Respiratory Pathology Practice Questions

Q: Which of the following statements regarding oat cell carcinoma of the lung is FALSE?

It is a variant of large cell anaplastic carcinoma.. **Explanation:** **Oat cell carcinoma** is a historical synonym for **Small Cell Lung Cancer (SCLC)**. It is characterized by small, round-to-oval cells with scanty cytoplasm, hyperchromatic nuclei, and "salt-and-pepper" chromatin. 1. **Why Option A is the Correct Answer (The False Statement):** Oat cell carcinoma is a distinct neuroendocrine tumor and is **not** a variant of large cell anaplastic carcinoma. Large cell carcinoma is a subtype of Non-Small Cell Lung Cancer (NSCLC) characterized by large nuclei and prominent nucleoli. SCLC and Large Cell Carcinoma are histologically and clinically separate entities. 2. **Analysis of Other Options:** * **Option B:** SCLC is highly sensitive to chemotherapy and radiotherapy (though it has a high recurrence rate). It is considered a "systemic disease" at presentation, making chemotherapy the mainstay of treatment. * **Option C & D:** SCLC is the most common lung cancer associated with **paraneoplastic syndromes** due to its neuroendocrine origin [1]. It frequently secretes ectopic hormones, most notably **ADH (causing SIADH)** and **ACTH (causing Cushing Syndrome)** [1], [2]. It is also associated with Lambert-Eaton Myasthenic Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Typically **central/hilar** (arises from neuroendocrine Kulchitsky cells). * **Strongest Association:** Almost exclusively seen in **smokers** [3]. * **Genetics:** Nearly 100% show mutations in **TP53 and RB1** genes. * **Azzopardi Effect:** A characteristic histological finding where DNA from necrotic tumor cells encrusts venule walls. * **Staging:** Uses "Limited" vs. "Extensive" stage rather than traditional TNM for treatment decisions [4].

Q: A 40-year-old female presented with a 3-month history of fever, loss of appetite, weight loss, cough, and weakness. A chest X-ray revealed consolidation in the upper lung. She died a few days after admission. Autopsy revealed gross lung findings and biopsy findings. What is your diagnosis?

Tuberculosis of the lung. ***Tuberculosis of the lung*** - The combination of **constitutional symptoms** (fever, weight loss, loss of appetite) with **upper lobe consolidation** on chest X-ray is classic for pulmonary tuberculosis. - Autopsy findings would show **caseating granulomas** with **caseous necrosis** and **Langhans giant cells**, pathognomonic for TB. *Sarcoidosis* - Typically presents with **non-caseating granulomas** without central necrosis, unlike the caseating pattern seen in TB. - More commonly affects **bilateral hilar lymph nodes** and lower lobes, not upper lobe consolidation as described. *Carcinoma of the lung* - Histology would show **malignant epithelial cells** and **pleomorphic nuclei**, not granulomatous inflammation. - While constitutional symptoms can occur, the **upper lobe predilection** and granulomatous response favor infectious etiology. *Bronchiectasis* - Characterized by **airway dilation** and **chronic suppurative infection**, not consolidation or granulomas. - Typically presents with **chronic productive cough** with purulent sputum, not the acute presentation described.

Q: Which of the following is true about bronchial carcinoids?

Metastasis is common. **Explanation:** Bronchial carcinoids are neuroendocrine tumors arising from **Kulchitsky cells** of the bronchial epithelium. While often classified as "low-grade" compared to small cell carcinoma, they are nonetheless malignant. **Why Option B is Correct:** Contrary to the misconception that they are benign, bronchial carcinoids are inherently malignant. **Metastasis is common**, occurring in approximately **15–20% of typical carcinoids** and up to **50–70% of atypical carcinoids**. Metastasis usually involves the regional (hilar and mediastinal) lymph nodes, followed by distant sites like the liver and bone. **Analysis of Incorrect Options:** * **Option A:** Bronchial carcinoids are generally **radioresistant**. The primary treatment of choice is surgical resection (e.g., lobectomy or sleeve resection). * **Option C:** While rare (occurring in <5% of cases), **carcinoid syndrome can manifest**, especially when there are extensive liver metastases. Interestingly, bronchial carcinoids can sometimes cause the syndrome even without liver metastasis because their secretions enter the systemic circulation directly via the pulmonary veins, bypassing the portal circulation. * **Option D:** Most bronchial carcinoids (approx. 80%) are **central**, arising from the **large (mainstem/lobar) bronchi**, not the terminal bronchioles. This central location often leads to symptoms like persistent cough, hemoptysis, and obstructive pneumonia. **High-Yield NEET-PG Pearls:** * **Histology:** Look for a "salt and pepper" chromatin pattern and organoid growth. * **Classification:** Divided into **Typical** (<2 mitoses/10 HPF, no necrosis) and **Atypical** (2–10 mitoses/10 HPF or necrosis). * **Markers:** Positive for Chromogranin A, Synaptophysin, and CD56. * **Paraneoplastic Syndromes:** Bronchial carcinoids are a known cause of ectopic **ACTH production**, leading to Cushing’s syndrome.

Q: What condition is indicated by the presence of Creola bodies in sputum?

Bronchial Asthma. **Bronchial Asthma** is the correct answer. **Creola bodies** are compact, multi-layered clusters of desquamated ciliated columnar epithelial cells found in the sputum of asthmatic patients. They result from the intense airway inflammation and mechanical sloughing of the bronchial mucosa characteristic of an asthma exacerbation [1]. **Analysis of Options:** * **Bronchial Asthma (Correct):** In addition to Creola bodies, asthma is associated with other classic sputum findings: **Curschmann spirals** (coiled mucus plugs from small airways) and **Charcot-Leyden crystals** (eosinophil-derived galectin-10) [1]. * **Chronic Bronchitis:** While this involves mucus hypersecretion and goblet cell hyperplasia, the characteristic finding is an increased **Reid Index** (>0.4) on histopathology, not Creola bodies. * **Bronchogenic Carcinoma:** Sputum cytology here would typically show malignant cells with nuclear pleomorphism, hyperchromasia, and keratin pearls (in squamous cell carcinoma), rather than organized clusters of benign ciliated cells. * **Pulmonary Tuberculosis:** This is characterized by **caseating granulomas** and the presence of Acid-Fast Bacilli (AFB) on Ziehl-Neelsen staining. **NEET-PG High-Yield Pearls:** * **Creola Bodies:** Ciliated epithelial cell clusters (Asthma). * **Curschmann Spirals:** Whorled mucus plugs (Asthma) [1]. * **Charcot-Leyden Crystals:** Rhomboid-shaped crystals from eosinophil breakdown (Asthma/Eosinophilic conditions). * **Reid Index:** Ratio of bronchial gland thickness to total wall thickness (Increased in Chronic Bronchitis). * **Ferruginous Bodies:** Asbestos fibers coated with iron (Asbestosis). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 688-690.

Question 1

Carcinoid tumors of the lung arise from which of the following cells?

Accepted Answer

Kulchitsky (K) cells

Answer

Type-II pneumocytes

Answer

Mucus (goblet) cells

Answer

Clara cells

Question 2

Which of the following statements regarding oat cell carcinoma of the lung is FALSE?

Accepted Answer

It is a variant of large cell anaplastic carcinoma.

Answer

Chemotherapy is generally effective.

Answer

Paraneoplastic syndromes may be present.

Answer

It can cause the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH).

Question 3

A 40-year-old female presented with a 3-month history of fever, loss of appetite, weight loss, cough, and weakness. A chest X-ray revealed consolidation in the upper lung. She died a few days after admission. Autopsy revealed gross lung findings and biopsy findings. What is your diagnosis?

Accepted Answer

Tuberculosis of the lung

Answer

Sarcoidosis

Answer

Carcinoma of the lung

Answer

Bronchiectasis

Question 4

Caplan syndrome is seen in which of the following conditions?

Accepted Answer

Pneumoconiosis

Answer

COPD

Answer

Pulmonary edema

Answer

Bronchial asthma

Question 5

Which type of lung carcinoma is most commonly associated with causing Superior Vena Cava (SVC) syndrome?

Accepted Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Anaplastic carcinoma

Question 6

Ghons focus is seen in?

Accepted Answer

Primary Tuberculosis

Answer

Amoebiasis

Answer

Lepromatous Leprosy

Answer

Syphilis

Question 7

Which of the following is NOT a typical histological feature of Hypersensitivity Pneumonitis?

Accepted Answer

Eosinophilic abscess

Answer

Interstitial pneumonitis

Answer

Non-caseating granuloma

Answer

Interstitial fibrosis

Question 8

Which of the following statements about lung carcinoma is true?

Accepted Answer

Oat cell variant is typically associated with hilar adenopathy.

Answer

Squamous cell variant accounts for 70% of all lung cancer.

Answer

Oat cell variant typically presents with cavitation.

Answer

Adenocarcinoma variant is typically central in location.

Question 9

Which of the following is true about bronchial carcinoids?

Accepted Answer

Metastasis is common

Answer

Highly radiosensitive

Answer

Carcinoid syndrome does not manifest

Answer

Commonly arise from terminal bronchioles

Question 10

What condition is indicated by the presence of Creola bodies in sputum?

Accepted Answer

Bronchial Asthma

Answer

Chronic Bronchitis

Answer

Bronchogenic Carcinoma

Answer

Pulmonary Tuberculosis

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?