Pulmonology Practice Questions

Q: What is the probable diagnosis in a patient with the following flow-volume loop after spirometry?

Myasthenia gravis. ***Myasthenia gravis*** - Presents with a characteristic **saw-tooth pattern** or **variable extrathoracic obstruction** on flow-volume loop due to **upper airway muscle weakness**. - The **fluctuating muscle weakness** affects respiratory muscles, causing irregular, oscillating flow patterns during forced breathing maneuvers. *Emphysema* - Shows a **scooped expiratory limb** on flow-volume loop due to **air trapping** and **loss of elastic recoil**. - The pattern reflects **obstructive disease** with prolonged expiration, not the variable oscillating pattern seen here. *Bronchial Asthma* - Demonstrates **obstructive pattern** with **reduced peak expiratory flow** and **concave expiratory limb**. - The obstruction is **reversible with bronchodilators**, unlike the neuromuscular weakness causing variable patterns. *Endobronchial neoplasm* - Produces **fixed bilateral flattening** of both inspiratory and expiratory limbs due to **mechanical obstruction**. - The flow limitation is **constant and symmetric**, contrasting with the variable, oscillating pattern of neuromuscular weakness.

Q: Pleural fluid with low glucose is seen in all of the following conditions EXCEPT?

Tuberculosis. In the context of NEET-PG, "low pleural fluid glucose" is typically defined as a level **<60 mg/dL** (or a pleural fluid/serum glucose ratio <0.5). This occurs due to either increased metabolic consumption of glucose by bacteria/cells or impaired transport across the pleural membrane. **Why Tuberculosis is the Correct Answer (in this context):** While Tuberculosis (TB) is traditionally listed among causes of low pleural glucose, it is **not** characteristically low in the majority of cases. In TB pleurisy, glucose levels are usually similar to serum levels. It only drops significantly in very chronic or severe cases. When compared to the other options—where low glucose is a hallmark diagnostic feature—TB is the "least likely" or the "exception" in standard MCQ patterns. **Analysis of Other Options:** * **Rheumatoid Arthritis (RA):** Characteristically has the **lowest** glucose levels among all pleural effusions (often **<30 mg/dL**). This is due to a specific defect in glucose transport. A low pH suggests infection but may also be seen in rheumatoid arthritis [1]. * **Empyema:** Low glucose is expected because active bacterial metabolism and high leukocyte activity consume glucose rapidly [1]. Simple aspiration provides information on the colour and texture of fluid and these alone may immediately suggest an empyema [1]. * **Mesothelioma:** Malignancies (including Mesothelioma and metastatic carcinoma) cause low glucose due to high metabolic demand by tumor cells and thickened pleura hindering transport [1]. **NEET-PG High-Yield Pearls:** 1. **Lowest Glucose ( 40 U/L).

Q: Which of the following statements is FALSE regarding Idiopathic Pulmonary Fibrosis?

Bronchoalveolar lavage shows eosinophils.. ### Explanation **Idiopathic Pulmonary Fibrosis (IPF)** is a chronic, progressive fibrosing interstitial pneumonia of unknown etiology, primarily affecting older adults [1]. It is histologically characterized by the **Usual Interstitial Pneumonia (UIP)** pattern [1]. **Why Option C is False:** Bronchoalveolar lavage (BAL) in IPF typically shows a mild increase in **neutrophils** (up to 70-90% of cases) and occasionally a slight increase in eosinophils, but it is **not** a diagnostic or characteristic feature. A significant eosinophilia in BAL would instead point toward diagnoses like Eosinophilic Pneumonia or Churg-Strauss syndrome. In modern practice, BAL is mainly used to exclude other conditions (like infection or malignancy) rather than to confirm IPF [1]. **Analysis of Other Options:** * **Option A:** Smoking is a well-established environmental risk factor for IPF, along with metal/wood dust exposure and chronic micro-aspiration [1]. * **Option B:** IPF is a **non-granulomatous** disease. The presence of granulomas would suggest alternative diagnoses like Sarcoidosis or Hypersensitivity Pneumonitis. * **Option D:** The hallmark radiological (HRCT) and pathological finding of IPF/UIP is **subpleural, basal-predominant fibrosis** with honeycombing and traction bronchiectasis [1]. **NEET-PG High-Yield Pearls:** * **Clinical Sign:** "Velcro" crackles on auscultation and digital clubbing [1]. * **HRCT Gold Standard:** Subpleural reticular opacities and **honeycombing** [1]. * **Histology:** Temporal heterogeneity (coexistence of old collagen fibrosis and active **fibroblastic foci**). * **Management:** Pirfenidone and Nintedanib (antifibrotic agents) slow disease progression; Lung transplant is the only definitive cure [1].

Q: Bronchiectasis with predominantly upper lobe involvement is characteristic of which condition?

Cystic fibrosis. ### Explanation **Correct Answer: C. Cystic Fibrosis** **Why it is correct:** Bronchiectasis is the permanent dilation of bronchi due to a cycle of infection and inflammation. The anatomical distribution of bronchiectasis is a high-yield diagnostic clue. **Cystic Fibrosis (CF)** is the classic cause of **upper lobe predominant** bronchiectasis [1]. This occurs because the thick, inspissated mucus characteristic of CF leads to impaired mucociliary clearance, which is most pronounced in the upper lobes where ventilation-perfusion ratios and oxygen tension are higher, favoring the growth of pathogens like *Pseudomonas aeruginosa* [1]. **Analysis of Incorrect Options:** * **A. Granulomatosis with polyangiitis:** While it can cause pulmonary nodules, cavitations, and alveolar hemorrhage, it is not a primary cause of localized upper-lobe bronchiectasis. * **B. Hypogammaglobulinemia:** Immunodeficiency syndromes (like CVID) typically cause **lower lobe** bronchiectasis due to the effects of gravity on secretions and recurrent aspiration-like patterns of infection. * **D. Alpha-1 antitrypsin deficiency:** This condition characteristically causes **panacinar emphysema** with a marked predilection for the **lower lobes (basal distribution)**. **NEET-PG High-Yield Pearls:** * **Upper Lobe Bronchiectasis:** Cystic Fibrosis, ABPA (Allergic Bronchopulmonary Aspergillosis - usually central), and Tuberculosis (post-tubercular) [1]. * **Lower Lobe Bronchiectasis:** Post-infectious (viral/bacterial), Hypogammaglobulinemia, and Recurrent aspiration. * **Middle Lobe/Lingula:** Primary Ciliary Dyskinesia (Kartagener Syndrome) and MAC (*Mycobacterium avium* complex/Lady Windermere syndrome). * **Signet Ring Sign:** The classic radiological finding on HRCT where the dilated bronchus is larger than its accompanying pulmonary artery.

Question 1

A patient with limited systemic sclerosis for the past 10 years complains of shortness of breath for the past one year. His pulmonary function tests are as follows: FVC 2.63 (predicted 2.82), FEV1 88% of predicted, and DLCO 5.2 (predicted 16.3). Which among the following is the probable diagnosis?

Accepted Answer

Pulmonary hypertension

Answer

Interstitial lung disease

Answer

Pneumothorax

Answer

Diaphragmatic weakness

Question 2

What is the probable diagnosis in a patient with the following flow-volume loop after spirometry?

Accepted Answer

Myasthenia gravis

Answer

Emphysema

Answer

Bronchial Asthma

Answer

Endobronchial neoplasm

Question 3

A 29-year-old unmarried female presents with dyspnea. Her chest X-ray is normal, FVC is 92%, FEV1/FVC is 89%, and DLCO is 59% of normal. On exercise, her oxygen saturation drops from 92% to 86%. What is the likely diagnosis?

Accepted Answer

Primary pulmonary hypertension

Answer

Alveolar hypoventilation

Answer

Interstitial lung disease

Answer

Anxiety

Question 4

Which of the following conditions are associated with transudative pleural effusion?

Accepted Answer

Myxedema

Answer

Chylothorax

Answer

Dialysis-related effusion

Answer

Nephrotic syndrome

Question 5

Pleural fluid with low glucose is seen in all of the following conditions EXCEPT?

Accepted Answer

Tuberculosis

Answer

Empyema

Answer

Mesothelioma

Answer

Rheumatoid arthritis

Question 6

A 45-year-old female presents with hemoptysis and cough. The hemoptysis started 2 weeks ago, followed by fever and cough. X-rays showed left upper lobe consolidation. Antibiotics were administered. The fever improved, but the cough and hemoptysis persisted. BP 110/72 mmHg, Pulse 70/min. Bronchoscopy shows a mass filling the left bronchus. What is the likely diagnosis?

Accepted Answer

Carcinoid

Answer

Hamartoma

Answer

Pulmonary tuberculosis

Answer

Sarcoidosis

Question 7

Which of the following statements is FALSE regarding Idiopathic Pulmonary Fibrosis?

Accepted Answer

Bronchoalveolar lavage shows eosinophils.

Answer

Smoking is a predisposing factor.

Answer

It is a non-granulomatous condition.

Answer

Subpleural fibrosis is a characteristic finding.

Question 8

Recognized features of asbestosis do not include which of the following?

Accepted Answer

Parenchymal interstitial fibrosis

Answer

Calcification of pleura

Answer

Clubbing of fingers

Answer

Restrictive pattern of ventilatory defect shown by pulmonary function

Question 9

Pneumatoceles are seen in which of the following conditions?

Accepted Answer

Klebsiella pneumonia

Answer

Pneumococcal pneumonia

Answer

Mycoplasma pneumonia

Answer

Streptococcal pneumonia

Question 10

Bronchiectasis with predominantly upper lobe involvement is characteristic of which condition?

Accepted Answer

Cystic fibrosis

Answer

Granulomatosis with polyangiitis

Answer

Hypogammaglobulinemia

Answer

Alpha-1 antitrypsin deficiency

Pulmonology — MCQs

Pulmonology — MCQs

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