Respiratory Pathology Practice Questions

Q: What is the pathophysiological cause of the disease shown in the X-ray and gross specimen from an ICU patient?

Diffuse alveolar damage. ***Diffuse alveolar damage*** - **DAD** is the hallmark pathophysiological process of **ARDS** in ICU patients, characterized by **bilateral diffuse infiltrates** on X-ray and **heavy, firm, dark congested lungs** on gross examination. - Features **hyaline membrane formation**, **alveolar epithelial cell necrosis**, and **capillary endothelial damage** leading to increased vascular permeability and protein-rich edema. *Usual interstitial pneumonia* - **UIP** is a chronic fibrotic process with **honeycombing** and **subpleural distribution**, not the acute bilateral pattern seen in ICU settings. - Associated with **idiopathic pulmonary fibrosis** and shows **temporal heterogeneity** with areas of normal lung, inflammation, and fibrosis. *Acute interstitial pneumonia* - **AIP** (Hamman-Rich syndrome) presents similarly to DAD but is an **idiopathic** condition, not associated with the acute critical illness context of ICU patients. - Shows **diffuse alveolar damage** histologically but lacks the **identifiable precipitating factors** typically present in ICU-related ARDS. *Organizing pneumonia* - **OP** shows **intraluminal fibroblastic plugs** (Masson bodies) within **alveolar ducts and bronchioles**, creating a patchy rather than diffuse pattern. - Characterized by **preservation of lung architecture** and **good response to corticosteroids**, unlike the severe acute damage in ICU patients.

Q: Rasmussen's aneurysm is seen in which of the following arteries?

Pulmonary artery. Rasmussen’s aneurysm is a pseudoaneurysm of the pulmonary artery (Option B) that occurs as a late complication of pulmonary tuberculosis. It develops when a tuberculous cavity expands and erodes the wall of an adjacent pulmonary artery. The chronic inflammation weakens the adventitia and media of the vessel, leading to focal dilation. If this aneurysm ruptures into the cavity, it results in massive, life-threatening hemoptysis. Analysis of Options: * Option A (Bronchial artery): While bronchial arteries are the most common source of massive hemoptysis in chronic lung diseases (due to high-pressure systemic circulation), they are *not* the site of Rasmussen’s aneurysm. * Options C & D (Vertebral/Internal carotid): These are systemic arteries. Aneurysms here (like Berry aneurysms) are associated with subarachnoid hemorrhages or vascular syndromes, not pulmonary tuberculosis. High-Yield Clinical Pearls for NEET-PG: * Pathogenesis: It is a pseudoaneurysm (not a true aneurysm) caused by the erosion of the vessel wall from the *outside* (the cavity side) rather than intraluminal pressure. * Location: Usually occurs in the branches of the pulmonary artery located in the walls of upper lobe cavities. * Management: The gold standard for diagnosis and immediate management is Bronchial/Pulmonary Angiography followed by Embolization. * Differential: Do not confuse this with Dieulafoy’s lesion (a vascular malformation in the bronchus or GI tract) or Aspergilloma (fungal ball), both of which also cause massive hemoptysis in old TB cavities [1].

Question 1

A lung section from an autopsy of an AIDS patient with a CD4 count less than 100/mm³ shows desquamation of type 1 pneumocytes with prominent intranuclear basophilic inclusion bodies surrounded by a clear halo. What is the most likely diagnosis causing these features?

Accepted Answer

CMV pneumonia

Answer

Acute respiratory distress syndrome

Answer

Pneumocystis jirovecii pneumonia

Answer

Mycobacterium avium-intracellulare pneumonia

Question 2

All of the following statements are true regarding the histological features of emphysema, except?

Accepted Answer

The pores of Kohn become narrower and obstructed.

Answer

There is loss of attachments of the alveoli to the outer wall of small airways.

Answer

It causes a decrease in the capillary bed area.

Answer

There are large abnormal airspaces, blebs, and bullae.

Question 3

Asbestosis of the lung is associated with all of the following except?

Accepted Answer

Nodular lesions involving upper lobe

Answer

Mesothelioma

Answer

Progression of lesion even after stopping exposure to asbestos

Answer

Asbestos bodies in sputum

Question 4

Which of the following is the most characteristic feature of Adult Respiratory Distress Syndrome (ARDS)?

Accepted Answer

Diffuse alveolar damage

Answer

Hypoxemia and hypoxia

Answer

Surfactant deficiency

Answer

Hypocapnia

Question 5

What is the pathophysiological cause of the disease shown in the X-ray and gross specimen from an ICU patient?

Accepted Answer

Diffuse alveolar damage

Answer

Usual interstitial pneumonia

Answer

Acute interstitial pneumonia

Answer

Organizing pneumonia

Question 6

The term "brown induration" is used in relation to which of the following organs?

Accepted Answer

Chronic passive congestion of the lung

Answer

Chronic passive congestion of the liver

Answer

Chronic passive congestion of the spleen

Answer

Chronic passive congestion of the kidney

Question 7

In the course of a laryngoscopic examination for hoarseness, a small lesion is found on the true vocal cord of a 57-year-old male smoker. On biopsy, severe squamous dysplasia is noted. If untreated, this lesion may progress to which of the following?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Lymphoepithelioma

Answer

Mucoepidermoid carcinoma

Question 8

A patient presents with a stony hard, painless lymph node in the left supraclavicular fossa. A biopsy report states squamous cell carcinoma. What is the most likely primary diagnosis?

Accepted Answer

Lung carcinoma

Answer

Stomach carcinoma

Answer

Breast carcinoma

Answer

Pancreas carcinoma

Question 9

Rasmussen's aneurysm is seen in which of the following arteries?

Accepted Answer

Pulmonary artery

Answer

Bronchial artery

Answer

Vertebral artery

Answer

Internal carotid artery

Question 10

BAL of a patient shows foamy macrophages with decreased CD4:CD8 ratio. What is the diagnosis?

Accepted Answer

Organising pneumonia

Answer

Sarcoidosis

Answer

Hypersensitivity pneumonitis

Answer

Diffuse alveolar hemorrhage

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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