Pulmonology Practice Questions

Q: Acute Respiratory Distress Syndrome (ARDS) is associated with which of the following conditions?

All the above. **Explanation:** Acute Respiratory Distress Syndrome (ARDS) is a clinical syndrome characterized by acute onset of non-cardiogenic pulmonary edema, severe hypoxemia, and decreased lung compliance [1]. It results from a diffuse inflammatory injury to the alveolar-capillary membrane, triggered by either **direct** lung injury or **indirect** systemic insults. **Analysis of Options:** * **Acute Pancreatitis (Indirect Injury):** This is a classic systemic cause. The release of large amounts of pancreatic enzymes (phospholipase A2) and systemic inflammatory mediators into the circulation leads to systemic inflammatory response syndrome (SIRS), which damages the pulmonary capillary endothelium. * **Trauma (Indirect/Direct Injury):** Major trauma, especially involving long bone fractures (fat embolism), head injury, or massive blood transfusions (TRALI), triggers a massive cytokine storm that leads to ARDS [2]. * **Severe Falciparum Malaria (Indirect Injury):** ARDS is a dreaded complication of severe malaria. It is caused by the sequestration of parasitized RBCs in the pulmonary microvasculature and the subsequent intense host inflammatory response. Since all three conditions are well-documented triggers for the inflammatory cascade leading to ARDS, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Berlin Criteria:** Acute onset (<1 week), bilateral opacities on imaging (not explained by effusions/collapse), and $PaO_2/FiO_2$ ratio $\leq 300$ mmHg with PEEP $\geq 5 \text{ cm } H_2O$ [1]. * **PCWP:** In ARDS, the Pulmonary Capillary Wedge Pressure is typically **$< 18 \text{ mmHg}$** (ruling out cardiogenic edema). * **Management:** The mainstay is **Low Tidal Volume Ventilation** (6 mL/kg of predicted body weight) to prevent volutrauma and barotrauma. * **Most common cause:** Sepsis (overall) and Pneumonia (direct).

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: The majority of cases of community-acquired pneumonia are due to infection with which organism?

Streptococcus pneumoniae. **Explanation:** **Streptococcus pneumoniae** (Pneumococcus) remains the most common cause of community-acquired pneumonia (CAP) worldwide, accounting for approximately 30–50% of cases where an etiology is identified [1]. It is a Gram-positive, lancet-shaped diplococcus [1]. The pathogenesis involves the aspiration of oropharyngeal flora into the lower respiratory tract, leading to classic lobar consolidation. **Analysis of Incorrect Options:** * **Legionella pneumophila:** This is an "atypical" pathogen often associated with contaminated water sources (air conditioning, cooling towers) [1]. While it can cause severe pneumonia with multisystem involvement (hyponatremia, diarrhea, elevated LFTs), it is far less common than *S. pneumoniae*. * **Haemophilus influenzae:** This is the second most common bacterial cause of CAP. It is particularly prevalent in patients with underlying chronic obstructive pulmonary disease (COPD) or smoking history, but it does not surpass Pneumococcus in overall incidence. * **Staphylococcus aureus:** This is a less common cause of CAP but often follows a viral prodrome (e.g., post-influenza pneumonia) [1]. It is associated with necrotizing pneumonia, cavitations, and pneumatoceles. **Clinical Pearls for NEET-PG:** 1. **Classic Presentation:** *S. pneumoniae* typically presents with sudden onset high-grade fever, productive cough with **"rusty-colored" sputum**, and pleuritic chest pain [2]. 2. **Radiology:** Characteristically shows **lobar consolidation**. 3. **Vaccination:** Two types are available—PPSV23 (polysaccharide) and PCV13 (conjugate)—recommended for the elderly and immunocompromised. 4. **Most common cause of CAP in HIV patients:** Still *Streptococcus pneumoniae*, though *Pneumocystis jirovecii* is a significant opportunistic consideration [1].

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.

Question 1

Acute Respiratory Distress Syndrome (ARDS) is associated with which of the following conditions?

Accepted Answer

All the above

Answer

Acute pancreatitis

Answer

Trauma

Answer

Severe falciparum malaria

Question 2

A 50-year-old male presented with complaints of cough with expectoration, fever, and malaise for 3 weeks. The patient is a chronic alcoholic and has had frequent hospitalizations in the past. On examination, he has extremely poor dentition, foul-smelling sputum, and wheezing over the upper zone of the right lung. A chest x-ray and a CT scan were conducted. Which is the most appropriate therapy to be given in the above condition?

Accepted Answer

Clindamycin

Answer

Penicillin

Answer

Metronidazole

Answer

Aztreonam

Question 3

All of the following statements about Non-Small Cell Lung Carcinoma (NSCLC) are true, except:

Accepted Answer

Gefitinib is most effective for female non-smokers with adenocarcinoma on histology.

Answer

Contralateral mediastinal nodes are a contraindication to surgical resection.

Answer

Single agent chemotherapy is preferred for patients > 70 years with advanced disease.

Answer

Squamous cell carcinoma is the most common NSCLC amongst the Asian population.

Question 4

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 5

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 6

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 7

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 8

The majority of cases of community-acquired pneumonia are due to infection with which organism?

Accepted Answer

Streptococcus pneumoniae

Answer

Legionella pneumophila

Answer

Haemophilus influenzae

Answer

Staphylococcus aureus

Question 9

Which of the following is NOT a cause of central cyanosis?

Accepted Answer

Congestive heart failure

Answer

Chronic Asthma

Answer

Congenital Pulmonary stenosis

Answer

Alveolar hypoventilation

Question 10

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

Accepted Answer

Rheumatoid arthritis

Answer

Nephrotic syndrome

Answer

Constrictive pericarditis

Answer

Myxedema

Pulmonology — MCQs

Pulmonology — MCQs

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