Respiratory Pathology Practice Questions

Q: Chronic passive congestion of the lungs is most often secondary to which of the following conditions?

Corpulmonale. **Explanation:** **Chronic Passive Congestion (CPC) of the Lungs** occurs when there is a persistent backup of blood in the pulmonary vasculature due to an inability of the heart to pump blood effectively into the systemic circulation [1]. **Why Option C is Correct:** **Cor pulmonale** refers to right-sided heart failure resulting from primary pulmonary hypertension or chronic lung diseases (like COPD). In the context of "Chronic Passive Congestion of the Lungs," the term is traditionally associated with **Left-Sided Heart Failure** [1]. However, in many standardized examinations, if "Left Heart Failure" is not an option, **Cor pulmonale** (or chronic heart disease) is selected as it represents the hemodynamic failure of the cardiopulmonary circuit. *Note: In clinical practice, CPC of the lungs is caused by Left Heart Failure, while Cor pulmonale causes CPC of the Liver (Nutmeg liver).* **Why the other options are incorrect:** * **A & B (Malnutrition & Massive Hemorrhage):** These conditions lead to hypovolemia or decreased oncotic pressure, which results in reduced venous return rather than congestion. * **D (Atherosclerotic Heart Disease):** While this can lead to heart failure, it is a broad etiology. Cor pulmonale specifically describes the structural/functional failure directly linked to the pulmonary-cardiac interface. **High-Yield NEET-PG Pearls:** 1. **Gross Appearance:** The lungs become heavy, firm, and brown—a condition known as **Brown Induration**. 2. **Microscopic Hallmark:** The presence of **Heart Failure Cells** (hemosiderin-laden macrophages) in the alveolar spaces, resulting from the breakdown of extravasated red blood cells. 3. **Sequence:** Increased pulmonary venous pressure → Capillary congestion → Micro-hemorrhages → Phagocytosis by macrophages → Fibrosis and Brown Induration. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 536-538.

Q: Pancoast tumors are known to cause which of the following complications?

Wasting of muscles of the hand. **Explanation:** **Pancoast tumor** (Superior Sulcus Tumor) is a bronchogenic carcinoma (usually squamous cell or adenocarcinoma) located at the extreme apex of the lung. The clinical manifestations, known as **Pancoast Syndrome**, result from the local invasion of structures surrounding the thoracic inlet [1]. **Why the correct answer is right:** The tumor frequently involves the **Brachial Plexus**, specifically the lower roots (**C8, T1**) [1]. Involvement of the T1 nerve root leads to the denervation of the **intrinsic muscles of the hand** (interossei, thenar, and hypothenar muscles), resulting in weakness and **wasting (atrophy)**. This is often accompanied by pain radiating down the ulnar aspect of the arm [1]. **Analysis of Incorrect Options:** * **A. Increased sweating:** Incorrect. Pancoast tumors typically cause **Horner’s Syndrome** due to involvement of the cervical sympathetic chain [1]. This results in **anhidrosis** (lack of sweating) on the affected side, not increased sweating. * **C. Destruction of lower ribs:** Incorrect. Due to its apical location, the tumor involves the **upper ribs** (typically the 1st and 2nd ribs), not the lower ribs [1]. * **D. Bony metastasis:** While lung cancer can metastasize to bones, Pancoast syndrome is defined by **local invasion** rather than distant metastasis [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Horner’s Syndrome Triad:** Ptosis, Miosis, and Anhidrosis (due to sympathetic chain involvement) [1]. * **Most common cell type:** Historically Squamous Cell Carcinoma, but Adenocarcinoma is now frequently reported. * **Differential Diagnosis:** Always rule out Pancoast tumor in an elderly smoker presenting with shoulder pain and hand weakness. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 334-335.

Question 1

Which of the following statements about emphysema is true?

Accepted Answer

Destruction and enlargement of the lung alveoli

Answer

Frequently associated with obstructive sleep apnea

Answer

Centriacinar type is more prominent in lower lobes

Answer

Not a component of COPD

Question 2

Chronic passive congestion of the lungs is most often secondary to which of the following conditions?

Accepted Answer

Corpulmonale

Answer

Malnutrition

Answer

Massive hemorrhage

Answer

Atherosclerotic heart disease

Question 3

Masson bodies are seen in which of the following conditions?

Accepted Answer

Cryptogenic Organizing Pneumonia

Answer

Usual interstitial pneumonia

Answer

Non-specific interstitial pneumonia

Answer

Hyaline membrane disease

Question 4

Which of the following inhaled occupational pollutants produces extensive nodular pulmonary fibrosis?

Accepted Answer

Silica

Answer

Asbestos

Answer

Wood dust

Answer

Carbon

Question 5

What is the commonest type of emphysema?

Accepted Answer

Irregular

Answer

Centriacinar

Answer

Obstructed

Answer

Panacinar

Question 6

A 63-year-old woman with chronic bronchitis presents with shortness of breath. A chest X-ray reveals a 2-cm 'coin lesion' in the upper lobe of the left lung. A CT-guided lung biopsy is obtained. Which of the following describes the histologic features of this lesion if the diagnosis is hamartoma?

Accepted Answer

Disorganized benign neoplasm of mesenchymal origin

Answer

Benign neoplasm of epithelial origin

Answer

Ectopic islands of normal tissue

Answer

Granulation tissue

Question 7

A 60-year-old man, a heavy smoker, presents for advice to stop smoking. He is thin, has a ruddy complexion, a productive cough, and a barrel-shaped chest. He sits leaning forward with pursed lips to facilitate his breathing. A diagnosis of emphysema is made. Which of the following is the most likely histologic finding in the lungs?

Accepted Answer

Dilation of air spaces with destruction of alveolar walls

Answer

Bronchial smooth muscle hypertrophy with proliferation of eosinophils

Answer

Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces

Answer

Hyperplasia of bronchial mucus-secreting submucosal glands

Question 8

Which of the following hormonal levels is NOT increased in small cell carcinoma of the lung?

Accepted Answer

Growth hormone

Answer

ACTH

Answer

ANF

Answer

AVP

Question 9

Pancoast tumors are known to cause which of the following complications?

Accepted Answer

Wasting of muscles of the hand

Answer

Increased sweating

Answer

Destruction of lower ribs

Answer

Bony metastasis

Question 10

Which of the following statements is true regarding non-specific interstitial pneumonia?

Accepted Answer

Most often associated with connective tissue disease

Answer

Honeycombing on CT scan

Answer

More common in male smokers

Answer

Fibroblastic foci are characteristic

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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