1M-PULMO

Question 1

The lungs are subdivided into __ lobes

Answer 1

5

○ Three on the right (Upper, Middle, and
Lower)

○ Two on the left (Upper and Lower)

Question 2

____ are of special importance to thoracic surgeons in cases of resection, there is no need to resect the whole lobe.

Answer 2

*Bronchopulmonary segments

Question 3

The cut surface of the normal lung is characterized
by connective tissue septa that subdivide the
parenchyma into ___

Answer 3

Polygonal pulmonary lobules

Question 4

The 2 main components of the lung interstitium

Answer 4

Alveolar walls and extra-alveolar connective tissue

Question 5

• Covers the lungs

- For gas exchange

Answer 5

Type I pneumocytes

Question 6

• Produce surfactant

- Main proliferating component after alveolar injury

Answer 6

Type II pneumocytes

Question 7

Produce mucin & contribute to the defense of lungs against pathogens

Answer 7

Goblet and ciliated cells

Question 8

Decrease in number as one
approaches the terminal
bronchioles

Answer 8

Goblet and ciliated cells

Question 9

Increase in number as one
approaches the terminal
bronchioles

Answer 9

Clara cells

Question 10

Has secretory function
and represent the main
progenitor cells after
bronchiolar injury.

Answer 10

Clara cells

Question 11

Numerous in the fetus and neonate

Answer 11

*Airway-associated neuroendocrine cells

Question 12

The lymph drainage is mainly cephalad,

primarily through ___

Answer 12

Mediastinal lymph node
groups

also to abdominal lymph nodes

Question 13

The vasculature of the lung derives from ____

Answer 13

The pulmonary vessels and bronchial vessels

Question 14

Permanent dilation of bronchi with destruction of some elements of the bronchial wall and inflammatory changes that extend into lung
parenchyma.

Answer 14

BRONCHIECTASIS

Question 15

It represents the end stage of variety of unrelated

disorders

Answer 15

BRONCHIECTASIS

Question 16

Partial or total obliteration of the bronchial lumen.

It can occur in any area of the lung and
follows the branching pattern of the
obstructed bronchus.

Answer 16

Localized bronchiectasis

Question 17

Localized bronchiectasis: reversible or irreversible?

Answer 17

○ REVERSIBLE if the source of obstruction is relieved at an early stage

○ Otherwise, the secondary
inflammatory and fibrotic changes will
render the condition IRREVERSIBLE

Question 18

Consequence of inflammation and post
inflammatory destruction of airway walls
that is usually the result of repeated
episodes of infection.

Answer 18

Diffuse bronchiectasis

Question 19

Microscopic finding in bronchiectasis

Answer 19

Mixed infiltrate of both acute and chronic
inflammatory cells.

Lymphocytes often predominate

Question 20

Treatment for bronchiectasis

Answer 20

● Conservative medical treatment- focused on
prevention or suppression of infection and early
treatment for acute exacerbations is sufficient
● Surgical resection- is limited primarily to patients with
localized disease in whom hemorrhage and/or
repeated pulmonary infections cannot be controlled
with more conservative measures.

Question 21

Follow the aspiration of foreign material or are a complication of necrotizing pneumonia.

Answer 21

ABSCESS

Question 22

Most common locations of lung abscesses

Answer 22

Right upper lobe
Right lower lobe
Left lower lobe

In patients who are bedridden: apical portion

Question 23

Agents that are most commonly responsible for lung abscesses

Answer 23

Anaerobic organisms

Question 24

Have thick fibrotic walls and are surrounded by areas of organizing pneumonia.

Answer 24

Chronic abscesses

Question 25

Lung abscesses in children are most commonly due to?

Answer 25

Streptococcus species
Staphylococcus aureus
Klebsiella pneumoniae

Question 26

Treatment of Lung abscess

Answer 26

● Intravenous antibiotics - particularly in children.
● Aspiration and drainage or partial resection of the lobe - for small unilocular abscesses
● Lobectomy - For larger lesions

Question 27

Postoperative complications for LA

Answer 27

Bronchopleural fistula and empyema

Question 28

Simulate radiological and gross features of neoplastic processes.

Answer 28

GRANULOMATOUS INFLAMMATION

Question 29

Stains used for granulomatous inflammation?

Answer 29

● Ziehl-Neelsen for Mycobacteria

● Gomori Methenamine Silver stain for Fungi

Question 30

T or F: Gross features of tuberculosis in tissue obtained for diagnosis are similar with surgical specimens.

Answer 30

FALSE

In surgical specimens obtained from patients who have failed medical management, most of the resected tissue typically consists of:

• inflamed,
• fibrotic, and
• otherwise nonfunctioning lung parenchyma

Question 31

Localized conglomerates of necrotizing granulomatous infection due to Mycobacterium tuberculosis

Answer 31

*TUBERCULOMAS

Question 32

Round, discrete, firm, solitary lung nodules seen in adults and are a form of tuberculous reinfection

Answer 32

TUBERCULOMAS

Question 33

Microscopic finding in tuberculomas

Answer 33

Central caseous necrosis

Question 34

Granulomatous infections of caused by ‘atypical’ or ‘unclassified’ mycobacteria; commonly seen in
immunocompromised hosts and/or in patients with
preexisting lung disease.

Answer 34

ATYPICAL MYCOBACTERIOSIS

Question 35

Causative agent(s) of Atypical Mycobacteriosis

Answer 35

○ M. avium complex (MAC)
○ M. kansasii
○ M. xenopi
○ M. abscessus

Question 36

Diagnosis of Atypical Mycobacteriosis

Answer 36

● Cannot be distinguished from TB on the
basis of their gross or microscopic appearance.
● May be suspected from the appearance
of the organisms in acid-fast preparations
- Bacilli in atypical mycobacteriosis are a lot thicker and longer than in M. tuberculosis.
● Positive identification of the organism by culture
and/or polymerase chain reaction (PCR) techniques
is necessary.

Question 37

Hallmark of SARCOIDOSIS

Answer 37

Compact non-caseating granuloma

*composed of epithelioid cells, Langhans giant cells, and lymphocytes.

Question 38

SARCOIDOSIS can present in the thoracic cavity in various ways:

Answer 38

○ Moderate to marked perihilar lymph node
involvement without pulmonary disease
○ Diffuse pulmonary disease without
radiographic evidence of node involvement
○ Combination of lymph node enlargement
and diffuse pulmonary disease
○ Pulmonary interstitial fibrosis, and localized
bronchostenosis with distal bronchiectasis
and atelectasis.

Question 39

In sarcoidosis, granulomas are also frequently present

around and within ___?

Answer 39

Blood vessel walls

*predominantly pulmonary veins, and may contribute to pulmonary hypertension.

Question 40

A pulmonary disease characterized by extensive vascular granulomas that infiltrate and occlude pulmonary arteries and veins and are
accompanied by widespread necrosis of lung tissue

Answer 40

Necrotizing sarcoid granulomatosis

Question 41

Most common benign lung neoplasm of the lung

Answer 41

HAMARTOMA

Question 42

Adult male presents with an asymptomatic solitary lung nodule in the peripheral lung parenchyma just beneath the pleura. It is small (<2 cm) and has a characteristic popcorn pattern of calcification radiographically.

Answer 42

HAMARTOMA

Question 43

Sharply delineated and lobulated lung nodule. Its
cut surface is characterized by glistening nodules of
cartilage separated by ill-defined clefts.

Answer 43

HAMARTOMA

Question 44

Microscopically made up of normal cartilage arranged in islands, fats, smooth muscle, a characteristic myxoid stroma, and clefts lined by ciliated or nonciliated respiratory epithelium.

Answer 44

HAMARTOMA