Pulmonology Practice Questions

Q: Which of the following conditions typically presents with an exudative pleural effusion?

Mesothelioma. ### Explanation Pleural effusions are classified into **transudates** and **exudates** based on **Light’s Criteria** [1]. This distinction is fundamental in narrowing down the differential diagnosis. **Correct Answer: C. Mesothelioma** Mesothelioma is a primary malignancy of the pleura, typically associated with asbestos exposure. Malignancies cause **exudative effusions** because the tumor cells trigger an inflammatory response and increase capillary permeability, or obstruct lymphatic drainage [1]. This leads to the accumulation of fluid rich in protein and Lactate Dehydrogenase (LDH). **Incorrect Options:** * **A. Congestive Heart Failure (CHF):** This is the most common cause of **transudative** effusion. It occurs due to increased pulmonary capillary hydrostatic pressure, which "pushes" protein-poor fluid into the pleural space. * **B. Nephrotic Syndrome:** This causes a **transudative** effusion due to decreased plasma oncotic pressure (hypoalbuminemia), leading to systemic fluid leakage. * **C. Cirrhosis:** Hepatic hydrothorax in cirrhosis is **transudative**. It occurs when peritoneal fluid (ascites) moves across small defects in the diaphragm into the pleural space. **NEET-PG High-Yield Pearls:** 1. **Light’s Criteria for Exudate (Any one of the following):** * Pleural fluid protein / Serum protein ratio **> 0.5** * Pleural fluid LDH / Serum LDH ratio **> 0.6** * Pleural fluid LDH **> 2/3rd** the upper limit of normal serum LDH. 2. **Mesothelioma Marker:** Look for **Calretinin (+)** on immunohistochemistry. 3. **Pseudo-Meigs Syndrome:** A rare cause of transudative effusion associated with ovarian tumors. 4. **Low Glucose in Effusion:** Typically seen in Rheumatoid Arthritis, Empyema, or Malignancy [1].

Q: Which of the following is NOT a common cause of acute exacerbation of COPD?

Staphylococcus aureus. **Explanation:** Acute Exacerbation of COPD (AECOPD) is primarily triggered by respiratory tract infections (viral or bacterial) and environmental pollutants. **Why Staphylococcus aureus is the correct answer:** While *Staphylococcus aureus* can cause severe pneumonia, it is **not** a common or typical cause of routine AECOPD. It is generally seen only in specific subsets of patients, such as those with severe structural lung damage, recent hospitalization, or as a secondary infection following Influenza [1]. In the context of standard NEET-PG questions, it is considered an "atypical" or rare cause compared to the primary trio of respiratory pathogens. **Analysis of Incorrect Options:** * **Haemophilus influenzae (Option C):** This is the **most common** bacterial cause of AECOPD. It is a Gram-negative coccobacillus frequently isolated from the sputum of COPD patients. * **Streptococcus pneumoniae (Option A):** A very common cause of both community-acquired pneumonia and AECOPD [1]. It is a Gram-positive diplococcus. * **Moraxella catarrhalis (Option B):** The third most common bacterial pathogen involved in AECOPD, particularly in patients with more advanced airflow obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Most common trigger overall:** Viral infections (Rhinovirus is the most frequent). * **Most common bacterial trigger:** *Haemophilus influenzae*. * **Cardinal Symptoms of AECOPD (Anthonisen Criteria):** Increase in dyspnea, increase in sputum volume, and increase in sputum purulence. * **Management Priority:** Inhaled bronchodilators (SABA/SAMA), systemic corticosteroids, and antibiotics if purulence is present. * **Indications for Antibiotics:** Increased sputum purulence plus one other cardinal symptom.

Question 1

A 60-year-old man with a 30-pack-year smoking history presents with cough and mild hemoptysis. Chest radiography shows a large left perihilar mass. Sputum cytology demonstrates malignant polygonal cells with intercellular bridges and keratin pearls. Which laboratory finding is most characteristic of the paraneoplastic syndrome associated with this tumor?

Accepted Answer

Serum calcium of 13.6 mg/dL with suppressed intact parathyroid hormone

Answer

Serum sodium of 118 mEq/L with inappropriately concentrated urine

Answer

Hypokalemic metabolic alkalosis with elevated serum cortisol

Answer

Elevated hematocrit with an increased erythropoietin level

Question 2

Which of the following conditions typically presents with an exudative pleural effusion?

Accepted Answer

Mesothelioma

Answer

Congestive heart failure

Answer

Nephrotic syndrome

Answer

Cirrhosis

Question 3

Which of the following is NOT a common cause of acute exacerbation of COPD?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Moraxella catarrhalis

Answer

Haemophilus influenzae

Question 4

What is the most common cause of unilateral diaphragmatic paralysis?

Accepted Answer

Surgical trauma

Answer

Poliomyelitis

Answer

Polyneuritis

Answer

Tumour

Question 5

A 55-year-old male presents with a history of hand swelling and shortness of breath. On examination, facial plethora and distended neck veins were noted. Which is the most probable structure involved to cause these symptoms?

Accepted Answer

Superior vena cava obstruction

Answer

Pulmonary embolism

Answer

Congestive heart failure

Answer

Pneumonia

Question 6

A 45-year-old male with a history of alcohol abuse and periodontal disease presents with a spiking fever and chills. Physical examination reveals signs of lung consolidation. A chest x-ray shows a cavity in the right lower lobe with an air/fluid level. Based upon the clinical presentation, which of the following would be the most likely causative organism?

Accepted Answer

Anaerobic bacteria

Answer

Aspergillus fumigatus

Answer

Entamoeba histolytica

Answer

Staphylococcus aureus

Question 7

A 47-year-old female with a history of Antiphospholipid antibody syndrome, who has been non-compliant with warfarin, presents with deep vein thrombosis and dyspnea. She is hypotensive and tachypneic. CT of the chest shows a saddle embolus. She does not respond to heparin and fluids. Echocardiogram shows RV hypokinesis. Which of the following is the appropriate management?

Accepted Answer

Recombinant tissue plasminogen activator

Answer

Urgent referral for surgical embolectomy

Answer

Continue administration of fluids and heparin

Answer

Add lepirudin

Question 8

Which of the following is the most potent stimulus for the development of cor pulmonale in patients with chronic obstructive pulmonary disease?

Accepted Answer

Hypoxia

Answer

Obliteration of the pulmonary vascular bed

Answer

Alveolar membrane damage

Answer

Left ventricular failure

Question 9

Which of the following is NOT true about sarcoidosis?

Accepted Answer

Strongly positive tuberculin test

Answer

Bilateral symmetrical hilar adenopathy

Answer

Arthralgias

Answer

Increased ACE levels

Question 10

Serum angiotensin-converting enzyme may be raised in all of the following, except?

Accepted Answer

Bronchogenic carcinoma

Answer

Sarcoidosis

Answer

Silicosis

Answer

Berylliosis

Pulmonology — MCQs

Pulmonology — MCQs

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