Respiratory Pathology Practice Questions

Q: Which of the following statements is NOT true regarding Bronchoalveolar carcinoma?

It involves stromal invasion with desmoplasia.. **Explanation:** **Bronchoalveolar Carcinoma (BAC)**, now classified under the spectrum of **Adenocarcinoma in situ (AIS)** and **Minimally Invasive Adenocarcinoma (MIA)**, is unique because of its non-invasive growth pattern. [1] 1. **Why Option B is the correct answer (The "False" statement):** The hallmark of BAC is its **lepidic growth pattern**, meaning the tumor cells "crawl" along the pre-existing alveolar walls without invading the underlying stroma, blood vessels, or pleura. [1] Because there is no stromal invasion, there is **no desmoplastic response** (fibrotic reaction). If stromal invasion or desmoplasia is present, the diagnosis shifts to invasive adenocarcinoma. 2. **Analysis of Incorrect Options:** * **Option A:** BAC is a subtype of **Adenocarcinoma**. [1] It arises from peripheral lung tissue, specifically from Clara cells or Type II pneumocytes. * **Option C & D:** These describe the **Lepidic pattern**. The tumor uses the alveolar septa as a scaffold, preserving the basic lung architecture. [1] This preservation is why BAC often appears as a "ground-glass opacity" or mimics pneumonia on a chest X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Always peripheral. * **Radiology:** Can present as a single nodule, multiple nodules, or a diffuse "pneumonic" infiltrate. * **Microscopy:** Look for the "butterflies on a fence" appearance (cells lining alveolar walls). [1] * **Prognosis:** It has a significantly better prognosis than other bronchogenic carcinomas because of its non-invasive nature. * **Smoking:** It is the subtype least strongly associated with smoking and is the most common lung cancer found in non-smoking women. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 721-723.

Q: A 23-year-old woman presents with wheezing symptoms and shortness of breath on exertion, occurring primarily in the spring and resolving spontaneously. She is a nonsmoker with no personal or family history of atopy or asthma. Physical examination reveals normal vital signs and cardiac findings, with clear lungs on auscultation and no wheezing on forced expiration. What is the most likely mechanism of wheezing in this patient?

Nonspecific hyperirritability of the tracheobronchial tree. ### Explanation The patient presents with symptoms suggestive of **Intrinsic (Non-atopic) Asthma**. The hallmark of all forms of asthma, regardless of the trigger, is **nonspecific hyperirritability of the tracheobronchial tree** [1]. **1. Why Option C is Correct:** In this clinical scenario, the patient lacks a personal or family history of atopy (no eczema, allergic rhinitis, or hay fever) and has normal IgE levels (implied by the absence of atopy). This points toward intrinsic asthma [2]. The underlying pathophysiology in these patients involves an exaggerated bronchoconstrictor response to various stimuli (like cold air, exercise, or seasonal irritants). This "hyper-responsiveness" or "hyperirritability" is the physiological basis of the airway narrowing that leads to wheezing and dyspnea [1]. **2. Why Other Options are Incorrect:** * **Options A, B, and D:** These are all components of **Extrinsic (Atopic) Asthma**. This type is characterized by a Type I hypersensitivity reaction (disordered immediate hypersensitivity) mediated by IgE [2]. In atopic individuals, exposure to specific allergens leads to IgE-mediated mast cell degranulation. Since this patient has no history of atopy, these mechanisms are less likely to be the primary driver of her symptoms. **Clinical Pearls for NEET-PG:** * **Asthma Triad (Samter’s Triad):** Asthma, Aspirin sensitivity, and Nasal polyposis (a classic form of non-atopic asthma) [2]. * **Diagnosis:** The gold standard for diagnosing bronchial asthma is **Spirometry**, showing reversible airway obstruction (increase in FEV1 >12% and >200ml after bronchodilator). * **Methacholine Challenge:** Used when asthma is suspected but spirometry is normal; it specifically tests for the "bronchial hyper-responsiveness" mentioned in Option C [1]. * **Physical Exam:** A normal lung exam does not rule out asthma, as symptoms are often episodic and paroxysmal [3].

Question 1

A 25-year-old man experiences acute onset of fever, cough, dyspnea, headache, and malaise a day after moving into a new apartment. His symptoms subside over 3 days when he visits a friend in another city. On the day of his return, the symptoms recur. There are no remarkable findings on physical examination. A chest radiograph also is unremarkable. Which of the following pathogenic mechanisms is most likely to produce these findings?

Accepted Answer

Antigen-antibody complex-mediated injury

Answer

Antibody-mediated injury to basement membrane

Answer

Formation of mycolic acid as a result of tubercular infection

Answer

Generation of prostaglandins by basophil recruitment

Question 2

A 78-year-old man has had increasing dyspnea without cough or increased sputum production for the past 4 months. On physical examination, he is afebrile. Breath sounds are reduced in all lung fields. A chest CT scan shows a dense, brightly attenuated pleural mass encasing most of the left lung. Microscopic examination of a pleural biopsy specimen shows spindle and cuboidal cells that invade adipose tissue. Inhalation of which of the following pollutants is the most likely factor in the pathogenesis of this mass?

Accepted Answer

Asbestos

Answer

Bird dust

Answer

Coal dust

Answer

Cotton fibers

Question 3

Which of the following statements about small cell carcinoma of the lung is incorrect?

Accepted Answer

It is less associated with paraneoplastic syndromes compared to non-small cell lung cancers.

Answer

It is a poorly differentiated neuroendocrine tumor.

Answer

It usually presents as a central mass.

Answer

Cells show a salt and pepper chromatin pattern.

Question 4

Reactivation of TB is most commonly located near which anatomical area?

Accepted Answer

Apex

Answer

Bronchus

Answer

Subpleural space

Answer

Base

Question 5

Bronchial hyperplasia may be caused by all of the following except?

Accepted Answer

Theophylline

Answer

Smoking

Answer

Prematurity

Answer

Allergy

Question 6

Following thoracotomy, a lesion is detected in the right lower lung lobe of a 20-year-old man. The lesion is found to be nonfunctioning lung tissue served by vessels separate from those of the adjacent lung tissue. What is the most likely diagnosis?

Accepted Answer

Bronchopulmonary sequestration

Answer

Mesothelioma

Answer

Hiatal hernia

Answer

Glomus tumor

Question 7

Which of the following are histological features of pulmonary hypertension?

Accepted Answer

Thrombi in pulmonary vasculature and vaso-occlusive disease and arterial wall thickening

Answer

Capillaritis of alveolar septa and vaso-occlusive disease and arterial wall thickening

Answer

Saddle thrombi in pulmonary trunk and vaso-occlusive disease and arterial wall thickening

Answer

Capillaritis of alveolar septa and vaso-occlusive disease and arterial wall thickening

Question 8

Which of the following statements is NOT true regarding Bronchoalveolar carcinoma?

Accepted Answer

It involves stromal invasion with desmoplasia.

Answer

It is a type of Adenocarcinoma.

Answer

It shows preservation of the alveolar structure.

Answer

It grows along pre-existing anatomical structures.

Question 9

High Reid index is indicative of which disease?

Accepted Answer

Chronic bronchitis

Answer

Pulmonary tuberculosis

Answer

Bronchial asthma

Answer

Emphysema

Question 10

A 23-year-old woman presents with wheezing symptoms and shortness of breath on exertion, occurring primarily in the spring and resolving spontaneously. She is a nonsmoker with no personal or family history of atopy or asthma. Physical examination reveals normal vital signs and cardiac findings, with clear lungs on auscultation and no wheezing on forced expiration. What is the most likely mechanism of wheezing in this patient?

Accepted Answer

Nonspecific hyperirritability of the tracheobronchial tree

Answer

Elevated IgE levels

Answer

Mast cell instability

Answer

Disordered immediate hypersensitivity

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?