Pulmonology Practice Questions

Q: Pack year means

20 cigarettes per day for 1 year. ***20 cigarettes per day for 1 year*** - A **pack year** is a unit for measuring the amount a person has smoked over an extended period. - It is defined as smoking **20 cigarettes (one pack) per day for one year**. *50 cigarettes per day for 1 year* - This option refers to smoking **2.5 packs per day** for one year, which would equate to 2.5 pack years, not a single pack year. - This is an incorrect definition for a single pack year. *10 cigarettes per day for 1 year* - This option refers to smoking **half a pack per day** for one year, which would equate to 0.5 pack years, not a single pack year. - This is an incorrect definition for a single pack year. *40 cigarettes per day for 1 year* - This option refers to smoking **two packs per day** for one year, which would equate to 2 pack years, not a single pack year. - This is an incorrect definition for a single pack year.

Q: Most common extra-oral cause of Halitosis is?

Chronic Sinusitis. ***Chronic Sinusitis*** - **Chronic sinusitis** leads to postnasal drip, where mucus containing bacteria and inflammatory products drips down the back of the throat, causing unpleasant odors. - The breakdown of this protein-rich mucus by bacteria in the throat and on the tongue produces **volatile sulfur compounds (VSCs)**, which are a primary cause of halitosis. *Alcohol Intake* - While **alcohol intake** can cause temporary bad breath due to its dehydrating effect and breakdown products, it is not considered the most common chronic extra-oral cause of halitosis. - Alcohol can also exacerbate dry mouth, which contributes to increased bacterial growth and VSC production. *Diabetes Mellitus* - **Uncontrolled diabetes mellitus** can cause a fruity, acetone-like breath odor (ketoacidosis), but this is a distinct metabolic smell, not the typical VSC-related halitosis. - It's a specific metabolic issue rather than a common chronic cause of general halitosis. *Indigestion* - While conditions like **gastroesophageal reflux disease (GERD)**, a form of indigestion, can contribute to halitosis due to stomach contents and acid refluxing into the esophagus and mouth, it is less common than chronic sinusitis as an extra-oral cause. - Other forms of indigestion typically do not directly cause chronic halitosis unless there is significant reflux or underlying systemic issues.

Q: Which of the following is least likely to be associated with hemothorax?

Supine posture is better than erect posture. ***Supine posture is better than erect posture*** - This statement is least likely to be associated with hemothorax because **erect posture** allows for better visualization of blood in the pleural cavity on chest X-ray due to gravity. - In a supine patient, blood layers posteriorly and may be more difficult to detect or may only present as a **diffuse haziness** or **blunting of the costophrenic angles**. *Seen in choriocarcinoma* - **Choriocarcinoma** is a highly metastatic tumor that can spread to the lungs, leading to **pulmonary hemorrhage** and subsequent hemothorax. - **Pulmonary metastases** from choriocarcinoma are known to be particularly vascular and prone to bleeding. *Needle aspiration may be needed for diagnosis* - **Needle aspiration** (thoracentesis) is often used to confirm the presence of blood in the pleural space, which is diagnostic for hemothorax [1]. - It also helps to differentiate hemothorax from other pleural effusions and provides a means for initial therapeutic drainage [1]. *All of the options* - This option is incorrect because the statement regarding supine posture being better for hemothorax visualization is **false**, making it the least likely association. - The other two options (choriocarcinoma association and need for needle aspiration) are indeed characteristic of hemothorax.

Q: A 45-year-old crane operator at a construction site with pre-existing seropositive rheumatoid arthritis complains of progressive difficulty in breathing. On examination - Rheumatoid nodules are also present. Chest X-ray was performed. What is the diagnosis?

Caplan syndrome. Phase ***Caplan syndrome*** - **Caplan syndrome** is characterized by the presence of **rheumatoid arthritis**, lung nodules (usually multiple and bilateral), and a history of exposure to **occupational dusts**, particularly silica or coal dust [2]. The patient's history as a crane operator at a construction site suggests significant occupational dust exposure, fitting this diagnosis. [2] - The combination of pre-existing **seropositive rheumatoid arthritis**, rheumatoid nodules, and progressive difficulty in breathing with chest X-ray findings consistent with lung nodules points strongly to this rare but well-described condition [1], [2]. *Lung cancer* - While lung cancer can present with respiratory symptoms and nodules, the patient's history of **rheumatoid arthritis** and **rheumatoid nodules** makes Caplan syndrome a more specific and likely diagnosis given the occupational exposure. - Without further imaging or biopsy results, attributing the nodules solely to lung cancer would overlook the strong association with his existing autoimmune condition and work environment. *Bronchiolitis obliterans organizing pneumonia* - This condition involves inflammation and fibrosis within the bronchioles and alveoli, leading to respiratory symptoms and patchy infiltrates on chest imaging. - However, it is not typically associated with **rheumatoid nodules** or occupational dust exposure in the same manner as Caplan syndrome, making it less likely in this specific clinical context. *Felty syndrome* - **Felty syndrome** is a triad of **rheumatoid arthritis**, **splenomegaly**, and **neutropenia**. - While the patient has rheumatoid arthritis, there is no mention of splenomegaly or neutropenia, and the predominant respiratory symptoms with lung nodules are not features of Felty syndrome.

Q: All are features of Silico-tuberculosis except:

High sputum AFB +ve. ***High sputum AFB +ve*** - In **silico-tuberculosis**, the immune response against *Mycobacterium tuberculosis* is often contained within the **silicotic nodules**. - This compartmentalization means the bacteria are less likely to be actively shed into the airways, leading to **lower sputum bacillary load** and often negative AFB smears. *Nodular fibrosis* - **Nodular fibrosis** is a hallmark of silicosis, characterized by the formation of fibrotic nodules in the lung parenchyma [1]. - This fibrotic process provides a nidus for the development and progression of tuberculosis in silico-tuberculosis [2]. *Impairment of total lung* - Both silicosis and tuberculosis can cause significant **lung damage** and **fibrosis**. - The combination (silico-tuberculosis) often leads to more severe and generalized **restriction** and **loss of lung volume**, impairing total lung capacity [1]. *Children of such cases do not get disease* - **Tuberculosis is an infectious disease** spread by airborne droplets. - While silicosis itself is not transmissible, the co-existing active tuberculosis can be transmitted to close contacts, including **children**, particularly if the patient has active pulmonary TB [2].

Q: For doing ABG, which of the following is used?

Whole blood. ***Whole blood*** - **Arterial blood gases (ABG)** analyze the gaseous components and acid-base balance directly in the blood as it circulates, so **whole blood** is required. [3] - The sample is typically drawn from an **artery** and processed immediately to prevent changes in gas levels due to metabolism. [3] *RBC* - **Red blood cells (RBCs)** are only one component of blood; analyzing them alone would not provide the full picture of **gas exchange** and **acid-base status**. [1], [2] - While RBCs carry oxygen and carbon dioxide, the ABG test measures these gases dissolved in the **plasma** and within the RBCs. [2] *Serum* - **Serum** is the liquid portion of blood that remains after coagulation, meaning **clotting factors** and cells have been removed. - This process significantly alters the **gas concentrations** and **pH**, making it unsuitable for ABG analysis. *Plasma* - **Plasma** is the liquid component of blood, but collecting it requires the removal of **red blood cells** and other cellular components. [1] - ABG analysis relies on the interplay of gases in both the **cellular** and **liquid** phases of blood for accurate results. [3]

Q: Which of the following is not true about pulmonary embolus

Most of the emboli cause infarction. ***Most of the emboli cause infarction*** - While pulmonary emboli block blood flow, the **dual blood supply to the lungs** (pulmonary and bronchial arteries) typically prevents infarction in most cases. - Pulmonary infarction occurs in only about **10% of pulmonary embolism (PE) cases**, usually when the bronchial circulation is compromised or the patient has pre-existing heart failure. *Most lesions affect the lower lobes* - This statement is generally true; **pulmonary emboli are more common in the lower lobes** due to higher blood flow and gravitational effects [1]. - The majority of emboli tend to settle in areas with greater vascularity and gravity-dependent perfusion [1]. *Saddle embolus may cause sudden death* - This is true; a **saddle embolus** is a large embolus that straddles the bifurcation of the main pulmonary artery, blocking blood flow to both lungs. - It leads to **acute right heart failure** and circulatory collapse, often resulting in sudden cardiovascular death. *Small arterioles are blocked* - This statement is not entirely accurate; while small emboli can block arterioles, many significant pulmonary emboli are large enough to obstruct **larger pulmonary arteries and their major branches**. - The size of the blocked vessel depends on the size of the embolus, ranging from small arterioles to lobar or main pulmonary arteries.

Q: Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Intermediate. **Intermediate** - Clinical signs of **DVT (3 points)**, **tachycardia (heart rate > 100 bpm, 1.5 points)**, and a history of **cancer (1 point)** sum up to 5.5 points, which falls within the range for an intermediate probability (2-6 points) on the modified Well's score for PE. - The modified Well's criteria assigns specific points for risk factors and clinical findings, guiding the diagnostic approach for pulmonary embolism [1]. *Low* - A low probability for PE according to the modified Well's score is indicated by a total score of **less than 2 points** [1]. - The patient's presentation accumulates significantly more points than this threshold due to multiple contributing factors. *High* - A high probability for PE according to the modified Well's score is indicated by a total score of **greater than 6 points** [1]. - The patient's score of 5.5 points does not meet this threshold, placing them in the intermediate category.

Q: A known case of COPD with acute exacerbation of symptoms. On examination patient was conscious and alert, pulse was 110 beats/ min and bilateral wheeze present. All of the following are true in the management of the patient except:

Non invasive ventilation is contraindicated. ***Non invasive ventilation is contraindicated*** - This statement is **false**, therefore the correct exception. **Non-invasive ventilation (NIV)** is often indicated and beneficial in the management of acute exacerbations of COPD, especially in patients with **respiratory acidosis** or persistent dyspnea, as it can reduce the need for intubation and improve outcomes [2]. - The patient's presentation (conscious, alert, wheeze, tachycardia) suggests an acute exacerbation, for which NIV is a key intervention unless there are absolute contraindications like cardiac arrest or inability to protect the airway [3]. *Permissible hypercapnia allowed* - **Permissive hypercapnia** is a valid strategy in managing acute exacerbations of COPD, particularly during mechanical ventilation. The goal is to maintain an adequate pH (e.g., >7.20-7.25) rather than normalizing CO2, to avoid **barotrauma** and **volutrauma** from aggressive ventilation [3]. - This approach acknowledges that some CO2 retention is acceptable as long as acidosis is not severe, protecting the lungs from excessive pressure. *Inhalation with salbutamol* - **Inhaled bronchodilators**, such as **salbutamol (a short-acting beta-agonist)**, are a cornerstone of treatment for acute COPD exacerbations [1]. They act rapidly to relieve **bronchospasm** and improve airflow, addressing the wheeze observed in the patient. - Frequent administration of these agents is crucial in the initial management to open up the airways and reduce air trapping. *I/V steroids* - **Systemic corticosteroids**, such as intravenous methylprednisolone or oral prednisone, are essential in managing acute COPD exacerbations. They reduce **airway inflammation** and swelling, leading to improved lung function and reduced recovery time. - Steroids are typically given for a short course (e.g., 5-7 days) to minimize side effects while maximizing therapeutic benefits.

Q: A 60-year male with dyspnea shows honeycombing on HRCT. Labs show positive ANA. Diagnosis?

UIP. UIP - **Honeycombing** on HRCT is a hallmark finding of **Usual Interstitial Pneumonia (UIP)**, which is the most common pattern of **Idiopathic Pulmonary Fibrosis (IPF)** [1]. - While a **positive ANA** can be associated with various connective tissue diseases, it is not specific and in the context of isolated honeycombing, UIP remains the most likely pattern; mildly positive ANA is not uncommon in IPF cases [1]. *COP* - **Cryptogenic Organizing Pneumonia (COP)** typically presents with **peribronchial consolidation** and **ground-glass opacities** on HRCT, rather than widespread honeycombing. - While patient symptoms can overlap, the characteristic HRCT findings for COP are different from those described. *Sarcoidosis* - **Sarcoidosis** is characterized by **non-caseating granulomas** and typically presents with **lymphadenopathy**, **nodules**, or **reticulonodular opacities** on HRCT, not primarily honeycombing. - A positive ANA is not a typical serological marker for sarcoidosis. *NSIP* - **Nonspecific Interstitial Pneumonia (NSIP)** primarily shows **ground-glass opacities** and **reticular abnormalities** with less prominent or absent honeycombing compared to UIP. - NSIP is also more likely to show uniform inflammation and fibrosis without the patchy, peripheral predilection of UIP.

Question 1

Pack year means

Accepted Answer

20 cigarettes per day for 1 year

Answer

50 cigarettes per day for 1 year

Answer

10 cigarettes per day for 1 year

Answer

40 cigarettes per day for 1 year

Question 2

Most common extra-oral cause of Halitosis is?

Accepted Answer

Chronic Sinusitis

Answer

Alcohol Intake

Answer

Diabetes Mellitus

Answer

Indigestion

Question 3

Which of the following is least likely to be associated with hemothorax?

Accepted Answer

Supine posture is better than erect posture

Answer

Seen in choriocarcinoma

Answer

Needle aspiration may be needed for diagnosis

Answer

All of the options

Question 4

A 45-year-old crane operator at a construction site with pre-existing seropositive rheumatoid arthritis complains of progressive difficulty in breathing. On examination - Rheumatoid nodules are also present. Chest X-ray was performed. What is the diagnosis?

Accepted Answer

Caplan syndrome

Answer

Lung cancer

Answer

Bronchiolitis obliterans organizing pneumonia

Answer

Felty syndrome

Question 5

All are features of Silico-tuberculosis except:

Accepted Answer

High sputum AFB +ve

Answer

Nodular fibrosis

Answer

Impairment of total lung

Answer

Children of such cases do not get disease

Question 6

For doing ABG, which of the following is used?

Accepted Answer

Whole blood

Answer

RBC

Answer

Serum

Answer

Plasma

Question 7

Which of the following is not true about pulmonary embolus

Accepted Answer

Most of the emboli cause infarction

Answer

Most lesions affect the lower lobes

Answer

Saddle embolus may cause sudden death

Answer

Small arterioles are blocked

Question 8

Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Accepted Answer

Intermediate

Answer

Low

Answer

High

Question 9

A known case of COPD with acute exacerbation of symptoms. On examination patient was conscious and alert, pulse was 110 beats/ min and bilateral wheeze present. All of the following are true in the management of the patient except:

Accepted Answer

Non invasive ventilation is contraindicated

Answer

Permissible hypercapnia allowed

Answer

Inhalation with salbutamol

Answer

I/V steroids

Question 10

A 60-year male with dyspnea shows honeycombing on HRCT. Labs show positive ANA. Diagnosis?

Accepted Answer

UIP

Answer

COP

Answer

Sarcoidosis

Answer

NSIP

Pulmonology — MCQs

Pulmonology — MCQs

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