Pulmonology Practice Questions

Q: Which of the following signs is NOT suggestive of pulmonary embolism?

Wheeze. **Explanation** Pulmonary Embolism (PE) typically presents with signs and symptoms related to acute vascular obstruction and pulmonary infarction [1]. **Why "Wheeze" is the correct answer:** While bronchospasm can rarely occur due to the release of mediators like serotonin from platelets, **wheezing** is not a classic or suggestive sign of PE. It is far more characteristic of obstructive airway diseases like asthma, COPD, or heart failure ("cardiac asthma") [2], [4]. In the context of a sudden-onset respiratory distress question, the presence of wheezing usually points the clinician *away* from a diagnosis of PE and toward an alternative diagnosis. **Analysis of other options:** * **Tachypnea (B):** This is the **most common sign** of pulmonary embolism [1]. Increased respiratory rate occurs due to V/Q mismatch and reflex stimulation of irritant receptors. * **Pleuritic Chest Pain (A):** This occurs when the embolus is peripheral, leading to pulmonary infarction and inflammation of the adjacent parietal pleura [3]. It is a hallmark symptom of small, peripheral emboli. * **Hemoptysis (C):** This results from alveolar hemorrhage following pulmonary infarction [3]. Along with pleuritic pain and dyspnea, it forms the classic (though infrequent) Virchow’s triad of PE symptoms. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common symptom:** Dyspnea. 2. **Most common sign:** Tachypnea [1]. 3. **ECG findings:** Most common is **Sinus Tachycardia** [1]. The "classic" **S1Q3T3** pattern is specific but seen in only <20% of cases. 4. **Gold Standard Investigation:** CT Pulmonary Angiography (CTPA). 5. **Chest X-ray:** Usually normal, but may show **Hampton’s Hump** (wedge-shaped opacity) or **Westermark sign** (focal oligemia) [1].

Q: Apical lung carcinoma commonly manifests as:

Homer's syndrome. Apical lung carcinoma, specifically a **Pancoast tumor** (Superior Sulcus Tumor), arises at the extreme apex of the lung. The clinical manifestations are dictated by the local invasion of surrounding anatomical structures rather than typical endobronchial symptoms. **Why Horner’s Syndrome is Correct:** The tumor frequently invades the **paravertebral sympathetic chain** and the **stellate ganglion** (C8–T2). Destruction of these sympathetic fibers results in **ipsilateral Horner’s syndrome**, characterized by the classic triad of **Ptosis** (drooping eyelid), **Miosis** (clonstricted pupil), and **Anhidrosis** (lack of sweating). **Analysis of Incorrect Options:** * **A & B (Pleural/Pericardial involvement):** While lung cancers can cause effusions, these are more common in peripheral tumors or advanced metastatic disease. * **D (Tumour obstruction of the airway):** Apical tumors are peripheral. Airway obstruction and collapse/atelectasis [1] are characteristic of **central (hilar) tumors**, such as Squamous Cell Carcinoma or Small Cell Carcinoma, which involve the main bronchi. [1] **NEET-PG High-Yield Pearls:** * **Pancoast Syndrome:** Includes Horner’s syndrome plus shoulder pain radiating down the arm (ulnar distribution) due to involvement of the **brachial plexus** (C8, T1, T2) and destruction of the first/second ribs. * **Most Common Histology:** Most Pancoast tumors are **Adenocarcinomas** (previously thought to be Squamous Cell). * **Initial Symptom:** Shoulder pain is often the earliest presenting symptom, frequently misdiagnosed as cervical osteoarthritis or rotator cuff injury.

Question 1

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 2

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 3

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 4

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 5

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

Accepted Answer

Bronchogenic carcinoma

Answer

Sarcoidosis

Answer

Silicosis

Answer

Berylliosis

Question 6

Type IV respiratory failure best relates to which of the following?

Accepted Answer

Hypoperfusion of respiratory muscles

Answer

Alveolar hypoventilation

Answer

Alveolar flooding

Answer

Lung atelectasis

Question 7

Pulmonary hypertension is caused by?

Accepted Answer

Interstitial lung disease

Answer

Myocardial infarction

Answer

Systemic hypertension

Answer

Thromboembolism

Question 8

Which of the following signs is NOT suggestive of pulmonary embolism?

Accepted Answer

Wheeze

Answer

Pleuritic chest pain

Answer

Tachypnea

Answer

Hemoptysis

Question 9

What is the most common cause of pulmonary embolism?

Accepted Answer

Thrombophlebitis

Answer

Endarteritis

Answer

Atherosclerosis

Answer

Lymphangitis

Question 10

Apical lung carcinoma commonly manifests as:

Accepted Answer

Homer's syndrome

Answer

Pleural effusion

Answer

Pericardial involvement

Answer

Tumour obstruction of the airway

Pulmonology — MCQs

Pulmonology — MCQs

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