Pulmonary Practice Questions

Q: A 31 year-old African-American female presents with painful shin nodules, uveitis, and calcified hilar lymph nodes. A transbronchial biopsy of the lung would most likely show which of the following histologies?

Non-caseating granulomas. ***Non-caseating granulomas*** - The constellation of **erythema nodosum** (painful shin nodules), **uveitis**, and **hilar lymphadenopathy** in an African-American female is highly characteristic of **sarcoidosis**. - **Sarcoidosis** is pathologically defined by the presence of **non-caseating granulomas** in affected tissues, which would be visible on a transbronchial biopsy. *Golden-brown fusiform rods* - These are **ferruginous bodies**, characteristic of **asbestosis**, which is not supported by the patient's presentation. - Asbestosis would typically involve a history of **asbestos exposure** and present with **pleural plaques** or **interstitial fibrosis**. *Inflammation, fibrosis and cyst formation that is most prominent in subpleural regions* - This description is more indicative of **pulmonary Langerhans cell histiocytosis**, a rare disease usually associated with **smoking**. - It does not align with the patient's specific systemic manifestations like uveitis or erythema nodosum. *Silica particles (birefringent) surrounded by collagen* - This describes the histological findings of **silicosis**, an occupational lung disease resulting from exposure to **silica dust**. - Silicosis is not typically associated with uveitis or erythema nodosum. *Patchy interstitial lymphoid infiltrate into walls of alveolar units* - This pattern can be seen in various interstitial lung diseases, but it is not specific for sarcoidosis. - It could be found in conditions like **lymphoid interstitial pneumonia**, which does not fit the overall clinical picture.

Question 1

A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and a dry cough. Chest CT reveals bilateral pleural plaques. A wedge biopsy of the lung parenchyma is obtained. Histologic examination reveals elongated, beaded structures with a golden-brown iron-protein coat within macrophages and alveolar spaces, surrounded by mild interstitial fibrosis. Which of the following best describes the structure most characteristic of asbestos exposure identified in this biopsy?

Accepted Answer

Asbestos bodies, a subset of ferruginous bodies formed specifically by iron-protein coating of inhaled asbestos fibers

Answer

Schaumann bodies representing calcified concentric lamellae within giant cells

Answer

Corpora amylacea composed of glycoprotein deposits in alveolar spaces

Answer

Charcot-Leyden crystals derived from eosinophil membrane phospholipids

Answer

Curschmann spirals formed by inspissated mucus in small airways

Question 2

A 67-year-old man with longstanding poorly controlled type 2 diabetes mellitus dies of a myocardial infarction. At autopsy, both kidneys appear symmetrically shrunken with granular surfaces. A PAS-stained section of renal cortex at 20× magnification shows ovoid, laminated, acellular deposits within the mesangium of glomeruli, compressing the capillary loops. The tubular basement membranes are markedly thickened. Which of the following best characterizes the composition and pathogenetic mechanism of the glomerular deposits shown?

Accepted Answer

Mesangial accumulation of type IV collagen and laminin due to excess TGF-β–driven matrix synthesis

Answer

Subepithelial immune complex deposition of IgG and C3 activating the classical complement pathway

Answer

Amyloid fibrils derived from serum amyloid A protein deposited in a beta-pleated sheet configuration

Answer

Fibrin thrombi within capillary loops secondary to thrombotic microangiopathy

Answer

Nodular deposits of immunoglobulin light chains arranged in a non-fibrillar pattern

Question 3

A 45-year-old woman presents with a 3-cm solitary thyroid nodule. Fine-needle aspiration is performed. The cytology reveals cells arranged in papillary clusters with enlarged nuclei exhibiting longitudinal grooves, pale 'ground-glass' chromatin, and intranuclear cytoplasmic pseudoinclusions. Scattered in the smear/background and within papillary fragments are laminated calcified spherules. Which of the following eponymous structures are represented by those calcified deposits, and in which additional neoplasm are identical structures characteristically found?

Accepted Answer

Psammoma bodies; found characteristically in serous ovarian carcinoma

Answer

Schaumann bodies; found characteristically in follicular thyroid carcinoma

Answer

Ferruginous bodies; found characteristically in mesothelioma

Answer

Asteroid bodies; found characteristically in medullary thyroid carcinoma

Answer

Michaelis-Gutmann bodies; found characteristically in meningioma

Question 4

A 55-year-old woman with a history of Barrett esophagus undergoes surveillance endoscopy. A 1.5 cm nodular lesion is identified in the distal esophagus and biopsied. The photomicrograph shows glandular epithelium with marked nuclear enlargement, prominent nucleoli, loss of polarity, and atypical mitoses. The abnormal cells are confined to the epithelium above an intact basement membrane with no stromal invasion. The adjacent non-dysplastic mucosa shows columnar epithelium with goblet cells. Which of the following best characterizes the biological behavior and reversibility of the lesion depicted in this biopsy?

Accepted Answer

The lesion is irreversible and represents a committed neoplastic transformation, but surgical resection at this stage is expected to be curative because invasion has not occurred

Answer

The lesion is reversible with proton pump inhibitor therapy because the columnar metaplasia has not yet acquired irreversible genomic instability

Answer

The lesion is reversible because dysplastic changes confined to the epithelium retain the capacity for differentiation under appropriate hormonal signaling

Answer

The lesion is irreversible and has already metastasized through lymphatic channels because high-grade nuclear atypia invariably accompanies vascular invasion

Answer

The lesion is reversible because the intact basement membrane prevents acquisition of additional oncogenic mutations necessary for malignant transformation

Question 5

A 31 year-old African-American female presents with painful shin nodules, uveitis, and calcified hilar lymph nodes. A transbronchial biopsy of the lung would most likely show which of the following histologies?

Accepted Answer

Non-caseating granulomas

Answer

Golden-brown fusiform rods

Answer

Inflammation, fibrosis and cyst formation that is most prominent in subpleural regions

Answer

Silica particles (birefringent) surrounded by collagen

Answer

Patchy interstitial lymphoid infiltrate into walls of alveolar units

Pulmonary — MCQs

Pulmonary — MCQs

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