Pulmonology Practice Questions

Q: Which of the following is the most significant risk factor for pulmonary embolism?

Malignancy. **Malignancy** - **Malignancy** significantly increases the risk of pulmonary embolism due to a hypercoagulable state often induced by tumor cells producing procoagulant factors and inflammatory cytokines. [1] - Cancer patients are at a 4-7 times higher risk of venous thromboembolism (VTE) compared to the general population, making it a leading cause of death in this group. [1] *Protein S deficiency* - **Protein S deficiency** is a genetic **thrombophilia** that increases the risk of clotting, but it is less common and, on its own, generally carries a lower overall population attributable risk for PE than malignancy. - While it predisposes to recurrent VTE, it does not represent the most significant risk factor in the general context of PE etiologies. *Obesity* - **Obesity** is a risk factor for pulmonary embolism, as it is associated with chronic inflammation, endothelial dysfunction, and impaired fibrinolysis, all of which promote a prothrombotic state. - However, the increased risk associated with obesity is generally moderate compared to the profound prothrombotic effects of malignancy. *Progesterone therapy* - **Progesterone therapy**, particularly in the context of oral contraceptives or hormone replacement therapy, can increase the risk of VTE, including PE. - This effect is primarily due to changes in clotting factors, but the overall risk increase is typically less pronounced compared to the highly procoagulant state associated with active cancer.

Q: Superior sulcus tumor of the lungs characteristically presents with:

Pancoast syndrome. ***Pancoast syndrome*** - A **superior sulcus tumor**, specifically a Pancoast tumor, is defined by its characteristic presentation as **Pancoast syndrome**. - This syndrome includes a constellation of symptoms resulting from the tumor's invasion of surrounding structures, such as the **brachial plexus**, **cervical sympathetic chain**, and **vertebral bodies**. *Horner's syndrome* - **Horner's syndrome** is a *component* of Pancoast syndrome, caused by the tumor's invasion of the **cervical sympathetic chain**. - While it's a key feature, it doesn't encompass the entire clinical presentation of a superior sulcus tumor, which also includes shoulder and arm pain due to brachial plexus involvement. *Breathlessness* - **Shortness of breath** is a general symptom of many lung conditions, including central lung tumors [1], but it is **not characteristic** of a superior sulcus tumor's typical presentation. - Superior sulcus tumors are located peripherally at the lung apex and often present with local invasive symptoms rather than respiratory distress unless very advanced [2]. *Hemoptysis* - **Hemoptysis** (coughing up blood) is more commonly associated with tumors invading central airways or large vessels [1], but it is **not a characteristic initial presentation** of a superior sulcus tumor. - The location of a superior sulcus tumor in the lung apex makes bleeding into the airways less likely as a primary symptom.

Q: Which condition is associated with the development of a bovine cough?

Tracheitis. ***Tracheitis*** - **Tracheitis** involves inflammation of the trachea, which can lead to a characteristic **bovine cough** due to irritation and narrowing of the airway [3]. - The cough is often **deep, harsh**, and **nonproductive**, resembling the sound made by a cow [2]. *Acute epiglotitis* - Acute epiglottitis typically presents with a **muffled voice**, **stridor**, and **difficulty swallowing**, not a bovine cough [2]. - It is an emergent condition due to potential **airway obstruction** at the level of the epiglottis. *Laryngeal adenoidectomy* - Laryngeal adenoidectomy is not a recognized medical procedure; adenoids are located in the **nasopharynx**. - A laryngeal procedure would affect the voice but is not associated with a **bovine cough** [1]. *Antibiotics* - Antibiotics are a **treatment** for bacterial infections, not a condition that causes a bovine cough. - They are used to address the underlying bacterial cause of conditions like **bacterial tracheitis**.

Q: Which of the following conditions is least likely to cause pneumothorax?

Bronchopulmonary Aspergillosis. ***Bronchopulmonary Aspergillosis*** - Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to *Aspergillus* species, primarily causing **bronchospasm**, **mucus plugging**, and **bronchiectasis**, rarely leading to pneumothorax [1]. - While it can cause significant lung damage, **pneumothorax** is not a characteristic or common complication, unlike the other conditions listed. *Marfan syndrome* - Patients with **Marfan syndrome** have connective tissue abnormalities, including those affecting the pleura and lung parenchyma. - This predisposition can lead to the formation of **apical blebs and bullae**, which are prone to rupture and cause **spontaneous pneumothorax** [2]. *Assisted ventilation* - **Positive pressure ventilation**, especially with high pressures or volumes, can cause barotrauma or volutrauma to the lungs [2]. - This can lead to alveolar rupture, resulting in **pneumothorax**, particularly in patients with pre-existing lung disease or those requiring high ventilatory support. *Eosinophilic granuloma* - Also known as **pulmonary Langerhans cell histiocytosis**, this condition involves the infiltration of the lungs by Langerhans cells. - It often leads to the formation of **cysts and nodules**, which can rupture and cause recurrent **spontaneous pneumothorax**.

Q: Which of the following best describes the arterial blood gas findings in type II respiratory failure?

Low pO2 and high pCO2. ***Low pO2 and high pCO2*** - Type II respiratory failure is characterized by **hypoxemia** (low pO2) and **hypercapnia** (high pCO2), indicating a failure of both oxygenation and ventilation [1]. - This condition arises when the respiratory system cannot adequately remove carbon dioxide, leading to its accumulation in the blood [2]. *Low pO2 and low pCO2* - This pattern would typically suggest **compensated metabolic acidosis** or a response to profound hypoxemia with hyperventilation, not primary respiratory failure. - While there is hypoxemia, the low pCO2 indicates efficient or excessive CO2 removal, which is contrary to the definition of type II respiratory failure. *Normal pO2 and high pCO2* - A normal pO2 with high pCO2 is unlikely in true respiratory failure, as **hypoxemia** is a defining feature of any respiratory failure type [1]. - Isolated hypercapnia without hypoxemia would suggest a unique form of ventilation-perfusion mismatch that is not characteristic of respiratory failure. *Low pO2 and normal pCO2* - This description aligns with **Type I respiratory failure**, which is characterized by **hypoxemia** without significant hypercapnia or with normal pCO2 [1]. - In Type I, the primary issue is impaired oxygenation, while CO2 removal (ventilation) might still be adequate [1].

Q: In acute pulmonary embolism, which among the following is the most frequent ECG finding?

Sinus tachycardia. ***Sinus tachycardia*** - **Sinus tachycardia** is the most frequent ECG finding in acute pulmonary embolism, seen in up to 40% of cases [1]. - It reflects the body's compensatory response to hypoxemia and decreased cardiac output. *S1Q3T3 pattern* - The classic **S1Q3T3 pattern** (S wave in lead I, Q wave in lead III, inverted T wave in lead III) is specific for acute right heart strain but is only found in approximately 10-20% of cases [1]. - It indicates more significant right ventricular dysfunction and is not the most frequent finding. *P. pulmonale* - **P. pulmonale**, characterized by tall, peaked P waves in leads II, III, and aVF, suggests **right atrial enlargement** due to chronic lung disease or pulmonary hypertension [1]. - While it can be seen in severe, prolonged right heart strain, it is much less common in acute PE than sinus tachycardia. *Right axis deviation* - **Right axis deviation** indicates **right ventricular hypertrophy** or acute right heart strain. - Like the S1Q3T3 pattern, it is a sign of more significant right heart involvement and is not as common as sinus tachycardia in all cases of acute PE [1].

Q: A 40-year-old man presented with repeated episodes of bronchospasm and hemoptysis. Chest X-ray revealed perihilar bronchiectasis. The most likely diagnosis is

Bronchopulmonary aspergillosis. ***Bronchopulmonary aspergillosis*** - **Allergic bronchopulmonary aspergillosis (ABPA)** is characterized by **bronchospasm**, recurrent fleeting pulmonary infiltrates, and **hemoptysis** in patients with asthma or cystic fibrosis. - The chest X-ray findings of **perihilar bronchiectasis** are a hallmark of ABPA, resulting from airway damage caused by the allergic response to *Aspergillus fumigatus*. *Sarcoidosis* - Sarcoidosis is a **granulomatous disease** that typically presents with non-caseating granulomas, often affecting the lungs, lymph nodes, eyes, and skin. [1] - While it can cause respiratory symptoms, **bronchiectasis** and **hemoptysis** are not typical primary features; more common findings include bilateral hilar lymphadenopathy and interstitial lung disease. [1] *Idiopathic pulmonary fibrosis* - Idiopathic pulmonary fibrosis (IPF) is a **chronic, progressive interstitial lung disease** characterized by progressive scarring of the lung tissue. [2] - While IPF causes respiratory symptoms like dyspnea and cough, it does not typically present with recurrent **bronchospasm**, **hemoptysis**, or **perihilar bronchiectasis**. [2] *Extrinsic allergic alveolitis* - Extrinsic allergic alveolitis, also known as **hypersensitivity pneumonitis**, is an immune-mediated lung disease caused by exposure to various inhaled antigens. - It typically presents with flu-like symptoms, cough, and dyspnea, and while it can cause interstitial lung disease, **bronchospasm** and **bronchiectasis** are not characteristic features.

Q: The most common cause of lung abscess is:

Aspiration. **Aspiration** - **Aspiration of oropharyngeal secretions** containing anaerobic bacteria is the most common mechanism leading to lung abscess formation. [1] - This often occurs in individuals with **impaired consciousness** (e.g., due to alcohol intoxication, stroke, seizures), dysphagia, or poor dental hygiene. [1] *Hematogenous spread from distant site* - While possible, **hematogenous spread** (e.g., from endocarditis or septic thrombophlebitis) is a less common cause of lung abscess compared to aspiration. - This typically results in **multiple, diffuse abscesses**, rather than a single, large one. *Direct contact* - **Direct contact** or extension from an adjacent infection (e.g., empyema) can cause lung involvement, but it is not the most frequent etiology of primary lung abscess. - This refers to the spread from a contiguous thoracic infection invading the lung parenchyma. *Lymphatic spread* - **Lymphatic spread** is a rare cause of lung abscess and is more typically associated with the dissemination of malignancy or certain fungal infections rather than bacterial abscess formation. - The lymphatic system primarily drains fluid and immune cells, not typically leading to focal pus collections.

Q: Which of the following is NOT a characteristic feature of sarcoidosis?

Erythema marginatum. ***Erythema marginatum*** - This is a hallmark feature of **acute rheumatic fever**, characterized by a pink-red rash with raised borders and central clearing. - It is **not associated with sarcoidosis**, a multi-system granulomatous disease [1]. *Panda sign* - The **"Panda sign"** refers to increased uptake in the lacrimal and parotid glands on a gallium scan, a finding consistent with sarcoidosis. - This sign indicates **lymphocytic infiltration** of these glands, a common manifestation of the disease. *Egg shell calcification* - **Eggshell calcification** can be seen in the hilar or mediastinal lymph nodes in sarcoidosis, though it is more classically associated with **silicosis** [2]. - It represents calcification occurring in the periphery of a lymph node. *Hilar lymphadenopathy* - **Bilateral hilar lymphadenopathy** is the most common radiological finding in sarcoidosis, present in up to 90% of cases [1]. - It is often asymptomatic and detected on a routine chest X-ray [1].

Q: Which statement is true regarding pneumothorax?

Absent breath sounds. ***Absent breath sounds*** * **Complete absence of breath sounds** on the affected side is a hallmark sign of a pneumothorax, indicating collapsed lung tissue and air in the pleural space. * Air in the pleural space attenuates sound transmission, leading to a significant reduction or **absence of vesicular breath sounds** [2]. *Decreased percussion note* * A pneumothorax typically leads to a **hyperresonant percussion note** due to the presence of air in the pleural space. * A decreased or dull percussion note is usually associated with conditions like **pleural effusion** or consolidation [3]. *Always needs chest tube insertion* * **Small, stable pneumothoraces** can often be managed with observation and oxygen, especially if the patient is asymptomatic. * Chest tube insertion is reserved for **larger pneumothoraces**, symptomatic patients, or those with tension pneumothorax [1]. *Tracheal tug* * **Tracheal deviation**, not tracheal tug, can be a sign of a **tension pneumothorax**, where the trachea is pushed away from the affected side [1]. * Tracheal tug, or upward movement of the trachea with inspiration, is more indicative of **severe airway obstruction** or respiratory distress.

Question 1

Which of the following is the most significant risk factor for pulmonary embolism?

Accepted Answer

Malignancy

Answer

Protein S deficiency

Answer

Obesity

Answer

Progesterone therapy

Question 2

Superior sulcus tumor of the lungs characteristically presents with:

Accepted Answer

Pancoast syndrome

Answer

Breathlessness

Answer

Hemoptysis

Answer

Horner's syndrome

Question 3

Which condition is associated with the development of a bovine cough?

Accepted Answer

Tracheitis

Answer

Laryngeal adenoidectomy

Answer

Acute epiglotitis

Answer

Antibiotics

Question 4

Which of the following conditions is least likely to cause pneumothorax?

Accepted Answer

Bronchopulmonary Aspergillosis

Answer

Marfan syndrome

Answer

Assisted ventilation

Answer

Eosinophilic granuloma

Question 5

Which of the following best describes the arterial blood gas findings in type II respiratory failure?

Accepted Answer

Low pO2 and high pCO2

Answer

Low pO2 and low pCO2

Answer

Normal pO2 and high pCO2

Answer

Low pO2 and normal pCO2

Question 6

In acute pulmonary embolism, which among the following is the most frequent ECG finding?

Accepted Answer

Sinus tachycardia

Answer

Right axis deviation

Answer

S1Q3T3 pattern

Answer

P. pulmonale

Question 7

A 40-year-old man presented with repeated episodes of bronchospasm and hemoptysis. Chest X-ray revealed perihilar bronchiectasis. The most likely diagnosis is

Accepted Answer

Bronchopulmonary aspergillosis

Answer

Sarcoidosis

Answer

Idiopathic pulmonary fibrosis

Answer

Extrinsic allergic alveolitis

Question 8

The most common cause of lung abscess is:

Accepted Answer

Aspiration

Answer

Lymphatic spread

Answer

Hematogenous spread from distant site

Answer

Direct contact

Question 9

Which of the following is NOT a characteristic feature of sarcoidosis?

Accepted Answer

Erythema marginatum

Answer

Panda sign

Answer

Egg shell calcification

Answer

Hilar lymphadenopathy

Question 10

Which statement is true regarding pneumothorax?

Accepted Answer

Absent breath sounds

Answer

Decreased percussion note

Answer

Tracheal tug

Answer

Always needs chest tube insertion

Pulmonology — MCQs

Pulmonology — MCQs

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