Respiratory Pathology Practice Questions

Q: Heart failure cells are

Pigmented alveolar macrophages. ***Pigmented alveolar macrophages*** - These macrophages engulf **hemosiderin** (iron-rich pigment from degraded red blood cells) that leaks into the alveoli due to increased capillary pressure in left-sided **heart failure**. - The presence of **hemosiderin-laden macrophages** in the sputum or lung tissue is diagnostic for chronic pulmonary congestion caused by heart failure. *Lipofuscin granules in cardiac cells* - **Lipofuscin** is a "wear-and-tear" pigment that accumulates in aging cells, including cardiac cells. - While present in older hearts, its presence does not specifically indicate **heart failure** or represent "heart failure cells" in the described context. *Pigmented pancreatic acinar cells* - Pancreatic acinar cells primarily produce digestive enzymes and are not typically associated with **pigment accumulation** in the context of heart failure. - Pigmentation in pancreatic cells would suggest other pathologies, such as **hemochromatosis** affecting the pancreas. *Pigment cells seen in liver* - The liver can accumulate various pigments, such as **hemosiderin** in hemochromatosis or **bilirubin** in cholestasis. - While liver congestion can occur in right-sided heart failure, the specific "heart failure cells" refer to the **pulmonary macrophages**.

Q: Which of the following is more prone to produce mesothelioma?

Crocidolite. ***Crocidolite*** - Crocidolite, or **blue asbestos**, is the most hazardous type of asbestos linked to **mesothelioma** [1][2]. - Its **fibrous nature** and high durability result in significant inhalation exposure, increasing cancer risk. *Chrysolite* - Also known as **white asbestos**; is the least carcinogenic and less associated with mesothelioma compared to other asbestos types. - Primarily used in **ceiling tiles** and insulation, exposure levels are typically lower. *Anthophyllite* - Rarely used commercially and associated with a **lower incidence** of cancer compared to crocidolite or amosite. - Its exposure is more commonly linked to **contaminated talc**, not significant for mesothelioma. *Amosite* - Known as **brown asbestos**; while associated with lung cancer, it is less frequently linked to mesothelioma than crocidolite. - It poses risks primarily through prolonged exposure in industrial settings, but is not the most potent carcinogen for mesothelioma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 697-698. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Q: All the following statements about primary tuberculosis are true except

Cavitary lesion. ***Cavitary lesion*** - **Cavitary lesions** are typically associated with **post-primary (reactivation) tuberculosis**, which occurs when dormant primary infection reactivates, usually in immunocompromised individuals [3]. - In primary tuberculosis, initial infection often leads to **Ghon complexes** or calcified granulomas, but not typically cavitary disease at the primary stage [1]. *Pleural effusion* - **Pleural effusions** can occur in **primary tuberculosis** as a hypersensitivity reaction to mycobacterial antigens or due to direct extension of infection into the pleural space [2]. - They are often seen in younger patients and usually resolve with anti-TB treatment. *Fibrocaseous lesion* - **Fibrocaseous lesions** represent the typical pathology of primary tuberculosis, where granuloma formation with central **caseous necrosis** and fibrous encapsulation occurs [1]. - This lesion may eventually heal with calcification (forming a Ghon focus) or progress [1]. *Phlyctenular conjunctivitis* - **Phlyctenular conjunctivitis** is an immune-mediated hypersensitivity reaction to tuberculoproteins, often occurring during or after primary tuberculosis. - It presents as small, raised nodules on the conjunctiva or cornea and is a recognized ophthalmic manifestation of TB exposure.

Q: Small deposits of neuroendocrine cell hyperplasia in scarred lungs are known as:

Tumorlet. ***Tumorlet*** - Small deposits of **neuroendocrine cell hyperplasia** in scarred lungs are specifically referred to as tumorlets, which can be associated with various lung diseases. - Tumorlets are typically benign, comprising **small clusters of neuroendocrine cells** that are usually found in pulmonary scars. *Teratoma* - Teratomas are **germ cell tumors** that typically contain tissue from all three embryonic layers and are not associated with neuroendocrine cell hyperplasia. - They usually occur in **gonadal** sites or mediastinum and do not relate to scarring in lung tissue. *Carcinoid* - Carcinoids are **neuroendocrine tumors** but larger and more defined than tumorlets, often causing obstruction or symptoms. - Unlike tumorlets, carcinoids present as **solitary masses**, typically found in the gastrointestinal tract or lungs but not as small deposits in scarred tissue. *Hamartoma* - Hamartomas are benign tumors made of **disorganized tissue** native to the organ in which they arise, but they do not involve neuroendocrine cells specifically [1]. - They are generally characterized as **well-circumscribed** nodules and do not correlate with neuroendocrine hyperplasia in scarred lungs [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 727-728.

Q: Which of the following is a characteristic of bronchoalveolar carcinoma?

Lepidic growth with preservation of alveolar structure. ***Adenocarcinoma*** - Bronchoalveolar carcinoma is classified as a subtype of **adenocarcinoma**, specifically presenting as non-small cell lung cancer (NSCLC) [1]. - It is characterized by **lepidic growth pattern** in the alveolar structures, which preserves the architecture of the lung parenchyma. *Stromal invasion with desmoplasia* - Typically, bronchoalveolar carcinoma shows **minimal invasion**, contrasting with the extensive desmoplastic reaction seen in other types of lung cancer. - This type is more about growth patterns than typical invasive features associated with stromal changes. *Grows along pre-existing anatomical structures* - While some lung tumors may grow along bronchi, bronchoalveolar carcinoma primarily **grows along alveolar surfaces** rather than conforming to anatomical structures. - This growth pattern leads to its distinct histological features, differing from the infiltrative patterns of other cancers. *Preservation of Alveolar structure* - Although bronchoalveolar carcinoma does preserve some architecture, stating it relies solely on this aspect is misleading as this does not comprehensively define the tumor. - Its distinction lies in its subtype classification as an **adenocarcinoma** rather than merely structural preservation [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-336.

Q: A patient develops pulmonary thromboembolism most commonly due to what?

Deep Vein Thrombosis (DVT). ***Deep Vein Thrombosis (DVT)*** - **Deep vein thrombosis (DVT)** is the most common cause of pulmonary thromboembolism, as clots from deep veins, typically in the legs, travel to the lungs [1]. - The initial clot formation in DVT is often multifactorial, involving elements of **Virchow's triad** (venous stasis, endothelial injury, and hypercoagulability) [1]. *Chronic Venous Hypertension* - **Chronic venous hypertension** results from sustained high pressure in leg veins, leading to symptoms like edema, skin changes, and ulcers, but does not directly cause emboli. - It's a consequence of venous insufficiency and doesn't involve the formation of typical occlusive thrombi that can embolize to the pulmonary arteries. *Disseminated intravascular coagulation (DIC)* - **Disseminated intravascular coagulation (DIC)** is a severe, systemic condition characterized by widespread activation of coagulation, leading to microthrombi formation and consumption of clotting factors, often resulting in bleeding. - While small thrombi can form, the primary manifestation is diffuse bleeding, and the thrombi are usually diffuse microvascular clots rather than large, embolizing thrombi to the pulmonary arteries. *Inherited Thrombophilia* - **Inherited thrombophilias** are genetic predispositions to excessive clotting and are risk factors for DVT, but they are not the direct cause of pulmonary embolism. - They increase the likelihood of developing DVT, which then *in turn* can lead to pulmonary embolism [1].

Question 1

Heart failure cells are

Accepted Answer

Pigmented alveolar macrophages

Answer

Lipofuscin granules in cardiac cells

Answer

Pigmented pancreatic acinar cells

Answer

Pigment cells seen in liver

Question 2

Which of the following is more prone to produce mesothelioma?

Accepted Answer

Crocidolite

Answer

Anthophyllite

Answer

Chrysotile

Answer

Amosite (Brown asbestos)

Question 3

All the following statements about primary tuberculosis are true except

Accepted Answer

Cavitary lesion

Answer

Fibrocasseous lesion

Answer

Phlyctenular conjunctivitis

Answer

Pleural effusion

Question 4

Small deposits of neuroendocrine cell hyperplasia in scarred lungs are known as:

Accepted Answer

Tumorlet

Answer

Teratoma

Answer

Carcinoid

Answer

Hamartoma

Question 5

Which of the following is a characteristic of bronchoalveolar carcinoma?

Accepted Answer

Lepidic growth with preservation of alveolar structure

Answer

Stromal invasion with desmoplasia

Answer

Grows along existing anatomical structures

Answer

Adenocarcinoma

Question 6

A patient develops pulmonary thromboembolism most commonly due to what?

Accepted Answer

Deep Vein Thrombosis (DVT)

Answer

Chronic Venous Hypertension

Answer

Disseminated intravascular coagulation (DIC)

Answer

Inherited Thrombophilia

Question 7

Which of the following is LEAST likely to be a feature of an exudate?

Accepted Answer

Serum-Pleural fluid Albumin gradient > 1.2 g/dL

Answer

Pleural fluid cholesterol > 55 mg/dL

Answer

Fluid : Serum Protein ratio > 0.5

Answer

Fluid : Serum LDH ratio > 0.6

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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