanation:** **Why Option D is the correct answer:** While **Schaumann bodies** (laminated calcium-protein concretions) and **asteroid bodies** (stellate inclusions within giant cells) are classic histological findings in sarcoidosis, they are **not pathognomonic**. These inclusions can also be seen in other granulomatous diseases, such as tuberculosis, berylliosis, and foreign body granulomas. The diagnosis of sarcoidosis remains one of exclusion, requiring a compatible clinical/radiological picture and histological evidence of non-caseating granulomas. **Analysis of Incorrect Options:** * **Option A:** Sarcoidosis is characterized by an exaggerated T-helper cell response. Bronchoalveolar lavage (BAL) typically shows a **high CD4:CD8 ratio** (often >3.5:1), which is a high-yield diagnostic marker. * **Option B:** Macrophages within the sarcoid granulomas possess **1-alpha-hydroxylase** activity, which converts Vitamin D to its active form (1,25-dihydroxyvitamin D). This leads to increased intestinal calcium absorption, resulting in **hypercalciuria** (more common) and **hypercalcemia** [1]. * **Option C:** **ACE levels** are elevated in approximately 60-80% of patients with active sarcoidosis, as ACE is produced by the epithelioid cells of the granuloma. While useful for monitoring disease activity, it lacks specificity. **NEET-PG Clinical Pearls:** * **Lofgren’s Syndrome:** A classic triad of Erythema nodosum, bilateral hilar lymphadenopathy (BHL), and arthralgia (excellent prognosis) [1]. * **Heerfordt’s Syndrome (Uveoparotid fever):** Parotid enlargement, facial nerve palsy, and anterior uveitis [1]. * **Radiology:** Stage I is characterized by Bilateral Hilar Lymphadenopathy (BHL) alone [1]. * **Histology:** The hallmark is the **non-caseating granuloma**.

Question 1

A patient presents with recurrent episodic diarrhea, triggered by food or alcohol. During episodes, he experiences flushing, wheezing, and malaise. A chest x-ray reveals a lung mass. Which of the following would MOST likely be present on biopsy of the lesion?

Accepted Answer

Carcinoid tumor

Answer

Bronchioloalveolar carcinoma

Answer

Primary tuberculosis

Answer

Recurrent tuberculosis

Question 2

A 50-year-old man with a 30-year history of smoking reports copious sputum production for approximately 6 months per year for the preceding 5 years. This sputum production is most likely closely related to increased numbers of which of the following cell types in his bronchioles and small (<3 mm) bronchi?

Accepted Answer

Goblet cells

Answer

Smooth muscle cells

Answer

Squamous cells

Answer

Type I pneumocytes

Question 3

Which of the following occupational lung diseases can develop into lung cancer?

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Byssinosis

Answer

Anthracosis

Question 4

Which of the following cells play a crucial role in the pathogenesis of alveolar-capillary damage in adult respiratory distress syndrome (ARDS)?

Accepted Answer

Neutrophils

Answer

CD4-positive lymphocytes

Answer

CD8-positive lymphocytes

Answer

Eosinophils

Question 5

Which of the following is NOT a cancer caused by asbestosis?

Accepted Answer

Pancreatic Ca

Answer

Adenocarcinoma of lung

Answer

Mesothelioma

Answer

Gastric Ca

Question 6

What is the characteristic feature of viral pneumonias?

Accepted Answer

Interstitial mononuclear infiltration

Answer

Intra-alveolar proteinaceous exudate

Answer

Hyaline membrane lining alveoli

Answer

Fibrotic septa

Question 7

Which of the following is NOT a pathological feature of Idiopathic pulmonary Hemosiderosis?

Accepted Answer

Diffuse alveolar proteinosis

Answer

Hyperplasia of type II alveolar pneumocytes

Answer

Alveolar capillary dilatation

Answer

Hemosiderin laden macrophages

Question 8

All are features of sarcoidosis except:

Accepted Answer

Schaumann and asteroid bodies are pathognomic

Answer

High CD4:CD8 ratio

Answer

Hypercalciuria and hypercalcemia may be present

Answer

Elevated serum levels of angiotensin-converting enzyme (ACE)

Question 9

Which type of lung cancer commonly exhibits lung-to-lung metastasis?

Accepted Answer

Adenocarcinoma of lung

Answer

Squamous cell carcinoma

Answer

Small cell carcinoma

Answer

Neuroendocrine tumor of lung

Question 10

Which cells are most important in the causation of asthma?

Accepted Answer

Mast cells

Answer

Macrophages

Answer

Neutrophils

Answer

Lymphocytes

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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