Respiratory Pathology Practice Questions

Q: Bronchogenic carcinoma commonly metastasizes to which endocrine organ?

Adrenals. **Explanation:** **Correct Answer: D. Adrenals** Bronchogenic carcinoma is notorious for its aggressive metastatic potential. The **adrenal glands** are the most common site of endocrine metastasis for lung cancer, with involvement seen in approximately 40% of cases at autopsy [1]. The underlying medical concept involves the rich vascular supply of the adrenal glands (specifically the cortex), which facilitates the hematogenous seeding of malignant cells. While lung cancer frequently spreads to the liver, brain, and bones, the adrenals are the classic "high-yield" endocrine destination [1]. Interestingly, despite extensive bilateral involvement, these metastases rarely cause clinical adrenal insufficiency (Addison’s disease) because more than 90% of the gland must be destroyed before symptoms manifest. **Why other options are incorrect:** * **Ovaries (A):** While the ovaries are common sites for "Krukenberg tumors" (typically from gastric or colonic primaries), they are rare sites for lung cancer metastasis. * **Testes (B):** Metastasis to the testes is extremely rare from any primary site; most testicular tumors are primary germ cell tumors. * **Thyroid (C):** Although the thyroid is highly vascular, it is an infrequent site for clinically significant metastasis from the lungs compared to the adrenals. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of distant metastasis:** Liver [1]. * **Most common endocrine site:** Adrenals [1]. * **Imaging Tip:** In a patient with a known lung mass, an incidental adrenal mass on CT is highly suspicious for metastasis and often requires PET-CT or biopsy for staging. * **Small Cell Carcinoma:** This subtype is the most likely to present with early, widespread metastasis to the adrenals and brain. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725.

Q: An adult with newly diagnosed tuberculosis is most likely to have which of the following types of lesions?

A single lesion in a lung apex. This question tests your ability to distinguish between **Primary Tuberculosis** and **Secondary (Reactivation) Tuberculosis**. ### **Explanation of the Correct Answer** In an **adult** with newly diagnosed tuberculosis, the disease is most commonly **Secondary Tuberculosis**. This occurs either due to the reactivation of a latent primary infection or exogenous reinfection. * **The Concept:** *Mycobacterium tuberculosis* is an obligate aerobe. Secondary TB characteristically involves the **apex of the lungs** (specifically the apical or posterior segments of the upper lobes) because these areas have the highest ventilation-perfusion (V/Q) ratio and the highest oxygen tension ($PO_2$), providing an ideal environment for the bacteria to thrive. These lesions often undergo caseous necrosis and cavitation. ### **Analysis of Incorrect Options** * **Option B:** While intestinal TB exists (usually via ingestion of *M. bovis* or swallowing infected sputum), it is not the "most likely" presentation compared to pulmonary TB. * **Option C & D:** These options describe the **Ghon Complex**, which is the hallmark of **Primary Tuberculosis**. A Ghon complex consists of a subpleural lesion (Ghon focus) in the lower part of the upper lobe or upper part of the lower lobe, plus associated hilar/mediastinal lymphadenopathy. This is the typical presentation in children, not the standard presentation for an adult "newly diagnosed" with active disease. ### **NEET-PG High-Yield Pearls** * **Ghon Focus:** Subpleural parenchymal lesion (usually mid-zone). * **Ghon Complex:** Ghon focus + Lymphadenopathy. * **Ranke Complex:** Calcified Ghon complex (visible on X-ray). * **Assmann Focus:** The infraclavicular lesion seen in secondary TB. * **Simmonds Focus:** Apical nodules in secondary TB. * **Key Difference:** Primary TB involves the lower/middle lobes + lymph nodes; Secondary TB involves the apex and rarely involves lymph nodes.

Question 1

Histologic examination of lung tissue reveals multiple suppurative, neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces only. The majority of lung tissue is not involved in this inflammatory process. Hyaline membranes are not found. This histologic appearance best describes which of the following conditions?

Accepted Answer

Bronchopneumonia

Answer

Bronchiectasis

Answer

Lobar pneumonia

Answer

Interstitial pneumonitis

Question 2

Bronchogenic carcinoma commonly metastasizes to which endocrine organ?

Accepted Answer

Adrenals

Answer

Ovaries

Answer

Testes

Answer

Thyroid

Question 3

Schaumann bodies are seen in which condition?

Accepted Answer

Sarcoidosis

Answer

Chronic bronchitis

Answer

Asthma

Answer

Syphilis

Question 4

A 37-year-old man presents with a productive cough, fever, and night sweats. A chest X-ray reveals an ill-defined area of consolidation at the periphery of the right middle lobe and mediastinal lymphadenopathy. Sputum culture is positive for acid-fast bacilli. What pathologic finding is most likely to be seen in a lymph node biopsy from this patient?

Accepted Answer

Caseating granulomas

Answer

Follicular hyperplasia

Answer

Nodular amyloidosis

Answer

Noncaseating granulomas

Question 5

A 70-year-old man has smoked for years despite a chronic productive cough. He notices blood in his sputum and sees his physician. A chest x-ray reveals a mass in the left lung, which is biopsied during a fiberoptic bronchoscopy. Assuming that this patient's cancer is etiologically related to his smoking, which of the following diagnoses are most likely to be returned by the pathology laboratory?

Accepted Answer

Small cell carcinoma or squamous cell carcinoma

Answer

Adenocarcinoma or bronchioloalveolar carcinoma

Answer

Adenocarcinoma or small cell carcinoma

Answer

Bronchioloalveolar carcinoma or small cell carcinoma

Question 6

Bronchus is the site of pathological changes for all of the following diseases, except:

Accepted Answer

Emphysema

Answer

Chronic bronchitis

Answer

Asthma

Answer

Bronchiectasis

Question 7

A 49-year-old woman has experienced increasing weakness and chest pain over the past 6 months. On physical examination, she is afebrile and normotensive. Motor strength is 5/5 in all extremities, but diminishes to 4/5 with repetitive movement. There is no muscle pain or tenderness. Laboratory studies show hemoglobin, 14 g/dL; hematocrit, 42%; platelet count, 246,000/mm3; and WBC count, 6480/mm3. A chest CT scan shows an irregular 10x12 cm anterior mediastinal mass. The surgeon has difficulty removing the mass because it infiltrates surrounding structures. Microscopically, the mass is composed of large, spindled, atypical epithelial cells mixed with lymphoid cells. Which of the following is the most likely cause of this mass lesion?

Accepted Answer

Malignant thymoma

Answer

Extrapulmonary tuberculosis

Answer

Hodgkin lymphoma

Answer

Lymphoblastic lymphoma

Question 8

An adult with newly diagnosed tuberculosis is most likely to have which of the following types of lesions?

Accepted Answer

A single lesion in a lung apex

Answer

A single lesion in the gastrointestinal tract

Answer

A single lesion subjacent to the pleura

Answer

Both a lesion subjacent to the pleura in the lower part of an upper lobe and active disease in the mediastinal lymph nodes

Question 9

What is the lung pathology occurring in persons working in cotton-wool industries?

Accepted Answer

Asthma like features

Answer

Hypersensitivity pneumonitis

Answer

Lung cancer

Answer

Chronic bronchitis

Question 10

Which of the following conditions is NOT associated with bronchiectasis?

Accepted Answer

Lung cancer

Answer

Pericarditis

Answer

Amyloidosis

Answer

Hemoptysis

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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