Pulmonology Practice Questions

Q: Which of the following is not part of the definition of chronic bronchitis?

Hemoptysis. ### Explanation Chronic bronchitis is defined **clinically** based on specific criteria regarding the duration and nature of symptoms. **1. Why Hemoptysis is the Correct Answer:** Hemoptysis (coughing up blood) is **not** part of the diagnostic criteria for chronic bronchitis [4]. While patients with chronic bronchitis may occasionally experience blood-streaked sputum due to mucosal inflammation or forceful coughing, hemoptysis is a "red flag" symptom. Its presence should prompt an immediate investigation for other pathologies such as **Bronchogenic Carcinoma, Bronchiectasis, or Tuberculosis.** [3] [4] **2. Analysis of Incorrect Options:** * **Options A & C (Duration):** The formal clinical definition requires a productive cough for at least **3 months** in a year, for at least **2 consecutive years**. Option A is a core component of this definition. Option C is technically incorrect in its phrasing (it should be 2 years, not 2 months), but in the context of this specific question, Hemoptysis is the most definitive "non-definition" feature. * **Option B (Productive Cough):** Chronic bronchitis is characterized by goblet cell hyperplasia and mucus hypersecretion, making a **productive (sputum-producing)** cough the hallmark of the disease [1]. **Clinical Pearls for NEET-PG:** * **Blue Bloaters:** Patients with chronic bronchitis are often called "Blue Bloaters" due to cyanosis (hypoxemia) and fluid retention/edema (secondary to right heart failure/Cor Pulmonale). * **Reid Index:** The pathological hallmark is an increased Reid Index (>0.4), which measures the ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and the cartilage. * **Etiology:** Smoking is the most common cause; however, in the Indian context, exposure to **biomass fuel smoke** is a significant risk factor [2].

Q: A 67-year-old male smoker presents with cough and was treated for acute bronchitis. A chest X-ray prompted a referral to the chest clinic. The patient has a past history of myocardial infarction but is currently asymptomatic. Blood pressure is 128/80, and cardiopulmonary examination is unremarkable. A purified protein derivative (PPD) test result is 7 mm. The chest X-ray is shown. What is the likely diagnosis?

Left ventricular aneurysm. ***Left ventricular aneurysm*** - In a patient with **previous myocardial infarction**, a localized bulge at the **left cardiac border** on chest X-ray is characteristic of a **left ventricular aneurysm** formation. - The **asymptomatic presentation** with normal cardiopulmonary examination is typical, as many LV aneurysms remain clinically silent until complications develop. *Hypertensive cardiomyopathy* - Would present with **generalized cardiomegaly** rather than a localized cardiac border bulge seen on the chest X-ray. - The patient's **normal blood pressure** (128/80) makes active hypertensive heart disease unlikely. *Tuberculous pericarditis* - A **PPD test of 7 mm** is considered **negative** in immunocompetent individuals, making active tuberculosis unlikely. - Would typically present with **pericardial effusion** causing a globular heart shadow, not a localized bulge. *Epicardial fat pad* - Appears as a **smooth, well-defined opacity** at the **cardiophrenic angles**, not as a bulge at the left cardiac border. - More commonly seen in **obese patients** and would not be related to the patient's **history of myocardial infarction**.

Q: The Ellis curve is characteristic of which of the following conditions?

Pleural effusion. **Explanation:** The **Ellis Curve** (also known as the Damoiseau-Ellis line) is a classic radiological sign seen on a chest X-ray in patients with a **moderate-sized, free-flowing pleural effusion**. [1] **Why it occurs:** In a pleural effusion, fluid accumulates in the pleural space. Due to the negative intrapleural pressure and the natural elastic recoil of the lungs, the fluid is pulled higher along the lateral chest wall than it is medially. This creates a characteristic **S-shaped, upward-curving, convex line** that is highest at the axilla and slopes downward toward the spine. **Analysis of Incorrect Options:** * **A. Pneumothorax:** Characterized by a "hyper-lucent" area with an absent lung vascular marking and a visible **visceral pleural line**. It does not form a curved fluid meniscus. * **C. Pneumonia:** Typically presents as **consolidation** with air bronchograms. [1] While it can be associated with a parapneumonic effusion, the consolidation itself does not form an Ellis curve. [2] * **D. Asthma:** Primarily a clinical diagnosis. Radiologically, it may show **hyperinflation** (flattened diaphragms, increased retrosternal space) but no fluid-related curves. [1] **NEET-PG High-Yield Pearls:** * **Minimum fluid for detection:** Approximately 200–300 ml is required to see blunting of the costophrenic angle on a PA view, but as little as 50 ml can be seen on a **Lateral Decubitus** view (the most sensitive position). * **Loculated effusion:** If the fluid is trapped by adhesions, it will not form an Ellis curve; instead, it appears as a D-shaped opacity. * **Massive effusion:** Causes a complete "white-out" of the hemithorax with a **mediastinal shift to the opposite side**.

Q: Which of the following is not a feature of granulomatosis with polyangiitis (Wegener's syndrome)?

Cardiomegaly. **Explanation:** **Granulomatosis with Polyangiitis (GPA)**, formerly known as Wegener’s granulomatosis, is a small-vessel vasculitis characterized by a triad of necrotising granulomas of the upper and lower respiratory tracts, systemic vasculitis, and glomerulonephritis [1]. **Why Cardiomegaly is the correct answer:** While GPA can occasionally involve the heart (pericarditis or coronary vasculitis) [2], **cardiomegaly** is not a characteristic or diagnostic feature of the syndrome. GPA primarily targets the respiratory system and kidneys. Cardiomegaly is more typically associated with conditions causing congestive heart failure or valvular diseases, rather than primary small-vessel vasculitis. **Analysis of other options:** * **Chronic Sinusitis:** This is the most common presenting feature of GPA (found in >90% of cases). Patients often present with nasal crusting, epistaxis, and saddle-nose deformity due to septal perforation [1]. * **Bronchiectasis:** GPA causes chronic inflammation and scarring of the airways. Necrotising granulomas and recurrent infections secondary to airway stenosis can lead to permanent dilation of the bronchi (bronchiectasis). * **Situs Inversus:** While not a primary feature of GPA itself, this option is often used in exams to differentiate GPA from **Kartagener’s Syndrome** (Primary Ciliary Dyskinesia), which presents with the triad of situs inversus, bronchiectasis, and sinusitis. In the context of this specific question, situs inversus is considered a "distractor" or a feature *not* associated with GPA. **High-Yield Clinical Pearls for NEET-PG:** * **Serology:** Highly specific for **c-ANCA** (anti-proteinase 3 antibodies). * **Classic Triad:** Upper respiratory tract + Lower respiratory tract + Kidneys (Pauci-immune glomerulonephritis) [1]. * **Radiology:** Lung nodules with **cavitation** are a hallmark finding [1]. * **Treatment:** Induction with Corticosteroids + Cyclophosphamide (or Rituximab).

Q: Which of the following is NOT a cause of decreased DLCO?

Goodpasture syndrome. Explanation: DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide) measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries. It depends on the surface area available for gas exchange, the thickness of the alveolar-capillary membrane, and the hemoglobin concentration [1]. **Why Goodpasture Syndrome is the correct answer:** In **Goodpasture syndrome**, there is diffuse alveolar hemorrhage. The presence of "free" hemoglobin within the alveoli (extravasated RBCs) binds to the carbon monoxide used during the test. This results in an **increased DLCO**, rather than a decrease. This is a classic "exception" frequently tested in exams. **Analysis of incorrect options (Causes of decreased DLCO):** * **Anemia:** Since DLCO relies on hemoglobin to bind the CO, a reduction in total hemoglobin leads to a lower carrying capacity and thus a **decreased DLCO**. * **Interstitial Lung Diseases (ILD):** These conditions cause fibrosis and thickening of the alveolar-capillary membrane, increasing the distance the gas must travel, which **decreases DLCO**. * **Emphysema:** This involves the destruction of alveolar walls, which significantly reduces the total surface area available for gas exchange, leading to a **decreased DLCO** [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Increased DLCO is seen in:** Alveolar hemorrhage (Goodpasture’s), Polycythemia, Left-to-right shunts, Obesity, and sometimes early-stage Asthma. * **DLCO in Asthma vs. COPD:** DLCO is typically **normal or increased in Asthma**, but **decreased in Emphysema** [2]. This is a key physiological differentiator. * **Isolated low DLCO** with normal lung volumes often suggests Pulmonary Hypertension or Pulmonary Embolism.

Q: Carbon monoxide diffusion capacity decreases in all, except?

Alveolar hemorrhage. ### Explanation The **Carbon Monoxide Diffusing Capacity (DLCO)** measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries. It depends on the surface area of the alveolar-capillary membrane, the capillary blood volume, and the hemoglobin concentration [1]. **Why Alveolar Hemorrhage is the Correct Answer:** In **Alveolar Hemorrhage** (e.g., Goodpasture syndrome, Wegener’s), there is "extravasated" blood sitting within the alveoli. Carbon monoxide (CO) has an extremely high affinity for hemoglobin [1]. When the patient inhales the test gas, this intra-alveolar hemoglobin binds the CO before it even reaches the capillaries. This results in an **increased DLCO** (or a pseudo-elevation), making it the only condition among the choices where DLCO does not decrease. **Analysis of Incorrect Options:** * **Emphysema (A):** DLCO **decreases** due to the destruction of alveolar walls, which significantly reduces the total surface area available for gas exchange [1]. * **Primary Pulmonary Hypertension (B):** DLCO **decreases** because of the destruction or narrowing of the pulmonary vascular bed, reducing the effective capillary blood volume. * **Infiltrative Lung Disease (D):** Conditions like Interstitial Lung Disease (ILD) **decrease** DLCO because the alveolar-capillary membrane becomes thickened and scarred (fibrosis), increasing the barrier for diffusion [1]. **High-Yield Clinical Pearls for NEET-PG:** * **DLCO Increases in:** Alveolar hemorrhage, Polycythemia, Left-to-right shunts, and sometimes Obesity or Asthma (due to increased apical blood flow). * **DLCO Decreases in:** Anemia, Emphysema, ILD, Pulmonary Embolism, and Pulmonary Hypertension. * **Key Distinction:** DLCO is **normal** in Chronic Bronchitis but **decreased** in Emphysema [1]. This is a classic board-style differentiator for COPD phenotypes.

Q: Fleeting pulmonary infiltrates on sequential chest skiagrams in an individual who suffers from asthma are characteristic of?

Allergic bronchopulmonary aspergillosis. ### Explanation **Correct Option: A. Allergic bronchopulmonary aspergillosis (ABPA)** ABPA is a hypersensitivity reaction to *Aspergillus fumigatus* colonization in the airways, typically occurring in patients with **long-standing asthma** or cystic fibrosis. The "fleeting" or "evanescent" pulmonary infiltrates (also known as **Rosenberg-Patterson criteria**) represent areas of mucoid impaction and eosinophilic pneumonia that resolve in one area and reappear in another. This is a classic radiological hallmark of ABPA. **Why the other options are incorrect:** * **B. Mycobacterium tuberculosis:** Typically presents with persistent, progressive cavitary lesions (upper lobes) or miliary patterns. Infiltrates are chronic and do not "flee" or shift rapidly. * **C. Pneumocystis jirovecii (PJP):** Characterized by bilateral, symmetrical ground-glass opacities radiating from the hilum (perihilar distribution), usually in immunocompromised patients (HIV/AIDS). * **D. Nocardia infection:** Usually presents as subacute pneumonia with nodules or abscesses [2], often with cavitation, primarily in immunocompromised hosts. It does not show a migratory pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Radiological Signs of ABPA:** * **Finger-in-glove appearance:** Due to mucoid impaction in dilated bronchi [1]. * **Central Bronchiectasis:** A highly specific diagnostic feature. * **Fleeting Opacities:** Migratory shadows on sequential X-rays. * **Diagnostic Markers:** Elevated serum **IgE levels** (>1000 IU/mL) [3], peripheral blood **eosinophilia**, and positive skin test for *Aspergillus* antigen. * **Treatment:** The mainstay of treatment is **Oral Corticosteroids** (to reduce inflammation) and **Itraconazole** (to reduce fungal burden).

Q: Which of the following is NOT true about Interstitial Fibrosis?

FEV1/FVC ratio is normal or increased. Interstitial Fibrosis is the hallmark of **Restrictive Lung Diseases (RLD)**. The fundamental pathology involves stiffening of the lung parenchyma, which reduces lung compliance [2] and impairs gas exchange. Pulmonary function tests typically show a restrictive ventilatory defect in the presence of small lung volumes and reduced gas transfer [1]. ### **Analysis of Options** * **Option B (Correct Answer):** The question asks which statement is **NOT** true. However, in Restrictive Lung Disease, the FEV1/FVC ratio is typically **normal or even increased** (often >0.8). This occurs because both FEV1 and FVC decrease proportionately, or FVC decreases more significantly due to loss of lung volume. Since the statement "FEV1/FVC ratio is normal or increased" is actually **TRUE**, it serves as the correct answer choice for this "Except" type question format. * **Option A:** **FVC < 80%** is a diagnostic criterion for restriction. As the lungs become fibrotic and "small," the total volume of air that can be forcibly exhaled is significantly reduced [1]. * **Option C:** **DLCO is decreased** because fibrosis increases the thickness of the alveolar-capillary membrane, creating a physical barrier that hinders the diffusion of carbon monoxide (and oxygen) [1]. * **Option D:** **TLC is decreased** is the gold standard for diagnosing restriction. Fibrosis prevents the lungs from expanding fully, leading to reduced total lung capacity [1]. ### **NEET-PG High-Yield Pearls** * **PFT Pattern in RLD:** ↓ TLC, ↓ FVC, ↓ FRC, and **Normal/↑ FEV1/FVC ratio**. * **Compliance:** Lung compliance is **decreased** (stiff lungs), while elastic recoil is **increased** [2]. * **Radiology:** Look for "Honeycombing" and "Traction Bronchiectasis" on HRCT, which are classic signs of advanced interstitial fibrosis [1]. * **Clinical Sign:** Fine "Velcro" inspiratory crackles on auscultation and digital clubbing [1].

Question 1

Which of the following is not part of the definition of chronic bronchitis?

Accepted Answer

Hemoptysis

Answer

Cough present for at least 3 months in a year

Answer

Productive cough

Answer

Cough present for more than 2 consecutive months

Question 2

A 55-year-old male has a 5 cm cavitating lesion of unknown duration at the apex of the right lung. Which investigation should be carried out next?

Accepted Answer

Transbronchial biopsy

Answer

CT scan

Answer

FNAC

Answer

Bronchography

Question 3

A 67-year-old male smoker presents with cough and was treated for acute bronchitis. A chest X-ray prompted a referral to the chest clinic. The patient has a past history of myocardial infarction but is currently asymptomatic. Blood pressure is 128/80, and cardiopulmonary examination is unremarkable. A purified protein derivative (PPD) test result is 7 mm. The chest X-ray is shown. What is the likely diagnosis?

Accepted Answer

Left ventricular aneurysm

Answer

Hypertensive cardiomyopathy

Answer

Tuberculous pericarditis

Answer

Epicardial fat pad

Question 4

The Ellis curve is characteristic of which of the following conditions?

Accepted Answer

Pleural effusion

Answer

Pneumothorax

Answer

Pneumonia

Answer

Asthma

Question 5

Which of the following is not a feature of granulomatosis with polyangiitis (Wegener's syndrome)?

Accepted Answer

Cardiomegaly

Answer

Situs inversus

Answer

Chronic sinusitis

Answer

Bronchiectasis

Question 6

Which of the following is NOT a cause of decreased DLCO?

Accepted Answer

Goodpasture syndrome

Answer

Anemia

Answer

Interstitial lung diseases

Answer

Emphysema

Question 7

Carbon monoxide diffusion capacity decreases in all, except?

Accepted Answer

Alveolar hemorrhage

Answer

Emphysema

Answer

Primary pulmonary hypertension

Answer

Infiltrative lung disease

Question 8

A 40-year-old man presents with recurrent hemoptysis and purulent cough. Chest X-ray was found to be normal. What is the next investigation to aid in diagnosis?

Accepted Answer

Bronchoscopy

Answer

MRI

Answer

HRCT

Answer

CT guided biopsy

Question 9

Fleeting pulmonary infiltrates on sequential chest skiagrams in an individual who suffers from asthma are characteristic of?

Accepted Answer

Allergic bronchopulmonary aspergillosis

Answer

Mycobacterium tuberculosis infection

Answer

Pneumocystis jirovecii pneumonia

Answer

Nocardia infection

Question 10

Which of the following is NOT true about Interstitial Fibrosis?

Accepted Answer

FEV1/FVC ratio is normal or increased

Answer

FVC < 80% Predicted

Answer

DLCO is decreased

Answer

TLC is decreased

Pulmonology — MCQs

Pulmonology — MCQs

On this page

Practice by Chapter

Want unlimited practice?