PA25.1-7 | Respiratory System — Practice Quiz

On gross examination, a lobe of lung from a 55-year-old male who died of pneumonia appears grey, airless, and liver-like. Microscopically the alveoli are packed with neutrophils and fibrin strands, with no macrophages visible. Which stage of lobar pneumonia is this specimen in?

A 70-year-old bedridden patient with aspiration pneumonia develops a foul-smelling, thick purulent cough over 3 weeks. Chest X-ray shows a 4 cm cavity with an air-fluid level in the right lower lobe. The most likely causative organisms are:

A 38-year-old with a history of chronic heavy smoking presents with progressive dyspnoea. PFTs reveal FEV1/FVC = 0.62, increased TLC, and reduced DLCO. HRCT shows bilateral basal-predominant emphysema involving the lower zones with destruction spanning the full acinus from respiratory bronchiole to alveolar sac. Which morphological type of emphysema is this?

Chronic bronchitis is defined clinically. Microscopically, the pathological hallmark used to quantify mucous gland hypertrophy in bronchial biopsies is the Reid index. The Reid index is the ratio of:

A 60-year-old male with COPD is described as a 'pink puffer': thin, using accessory muscles, PaO2 relatively preserved, minimal cyanosis, and prominent dyspnoea. The underlying predominant pathological finding in this phenotype is:

A 28-year-old medical student with asthma dies suddenly during an acute exacerbation. At autopsy, the bronchi show plugged mucoid casts. Microscopy of the plugs reveals spirals of shed epithelium and rhomboid crystalline structures derived from eosinophil granule proteins. These findings are:

A 10-year-old child presents with a 3-week history of cough and low-grade fever. Chest X-ray shows a 1.5 cm calcified nodule in the lower lobe periphery with ipsilateral calcified hilar lymph nodes. The combination of peripheral nodule + draining hilar lymph node calcification is called the:

Histology of a caseating granuloma in pulmonary TB would characteristically show:

A 45-year-old sandstone quarry worker develops progressive exertional dyspnoea and radiological 'eggshell calcification' of hilar lymph nodes. His occupational history also puts him at significantly elevated risk for tuberculosis. The pathological pulmonary lesion is a:

A 55-year-old shipyard insulation worker presents with progressive dyspnoea and bilateral basal fine crackles over 10 years. HRCT shows bilateral basal sub-pleural reticulation and honeycombing. Bronchoalveolar lavage shows golden-brown dumbbell-shaped structures that stain with Prussian blue. These structures are best called:

A 65-year-old male, ex-smoker with 40 pack-years, presents with a central hilar mass on CT, post-obstructive pneumonia, and haemoptysis. Bronchoscopic biopsy shows a tumour with intercellular bridges and keratin pearl formation. This tumour is most likely:

A 62-year-old woman, never-smoker, presents with a peripheral 2.8 cm lung nodule. EBUS-guided biopsy shows a tumour with glandular formation, lepidic growth pattern, and TTF-1 positivity. Molecular testing is requested to identify a targetable driver mutation for first-line tyrosine kinase inhibitor therapy. The most clinically relevant mutation to test for in this tumour type is:

A 58-year-old male with a 30-year history of asbestos exposure presents with progressive unilateral chest pain, dyspnoea, and a pleural-based mass encasing the lung on CT. Pleural fluid cytology is inconclusive. Thoracoscopic biopsy shows elongated malignant cells growing along pleural surfaces. Immunohistochemistry is positive for calretinin, WT-1, and CK5/6, and negative for CEA and TTF-1. The diagnosis is:

A 52-year-old male coal miner with 25 years of underground work presents with progressive dyspnoea. Chest X-ray shows small round opacities (< 1 cm) predominantly in the upper and mid zones bilaterally. Histology of the lung shows carbon-laden macrophages aggregated around respiratory bronchioles with focal centrilobular emphysema. This is consistent with: