Pulmonology Practice Questions

Q: Which of the following is not used in the treatment of pulmonary hypertension?

Alpha blockers. **Explanation:** The treatment of Pulmonary Arterial Hypertension (PAH) focuses on reversing the imbalance between endogenous vasodilators and vasoconstrictors. **Alpha-blockers (Option B)** are not used in the management of pulmonary hypertension because they primarily act on peripheral systemic vasculature to treat systemic hypertension or benign prostatic hyperplasia. They have no significant effect on pulmonary vascular resistance and are not part of any established treatment guidelines. **Analysis of other options:** * **Calcium Channel Blockers (Option A):** These are used in a specific subset of patients (approx. 5-10%) who show a positive **vasoreactivity test** during right heart catheterization. High-dose CCBs (e.g., Nifedipine, Diltiazem) can significantly improve survival in these "responders." * **Prostacyclins (Option C):** Patients with PAH have a deficiency of prostacyclin (a potent vasodilator). Synthetic analogs like **Epoprostenol** (IV), Treprostinil, and Iloprost are mainstay treatments, especially for severe (WHO Class IV) disease. * **Endothelin Receptor Antagonists (Option D):** Endothelin-1 is a potent vasoconstrictor elevated in PAH. Drugs like **Bosentan** (dual ET-A & ET-B antagonist) and Ambrisentan block these receptors to induce vasodilation. **NEET-PG High-Yield Pearls:** 1. **Gold Standard Diagnosis:** Right Heart Catheterization (mPAP >20 mmHg at rest). 2. **Drug of Choice for Vasoreactive patients:** Calcium Channel Blockers. 3. **PDE-5 Inhibitors:** Sildenafil and Tadalafil are also used (increase cGMP). 4. **Soluble Guanylate Cyclase Stimulator:** Riociguat is used for both PAH and CTEPH (Chronic Thromboembolic Pulmonary Hypertension). 5. **Bosentan Side Effect:** Hepatotoxicity (requires monthly LFT monitoring) and teratogenicity.

Q: Bronchial adenoma commonly presents as which of the following?

Recurrent hemoptysis. **Explanation:** **Bronchial adenoma** is a misnomer historically used to describe a group of low-grade malignant neuroendocrine tumors, the most common being **Bronchial Carcinoid** (80-90%). **Why Recurrent Hemoptysis is the Correct Answer:** These tumors are typically **central/endobronchial** in location [1] and are characterized by extreme **hypervascularity**. Because they arise from the bronchial mucosa and have a rich blood supply, the most classic and frequent clinical presentation is **recurrent hemoptysis** [1]. The bleeding occurs when the fragile overlying mucosa or the tumor itself undergoes minor trauma during coughing or respiration. **Analysis of Incorrect Options:** * **B. Cough:** While cough is a common symptom due to endobronchial irritation, it is non-specific and seen in almost all pulmonary pathologies [2]. Hemoptysis is more characteristic and "classic" for this specific vascular tumor. * **C. Dyspnea:** This usually occurs late in the disease course if the tumor grows large enough to cause significant airway obstruction or collapse of a lung lobe (atelectasis) [1]. * **D. Chest pain:** This is uncommon unless the tumor involves the pleura or chest wall, which is rare for these typically central, slow-growing tumors. **NEET-PG High-Yield Pearls:** * **Most common type:** Carcinoid tumor (specifically Typical Carcinoid). * **Classic Sign:** "Iceberg lesion" (a small endobronchial component with a large extrabronchial extension). * **Diagnosis:** Bronchoscopy often reveals a "cherry-red" or pinkish vascular mass. **Biopsy** must be done cautiously due to the high risk of significant bleeding. * **Carcinoid Syndrome:** Rare in bronchial carcinoids (<5%) unless there are extensive liver metastases.

Q: Klebsiella pneumonia has all of the following characteristics except?

Lung abscess formation is very uncommon. **Explanation:** *Klebsiella pneumoniae* is a Gram-negative, encapsulated bacillus that typically causes severe, necrotizing pneumonia, particularly in patients with underlying risk factors like chronic alcoholism [1] or diabetes mellitus. **Why Option D is the correct answer:** The statement "Lung abscess formation is very uncommon" is **false**. *Klebsiella* is notorious for causing extensive tissue necrosis and alveolar wall destruction. This pathological process frequently leads to the formation of **lung abscesses** and cavitation. Therefore, saying it is "uncommon" is clinically inaccurate. **Analysis of Incorrect Options:** * **Option A (Upper lobes involved):** This is a classic feature. *Klebsiella* has a predilection for the upper lobes (especially the right upper lobe). The heavy, mucoid inflammatory exudate often causes the fissure to sag, known as the **"Bulging Fissure Sign"** on X-ray. * **Option B (Pneumatocele):** While more classically associated with *Staphylococcus aureus*, pneumatoceles (thin-walled, air-filled cysts) can occur in *Klebsiella* due to the necrotizing nature of the infection. * **Option C (Empyema):** Because *Klebsiella* causes significant pleural inflammation and parenchymal destruction, the progression to parapneumonic effusions and **empyema** is a frequent complication. **NEET-PG High-Yield Pearls:** * **Patient Profile:** Classically seen in alcoholics [1] ("Friedlander’s pneumonia"). Poor dental hygiene is also a consideration for Klebsiella infection [2]. * **Sputum:** Characterized by **"Currant Jelly Sputum"** (due to blood and thick capsular polysaccharides). * **Radiology:** Look for the **Bulging Fissure Sign**. * **Treatment:** Usually treated with third-generation cephalosporins, carbapenems, or aminoglycosides, though multi-drug resistance (KPC-producing strains) is a growing concern.

Q: Which of the following is an obstructive lung disease?

Emphysema. **Explanation:** Lung diseases are broadly classified into **Obstructive** and **Restrictive** patterns based on pulmonary function tests (PFTs). **1. Why Emphysema is Correct:** Emphysema is a classic **Obstructive Lung Disease** (along with Chronic Bronchitis, Asthma, and Bronchiolitis). The underlying pathology involves the destruction of alveolar walls and loss of elastic recoil [1]. This leads to the collapse of small airways during expiration, resulting in **increased airway resistance**, air trapping, and hyperinflation. On PFTs, this is characterized by a **decreased FEV1/FVC ratio (<0.7)** [2]. **2. Why the other options are Incorrect:** Options A, B, and D represent **Restrictive Lung Diseases**, characterized by reduced lung volumes (decreased TLC) but a normal or increased FEV1/FVC ratio. * **Interstitial Fibrosis (A):** An intrinsic restrictive disease where the lung parenchyma becomes stiff, limiting expansion. Pulmonary function tests typically show a restrictive ventilatory defect in the presence of small lung volumes and reduced gas transfer [3]. * **Obesity (B) and Kyphosis (D):** These are extrinsic (extra-parenchymal) restrictive disorders. They limit the chest wall's ability to expand, thereby reducing total lung capacity without obstructing the airways themselves. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Obstructive Diseases:** **CBABE** (Cronic Bronchitis, Bronchiectasis, Asthma, Bronchiolitis, Emphysema). * **DLCO (Diffusion Capacity):** In Emphysema, DLCO is **decreased** due to alveolar wall destruction [3]. In Asthma (another obstructive disease), DLCO is typically **normal or increased**. * **Flow-Volume Loop:** Obstructive diseases show a characteristic **"scooped-out"** appearance on the expiratory limb [2]. * **Residual Volume (RV):** RV and TLC are typically **increased** in obstructive diseases due to air trapping [1].

Q: The Kveim test is used for the diagnosis of which condition?

Sarcoidosis. **Explanation:** The **Kveim test** (also known as the Kveim-Siltzbach test) is a historical diagnostic tool for **Sarcoidosis**. It involves the intradermal injection of a heat-sterilized suspension of spleen or lymph node tissue derived from a patient with known sarcoidosis. If the patient has active sarcoidosis, a papule develops at the injection site within 4–6 weeks. A biopsy of this papule revealing **non-caseating granulomas** confirms a positive result. While highly specific, it is rarely used in modern clinical practice due to the risk of infection transmission (e.g., BSE, HIV) and the availability of safer diagnostic methods like EBUS-guided biopsy. **Analysis of Incorrect Options:** * **Sicca syndrome (Sjogren’s Syndrome):** Diagnosed via the Schirmer test (tear production), salivary gland biopsy (focus score), and autoantibodies (Anti-Ro/SSA, Anti-La/SSB). * **Scleroderma (Systemic Sclerosis):** Diagnosis is clinical, supported by skin thickening (Rodnan skin score) and autoantibodies like Anti-Scl-70 (topoisomerase I). * **C.R.E.S.T syndrome:** A limited form of systemic sclerosis characterized by Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. The hallmark antibody is **Anti-centromere antibody**. **NEET-PG High-Yield Pearls:** * **Sarcoidosis Hallmark:** Bilateral hilar lymphadenopathy on CXR and elevated Serum ACE levels [1]. * **Lofgren’s Syndrome:** A triad of Erythema nodosum, bilateral hilar lymphadenopathy, and polyarthritis (favorable prognosis) [1]. * **Heerfordt’s Syndrome (Uveoparotid fever):** Parotitis, Uveitis, and Facial nerve palsy. * **Asteroid bodies and Schaumann bodies** are characteristic microscopic findings in sarcoid granulomas.

Q: All of the following are common causes of community-acquired pneumonia EXCEPT:

Staphylococcus. **Explanation:** The question asks for the organism that is **not** a common cause of Community-Acquired Pneumonia (CAP). While *Staphylococcus aureus* can cause pneumonia, it is considered an **uncommon** cause of CAP in the general healthy population, typically accounting for less than 1–5% of cases [1]. **1. Why Staphylococcus is the Correct Answer:** *Staphylococcus aureus* is primarily associated with **Hospital-Acquired Pneumonia (HAP)** or Ventilator-Associated Pneumonia (VAP) [3]. In the community setting, it usually only occurs as a secondary bacterial infection following an **Influenza virus** infection (post-viral pneumonia) or in specific risk groups like IV drug users (via hematogenous spread) [1]. **2. Analysis of Incorrect Options:** * **Streptococcus pneumoniae (Option D):** This is the **most common** cause of CAP worldwide across all age groups [1]. It typically presents with lobar consolidation and "rusty" sputum [2]. * **Mycoplasma pneumoniae (Option B):** The most common cause of **"Atypical Pneumonia,"** especially in young adults and school-aged children. It often presents with extrapulmonary symptoms like bullous myringitis or hemolytic anemia. * **Chlamydia pneumoniae (Option C):** Another frequent cause of atypical CAP, often manifesting as a mild, subacute respiratory illness in young adults. **NEET-PG High-Yield Pearls:** * **Most common cause of CAP:** *Streptococcus pneumoniae* [1]. * **Most common atypical cause:** *Mycoplasma pneumoniae*. * **Post-Influenza Pneumonia:** Think *S. aureus* (look for cavitary lesions or pneumatoceles on X-ray) [1]. * **Alcoholics/Diabetes:** Think *Klebsiella pneumoniae* ("currant jelly" sputum) [2]. * **Air conditioners/Water cooling towers:** Think *Legionella pneumophila* (associated with hyponatremia and GI symptoms) [1].

Q: All the following are true about Chronic Obstructive Pulmonary Disease (COPD) except:

Decreased diffusion capacity. **Explanation:** The core pathophysiology of **Chronic Obstructive Pulmonary Disease (COPD)** involves airflow obstruction and air trapping [1]. COPD is an umbrella term encompassing **Chronic Bronchitis** and **Emphysema**. **Why "Decreased Diffusion Capacity" is the correct (Except) answer:** Diffusion capacity (DLCO) is **not** decreased in all forms of COPD. While DLCO is significantly reduced in **Emphysema** (due to the destruction of the alveolar-capillary membrane), it remains **normal** in **Chronic Bronchitis**. Since the question asks for a statement true for "COPD" as a whole, "Decreased diffusion capacity" is the incorrect generalization [2]. **Analysis of other options:** * **A. Decreased FEV1:** This is the hallmark of obstructive lung disease. Inflammation and airway narrowing lead to a reduced Forced Expiratory Volume in 1 second [1]. * **B. Decreased MEFR:** Maximal Expiratory Flow Rate (MEFR) reflects the flow during the middle portion of expiration. In COPD, premature airway closure leads to a significant reduction in flow rates. * **C. Increased RV:** Air trapping occurs because airways collapse during expiration [3]. This leads to an increase in **Residual Volume (RV)** and Total Lung Capacity (TLC), manifesting clinically as hyperinflation (barrel chest). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Post-bronchodilator FEV1/FVC ratio **< 0.70**. * **Pink Puffers (Emphysema):** High V/Q ratio, decreased DLCO, thin build [2]. * **Blue Bloaters (Chronic Bronchitis):** Low V/Q ratio, normal DLCO, cyanosis, and edema [2]. * **Reversibility:** Unlike asthma, the airflow obstruction in COPD is typically **not fully reversible** with bronchodilators.

Question 1

Which of the following is not used in the treatment of pulmonary hypertension?

Accepted Answer

Alpha blockers

Answer

Calcium channel blockers

Answer

Prostacyclins

Answer

Endothelin receptor antagonists

Question 2

A 61-year-old man presents with a persistent, non-productive cough for 1 month. He has no other symptoms. He has been smoking approximately 20 bidis per day for the last 25 years. Physical examination is normal. What is the appropriate line of management?

Accepted Answer

Perform a chest X-ray and refer to a smoking cessation clinic

Answer

Reassurance and advice to quit smoking

Answer

Prescribe oral antibiotics for 7 days

Answer

Perform a CT thorax to visualize pathology

Question 3

Bronchial adenoma commonly presents as which of the following?

Accepted Answer

Recurrent hemoptysis

Answer

Cough

Answer

Dyspnea

Answer

Chest pain

Question 4

A 26-year-old African-American woman presents with bilateral hilar adenopathy. Radiography reveals multiple reticular densities in both lung fields. A bronchoscopic biopsy shows granulomatous inflammation with multiple giant cells but no evidence of caseous necrosis. What is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Aspergillosis

Answer

Tuberculosis

Answer

Histoplasmosis

Question 5

Klebsiella pneumonia has all of the following characteristics except?

Accepted Answer

Lung abscess formation is very uncommon

Answer

Upper lobes are frequently involved

Answer

Pneumatocele may occur commonly

Answer

Empyema is much more common

Question 6

Which of the following is an obstructive lung disease?

Accepted Answer

Emphysema

Answer

Interstitial fibrosis

Answer

Obesity

Answer

Kyphosis

Question 7

The Kveim test is used for the diagnosis of which condition?

Accepted Answer

Sarcoidosis

Answer

Sicca syndrome

Answer

Scleroderma

Answer

C.R.E.S.T syndrome

Question 8

All of the following are true for sarcoidosis except?

Accepted Answer

Caseating epithelioid granulomas

Answer

Kveim test is the most specific test for sarcoidosis

Answer

Most commonly involves lungs

Answer

Unknown etiology

Question 9

All of the following are common causes of community-acquired pneumonia EXCEPT:

Accepted Answer

Staphylococcus

Answer

Mycoplasma

Answer

Chlamydia pneumoniae

Answer

Streptococcus

Question 10

All the following are true about Chronic Obstructive Pulmonary Disease (COPD) except:

Accepted Answer

Decreased diffusion capacity

Answer

Decreased FEV1

Answer

Decreased MEFR

Answer

Increased RV

Pulmonology — MCQs

Pulmonology — MCQs

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