Pulmonology Practice Questions

Q: Regarding Allergic Bronchopulmonary Aspergillosis, which of the following is NOT true?

Peripheral bronchiectasis. **Explanation:** **Allergic Bronchopulmonary Aspergillosis (ABPA)** is a complex hypersensitivity reaction to *Aspergillus fumigatus* that occurs primarily in patients with bronchial asthma or cystic fibrosis [1]. **1. Why "Peripheral Bronchiectasis" is the correct answer (The False Statement):** In ABPA, the characteristic radiological finding is **Central Bronchiectasis** (involving the medial two-thirds of the lung fields), typically affecting the upper and middle lobes. This occurs because the thick, tenacious mucus plugs containing *Aspergillus* hyphae lodge in the large proximal airways, leading to wall destruction and dilation. **Peripheral bronchiectasis** is not a feature of ABPA; in fact, the presence of peripheral sparing while having central dilation is a classic diagnostic clue. **2. Analysis of Other Options:** * **A. Peripheral blood eosinophilia:** This is a hallmark of ABPA (usually >1000 cells/μL). It reflects the systemic inflammatory response to the fungal antigens. * **B. Elevated IgE:** Total serum IgE levels are characteristically very high (often >1000 IU/mL) [1]. It is used both for diagnosis and for monitoring treatment response/relapses. * **D. Type I hypersensitivity reaction:** ABPA is unique because it involves a combination of **Type I** (IgE-mediated mast cell degranulation), **Type III** (Immune-complex mediated), and **Type IV** (cell-mediated) hypersensitivity reactions. Since Type I is a major component, this statement is true [1]. **Clinical Pearls for NEET-PG:** * **Classic Sign:** "Finger-in-glove" appearance on Chest X-ray/CT (due to mucoid impaction). * **Diagnosis:** Rosenberg-Patterson Criteria. * **Treatment:** Oral Corticosteroids (to reduce inflammation) + Itraconazole (to reduce fungal burden). * **High-Yield:** ABPA is a common cause of "refractory asthma" or "difficult-to-treat asthma." Always check IgE levels in such patients.

Q: Kartagener syndrome is not associated with which of the following?

Subluxation of lens. **Explanation:** **Kartagener Syndrome** is a subset of **Primary Ciliary Dyskinesia (PCD)**, an autosomal recessive disorder characterized by the structural and functional impairment of cilia. The classic triad of Kartagener syndrome includes **Situs inversus, Bronchiectasis, and Sinusitis.** 1. **Why Subluxation of Lens is the Correct Answer:** Subluxation of the lens (Ectopia lentis) is not a feature of Kartagener syndrome. It is typically associated with connective tissue disorders like **Marfan syndrome** (upward dislocation) or **Homocystinuria** (downward dislocation). Ciliary dysfunction in Kartagener syndrome affects motile cilia, whereas lens stability depends on zonular fibers (fibrillin), which are unrelated to ciliary motility. 2. **Analysis of Incorrect Options:** * **Situs inversus (Option A):** Occurs in 50% of patients with PCD. During embryogenesis, normal ciliary beat is required for the left-right patterning of internal organs. Absent ciliary function leads to random organ placement. * **Bronchiectasis (Option C):** Impaired mucociliary clearance leads to chronic endobronchial infections, resulting in permanent dilation of the bronchi. * **Sinusitis (Option D):** Ciliary dysfunction in the paranasal sinuses prevents mucus drainage, leading to chronic inflammation and recurrent infections. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad:** Bronchiectasis + Sinusitis + Situs Inversus. * **Infertility:** Common in males due to immotile spermatozoa (flagella are modified cilia) and in females due to impaired ciliary action in the fallopian tubes. * **Diagnosis:** Screening via **Nasal Nitric Oxide (nNO)** levels (low in PCD). Gold standard is **Digital High-Speed Videomicroscopy** or Electron Microscopy (showing absence of dynein arms). * **Genetics:** Most common defect is the absence of **outer dynein arms**.

Q: All of the following are causes of transudative pleural effusion EXCEPT:

Rheumatoid arthritis. **Explanation:** The differentiation between transudative and exudative pleural effusions is a high-yield topic for NEET-PG, typically governed by **Light’s Criteria**. **Why Rheumatoid Arthritis (RA) is the correct answer:** Rheumatoid arthritis causes an **exudative** pleural effusion [1]. The underlying mechanism is local inflammation of the pleura (pleuritis), which increases capillary permeability, allowing proteins and cells to leak into the pleural space [2]. * **High-Yield Fact:** RA pleural fluid is characteristically associated with **very low glucose levels (<30 mg/dL)**, low pH, and high LDH [1]. **Analysis of Incorrect Options (Transudative Causes):** Transudates occur due to systemic factors altering hydrostatic or oncotic pressure, without primary pleural disease. * **Nephrotic Syndrome:** Causes decreased plasma oncotic pressure due to severe hypoalbuminemia, leading to fluid leakage. * **Constrictive Pericarditis:** Increases systemic venous hydrostatic pressure, forcing fluid into the pleural space. * **Myxedema (Hypothyroidism):** While it can occasionally be exudative, it is a classic recognized cause of transudative effusion (often multifactorial, involving increased capillary permeability or decreased lymphatic drainage). **NEET-PG Clinical Pearls:** 1. **Most common cause of Transudate:** Congestive Heart Failure (CHF). 2. **Most common cause of Exudate:** Bacterial pneumonia (Parapneumonic effusion) and Malignancy. 3. **Meigs’ Syndrome:** Triad of benign ovarian tumor (fibroma), ascites, and pleural effusion (usually transudative). 4. **Superior Vena Cava (SVC) Obstruction:** Can cause both transudative and exudative effusions.

Q: Bilateral pleural plaques and pulmonary fibrosis involving bases is a hallmark of which condition?

Asbestosis. The clinical presentation of bilateral pleural plaques and basal pulmonary fibrosis is the classic hallmark of **Asbestosis**. 1. **Why Asbestosis is correct:** Asbestos fibers are inhaled and deposited in the distal airways and alveoli. Unlike many other pneumoconioses, asbestos primarily affects the **lower lobes (bases)** [1]. The most specific radiographic finding for asbestos exposure is **pleural plaques** (calcified or non-calcified), typically involving the parietal pleura and the diaphragm. When interstitial fibrosis occurs due to these fibers, the condition is termed Asbestosis [1]. 2. **Why other options are incorrect:** * **Silicosis:** Characteristically involves the **upper lobes** [2]. It presents with "eggshell calcification" of hilar lymph nodes and nodular opacities, not isolated pleural plaques [2]. * **Scleroderma:** While it causes basal pulmonary fibrosis (NSIP pattern), it is a systemic autoimmune disease and does **not** cause pleural plaques. * **Byssinosis:** Caused by cotton dust exposure. It is an airway disease (occupational asthma/bronchitis) characterized by "Monday chest tightness" and does not cause pleural plaques or significant interstitial fibrosis. **High-Yield Pearls for NEET-PG:** * **Pathognomonic finding:** Ferruginous bodies (asbestos bodies) seen on Prussian blue stain (iron-coated fibers) [1]. * **Most common malignancy:** Bronchogenic carcinoma (risk is synergistically increased with smoking). * **Most specific malignancy:** Mesothelioma (rare, but highly associated with asbestos; smoking does *not* increase risk). * **Imaging:** HRCT shows subpleural curvilinear lines and honeycombing in advanced stages [1].

Q: Hypersensitivity pneumonitis is caused by which of the following?

Bagassosis. Explanation: Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, is an immunologically mediated inflammation of the lung parenchyma (alveoli and bronchioles) caused by intense or repeated inhalation of organic dusts or certain chemicals. Why Bagassosis is correct: Bagassosis is a classic example of HP caused by inhalation of thermophilic actinomycetes (specifically Thermoactinomyces sacchari) found in moldy sugar cane residue (bagasse). It involves a Type III (immune complex) and Type IV (cell-mediated) hypersensitivity reaction. Other common examples include Farmer’s lung (moldy hay) and Bird fancier’s lung (avian proteins) [1]. Why the other options are incorrect: * Coal worker's pneumoconiosis (A) and Silicosis (C): These are Pneumoconioses, which are restrictive lung diseases caused by the inhalation of inorganic mineral dusts (coal dust and silica, respectively). Unlike HP, these are not primarily immunological "allergic" reactions but rather chronic fibrotic responses to mineral particles. * Sarcoidosis (D): This is a multisystem granulomatous disease of unknown etiology. While it shares some radiological features with HP (like ground-glass opacities or nodules), it is not triggered by a specific external organic allergen. High-Yield Clinical Pearls for NEET-PG: * Histopathology: HP typically shows non-caseating, poorly formed (loose) granulomas and "triad" of bronchiolitis, interstitial pneumonitis, and fibrosis [1]. * Radiology: Acute HP shows ground-glass opacities [1]; Chronic HP shows a "Headcheese sign" (mosaic attenuation) on HRCT. In cases of acute HP, the chest X-ray typically shows ill-defined patchy airspace shadowing [1]. * Management: The most crucial step is the removal of the offending antigen. Steroids are used for symptomatic relief in acute/subacute stages.

Question 1

Regarding Allergic Bronchopulmonary Aspergillosis, which of the following is NOT true?

Accepted Answer

Peripheral bronchiectasis

Answer

Peripheral blood eosinophilia

Answer

Elevated IgE

Answer

Type I hypersensitivity reaction

Question 2

A patient with severe neurological devastation after head trauma has been mechanically ventilated for their entire hospital stay. Which of the following clinical findings is diagnostic of ventilator-associated pneumonia?

Accepted Answer

Greater than 10,000 colony-forming U/mL of an organism on bronchoalveolar lavage

Answer

White blood cell count of greater than 12,000/mm³

Answer

Greater than 1,000 colony-forming U/mL of an organism on bronchoalveolar lavage

Answer

Purulent tracheal secretions

Question 3

A 50-year-old male smoker presents with chronic shortness of breath. Physical examination reveals a pulse of 110 bpm, normal temperature, respirations of 30/min with accessory muscle use and pursed-lip breathing, and blood pressure of 110/78 mm Hg. Cardiac examination shows the apex beat medial to the midclavicular line, and lung examination reveals generalized decreased breath sounds. Arterial blood gases on room air show a pH of 7.38, PCO2 of 47 mm Hg, and PO2 of 67 mm Hg. Pulmonary function tests show FVC 2.80 L (67% of predicted), FEV1 1.56 L (50% of predicted), FEV1/FVC ratio of 56%, TLC 134% of predicted, RV 170% of predicted, and DLCO 43% of predicted. There is no reversibility with bronchodilators. What is the most likely diagnosis?

Accepted Answer

Emphysema

Answer

Bronchial asthma with status asthmaticus

Answer

Chronic bronchitis

Answer

Tuberous sclerosis

Question 4

A patient presents with a pH of 7.2, pO2 of 46, and pCO2 of 80. What condition do these arterial blood gas values indicate?

Accepted Answer

Acute exacerbation of asthma

Answer

Idiopathic pulmonary fibrosis

Answer

Cystic fibrosis

Answer

Allergic bronchopulmonary aspergillosis (ABPA)

Question 5

Kartagener syndrome is not associated with which of the following?

Accepted Answer

Subluxation of lens

Answer

Situs inversus

Answer

Bronchiectasis

Answer

Sinusitis

Question 6

All of the following are causes of transudative pleural effusion EXCEPT:

Accepted Answer

Rheumatoid arthritis

Answer

Nephrotic syndrome

Answer

Constrictive pericarditis

Answer

Myxedema

Question 7

Bilateral pleural plaques and pulmonary fibrosis involving bases is a hallmark of which condition?

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Scleroderma

Answer

Byssinosis

Question 8

Which of the following collagen disorders is NOT commonly associated with pulmonary fibrosis?

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Progressive systemic sclerosis

Answer

Rheumatoid arthritis

Question 9

A 25-year-old male with Sturge Weber syndrome and HBS positive status presents with high-grade fever, chills, rigor, followed by pleuritic chest pain. He also reports cough, breathlessness, and yellow sputum. A chest X-ray shows non-homogenous opacity in the right lower zone with an air bronchogram. What is the most likely diagnosis in this setting?

Accepted Answer

Pneumonia

Answer

Pulmonary infarction

Answer

Pulmonary hemorrhage

Answer

Pulmonary hypertension

Question 10

Hypersensitivity pneumonitis is caused by which of the following?

Accepted Answer

Bagassosis

Answer

Coal worker's pneumoconiosis

Answer

Silicosis

Answer

Sarcoidosis

Pulmonology — MCQs

Pulmonology — MCQs

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