XIII - The Lung

Question 1

Loss of lung volume cause by inadequate expansion of airspaces, resulting in shunting of inadequately oxygenated blood from pulmonary arteries into veins.

Answer 1

Atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 480

Question 2

Atelectasis which occurs when an obstruction prevents air from reaching distal airways.

Answer 2

Resorption atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 480

Question 3

Atelectasis usually associated with accumulation of fluid, blood, or air within the pleural cavity, which mechanically collapse the adjacent lung.

Answer 3

Compression atelectasis (aka passive or relaxation atelectasis)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 481

Question 4

Atelectasis which occurs when either local or generalized fibrotic changes in the lung or pleura hamper expansion and increase elastic recoil during expiration.

Answer 4

Contraction or cicatricial atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 481

Question 5

Lungs are dark red, firm, airless and heavy. There is capillary congestion, necrosis of alveolar epithelial cells, interstitial and intra-alveolar edema and hemorrhage and neutrophils in capillaries. Hyaline membrane is also characteristic, lining the alveolar ducts.

Answer 5

Acute Respiratory Distress Syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 482

Question 6

Diffuse pulmonary disease characterized by limitation of airflow, usually resulting from an increase in resistance caused by partial or complete obstruction atvany level.

Answer 6

Obstructive pulmonary disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483

Question 7

Diffuse pulmonary disease characterized by reduced expansion of lung parenchyma accompanied by decreased total lung capacity.

Answer 7

Restrictive lung disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483

Question 8

Lung volumes in obstructive lung disease:FEV1FVCFEV1:FVC ratio

Answer 8

FEV1 - decreasedFVC - normal / increasedFEV1:FVC ratio - decreased(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483

Question 9

Lung volumes in restrictive lung diseaseFEV1FVCFEV1:FVC ratio

Answer 9

FEV1 - normal/decreasedFVC - decreasedFEV1:FVC ratio - near normal(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483

Question 10

Characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls without obvious fibrosis. There is thinning oof the alveolar walls and loss of elastic tissue.

Answer 10

Emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485

Question 11

Type of emphysema involving the central or proximal parts of the acini, formed by respiratory bronchioles, while distal parts are spared. Lungs deep pink and less voluminous, affecting the upper 2/3 of the lungs. Occurs in smokers.

Answer 11

Centriacinar (centrilobular) Emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485

Question 12

Type of emphysema wherein the acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal alveoli. Occurs more commonly in the lower lung zones. Occurs in a-antitrypsin deficiency.

Answer 12

Panacinar (panlobular) emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485

Question 13

Type of emphysema wherein only the distal part is primarily involved. Lesion is adjacent to the pleura along the lobular connective tissue septa and at the lobe margins. More severe at the upper half of the lungs, forming bullae.

Answer 13

Distal acinar (paraseptal) emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 486

Question 14

Barrel-chested, dyspneic, prolonged expiration, sits forward in a hunched-over position, adequate oxygenation of oxygen. “Pink puffers”.

Answer 14

COPD predominantly emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 15

History of recurrent infections with purulent sputum, less prominent dyspnea and respiratory drive, becomes hypoxic and are pften cyanotic and obese. “Blue bloaters”.

Answer 15

COPD predominantly chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 16

Defined as persistent productive cough for at least 3 consecutive months in at least 2 consecutive years.

Answer 16

Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 17

Mucosal lining of the larger airways is usually hyperemic and swollen with edema fluid, often covered by a layer of mucinous or mucopurulent secretions. Trachea and bronchi have enlarged mucus-secreting glands.

Answer 17

Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 18

Characterized by goblet cell metaplasia, mucus plugging, inflammation and fibrosis, and sometimes complete obliteration of the lumen due to fibrosis.

Answer 18

Chronic bronchiolitis (small airway disease)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 19

Most important underlying risk factor for chronic bronchitis.

Answer 19

Cigarette smoking(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 20

Triad of 1.intermittent and reversible airway obstruction2.chronic bronchial inflammation with eosinophils3.bronchial smooth muscle cell hypertrophy and hyperreactivity

Answer 20

Asthma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 21

Collections of crystalloids made up of eosinophil proteins.

Answer 21

Charcot-Leyden crystals(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 492

Question 22

Whorls of shed epithelium found in mucus plugs.

Answer 22

Curschmann spirals(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 492

Question 23

Curshmann spirals and Charcot-Leyden crystals are found histologically in this disease.

Answer 23

Asthma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 492

Question 24

Permanent dilation of bronchi and bronchioles caused by destruction of theuscle and elastic supporting tissue, resulting from chronic necrotizing infections.

Answer 24

Bronchiectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 493

Question 25

An autosomal recessive disorder frequently associated with bronchiectasis and sterility in males.

Answer 25

Kartagener syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 493

Question 26

Refers to a pulmonary disorder of unknown etiology characterized patchy interstitial fibrosis. Grossly, pleural surfaces of the lung have the appearance of cobblestones because of retraction scars along the interlobular septa.

Answer 26

Idiopathic Pulmonary Fibrosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 495

Question 27

A thrombus that lodges astride a pulmonary artery bifurcation, which causes pulmonary hypertension, which can lead to hypoxia and cor pulmonale.

Answer 27

Saddle embolus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 505

Question 28

Most common symptom of pulmonary embolism.

Answer 28

None, asymptomatic 60-80% of the time.(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506

Question 29

Mean pulmonary pressures reach one-fourth or more of systemic pressures.

Answer 29

Pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506

Question 30

Encountered in young persons, more commonly in women, marked by fatigue, syncope, dyspnea on exertion, and sometimes chest pain. Cause of increased pulmonary pressures is unknown.

Answer 30

Primary pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506

Question 31

Clinical features of this disease reflect the underlying disease, with accentuation of respiratory insufficiency and right-sided heart strain.

Answer 31

Secondary pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 507

Question 32

Pneumonia with a patchy distribution of inflammation involving more than one lobe.

Answer 32

Bronchopneumonia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 509

Question 33

Four stages of pneumococcal pneumonia.

Answer 33

Congestion, red hepatization, gray hepatization, resolution(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 510

Question 34

Affected areas are red-blue, congested and subcrepitant. Inflammatory reaction is largely confined within the walls of the alveoli. Septa widened and edematous, with mononuclear infiltrates of lymphocytes, histiocytes and plasma cells. Alveolar spaces are free of cellular exudate.

Answer 34

Atypical pneumonia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 513

Question 35

A localized area of suppurative necrosis within the pulmonary parenchyma, resulting in the formation of one or more large cavities.

Answer 35

Lung abscess(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 515

Question 36

Pulmonary abscess resulting from aspiration of infective material are much more common on the left or right side?

Answer 36

Right side since it’s shorter and more vertical.(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 515

Question 37

Form of tuberculosis that develops in a previously unexposed, unsensitized person.

Answer 37

Primary tuberculosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518

Question 38

Implantation of the inhaled M. tuberculosis bacilli in the distal airspaces of the lungs, causes the formation of this 1 - 1.5 cm area of gray-white inflammatory consolidation.

Answer 38

Ghon focus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518

Question 39

Ghon focus + nodal involvement = ________

Answer 39

Ghon complex(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518

Question 40

Radiographically detectable calcified Ghon complex.

Answer 40

Ranke complex(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518

Question 41

Pattern of disease that arises in previously sensitized host to M. tuberculosis.

Answer 41

Secondary or reactivation TB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 520

Question 42

Occurs when TB bacilli drain through the lymphtics into lymphatic ducts, which eventually empty into the rightside of the heart and into pulmonary circulation. Individual lesions are small, visible foci of yellow-white consolidation scattered through the parenchyma.

Answer 42

Miliary TB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 520

Question 43

The most frequent form of extrapulmonary TB.

Answer 43

TB Lymphadenitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 521

Question 44

TB lymphadenitis of the cervical LN.

Answer 44

Scrofula(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 521

Question 45

Round to oval small yeast forms measuring 2-5 um in diameter.

Answer 45

Histoplasma capsulatum(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523

Question 46

Thick walled non-budding spherules 20-60 um diameter, often filled with small endospores.

Answer 46

Coccidiodomycosis immitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523

Question 47

Round to oval and larger fungi, which reproduce by broad-based budding.

Answer 47

Blastomycosis dermatitidis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523

Question 48

Cells infected by this virus exhibit gigantism of the cell and nucleus. An enlarged inclusion surrounded by a clear halo “owl’s eye” is seen. It is the most common opportunistic viral pathogen in AIDS.

Answer 48

Cytomegalovirus (CMV)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 524

Question 49

Opportunistic infection of the lungs having a characteristic intra-alveolar foamy, pink-staining exudate “cotton candy exudate”, with thickened septa and mononuclear infiltrate.

Answer 49

Pneumocystis carinii pneumonia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 526

Question 50

Most frequent disease-causing fungus.

Answer 50

Candida albicans(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 526

Question 51

The fungus is a 5-10 um yeast, has a thick, gelatinous capsule and reproduces by budding. Most likely acquired through bird droppings. Visualized by India ink or Giemsa stain.

Answer 51

Cryptococcus neoformans(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 527

Question 52

Which type of lung cancer is treated by chemotherapy only? Why?

Answer 52

Small cell lung carcinomaIt is an aggressive tumor which usually have metastasized at the time of diagnosis.(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 529

Question 53

Lung carcinoma best treated with surgery since they respond poorly to chemotherapy.

Answer 53

Non-small cell lung carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 529

Question 54

Types of lung cancer with strongest association with tobacco exposure.

Answer 54

Squamous cell carcinomaSmall-cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 530

Question 55

Lung cancer which are peripherally located, most common type of lung cancer in women and nonsmokers. Grows slowly and metastasize early. Assumes a variety of forms, incliding acinar, papillary and solid types.

Answer 55

Adenocarcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 531

Question 56

Lung carcinoma which typically have large, prominent nucleoli, and a moderate amount of cytoplasm, with minimal glandular or squamous differentiation.

Answer 56

Large-cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 531

Question 57

Lung carcinoma which appear as pale gray, centrally located masses. Nests and cords of polygonal cells with scant cytoplasm, granular chromatin and inconspicuous nuclei. FNAB shows nuclear molding of adjacent cells. Associated with several paraneoplastic syndromes.

Answer 57

Small cell lung carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532

Question 58

Other name for small cell lung carcinoma.

Answer 58

Oat cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532

Question 59

Paraneoplastic syndromes associated with oat cell carcinoma.

Answer 59

Cushing syndromeSIADH Lambert-Eaton myasthenic syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532

Question 60

Hypercalcemia due to excessive production of PTH related protein is usually seen in patients with this type of lung carcinoma.

Answer 60

Squamous cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532

Question 61

Form of lung cancer that is thought to arise from neuroendocrine cells, called Kulchitsky cells, that line the bronchial mucosa and resemble intestinal carcinoids. Nests of small, rounded, uniform cells with “salt and pepper” chromatin.

Answer 61

Bronchial carcinoids(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 534

Question 62

Presence of fluid in the pleural space.

Answer 62

Pleural effusion(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535

Question 63

Air or other gas in the pleural sac.

Answer 63

Pneumothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535

Question 64

A collection of whole blood in the pleural cavity.

Answer 64

Hemothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535

Question 65

A pleural collection of a milky lymphatic fluid containing microglobules of lipid.

Answer 65

Chylothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535

Question 66

A rare cancer seen in patients who work in shipyards, miners and insulators. Lesion is preceeded by extensive pleural fibrosis and plaque formation. May be epithelial, sarcomatoid or biphasic in morphology.

Answer 66

Malignant mesothelioma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 536

Question 67

Rare neoplasm with strong links to EBV and high frequency among the Chinese population. Characterized by large epithelial cells having indistinct borders (syncitial growth) and prominent eosinophilic nucleoli.

Answer 67

Nasopharyngeal carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537

Question 68

Smoothe, hemispherical protrusions located on the true vocal cords, composed of fibrous tissue and covered by stratified squamous mucosa.

Answer 68

Vocal cord nodules(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537

Question 69

A benign neoplasm usually on the true vocal cords that forms a soft, raspberry-like excresence rarely more then 1 cm in diameter. Consists of multiple, slender, finger-like projections.

Answer 69

Laryngeal papilloma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537

Question 70

Histologic manifestation of acute respiratory distress syndrome and acute lung injury.

Answer 70

Diffuse alveolar damage(TOPNOTCH)Robbins Pathologic Basis of Disease, 9th Ed. p. 672

Question 71

A 70 y/o male presented to the ER with a 10 day history of fever followed by rapidly progressive dyspnea for 3 days prior to admission. Physical examination revealed tachypnea, central cyanosis, and extensive fine inspiratory crackles of the chest. Severe hypoxemia was noted on ABG. Chest radiograph revealed bilateral diffuse alveolar infiltrates with normal cardiac size. An extensive ground glassing was also. Diagnosis? Characteristic histologic picture expected for this condition?

Answer 71

ARDS. Hyaline membranes lining the alveolar walls. (TOPNOTCH)

Question 72

The key initiating events and the basis of lung damage in ARDS

Answer 72

Damage to endothelial and alveolar epithelial cells. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 674

Question 73

Disease characterized by abnormally large alveoli separated by thin septa with only focal centriacinar fibrosis.

Answer 73

Emphysema (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 677

Question 74

Mild chronic inflammation of the airways (predominantly lymphocytes) and enlargement of mucus-secreting glands of the trachea and bronchi are seen in:

Answer 74

Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 679

Question 75

A 55 y/o female presented with chronic cough, productive of thick, tenacious sputum, recurrent episodes of fever associated with pleuritic chest pain. Crackles were noted on auscultation. Chest radiograph showed presence of “tram tracks”. The most likely diagnosis:

Answer 75

Bronchiectasis(TOPNOTCH)

Question 76

Dilation of bronchi and bronchioles, with acute and chronic inflammatory exudation, desquamation of the lining epithelium and extensive areas of ulceration, are characteristics of what disease?

Answer 76

Bronchiectasis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 683

Question 77

Earliest feature of chronic bronchitis

Answer 77

Hypersecretion of mucus in the large airways. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 678

Question 78

Subbasement membrane fibrosis, hyperplasia of bronchial wall muscle, hypertrophy of bronchial glands, and inflammatory infiltrate in the bronchial wall. These are morphologic findings in:

Answer 78

Asthma(TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 682

Question 79

Fundamental abnormality in atopic asthma

Answer 79

Exagerrated TH2 response (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 680

Question 80

Key inflammatory cells found in asthma

Answer 80

Eosinophils (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 683

Question 81

Most common bacterial cause of acute exacerbation of COPD

Answer 81

Haemophilus influenzae. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703

Question 82

A 3 y/o child was brought to ER due to sudden onset of high fever, labored breathing, and drooling. The most likely cause of this condition is:

Answer 82

Haemophilus influenzae (TOPNOTCH)

Question 83

3 most common causes of otitis media in children

Answer 83

Streptococcus penumoniae, Haemophilus influenzae, Moraxella catarrhalis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703

Question 84

Most freqent cause of gram negative bacterial pneumonia.

Answer 84

Klebsiella pneumoniae (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703

Question 85

A 45 y/o alcoholic male presented with fever, tachypnea, and cough with thick, mucoid, blood-tinged sputum. Chest radiograph showed right middle lobe opacification and bulging fissure sign. The most likely cause of pneumonia in this case is:

Answer 85

Klebsiella pneumoniae (TOPNOTCH)

Question 86

An important cause of secondary bacterial pneumonia in children and adults following a viral respiratory illness (measles, influenza)

Answer 86

Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703

Question 87

Cause of pneumonia associated with high incidence of lung abscess and empyema

Answer 87

Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703

Question 88

Most common cause of community acquired pneumonia

Answer 88

Streptococcus pneumoniae. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707

Question 89

Distribution of pneumonia caused by Streptococcus pneumoniae, lobar or patchy consolidation?

Answer 89

Lobar (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707

Question 90

Predominant histologic pattern in viral pneumonia

Answer 90

Interstitial inflammatory reaction of the walls of alveoli (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707

Question 91

Cause of pneumonia seen particularly in organ transplant recipients.

Answer 91

Pneumonia caused by Legionella pneumophila. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708

Question 92

Common cause of pneumonia in persons with cystic fibrosis, burn victims and in patients with neutropenia

Answer 92

Pneumonia caused by Pseudomonas aeruginosa (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708

Question 93

Most frequent cause/mechanism of lung abscess

Answer 93

Aspiration of infective material (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708

Question 94

Cardinal histologic change in lung abscess

Answer 94

Suppurative destruction of lung parenchyma within the central area of cavitation (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 709

Question 95

Major morphologic correlate of chronic rejection

Answer 95

Bronchiolitis obliterans (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 712

Question 96

Type of emphysema in smoking

Answer 96

Centriacinar (centrilobular) Emphysema(TOPNOTCH)

Question 97

Most common histologic pattern of bronchogenic carcinoma

Answer 97

Adenocarcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 715

Question 98

Most common site of lung squamous cell carcinoma

Answer 98

Central/hilar region (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 715

Question 99

Most common type of lung cancer in men

Answer 99

Squamous cell carcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 716

Question 100

Histologic characteristics of this type of lung carcinoma is keratinization and/or intercellular bridges.

Answer 100

Squamous cell carcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 716

Question 101

Pulmonary embolism could lead to this type of shock

Answer 101

Cardiogenic shock (TOPNOTCH)

Question 102

Mechanism of pulmonary edema in left sided CHF.

Answer 102

Increased hydrostatic pressure(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 671

Question 103

Associated with medial hypertrophy of the pulmonary muscular and elastic arteries, pulmonary arterial atherosclerosis, and right ventricular hypertrophy.

Answer 103

Pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 700

Question 104

An autoimmune disease characterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstitial pneumonitis.

Answer 104

Goodpasture syndrome(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 701

Question 105

Presents with cough, fever, and copious foul-smelling sputum, usually with antecedent primary lung infection. Cardinal histologic change in this condition is suppurative destruction of lung parenchyma within the central area of cavitaion.

Answer 105

Lung abscess(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 709

Question 106

Pneumonia acquired by inhalation of dust particles from soil contaminated with bird or bat droopings that contain micronidia. Symptoms resemble those of tuberculosis.

Answer 106

Histoplasmosis(TOPNOTCH)Robbins Basic Pathology, 9h Ed. p. 709

Question 107

The most common site of metastatic neoplasm

Answer 107

Lung(TOPNOTCH)Robbins Basic Pathology, 9h Ed. p. 721

Question 108

Sudden death in pulmonary embolism is caused by:

Answer 108

Blockage of blood flow through the lungs.(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 698

Question 109

Inflammatory cell implicated in the pathogenesis of ARDS (A) type II pneumocyte (B) neutrophil (C) fibroblast (D) eosinophil

Answer 109

neutrophil (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 482

Question 110

Of the types of emphysema that cause clinically significant airway obstruction, which one is the commonest? (A) centriacinar (B) panacinar (C) distal acinar (D) irregular

Answer 110

Centriacinar (centrilobular) Emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485

Question 111

In chronic bronchitis, a Reid index of more than 0.4 is diagnostic. The Reid index is the ratio of the thickness of the (A) metaplastic mucosa to the submucosal gland layer (B) submucosal gland layer to the bronchial wall (C) metaplastic mucos to the bronchial wall (D) cartilage to the submucosal gland layer

Answer 111

submucosal gland layer to the mucosal wall (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489

Question 112

Gross examination of lungs that show airways that can be followed almost to the pleural surfaces is characteristic of (A) emphysema (B) bronchiectasis (C) pulmonary sequestration (D) chronic bronchitis

Answer 112

Bronchiectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 493

Question 113

Usual interstitial pneumonia, or idiopathic pulmonary fibrosis, is differentiated from other fibrosing interstitial diseases by (A) the temporal heterogeneity of the fibrosing lesions (B) presence of a lymphocytic infiltrate (C) exuberant fibroblastic proliferation (D) association with a connective tissue disease such as SLE

Answer 113

the temporal heterogeneity of the fibrosing lesions (B is nonspecific and may occur in any; C may be seen in cryptogenic organizing pneumonia; D is wrong because by definition, “idiopathic” must not be associated with other conditions) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp. 495-496

Question 114

Which cell is the key element in the initiation and perpetuation of lung injury and fibrosis in pneumoconioses? (A) alveolar macrophage (B) neutrophil (C) respiratory epithelium basal cell (D) type II pneumocyte

Answer 114

alveolar macrophage (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 497

Question 115

Which pneomoconiosis is associated with an increased susceptibility to tuberculosis? (A) anthracosis (B) silicosis (C) asbestosis (D) sarcoidosis

Answer 115

silicosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 499

Question 116

Concomitant cigarette smoking in patients who have been exposed to asbestos greatly increases the risk of (A) bronchogenic carcinoma (B) mesothelioma (C) carcinoid tumor (D) hamartoma

Answer 116

bronchogenic carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 500, 530

Question 117

Which of the following is more prevalent in nonsmokers than smokers? (A) sarcoidosis (B) centriacinar emphysema (C) desquamative interstitial pneumonia (D) respiratory bronchiolitis

Answer 117

sarcoidosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P. 501

Question 118

What is the histopathologic sine qua non of sarcoidosis? (A) noncaseating epithelioid granuloma (B) Schaumann bodies (C) asteroid bodies (D) caseation necrosis

Answer 118

noncaseating epithelioid granuloma (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P501

Question 119

A 33 year old woman with mitral stenosis from rheumatic heart disease develops hepatomegaly and bipedal edema. She eventually dies of heart failure. An autopsy is done. Which of the following lung findings supports pulmonary hypertension? (A) coagulative necrosis of alveoli with intraparenchymal hemorrhage (B) medial hypertrophy and reduplication of elastic membranes in small arteries (C) medium arteries with chronic inflammatory infiltrate and fibrinoid necrosis (D) vessels of varying caliber with endothelial proliferation

Answer 119

medial hypertrophy and reduplication of elastic membranes in small arteries (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 507

Question 120

A 40 year old lady develops progressive dyspnea and hemoptysis of 1 week. On further history, she reports tea-colored urine. Her condition worsens, and she dies. At autopsy, her lung alveoli have thickened fibrous septa, and the lumens diffusely filled with hemosiderin-laden macrophages. Immunofluorescence showed a linear pattern of immunoglobulin deposition along the alveolar septa. Kidney samples also showed the same pattern. Her dismal clinical picture is a consequence of antibodies against (A) fibrillin (B) elastin (C) collagen III (D) collagen IV

Answer 120

collagen IV (Goodpasture syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 507-508

Question 121

Patients with sickle cell disease have an increased risk of streptococcal pneumonia because (A) macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (B) there is immunologic anergy to the streptococcal capsule which has structural similarity to hemoglobin S (C) the inherent resistance to malaria in sickle cell patients primes the cytotoxic T cells for protozoan, but not bacterial, infections (D) chronic hemolysis in sickle cell disease releases growth factors for the fastidious streptococcal bacteria

Answer 121

macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 428, 509

Question 122

Which of the following patients with secondary tuberculosis have an increased likelihood of NEGATIVE sputum AFB smears? (A) 55 year old HIV-positive man with CD4+ counts 300 cells/mm3 (C) 43 year old HIV-negative man

Answer 122

55 year old HIV-positive man with CD4+ counts

Question 123

A 55 year old man with a 50 pack year smoking history presents with a 5 cm right lung mass in the middle lobe. A CT-guided aspiration biopsy is performed, which shows round to polygonal cells twice the size of lymphocytes, with unappreciable cytoplasm, finely granular chromatin. Some of the cells demonstrate nuclear molding. What is the first line of treatment? (A) lobectomy (B) radiation therapy (C) chemotherapy (D) anti-Koch’s

Answer 123

chemotherapy (small cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 531-534)

Question 124

A 41 year old asymptomatic woman presents with a nodule on a routine xray. CT scan showed a 3-cm bronchial mucosal plaque penetrating the bronchial wall and fanning out into the peribrochial tissue, resembling a collar button. A bronchoscopy with core biopsy is done, which showed nests of uniform cells bearing regular round nuclei with salt-and-pepper chromatin, with little pleomorphism and mitosis. Which of the following is TRUE? (A) 70-80%% of patients with this tumor have hilar node metastasis at presentation (B) the tumor is thought to arise from the Kupffer cells that line the bronchial mucosa (C) Patients commonly present with the syndrome of diarrhea, flushing, and cyanosis (D) it can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms

Answer 124

it can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms (A- 5-15% nodal metastasis; B - arises from Kulchitsky cells; C - rarely presents with the syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 534

Question 125

A 28 year old man complains of epistaxis of one month duration. His otorhinolaryngologist finds an ill-defined erythematous mass in his nasopharynx, and performs a biopsy, which showed sheets and clusters of large epithelial cells having indistinct cell borders with eosinophilic nucleoli, with a background of lymphocytes. Which of the following is TRUE? (A) the mass is associated with EBV infection (B) the lymphocytes are neoplastic (C) the mass is usually resistant to radiotherapy (D) 5-year survival rates are less than 5%

Answer 125

the mass is associated with EBV infection (nasopharyngeal carcinoma) (B - the lymphocytes are not neoplastic; C - it is radiosensitive; D - 5-year survival rates 50% even for advanced cancers) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 537

Question 126

In laryngeal carcinoma, which tumor location has the best prognosis? (A) supraglottis (B) glottis (C) sublottis (D) epiglottis

Answer 126

glottis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 538