Respiratory Pathology Practice Questions

Q: Which of the following is/are characteristic pathological findings in asthma?

All of the options. ***All of the above*** - Asthma is associated with various pathological findings, including **Charcot-Leyden crystals** and **Curschmann spirals** during bronchial inflammation [1]. - These findings represent the underlying **eosinophilic** and **mucous** hypersecretion processes commonly seen in asthma [2,3]. *Charcot-Leyden crystals* - These **crystals** are associated with **eosinophilic** inflammation, but their presence alone is not definitive for asthma diagnosis [2]. - They are often found in **sputum** of asthmatic patients but are not the only indicator of asthma presence. *Curschmann spirals* - These **spirals** indicate **mucous plugging** of bronchi and are indeed seen in asthma, but signify only one aspect of the condition [1,3]. - They highlight the **mucosal** response in asthma rather than providing a comprehensive view of the disease. *Occlusion of bronchi and bronchioles by mucus* - **Mucus** production leading to **bronchial obstruction** occurs in asthma, but this statement is too narrow to encompass the condition's entirety [1]. - While it is a common feature, it does not consider the immunological or inflammatory elements intrinsic to asthma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 328-329. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 688-689. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 329-330.

Q: Which of the following statements is MOST accurate regarding adenocarcinoma of the lung?

Most commonly found in peripheral lung tissue. ***Most commonly found in peripheral lung tissue*** - Adenocarcinoma characteristically arises in the **peripheral regions** of the lung, particularly in the **subpleural areas** and lung periphery. - This **peripheral location** is the classic anatomic hallmark that distinguishes adenocarcinoma from other lung cancer types like squamous cell carcinoma. *Smoking is associated with adenocarcinoma* - While smoking is indeed a **risk factor** for adenocarcinoma, this association is not the most defining characteristic of this cancer type. - **Squamous cell carcinoma** and **small cell lung cancer** have much stronger smoking associations compared to adenocarcinoma. *Typically presents with central cavitations* - Adenocarcinoma typically presents as **solid peripheral nodules** or masses, not central cavitary lesions. - **Central cavitations** are more characteristic of **squamous cell carcinoma**, which tends to arise in central bronchi. *Relatively more common in non-smokers compared to other lung cancer types* - While adenocarcinoma is the **most common type** in non-smokers, this statement is less specific than the peripheral location characteristic. - The **peripheral anatomic distribution** is a more accurate and defining feature that applies to all adenocarcinomas regardless of smoking status.

Q: In primary tuberculosis, what is seen?

Ghon's focus. ***Ghon's focus*** - A **Ghon's focus** is the primary parenchymal lesion that develops at the site of initial infection in **primary tuberculosis**. - It consists of a small area of caseous necrosis in the lung parenchyma, typically in the **mid or lower zones**. - Combined with hilar lymph node involvement, it forms the **Ghon complex (primary complex)**, which is the pathological hallmark of primary TB. - This represents the **characteristic pathological finding** that defines primary tuberculosis [2]. *Pleural effusion* - **Pleural effusion** is actually a **common manifestation of primary tuberculosis**, particularly in adolescents and adults [3]. - It develops due to a hypersensitivity reaction to tubercular antigens in the pleural space. - While frequently seen in primary TB, it is a **clinical manifestation** rather than the defining pathological lesion (Ghon's focus). - Can occur in both primary and post-primary TB [3]. *Miliary mottling* - **Miliary mottling** on chest X-ray is characteristic of **miliary tuberculosis**, a severe form where the infection disseminates hematogenously [1]. - This represents a **complication of primary TB** due to lymphohematogenous spread, not the typical presentation [1]. - Shows multiple small nodules (1-3mm) scattered throughout both lung fields. *Fibrosis* - **Fibrosis** refers to scarring of lung tissue that occurs during the **healing phase** of tuberculosis. - It is a **sequela of TB infection**, not an acute finding in primary tuberculosis. - Develops after the active infection has been controlled or treated [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 320-321. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 379-380. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 728-729.

Q: A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:

Cytokeratin. ***Cytokeratin*** - **Cytokeratin** is a **intermediate filament protein** found in epithelial cells and is a key marker for carcinomas, which are the most common type of lung cancer [1]. - Given the patient's history (smoker, haemoptysis) and an undifferentiated tumor, a **carcinoma** is highly probable, making cytokeratin the most helpful marker for classification [2]. *Vimentin* - **Vimentin** is an intermediate filament protein typically expressed in **mesenchymal cells** (e.g., sarcomas, lymphomas, melanoma). - Its presence would suggest a non-epithelial tumor, which is less likely in this clinical context of a lung mass in a smoker. *GGT* - **Gamma-glutamyl transpeptidase (GGT)** is an enzyme primarily used as a marker for **liver function** and bile duct obstruction. - It is not a tumor marker and has no role in the immunohistochemical diagnosis of an undifferentiated lung tumor. *Calretinin* - **Calretinin** is a nuclear and cytoplasmic protein that is a useful marker for **mesothelioma** and some other neuroendocrine tumors. - While mesothelioma can occur in the lung, it is less common than carcinoma, and calretinin would only be considered if mesothelioma was specifically suspected. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 334-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721.

Q: Ferruginous bodies are seen in:

Asbestosis. ***Asbestosis*** - Ferruginous bodies are specifically associated with **exposure to asbestos**, which leads to asbestosis [1]. - These bodies are seen as **siderophilic structures** resembling a "dumbbell" shape under the microscope, which are indicative of this condition [1]. *Bagassosis* - Caused by exposure to **bagasse dust**, primarily from sugarcane, leading to allergic alveolitis rather than ferruginous bodies [1]. - Histopathology typically shows **lymphocytic infiltration** and non-caseating granulomas, not ferruginous bodies. *Byssinosis* - This is associated with inhalation of **cotton dust** and primarily results in **bronchoconstriction** and respiratory symptoms rather than ferruginous bodies. - Characterized by a **respiratory illness** that worsens at the beginning of the work week, missing the key features of asbestosis. *Silicosis* - Resulting from exposure to **silica dust**, this condition leads to macules and nodules in the lungs instead of ferruginous bodies [1]. - The hallmark findings are **hyaline nodules** on imaging and not the abnormal iron-containing structures seen in asbestosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 695, 698-699.

Q: The earliest lesion seen in asbestosis is:

Pleural plaques. ***Pleura plaques*** - The earliest lesion in asbestosis is characterized by the development of **pleural plaques**, which are indicative of asbestos exposure [1]. - These plaques are often asymptomatic but are a strong marker for previous exposure to **asbestos fibers** [1]. *Mesothelioma* - While **mesothelioma** is associated with asbestos exposure, it is a malignant tumor that typically arises years after the initial exposure and isn't the earliest lesion [1,3]. - This condition usually presents with pleuritic symptoms and effusions, occurring much later than pleural plaques [2]. *Hilar lymphadenopathy* - Hilar lymphadenopathy may indicate lung disease, but it is not a direct lesion associated with asbestosis and does not present as the earliest finding. - Commonly seen in various conditions like **sarcoidosis**, it signifies **lymph node enlargement** rather than a direct effect of asbestos. *Adenoma lung* - Lung adenomas are benign lesions that are not directly tied to asbestosis exposure and occur independently of asbestos-related diseases. - This option fails to recognize that the characteristic **asbestos-related lesions** develop much differently than a lung adenoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 698-699. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Q: Which of the following is not a stage in the progression of community-acquired pneumonia?

Liquefaction necrosis. ***Liquefaction necrosis*** - **Liquefaction necrosis** is a type of necrosis that typically results from **bacterial infection** or **ischemia** of brain tissue, where dead cells digest and form a viscous fluid. - While pneumonia involves inflammation and tissue damage, widespread **liquefaction necrosis** of lung tissue is **not a characteristic stage** in its typical progression. *Edema* - The **edema stage** (also called congestion) is the **first stage** of lobar pneumonia, characterized by vascular engorgement, intra-alveolar fluid, and scattered neutrophils [1], [2]. - This stage involves the outpouring of a proteinaceous exudate and often some red blood cells and neutrophils into the alveolar spaces [2]. *Grey hepatization* - The **grey hepatization stage** follows red hepatization, marked by the breakdown of red blood cells and the accumulation of fibrin and neutrophils [1]. - During this stage, the lung appears firmer and grayish due to the breakdown of capillaries and the continued presence of fibrin-rich exudate [1], [2]. *Red hepatization* - The **red hepatization stage** is the **second stage** of lobar pneumonia, where the lung appears red and firm due to massive extravasation of red blood cells, neutrophils, and fibrin into the alveoli [1], [2]. - This stage reflects an intense inflammatory response, leading to consolidation of the lung tissue [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 711-715. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318.

Q: Hypersensitivity pneumonitis is classically an immunologically mediated inflammatory reaction. Which type of hypersensitivity is primarily involved?

Type IV hypersensitivity. ***Immune complex mediated hypersensitivity*** - Hypersensitivity pneumonitis is indeed primarily characterized by **immune complex-mediated inflammation** in response to inhaled antigens [1][2]. - This condition often leads to a **Type III hypersensitivity reaction**, where immune complexes form and trigger inflammation in the lung tissues [1][2]. *Cell mediated hypersensitivity* - While cell-mediated mechanisms are important in many immune responses, hypersensitivity pneumonitis mainly involves **immune complex formation** [2]. - This type predominantly reflects a **Type III hypersensitivity** rather than the typical **Type IV** attributed to cell-mediated reactions [3], though T-cell mediated reactions may also contribute [2]. *Allergic reaction* - Allergic reactions generally refer to **IgE-mediated hypersensitivity**, which typically involves immediate responses and mast cell activation [3]. - Hypersensitivity pneumonitis is not an **immediate hypersensitivity** but rather a delayed immune response to **chronic antigen exposure** [2]. *Type II hypersensitivity* - Type II hypersensitivity is mediated by **IgG or IgM antibodies** targeting specific cells or tissues, causing cell destruction [3]. - This is **not applicable** to hypersensitivity pneumonitis, which involves **immune complexes** accumulating in response to environmental antigens [1][2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-215. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 701-702. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 208-210.

Q: Which of the following is characteristically associated with sarcoidosis?

Non-caseating granulomas. ***Grossly bullous appearance*** - This feature is **not typically seen** in sarcoidosis; instead, sarcoidosis usually presents with various tissue infiltrations [1]. - Characteristically, sarcoidosis features **granulomas**, not a bullous skin manifestation [1]. *Asteroid bodies* - Asteroid bodies are **star-shaped inclusions** found within the non-caseating granulomas seen in sarcoidosis. - Their presence supports the diagnosis, indicating **typical histological findings** of the disease. *Non caseating granulomas* - Sarcoidosis is definitively characterized by the presence of **non-caseating granulomas**, which are key diagnostic features [1]. - These granulomas differentiate sarcoidosis from other granulomatous diseases, like tuberculosis [2]. *Schaumann bodies* - Schaumann bodies are **calcium-laden** structures found within the granulomas in sarcoidosis, further supporting the diagnosis. - The presence of these bodies alongside non-caseating granulomas is a classic histopathological finding in sarcoidosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.

Question 1

Which of the following is/are characteristic pathological findings in asthma?

Accepted Answer

All of the options

Answer

Curschmann spirals

Answer

Charcot-Leyden crystals

Answer

Occlusion of bronchi and bronchioles by mucus

Question 2

Which of the following statements is MOST accurate regarding adenocarcinoma of the lung?

Accepted Answer

Most commonly found in peripheral lung tissue

Answer

Smoking is associated with adenocarcinoma

Answer

Typically presents with central cavitations

Answer

Relatively more common in non-smokers compared to other lung cancer types

Question 3

In primary tuberculosis, what is seen?

Accepted Answer

Ghon's focus

Answer

Pleural effusion

Answer

Miliary mottling

Answer

Fibrosis

Question 4

A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:

Accepted Answer

Cytokeratin

Answer

Vimentin

Answer

GGT

Answer

Calretinin

Question 5

Hypersensitivity pneumonitis due to prolonged inhalation of dust is a characteristic feature of Maltworker's lung, which is caused by:

Accepted Answer

Aspergillus clavatus

Answer

Pseudomonas

Answer

Micropolyspora faeni

Answer

Aspergillus fumigatus

Question 6

Ferruginous bodies are seen in:

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Byssinosis

Answer

Bagassosis

Question 7

The earliest lesion seen in asbestosis is:

Accepted Answer

Pleural plaques

Answer

Mesothelioma

Answer

Hilar lymphadenopathy

Answer

Adenoma of the lung

Question 8

Which of the following is not a stage in the progression of community-acquired pneumonia?

Accepted Answer

Liquefaction necrosis

Answer

Grey hepatization

Answer

Edema

Answer

Red hepatization

Question 9

Hypersensitivity pneumonitis is classically an immunologically mediated inflammatory reaction. Which type of hypersensitivity is primarily involved?

Accepted Answer

Type IV hypersensitivity

Answer

Type III hypersensitivity

Answer

Type I hypersensitivity

Answer

Type II hypersensitivity

Question 10

Which of the following is characteristically associated with sarcoidosis?

Accepted Answer

Non-caseating granulomas

Answer

Asteroid bodies

Answer

Granulomatous inflammation

Answer

Schaumann bodies

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?