Question 1

The accompanying photomicrograph shows a section of lung that had been resected from the right upper lobe of a 73 year old male who had smoked two packs of cigarettes a day since the age of 18.The inherent danger of bullae formation (B)in emphysema is the distinct possibility of which one of the following pathophysiologic events? 
A)Aspergillus infection
B)Heart failure
C)Lung cancer
D)Pneumothorax
E)Tuberculosis

Accepted Answer

While all of the listed events can occur with emphysema,the formation of bullae is most closely linked to the possibility of their rupture,with subsequent pneumothorax.It is feasible that the reason this apical portion of the lung was resected in the vignette was precisely because of the occurrence of such an event.

Question 2

A 54 year old male with a long history of congestive heart failure due to coronary artery disease brought about by smoking presented at the Emergency Department in acute respiratory distress.He was coughing up copious amounts of pink,frothy fluid.Unfortunately,he died,and the family requested an autopsy.A representative section of his lung is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma of the lung
B)Pulmonary oedema
C)Pulmonary embolism
D)Pulmonary fibrosis
E)Pulmonary infarct

Accepted Answer

The clinical vignette and the photomicrograph should both suggest the diagnosis of pulmonary oedemAThe frothy,pink fluid the patient is coughing up is typical.Fibrosis would eliminate all of the alveolar septae visible in the photomicrograph,and an infarct would cause extensive hemorrhagE

Question 3

At autopsy of a 69 year old man,the lungs had the appearance shown in the accompanying photomicrographs.Which one of the following is the best diagnosis? 
A)Adenocarcinoma
B)Asbestosis
C)Chronic bronchitis
D)Emphysema
E)Silicosis

Accepted Answer

Asbestos is diagnosed by finding so-called ferruginous bodies,which are brown under the microscope,and may provoke a granulomatous response,as seen herEAsbestos is associated with squamous cell carcinoma of the lung,and,more famously,with mesothelioma,a malignant tumour of the pleurA

Question 4

A 53 year old woman with a 40 pack year smoking history consulted her physician for a chronic cough.A chest x-ray disclosed an infiltrate in the right middle lobe.She was treated with two courses of antibiotics,but six weeks later,the infiltrate had not improved.A bronchoscopic biopsy was performed,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma
B)Bronchioloalveolar carcinoma
C)Carcinoid tumour
D)Large cell undifferentiated carcinoma
E)Small cell carcinoma 
F)Squamous cell carcinoma

Accepted Answer

Bronchioloalveolar carcinoma is an unusual malignancy that does not present as a distinct mass in the lung,and is often mistaken for pneumonia,as suggested in the clinical vignettEThe microscopic picture is pathognomonic,with large,often mucin-secreting cells lining the alveolar septaEThe tumour is classified as an adenocarcinoma,but bronchioloalveolar carcinoma is a more specific term for this histological pattern.

Question 5

The accompanying photomicrograph compares normal bronchial mucosa (left)with abnormal mucosa (right).The magnification is approximately the same.Which one of the following is the best diagnosis for the tissue depicted on the right? 
A)Chronic bronchitis
B)Emphysema
C)Neoplasia (cancer)
D)Pneumonia
E)Tuberculosis

Accepted Answer

The mucosa on the right is thickened by inflammation (In),hypertrophy of smooth muscle (M),and hyperplasia of mucinous glands (G).This condition is known as chronic bronchitis,and can be part of the clinical picture of chronic obstructive pulmonary disease (COPD).It is often caused by smoking,which can also lead to squamous metaplasia,and lack of cilial transport of excess mucus out of the respiratory treEIt often co-exists with emphysemA

Question 6

A 58-year-old white male with a 40 pack year smoking history presented to his local physician complaining of hoarseness for over one month.Laryngoscopy revealed an invasive tumour.A total laryngectomy was then performed,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma
B)Condyloma acuminatum
C)Squamous cell carcinoma
D)Squamous papilloma
E)Transitional cell carcinoma

Accepted Answer

Both the clinical vignette and the photomicrograph should lead you to the diagnosis of squamous cell carcinomAInvasive,keratinising (K)tongues of tumour can be seen at the right of the photograph.

Question 7

A 23 year old woman was seen by her primary care physician for a nasal obstruction.A polyp was seen and removed.A representative section is shown in the accompanying photomicrograph.From the histological appearance,which one of the following aetiological events is likely in this case? 
A)Allergic sinusitis
B)Bacterial sinusitis
C)Neoplasm due to smoking
D)Parasitic infection
E)Viral sinusitis

Accepted Answer

The large number of eosinophils (Eo)suggests the diagnosis of either a parasitic infection (very rare)or an allergic reaction (very common).Nasal polyps are often seen in those patients with allergic sinusitis,or "hay fever".

Question 8

A 65 year old woman with a long history of smoking was found dead at home.An autopsy was requested by the family.They reported that she had recently been experiencing increasing breathlessness.A representative section from her lung is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma of the lung
B)Pulmonary oedema
C)Pulmonary embolism
D)Pulmonary fibrosis
E)Pulmonary infarct

Accepted Answer

The photomicrograph shows extensive fibrosis of alveolar septae (A),along with some chronic inflammation (In).The histological pattern associated with this diagnosis is described as usual interstitial pneumonitis.

Question 9

A 64 year old man with a 60 pack year smoking history was seen by his local physician for fatigue.He also reported having lost 20 pounds over the previous two months,while eating his normal diet.Chest x-ray disclosed a 4 cm mass near the left lung hilum.An endoscopic biopsy was performed,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma
B)Bronchioloalveolar carcinoma
C)Carcinoid tumour
D)Large cell undifferentiated carcinoma
E)Small cell carcinoma 
F)Squamous cell carcinoma

Accepted Answer

The small,blue cells with little cytoplasm are typical of small cell carcinomAMitotic figures may be frequent (M),and the tumour is often found to be metastatic at the time of diagnosis.

Question 10

A 54 year old woman consulted her physician for a chronic,non-productive cough and fatigue.She had smoked approximately two packs of cigarettes a day for 35 years.A chest x-ray revealed a 6 cm hilar mass compressing the right main bronchus.An endoscopic biopsy was performed,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Adenocarcinoma
B)Bronchioloalveolar carcinoma
C)Carcinoid tumour
D)Large cell undifferentiated carcinoma
E)Small cell carcinoma 
F)Squamous cell carcinoma

Accepted Answer

Large cell undifferentiated carcinomas include extremely poorly differentiated squamous cell carcinomas and adenocarcinomas with no discernible features of squamous or glandular differentiation by light microscopy,although such features can (sometimes)be seen on electron microscopy.These tumours consist of large,anaplastic epithelial cells growing in islands and sheets.By definition,no evidence of keratinisation,intercellular bridges or intracytoplasmic mucin is seen.

Question 11

An otherwise well 68 year old woman presents at the Emergency Department with fever and shortness of breath.A chest-x-ray shows patchy lung infiltrates bilaterally.A pneumonologist is consulted,who then performs a bronchoscopic biopsy,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis? 
A)Aspergillus pneumonia
B)Bronchopneumonia
C)CMV pneumonitis
D)Lobar pneumonia
E)Pneumocystis jirovecii pneumonia

Accepted Answer

The chest x-ray suggests bronchopneumonia,as does the clinical history.The biopsy (which probably wasn't necessary,but useful in order to ask the question)shows an acute inflammatory infiltrate focus on a small bronchiole,but also involving surrounding alveolar spaces.In lobar pneumonia,bronchial involvement is usually not seen.

Quiz 12: Respiratory System

At autopsy of a 69 year old man,the lungs had the appearance shown in the accompanying photomicrographs.Which one of the following is the best diagnosis?

The accompanying photomicrograph compares normal bronchial mucosa (left) with abnormal mucosa (right) .The magnification is approximately the same.Which one of the following is the best diagnosis for the tissue depicted on the right?

A 23 year old woman was seen by her primary care physician for a nasal obstruction.A polyp was seen and removed.A representative section is shown in the accompanying photomicrograph.From the histological appearance,which one of the following aetiological events is likely in this case?