Respiratory Pathology Practice Questions

Q: A chronic smoker presents with cough and hemoptysis. The physician informs the patient that they have the most malignant type of bronchogenic carcinoma. Which type is it?

Small cell carcinoma. **Explanation:** **Small Cell Carcinoma (SCLC)** is considered the most malignant type of bronchogenic carcinoma due to its extremely rapid doubling time, high growth fraction, and early widespread metastasis. By the time of diagnosis, most patients already have micrometastatic disease, making surgical resection rarely an option [1]. It is strongly associated with cigarette smoking and originates from neuroendocrine (Kulchitsky) cells. **Why the other options are incorrect:** * **Squamous Cell Carcinoma:** While also strongly linked to smoking and central in location, it tends to stay localized longer and spreads to regional lymph nodes before distant sites. It is characterized by keratin pearls and intercellular bridges. * **Adenocarcinoma:** This is the most common type of lung cancer overall (especially in non-smokers and women). While it can be aggressive, its growth rate is generally slower than SCLC. * **Large Cell Carcinoma:** This is an undifferentiated epithelial tumor that grows rapidly and metastasizes early, but it does not match the extreme virulence and neuroendocrine aggressiveness of SCLC. **High-Yield Clinical Pearls for NEET-PG:** 1. **Location:** SCLC and Squamous cell carcinoma are typically **Central** (hilar), whereas Adenocarcinoma is **Peripheral**. 2. **Paraneoplastic Syndromes:** SCLC is classically associated with **SIADH** (hyponatremia), **ACTH** (Cushing syndrome), and **Lambert-Eaton Myasthenic Syndrome** [2]. 3. **Treatment:** Because it is "most malignant" and disseminated at onset, the treatment of choice for SCLC is **Chemotherapy/Radiotherapy**, not surgery [1]. 4. **Markers:** SCLC stains positive for neuroendocrine markers like **Chromogranin A, Synaptophysin, and CD56**. [3] Although it may be caused by bronchitic infection, haemoptysis in a smoker should always be investigated to exclude a bronchial carcinoma.

Question 1

Which paraneoplastic syndrome is not associated with small cell carcinoma of the lung?

Accepted Answer

Immune thrombocytopenic purpura

Answer

Ectopic ACTH production

Answer

Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer

Carcinoid syndrome

Question 2

A Ghon complex of the lung typically undergoes which of the following changes?

Accepted Answer

Calcification

Answer

Cavitation

Answer

Progression to tuberculous pneumonia

Answer

Progression to miliary tuberculosis

Question 3

A chronic smoker presents with cough and hemoptysis. The physician informs the patient that they have the most malignant type of bronchogenic carcinoma. Which type is it?

Accepted Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Large cell carcinoma

Answer

Adenocarcinoma

Question 4

Which of the following statements about lung metastasis is true?

Accepted Answer

Bilateral and multiple

Answer

Associated with cough with sputum production

Answer

Normal chest X-ray

Answer

Single lesion

Question 5

Pathologically, emphysema involves structures beyond which of the following?

Accepted Answer

Terminal bronchiole

Answer

Bronchi

Answer

Respiratory bronchiole

Answer

Alveolar sac

Question 6

Complications of lobar pneumonia do not include which of the following?

Accepted Answer

Amyloidosis

Answer

Lung abscess

Answer

Suppurative arthritis

Answer

Infective endocarditis

Question 7

Which of the following is true about pulmonary sarcoidosis?

Accepted Answer

Non-caseating granulomas are present.

Answer

Schaumann and asteroid bodies are pathognomic findings.

Answer

CD4/CD8 ratio is less than 2.5 in bronchoalveolar lavage (BAL).

Answer

None of the above.

Question 8

Which of the following is NOT true regarding mesothelioma?

Accepted Answer

It is bilaterally symmetrical

Answer

It is associated with asbestos exposure

Answer

Histopathology typically shows a biphasic pattern

Answer

It occurs in late middle age

Question 9

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

Accepted Answer

Chemosensitive tumor

Answer

Peripheral in location

Answer

Bone metastasis is uncommon

Answer

Paraneoplastic syndrome with ectopic PTH production is common

Question 10

All of the following features are seen in asbestosis except?

Accepted Answer

Emphysema

Answer

Diffuse pulmonary interstitial fibrosis

Answer

Fibrous pleural thickening

Answer

Calcific pleural plaques

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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