Pulmonology Practice Questions

Q: A 65-year-old man presented with hemoptysis and stage 3 clubbing. What is the probable diagnosis?

Non-small cell lung cancer. ### Explanation The combination of **hemoptysis** and **Stage 3 clubbing** in an elderly patient is a classic presentation for **Bronchogenic Carcinoma**, specifically **Non-Small Cell Lung Cancer (NSCLC)** [1]. **1. Why Non-Small Cell Lung Cancer (NSCLC) is correct:** Clubbing (Hypertrophic Pulmonary Osteoarthropathy) is a common paraneoplastic manifestation of lung malignancies [1]. Crucially, it is **frequently associated with NSCLC** (especially Adenocarcinoma and Squamous cell carcinoma). Hemoptysis in an elderly smoker is a "red flag" symptom that strongly points toward a primary endobronchial malignancy [1]. **2. Why the other options are incorrect:** * **Small Cell Lung Cancer (SCLC):** While SCLC causes hemoptysis and various paraneoplastic syndromes (like SIADH or Cushing’s), it is **rarely associated with clubbing** [1]. * **Tuberculosis (TB):** TB is a leading cause of hemoptysis; however, it typically presents with constitutional symptoms [2]. While chronic TB can cause clubbing, the association is much stronger with malignancy in this age group [2]. * **Sarcoidosis:** This typically presents with bilateral hilar lymphadenopathy and dry cough. Clubbing is **extremely rare** in sarcoidosis and only occurs in advanced Stage IV (fibrotic) disease. **Clinical Pearls for NEET-PG:** * **Stages of Clubbing:** Stage 3 is characterized by increased curvature of the nail in all dimensions (**"Parrot Beak"** appearance) and obliterated Schamroth’s window. * **Hypertrophic Osteoarthropathy (HOA):** When clubbing is associated with periostitis of long bones and joint swelling, it is most commonly due to **Adenocarcinoma** of the lung [1]. * **SCLC vs. NSCLC:** Remember, **"S"**mall cell is associated with **"S"**IADH and **"S"**yndrome of ectopic ACTH, but **NOT** usually with clubbing [1].

Q: A 74-year-old woman, in otherwise good health, sustained a leg injury 2 days ago and has been bedridden since the accident. Two hours ago, she became delirious. On physical examination, her temperature is 99 F, blood pressure is 120/70 mmHg, heart rate is 110, and respiratory rate is 32. Pulse oximetry shows an oxygen saturation of 80%, and a chest x-ray film is normal. Which of the following is the most likely diagnosis?

Pulmonary thromboembolism. ### Explanation The correct diagnosis is **Pulmonary Thromboembolism (PTE)**. **1. Why Pulmonary Thromboembolism is Correct:** The patient presents with the classic triad of **Virchow’s Triad** components: stasis (bedridden for 2 days) and advanced age. In elderly patients with lower limb injuries, the risk of Deep Vein Thrombosis (DVT) leading to PTE is high. * **Clinical Presentation:** Sudden onset of tachycardia, tachypnea, and significant hypoxia (SpO2 80%) with a **normal chest X-ray** is a hallmark of PTE. * **Delirium:** In the elderly, acute hypoxia often manifests as delirium or altered mental status rather than classic dyspnea. **2. Why Other Options are Incorrect:** * **Acute Cerebral Hemorrhage/Infarction:** While these cause delirium, they do not typically cause profound hypoxia (80%) or a respiratory rate of 32 in the absence of primary lung pathology. * **Myocardial Infarction:** While it can cause tachycardia and distress, the primary presentation would likely involve chest pain or signs of heart failure (pulmonary edema), which would show on a chest X-ray. * **Fat Embolism (Differential):** Though common in trauma, it usually presents with a petechial rash and "snowstorm" appearance on X-ray, typically occurring 24–72 hours after long bone fractures. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA). * **ECG Finding:** Most common is Sinus Tachycardia; most specific is **S1Q3T3** pattern. * **Chest X-ray:** Usually normal, but look for **Westermark sign** (focal oligemia) or **Hampton’s Hump** (wedge-shaped opacity). * **Initial Management:** Hemodynamic stabilization and anticoagulation (LMWH/Unfractionated Heparin).

Q: Tuberculosis is associated with which of the following conditions?

Silicosis. The correct answer is **Silicosis**. **Why Silicosis is the correct answer:** Silicosis is uniquely and strongly associated with an increased risk of developing Tuberculosis (TB), a condition termed **Silicotuberculosis**. The underlying pathophysiology involves the inhalation of crystalline silica particles, which are toxic to **alveolar macrophages**. Silica causes macrophage lysis and impairs their phagocytic capacity and phagolysosome formation. Since macrophages are the primary defense against *Mycobacterium tuberculosis*, their dysfunction allows the bacteria to proliferate unchecked [1]. Patients with silicosis have a 3-fold to 30-fold increased risk of TB compared to the general population. **Analysis of Incorrect Options:** * **Asbestosis:** While asbestos exposure significantly increases the risk of bronchogenic carcinoma and mesothelioma (especially when combined with smoking), it does not specifically predispose to TB [1]. * **Coal Worker’s Pneumoconiosis (CWP):** Simple CWP is generally not associated with an increased risk of TB unless there is concurrent silica exposure (anthracosilicosis) [1]. It is more commonly associated with Caplan Syndrome (RA nodules in the lung). * **Farmer’s Lung:** This is a type of Hypersensitivity Pneumonitis (Type III/IV hypersensitivity) caused by inhaling thermophilic actinomycetes from moldy hay. **High-Yield Clinical Pearls for NEET-PG:** * **Radiology:** Silicosis typically presents with "Eggshell calcification" of hilar lymph nodes [1]. * **Pathology:** The characteristic lesion is the "Silicotic nodule" (concentric whorls of collagen). * **Screening:** All patients diagnosed with silicosis should receive a tuberculin skin test (TST) or IGRA, as they are considered a high-risk group. * **Upper Lobe Predominance:** Like TB, silicosis primarily affects the upper lobes of the lungs [1].

Q: A 30-year-old male presents with bilateral lymphadenitis characterized by non-caseating granulomas on biopsy. What is the most likely diagnosis?

Sarcoidosis. **Explanation:** The hallmark of **Sarcoidosis** is the presence of **non-caseating granulomas**. In a young adult presenting with bilateral lymphadenopathy (typically hilar or cervical), the finding of granulomas without central necrosis (caseation) is highly suggestive of Sarcoidosis [1]. This is a multi-system inflammatory disease characterized by an exaggerated T-cell mediated immune response to unknown antigens. **Analysis of Options:** * **A. Tuberculosis (TB):** This is the most important differential. However, TB typically presents with **caseating** (cheesy, necrotic) granulomas. While non-caseating granulomas can occasionally be seen in early TB, "non-caseating" in a medical exam context is a classic buzzword for Sarcoidosis. * **B. Lymphoma:** While lymphoma causes significant lymphadenopathy, the biopsy would show **malignant lymphoid cells** (e.g., Reed-Sternberg cells in Hodgkin’s) rather than organized granulomatous structures. * **D. Any of the above:** Incorrect because the specific pathological description of "non-caseating granulomas" specifically points toward a granulomatous disease like Sarcoidosis rather than malignancy or typical TB. **NEET-PG High-Yield Pearls:** * **Pathology:** Look for **Asteroid bodies** and **Schaumann bodies** within the giant cells of the granuloma. * **Biomarkers:** Elevated **Serum ACE (Angiotensin-Converting Enzyme)** levels and **Hypercalcemia** (due to 1-alpha hydroxylase activity in macrophages) are common [1]. * **Imaging:** Stage I Sarcoidosis presents as **Bilateral Hilar Lymphadenopathy (BHL)** on Chest X-ray [1]. * **Kveim Test:** Historically used for diagnosis (though rarely used now).

Q: A 40-year-old male presented to the OPD with fever and breathlessness. His X-ray is shown below. What is the most probable diagnosis?

Pneumonia. ***Pneumonia*** - Fever and breathlessness with **consolidation** and **air bronchograms** on chest X-ray are classic features of pneumonia. - The acute presentation with respiratory symptoms strongly supports **community-acquired pneumonia** rather than chronic conditions. *Tuberculosis* - Typically presents with **upper lobe cavitation** or **miliary pattern** on chest X-ray, not consolidation. - Usually has a more **chronic course** with night sweats, weight loss, and hemoptysis over weeks to months. *Pleural effusion* - Chest X-ray would show **meniscus sign** and **homogeneous opacification** obscuring lung markings. - Clinical presentation includes **dull percussion note** and **reduced breath sounds** rather than consolidation features. *Bronchogenic carcinoma* - X-ray findings include **lung mass**, **hilar enlargement**, or **collapse/consolidation** due to obstruction. - Typically presents with **chronic cough**, **weight loss**, and **hemoptysis** rather than acute fever and breathlessness.

Q: All of the following statements about silicosis are true, EXCEPT:

Pleural plaques. The correct answer is **A (Pleural plaques)** because pleural plaques are the hallmark radiologic feature of **Asbestosis**, not Silicosis [1]. While silicosis primarily affects the lung parenchyma and hilar nodes, it does not typically involve the pleura. **Analysis of Options:** * **Option B (Predilection for upper lobes):** This is a true statement. Silicosis, like most inorganic dust pneumoconioses (except asbestosis), primarily involves the upper lobes of the lungs [1]. Small, rounded opacities (nodules) first appear in the upper zones [1]. * **Option C (Calcific hilar lymphadenopathy):** This is a classic feature of silicosis. The hilar lymph nodes may enlarge and develop a characteristic peripheral calcification pattern known as **"Eggshell calcification."** * **Option D (Associated with tuberculosis):** This is true. Silica is toxic to alveolar macrophages, impairing their ability to kill mycobacteria. This leads to a significantly increased risk (up to 30-fold) of developing tuberculosis, a condition termed **Silicotuberculosis**. **High-Yield Clinical Pearls for NEET-PG:** * **Occupational History:** Look for keywords like sandblasting, mining, stone cutting, or glass manufacturing. * **Pathology:** The characteristic lesion is the **Silicotic nodule**, which shows a central area of whorled collagen fibers and peripheral "dust-laden" macrophages. * **Birefringence:** Under polarized light, silica particles appear as weakly birefringent crystals. * **PMF:** Progressive Massive Fibrosis (PMF) occurs when nodules coalesce into large masses (>1 cm), leading to restrictive lung disease [1]. * **Caplan Syndrome:** The association of silicosis (or coal worker's pneumoconiosis) with Rheumatoid Arthritis.

Question 1

A 65-year-old man presented with hemoptysis and stage 3 clubbing. What is the probable diagnosis?

Accepted Answer

Non-small cell lung cancer

Answer

Small cell lung cancer

Answer

Tuberculosis

Answer

Sarcoidosis

Question 2

Which of the following is NOT a consequence of obstructive sleep apnea?

Accepted Answer

Parasympathetic hyperstimulation

Answer

Pulmonary vasoconstriction

Answer

Systemic hypertension

Answer

Polycythemia

Question 3

A 74-year-old woman, in otherwise good health, sustained a leg injury 2 days ago and has been bedridden since the accident. Two hours ago, she became delirious. On physical examination, her temperature is 99 F, blood pressure is 120/70 mmHg, heart rate is 110, and respiratory rate is 32. Pulse oximetry shows an oxygen saturation of 80%, and a chest x-ray film is normal. Which of the following is the most likely diagnosis?

Accepted Answer

Pulmonary thromboembolism

Answer

Acute cerebral hemorrhage

Answer

Acute cerebral infarction

Answer

Myocardial infarction

Question 4

Which one of the following parameters is consistent with pleural transudate?

Accepted Answer

LDH < 2/3 of the upper limit of serum LDH

Answer

WBC count > 1500/mm³

Answer

Specific gravity > 1.020

Answer

Protein level > 2.5 g/dL

Question 5

Tuberculosis is associated with which of the following conditions?

Accepted Answer

Silicosis

Answer

Asbestosis

Answer

Coal worker's pneumoconiosis

Answer

Farmer's lung

Question 6

A 30-year-old male presents with bilateral lymphadenitis characterized by non-caseating granulomas on biopsy. What is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Tuberculosis

Answer

Lymphoma

Answer

Any of the above

Question 7

A 55-year-old man presents with increasing shortness of breath and dry cough for several years. He has a significant smoking history and daily alcohol consumption. He experiences severe breathlessness with minimal exertion, prolonged expiration with wheezing, a barrel chest, hyperresonance on percussion, digital clubbing, facial plethora, and leg edema. Chest X-ray shows hyperinflation, flattened diaphragms, and increased retrosternal air space. What is the most likely diagnosis?

Accepted Answer

Emphysema

Answer

Asthma

Answer

Chronic bronchitis

Answer

Hypersensitivity pneumonitis

Question 8

Which of the following is the cause of sudden and unexpected onset of dyspnea at rest?

Accepted Answer

Spontaneous pneumothorax

Answer

Severe anemia

Answer

COPD

Answer

Large pleural effusion

Question 9

A 40-year-old male presented to the OPD with fever and breathlessness. His X-ray is shown below. What is the most probable diagnosis?

Accepted Answer

Pneumonia

Answer

Tuberculosis

Answer

Pleural effusion

Answer

Bronchogenic carcinoma

Question 10

All of the following statements about silicosis are true, EXCEPT:

Accepted Answer

Pleural plaques

Answer

Predilection for upper lobes

Answer

Calcific hilar lymphadenopathy

Answer

Associated with tuberculosis

Pulmonology — MCQs

Pulmonology — MCQs

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