Respiratory Pathology Practice Questions

Q: Lower lobe fibrosis is typically seen in which of the following conditions?

Asbestosis. **Explanation** The distribution of pulmonary fibrosis is a high-yield topic in NEET-PG. The correct answer is **Asbestosis** because it characteristically involves the **lower lobes** (subpleural and basal regions) [1]. **1. Why Asbestosis is Correct:** Asbestos fibers are inhaled and deposited deep into the distal airways and alveoli. Due to their physical properties and the gravity-dependent nature of ventilation, they primarily affect the lower lobes [1]. Over time, this leads to interstitial fibrosis (asbestosis), often accompanied by pleural plaques [1]. **2. Why the Other Options are Incorrect:** * **Silicosis (A):** Typically involves the **upper lobes** [1]. It is characterized by silicotic nodules and "eggshell calcification" of hilar lymph nodes [1]. * **Sarcoidosis (B):** Predominantly affects the **upper and middle lobes**. It is a multisystem granulomatous disease characterized by bilateral hilar lymphadenopathy [1]. * **Cystic Fibrosis (C):** Bronchiectasis and subsequent fibrosis in CF characteristically start in the **upper lobes** (specifically the right upper lobe initially). **3. Clinical Pearls for NEET-PG:** To remember the distribution of interstitial lung diseases (ILD), use these mnemonics: * **Upper Lobe Fibrosis (SCART):** * **S**ilicosis / **S**arcoidosis * **C**oal Worker's Pneumoconiosis [1] * **A**nkylosing Spondylitis * **R**adiation (Upper zone) * **T**uberculosis / **T**errible Fungi (Histoplasmosis) * **Lower Lobe Fibrosis (BAD):** * **B**ronchiectasis * **A**sbestosis [1] * **D**rugs (Amiodarone, Methotrexate, Bleomycin) / **D**ermatomyositis (and other Connective Tissue Diseases like RA/SLE) / **I**diopathic Pulmonary Fibrosis (IPF) **Key Fact:** While most inorganic dusts (Silica, Coal) affect the upper lobes, **Asbestos is the notable exception** that affects the lower lobes [1].

Q: Patient presents with dry cough, dyspnea and stridor. HPE of hilar LN shows stellate granulomas with giant cells and circular lamellated concretions on histopathology. Which of the following is the most likely diagnosis?

Sarcoidosis. ***Sarcoidosis*** - The histopathological finding of **stellate granulomas** (non-caseating) in the lymph node, combined with **circular lamellated concretions** (**Schaumann bodies**), is highly characteristic, if not pathognomonic, of **Sarcoidosis**. - The presentation of hilar lymphadenopathy (inferred from HPE of hilar LN) with dry cough and dyspnea is the most common manifestation of pulmonary sarcoidosis [1]. *Tuberculosis* - **Tuberculosis** typically results in granulomas that display **caseating necrosis** (cheese-like), a feature absent from the description of stellate granulomas. - Although TB causes hilar lymphadenopathy, it does not typically produce **Schaumann bodies** or exhibit the distinct, non-necrotizing stellate granuloma morphology. *GPA* - **Granulomatosis with Polyangiitis (GPA)** is characterized by **necrotizing vasculitis** and widespread **necrotizing granulomatous inflammation** involving the upper and lower respiratory tracts. - GPA granulomas are generally large and necrotizing, and they do not contain the specific organization or inclusion bodies like **Schaumann bodies** seen in sarcoidosis. *Hypersensitivity pneumonitis* - This condition involves scattered, often poorly formed, **non-necrotizing granulomas** typically located in the lung interstitium (centrilobular distribution). - Unlike sarcoidosis, generalized hilar lymph node involvement and the presence of classical **Schaumann bodies** or well-defined stellate granulomas are rare in Hypersensitivity Pneumonitis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701.

Q: A 35-year-old patient presents with progressive cough and hemoptysis. Bronchoscopy shows 4 cm polypoidal mass projecting into bronchial lumen. CT guided lung biopsy image is given below. All are true about the condition shown except:

Necrosis is common. ***Necrosis is common*** - The image and description are highly suggestive of a **bronchial carcinoid tumor**, which is a well-differentiated neuroendocrine tumor [1]. - **Necrosis** is typically **uncommon or absent** in typical carcinoid tumors, and its presence, especially extensive necrosis, would suggest a more aggressive neuroendocrine tumor like atypical carcinoid or small cell carcinoma [1]. *Chromogranin positivity* - **Chromogranin A** is a common **neuroendocrine marker** that stains positive in carcinoid tumors, indicating their neuroendocrine origin [1]. - This positivity aids in the diagnosis of carcinoid tumors and differentiates them from other lung malignancies. *Nests of tumor cells sharply demarcated by stroma* - Bronchial carcinoid tumors classically exhibit a **nested or insular growth pattern** with uniform cells [1]. - These nests are often **sharply demarcated** by a delicate, vascularized stroma, which is a characteristic histological feature. *Stain positively with Argyrophilic stains* - Carcinoid tumors are **neuroendocrine tumors** and contain neurosecretory granules that can be stained by **argyrophilic stains** (e.g., Grimelius, Sevier-Munger) [1]. - This staining property reflects their ability to take up and reduce silver salts, further confirming their neuroendocrine differentiation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 727.

Q: All are true about the type of lung cancer shown in the figure except: (Recent NEET Pattern 2016-17)

Dense core granules are absent. ***Dense core granules are absent*** - This statement is incorrect because **small cell lung carcinoma (SCLC)**, characterized by diffuse sheets of hyperchromatic cells and positive synaptophysin, is a neuroendocrine tumor. - Neuroendocrine tumors, by definition, contain **dense core granules** which store neurosecretory products. Their absence would contradict the neuroendocrine nature of SCLC. *Diffuse sheets of hyperchromatic cells* - This is a characteristic histological feature of **small cell lung carcinoma (SCLC)**, where cells are small, round to oval, with scant cytoplasm and hyperchromatic nuclei, often forming diffuse sheets [1]. - The cells show **nuclear molding** and a high mitotic rate, consistent with aggressive growth. *Positive for Synaptophysin* - **Synaptophysin** is a neuroendocrine marker, and its positivity is a key immunohistochemical feature of **small cell lung carcinoma (SCLC)**, confirming its neuroendocrine differentiation [1]. - Other neuroendocrine markers like **chromogranin A** and **CD56** are also typically positive in SCLC. *3p allele loss* - Loss of heterozygosity on the **short arm of chromosome 3 (3p)** is a very common genetic alteration found in **small cell lung carcinoma (SCLC)** [2,4]. - This region harbors several **tumor suppressor genes**, including *FHIT* and *RASSF1A*, whose inactivation contributes to SCLC pathogenesis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 721.

Question 1

Lower lobe fibrosis is typically seen in which of the following conditions?

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Sarcoidosis

Answer

Cystic Fibrosis

Question 2

A 60-year-old person presents with a mass located at the central bronchus causing distal bronchiectasis and recurrent pneumonia. Which of the following findings is expected from a biopsy of the mass?

Accepted Answer

Small round cells and hyperchromatic nuclei with nuclear moulding

Answer

Abundant osteoid matrix formation

Answer

Contains all three germ layers

Answer

Spindle cells with abundant stromal matrix

Question 3

Lobar pneumonia is caused predominantly by which organism?

Accepted Answer

Streptococcus pneumoniae

Answer

Klebsiella pneumoniae

Answer

Staphylococcus pyogenes

Answer

Haemophilus influenzae

Question 4

Which of the following types of bronchogenic carcinomas are most likely to develop within a residual area of peripheral scar tissue?

Accepted Answer

Adenocarcinoma

Answer

Small-cell carcinoma

Answer

Squamous-cell carcinoma

Answer

Large-cell carcinoma

Question 5

A 59-year-old male is found to have a 3.5-cm mass in the right upper lobe of his lung. A biopsy of this mass is diagnosed as a moderately differentiated squamous cell carcinoma. Workup reveals that no bone metastases are present, but laboratory examination reveals that the man's serum calcium levels are 11.5 mg/dL. This patient's paraneoplastic syndrome is most likely the result of ectopic production of which of the following?

Accepted Answer

Parathyroid hormone-related peptide

Answer

Parathyroid hormone

Answer

Calcitonin

Answer

Calcitonin-related peptide

Question 6

Mediastinal lymph node calcification is seen in which one of the following conditions?

Accepted Answer

Sarcoidosis

Answer

Metastatic neoplasm

Answer

Lymphoma

Answer

Bronchiectasis

Question 7

Asbestos exposure may be associated with which of the following malignancies?

Accepted Answer

Mesothelioma

Answer

Hepatic angiosarcoma

Answer

Skin carcinoma

Answer

Acute myeloid leukemia

Question 8

Patient presents with dry cough, dyspnea and stridor. HPE of hilar LN shows stellate granulomas with giant cells and circular lamellated concretions on histopathology. Which of the following is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

GPA

Answer

Hypersensitivity pneumonitis

Answer

Tuberculosis

Question 9

A 35-year-old patient presents with progressive cough and hemoptysis. Bronchoscopy shows 4 cm polypoidal mass projecting into bronchial lumen. CT guided lung biopsy image is given below. All are true about the condition shown except:

Accepted Answer

Necrosis is common

Answer

Chromogranin positivity

Answer

Nests of tumor cells sharply demarcated by stroma

Answer

Stain positively with Argyrophilic stains

Question 10

All are true about the type of lung cancer shown in the figure except: (Recent NEET Pattern 2016-17)

Accepted Answer

Dense core granules are absent

Answer

Diffuse sheets of hyperchromatic cells

Answer

Positive for Synaptophysin

Answer

3p allele loss

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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