Pulmonology Practice Questions

Q: What is the most common cause of diffuse bronchiectasis?

Cystic Fibrosis. **Explanation:** Bronchiectasis is the permanent, abnormal dilation of the bronchi due to a cycle of inflammation and infection [1]. To answer this question correctly, one must distinguish between **focal** and **diffuse** involvement. **Why Cystic Fibrosis (CF) is correct:** Cystic Fibrosis is the most common cause of **diffuse (bilateral)** bronchiectasis in developed nations and a high-yield cause globally [1]. It results from a mutation in the CFTR gene, leading to thick, viscous secretions that impair mucociliary clearance [3]. This leads to chronic endobronchial infection and progressive airway destruction throughout both lungs, typically starting in the upper lobes [1]. **Analysis of Incorrect Options:** * **Obstruction due to foreign bodies (B):** This is a classic cause of **focal (localized)** bronchiectasis. The pathology is limited to the airway segment distal to the obstruction [1]. * **Untreated pneumonia (A):** While severe or recurrent pneumonia can lead to bronchiectasis, it usually results in localized damage unless the patient has an underlying systemic predisposition [1]. * **Tuberculous infection (D):** In developing countries like India, TB is a very common cause of bronchiectasis. However, post-tubercular bronchiectasis is typically **focal** (often involving the upper lobes or the site of the primary lesion) rather than diffuse [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause (Global/Diffuse):** Cystic Fibrosis [1]. * **Most common cause (India/Focal):** Tuberculosis [1]. * **Most common organism in CF patients:** *Pseudomonas aeruginosa* (though *S. aureus* is common in childhood) [2]. * **Radiological Sign:** "Signet ring sign" on HRCT (bronchial artery appearing smaller than the dilated bronchus). * **Kartagener Syndrome:** A triad of bronchiectasis, sinusitis, and situs inversus (due to primary ciliary dyskinesia) [1].

Q: What is true about Bronchial Asthma?

Inhaled steroids are the mainstay of treatment. **Explanation:** **Bronchial Asthma** is a chronic inflammatory disorder of the airways characterized by reversible airflow obstruction and airway hyperresponsiveness [1]. **Why Option B is Correct:** The pathophysiology of asthma is driven by chronic airway inflammation. **Inhaled Corticosteroids (ICS)**, such as Budesonide or Fluticasone, are the most effective anti-inflammatory agents and are considered the **mainstay of long-term management**. They reduce airway edema, decrease mucus secretion, and prevent airway remodeling, thereby reducing the frequency of exacerbations. **Why Other Options are Incorrect:** * **Option A:** Asthma is characterized by **hyperresponsiveness** (exaggerated bronchoconstriction to stimuli), not hyporesponsiveness [1]. * **Option C:** **Samter’s Triad** (Aspirin-Exacerbated Respiratory Disease) consists of Asthma, **Nasal Polyposis**, and **Aspirin sensitivity** [1]. Urticaria is not a component of this specific triad. * **Option D:** **Intrinsic (Non-atopic) Asthma** is typically triggered by non-immune factors (e.g., exercise, cold air) and usually presents with **normal IgE levels**. Increased IgE levels are a hallmark of **Extrinsic (Atopic) Asthma** [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Gold standard is Spirometry showing reversibility (increase in FEV1 >12% and >200ml after bronchodilator). * **Drug of Choice (Acute):** SABA (Salbutamol) is the DOC for acute relief, but ICS-Formoterol is now preferred as the "Reliever" in GINA guidelines to address underlying inflammation. * **Charcot-Leyden Crystals & Curschmann Spirals:** Classic microscopic findings in the sputum of asthmatic patients. * **Status Asthmaticus:** A life-threatening emergency; look for a "silent chest" on auscultation, which indicates minimal air movement.

Q: A patient presents with elevated JVP on the right side and a positive Kussmaul sign. Superior Vena Cava (SVC) obstruction is suspected. In which of the following is SVC obstruction commonly seen?

Small cell lung cancer. Superior Vena Cava (SVC) Syndrome occurs due to the compression or invasion of the SVC, leading to venous congestion in the head, neck, and upper extremities. **Why Small Cell Lung Cancer (SCLC) is correct:** While non-small cell lung cancer (NSCLC) is more common overall, **Small Cell Lung Cancer** is the most frequent histological subtype associated with SVC syndrome [3]. This is because SCLC typically arises **centrally** [1] near the mediastinum and grows rapidly, leading to extrinsic compression of the thin-walled SVC. Approximately 7-10% of SCLC patients develop SVC syndrome, compared to only 1-2% of NSCLC patients. **Analysis of Incorrect Options:** * **A. Pancoast Tumour:** These are superior sulcus tumours (usually squamous cell or adenocarcinoma) located at the extreme apex of the lung. They typically present with **Horner’s syndrome** and brachial plexus involvement (shoulder pain), rather than SVC obstruction. * **B. Adenocarcinoma:** This is the most common type of lung cancer overall, but it is usually located **peripherally** [2]. Therefore, it is less likely to compress central structures like the SVC compared to SCLC. * **D. Hoarseness of voice:** This is a **symptom/sign** (often due to recurrent laryngeal nerve palsy), not a cause or a condition where SVC obstruction is "seen." **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of SVC Syndrome:** Malignancy (Lung cancer > Lymphoma). * **Kussmaul Sign:** A paradoxical rise in JVP on inspiration; in SVC syndrome, it indicates the inability of the heart to accommodate venous return due to the obstruction. * **Pemberton’s Sign:** Facial flushing and cyanosis upon raising both arms above the head; a classic bedside test for SVC obstruction (often seen in retrosternal goiters). * **Management:** SCLC is highly chemosensitive; therefore, chemotherapy is the primary treatment for SVC syndrome caused by SCLC.

Q: Cavernous respiration is heard in which of the following conditions?

Cavity. **Explanation:** **Cavernous respiration** is a specific subtype of bronchial breathing characterized by a low-pitched, hollow sound (resembling blowing across the mouth of an empty bottle). 1. **Why "Cavity" is correct:** Cavernous breathing occurs when a large, thin-walled **pulmonary cavity** (at least 2 cm in diameter) communicates freely with a bronchus. The cavity acts as a resonating chamber, filtering out high frequencies and amplifying low-pitched sounds during both inspiration and expiration. It is classically seen in **cavitary tuberculosis** [1] or a drained lung abscess [3]. 2. **Why other options are incorrect:** * **Consolidation:** Typically produces **Tubular bronchial breathing**. This is high-pitched and occurs because solidified lung tissue conducts sounds from the large airways to the periphery more efficiently than air-filled alveoli. * **Fibrosis:** Often associated with **bronchial breathing** if there is associated bronchiectasis, but more commonly presents with fine "velcro" inspiratory crackles. * **Interstitial inflammation:** Characteristically presents with **vesicular breath sounds** (often diminished) and fine end-inspiratory crepitations, not bronchial or cavernous breathing. **Clinical Pearls for NEET-PG:** * **Amphoric Breathing:** A variant of cavernous breathing that is even more high-pitched and metallic; it is seen in **large cavities** or **tension pneumothorax** (due to the "jar" effect). * **D'Espine's Sign:** Bronchial breathing heard over the spinous processes below T4, suggesting posterior mediastinal lymphadenopathy. * **Key Distinction:** In bronchial breathing, the expiratory phase is longer, louder, and higher-pitched than the inspiratory phase, with a distinct **pause** between the two.

Q: Which of the following is NOT seen in chronic obstructive pulmonary disease (COPD)?

Aplastic anemia. **Explanation:** **1. Why Aplastic Anemia is the Correct Answer:** Aplastic anemia is a bone marrow failure syndrome characterized by pancytopenia. It has no pathophysiological link to COPD. In contrast, patients with chronic hypoxemic lung diseases like COPD typically develop **Secondary Polycythemia** (increased red blood cell count) [1]. This occurs because chronic hypoxia stimulates the kidneys to release **erythropoietin**, which increases marrow production of RBCs to improve oxygen-carrying capacity [1]. **2. Analysis of Incorrect Options:** * **Hemoptysis:** While more common in bronchiectasis or lung cancer, hemoptysis can occur in COPD due to acute bronchitis (mucosal inflammation and friability) or during exacerbations. * **Cor Pulmonale:** This is a classic complication of late-stage COPD. Chronic hypoxia leads to pulmonary vasoconstriction, resulting in pulmonary hypertension, which eventually causes right ventricular hypertrophy and failure (Cor Pulmonale) [1]. * **Pneumothorax:** COPD patients often develop emphysematous bullae. The rupture of these subpleural blebs or bullae leads to **secondary spontaneous pneumothorax**, a common emergency in this population. **3. Clinical Pearls for NEET-PG:** * **Polycythemia in COPD:** Defined as a hematocrit >55%. It increases blood viscosity, further worsening pulmonary hypertension. * **Pink Puffers vs. Blue Bloaters:** Emphysema-predominant patients (Pink Puffers) maintain oxygenation by hyperventilating, while Bronchitis-predominant patients (Blue Bloaters) are often cyanotic and more prone to Cor Pulmonale [1]. * **ECG in COPD:** Look for "P-pulmonale" (tall, peaked P waves in lead II) and right axis deviation, indicating right heart involvement.

Question 1

What is the most common cause of diffuse bronchiectasis?

Accepted Answer

Cystic Fibrosis

Answer

Untreated pneumonia

Answer

Obstruction due to foreign bodies

Answer

Tuberculous infection

Question 2

What is true about Bronchial Asthma?

Accepted Answer

Inhaled steroids are the mainstay of treatment

Answer

Allergic hyporesponsiveness of airway

Answer

Is seen in Samter's triad along with urticaria

Answer

IgE levels are increased in intrinsic Asthma

Question 3

What is the least common site of lung abscess?

Accepted Answer

Left upper lobe

Answer

Left lower lobe

Answer

Right upper lobe

Answer

Right lower lobe

Question 4

A 65-year-old miner presents with a two-month history of 7 kg weight loss, cough, and blood-streaked sputum. He had a history of pulmonary tuberculosis 10 years ago. He also reports drooping of his left eyelid for one month. Physical examination reveals left-sided ptosis and pupillary miosis. Chest X-ray shows a round opacification in the left upper apical lobe. What is the most probable diagnosis?

Accepted Answer

Squamous cell carcinoma

Answer

Secondary tuberculosis

Answer

Adenocarcinoma

Answer

Asbestosis

Question 5

A 58-year-old female smoker with end-stage chronic obstructive pulmonary disease and osteoarthritis, who is on ipratropium bromide, albuterol inhalers, and hydrocodone-acetaminophen, presents with respiratory distress for 2 days. She has increased thick, yellow sputum production, low-grade fever, and increasing confusion. On examination, she is mildly obtunded but arousable, with a blood pressure of 160/100 mmHg, pulse of 115/min, respiratory rate of 30/min, and O2 saturation of 84% on her usual 3 L/min nasal cannula oxygen. She is using accessory muscles to breathe, has diffuse wheezing and rhonchi bilaterally, a prolonged expiratory phase, distant but regular heart sounds, and no peripheral edema. Arterial blood gases (ABGs) on arrival are: pH 7.20, PO2 70 mmHg, PCO2 65 mmHg, calculated HCO3 29 mEq/L. Electrolytes are: Na 140 mEq/L, K 5.1 mEq/L, HCO3 29 mEq/L, Cl 100 mEq/L, BUN 20 mg/dL, creatinine 1.5 mg/dL, glucose 89 mg/dL. After prompt initiation of noninvasive positive pressure ventilation (Bi-pap), blood cultures, toxicology screen, intravenous fluids, and IV antibiotics, consider the patient's metabolic situation. Which of the following best describes the acid-base condition and its etiology?

Accepted Answer

The patient has a baseline chronic respiratory acidosis with metabolic compensation, now with a superimposed further respiratory acidosis caused by decreased ventilation.

Answer

The patient has acute, severe respiratory acidosis caused by the sudden deterioration in her respiratory status.

Answer

The patient has an underlying metabolic acidosis caused by her renal insufficiency now compounded by a respiratory alkalosis.

Answer

The patient ingested abundant amounts of aspirin which caused a severe metabolic acidosis and respiratory failure.

Question 6

What is the commonest intrabronchial cause of hemoptysis?

Accepted Answer

Carcinoma of the lung

Answer

Adenoma of the lung

Answer

Emphysema

Answer

Bronchiectasis

Question 7

A patient presents with elevated JVP on the right side and a positive Kussmaul sign. Superior Vena Cava (SVC) obstruction is suspected. In which of the following is SVC obstruction commonly seen?

Accepted Answer

Small cell lung cancer

Answer

Pancoast tumour

Answer

Adenocarcinoma

Answer

Hoarseness of voice

Question 8

The Kveim test is used for the diagnosis of which condition?

Accepted Answer

Sarcoidosis

Answer

Tuberculosis

Answer

Systemic lupus erythematosus tissue

Answer

Cystic fibrosis

Question 9

Cavernous respiration is heard in which of the following conditions?

Accepted Answer

Cavity

Answer

Consolidation

Answer

Fibrosis

Answer

Interstitial inflammation

Question 10

Which of the following is NOT seen in chronic obstructive pulmonary disease (COPD)?

Accepted Answer

Aplastic anemia

Answer

Hemoptysis

Answer

Cor Pulmonale

Answer

Pneumothorax

Pulmonology — MCQs

Pulmonology — MCQs

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