Pulmonology Practice Questions

Q: Which sinus is most commonly affected in sinusitis?

Maxillary sinus. ***Maxillary sinus*** - The **maxillary sinus** is the largest of the paranasal sinuses and is involved in nearly all cases of acute rhinosinusitis. - Its **ostium** is located superiorly, which makes **drainage against gravity** difficult, predisposing it to infection and inflammation. *Frontal sinus* - The **frontal sinuses** are frequently affected, but less commonly than the maxillary sinus. - They develop later than other sinuses, making them less common in younger children. *Ethmoid sinus* - The **ethmoid sinuses** are involved in many cases of sinusitis, especially in children, as they are present at birth. - However, they are not the most common sinus to be singularly affected in acute sinusitis. *Sphenoid sinus* - The **sphenoid sinus** is the least commonly affected paranasal sinus in sinusitis [1]. - Involvement of the sphenoid sinus often indicates a more severe or chronic infection.

Q: A patient with known sarcoidosis presents with dyspnea and a dry cough. A chest X-ray shows bilateral hilar lymphadenopathy. What is the most appropriate next step in management?

High-resolution CT scan of the chest. A high-resolution CT (HRCT) scan provides more detailed imaging of the lungs and lymph nodes, which is crucial for assessing the extent and severity of pulmonary involvement in sarcoidosis [1]. It helps differentiate between various patterns of lung involvement (e.g., ground-glass opacities, nodules, fibrosis) and guides further management, including the need for biopsy or treatment [1]. While a biopsy is definitive for diagnosing sarcoidosis, it is usually reserved for cases where the diagnosis is uncertain or when there is atypical presentation or progression [2]. Given the patient's known sarcoidosis and classic chest X-ray findings [2], a less invasive step to assess disease extent is preferred before considering biopsy.

Q: In a patient with obstructive lung disease, which parameter is typically reduced during spirometry testing?

Forced expiratory volume in 1 second (FEV1). ***Forced expiratory volume in 1 second (FEV1)*** - In **obstructive lung diseases**, there is significant airflow limitation, meaning the patient struggles to exhale air quickly [1]. - This leads to a characteristic **reduction in FEV1**, as less air can be forcefully exhaled within the first second [1]. *Residual volume (RV)* - **Residual volume** is typically increased in obstructive lung diseases due to **air trapping**, as patients cannot fully empty their lungs. - An increase in RV reflects the inability to exhale all the air, not a reduction in expiratory flow. *Forced vital capacity (FVC)* - While **FVC** can be normal or slightly reduced in obstructive lung disease, it is its **ratio to FEV1 (FEV1/FVC)** that is consistently low and diagnostic [1]. - An isolated reduction in FVC is more characteristic of **restrictive lung diseases**, where lung volumes are primarily affected. *Total lung capacity (TLC)* - **Total lung capacity** is often normal or even increased in obstructive lung diseases due to **hyperinflation** and air trapping. - An increase in TLC is a compensatory mechanism and does not directly indicate airflow obstruction.

Q: Which ECG pattern is observed in pulmonary embolism?

S1Q3T3. ***S1Q3T3*** - The **S1Q3T3 pattern** on an ECG is a classic, though not always present, sign of **acute cor pulmonale** due to a large pulmonary embolism [1]. - It describes a **prominent S wave in lead I**, a **Q wave in lead III**, and an **inverted T wave in lead III** [1]. *S3Q3T1* - This pattern is not typically associated with pulmonary embolism. The combination of an S wave in lead III, Q wave in lead III, and T wave in lead I does not point to the characteristic right heart strain. - ECG changes in PE primarily reflect acute right ventricular strain and dilatation, which manifest differently [1]. *S1Q1T3* - This pattern is not a recognized ECG finding for pulmonary embolism. A Q wave in lead I is generally not characteristic of PE. - The classic PE pattern involves specific changes in leads I and III reflecting the acute right heart overload [1]. *S3Q3T3* - While a Q wave and inverted T wave in lead III are part of the classic PE pattern (S1Q3T3), an S wave in lead III alone is not diagnostic for the classic pattern, which requires an S wave in lead I. - The S1 component in lead I is crucial for the full classic S1Q3T3 pattern, indicating right ventricular strain.

Q: Inspiratory stridor is typically associated with which type of airway lesion?

Supraglottic lesions. ***Supraglottic lesions*** - **Inspiratory stridor** occurs due to turbulent airflow during inspiration, which is characteristic of **supraglottic obstruction** as the negative pressure during inspiration causes collapse of the lax tissues above the vocal cords [1]. - Common causes include **laryngomalacia**, epiglottitis, and foreign body aspiration in the pharynx or larynx above the vocal cords [1]. *Subglottic lesions* - **Subglottic lesions** typically cause **biphasic stridor** or expiratory stridor, as obstruction below the vocal cords affects both inspiratory and expiratory airflow. - Examples include **subglottic stenosis** or croup, where turbulent airflow occurs in both phases of respiration. *Tracheal lesions* - **Tracheal lesions** often lead to **biphasic inspiratory and expiratory stridor**, as the trachea is a rigid structure and obstruction affects airflow in both directions [1]. - Conditions like **tracheal stenosis** or tumors in the trachea cause constant airway narrowing [1]. *Bronchial lesions* - **Bronchial lesions** are more likely to cause **expiratory wheezing** or stridor, particularly if they are distal to the trachea. - Obstruction in the bronchi leads to air trapping and restricted outflow during expiration, producing a high-pitched whistling sound.

Q: In which of the following conditions is oxygen therapy generally not considered useful?

Severe laryngeal obstruction. Directly address the conditions where oxygen therapy is effective or ineffective. ***Severe laryngeal obstruction*** - In cases of **severe laryngeal obstruction**, the primary issue is a mechanical blockage preventing air from reaching the lungs, not impaired gas exchange at the alveolar level [3]. Oxygen therapy alone cannot bypass this physical obstruction. - The immediate and critical intervention for severe laryngeal obstruction is to secure an airway, often through procedures like **intubation** or **tracheostomy**, rather than relying on supplemental oxygen [4]. *Acute asthma exacerbation* - Patients with acute asthma exacerbations often experience **bronchoconstriction** and **airway inflammation**, leading to ventilation-perfusion mismatch and hypoxemia [2]. - Oxygen therapy is crucial in these patients to correct hypoxemia and reduce the work of breathing, improving tissue oxygenation [1]. *Bacterial pneumonia* - **Bacterial pneumonia** causes consolidation and inflammation in the lung parenchyma, impairing gas exchange and leading to hypoxemia [2]. - Oxygen therapy is a standard treatment to maintain adequate arterial oxygen saturation and support respiratory function in patients with pneumonia [1]. *Pulmonary fibrosis* - **Pulmonary fibrosis** involves scarring and thickening of the lung tissue, which impedes the diffusion of oxygen across the alveolar-capillary membrane. - Supplemental oxygen helps overcome this diffusion defect, particularly during exertion, improving hypoxemia and reducing dyspnea [1].

Q: A patient presents with symptoms of wheezing, shortness of breath, and a history of asthma. Which of the following conditions does this most likely signify?

Obstructive lung disease. ***Obstructive lung disease*** - **Wheezing** and **shortness of breath** in a patient with a **history of asthma** are classic signs of airway narrowing, which is characteristic of obstructive lung diseases [1]. - **Asthma** is a prototypical **obstructive lung disease** where inflammation and bronchoconstriction impede airflow, especially during exhalation [2]. *Normal lung function* - This option is incorrect because the patient is experiencing **symptoms** like wheezing and shortness of breath, which indicate **impaired respiratory function**. - **Normal lung function** would involve unobstructed airflow and the absence of such respiratory distress. *Restrictive lung disease* - **Restrictive lung diseases** typically involve reduced lung volumes due to stiffness of the lungs or chest wall, leading to difficulty **inhaling**. - While shortness of breath can be present, **wheezing** is not a primary symptom and the patient's history of asthma strongly points away from a restrictive process [1]. *Both* - The combination of **wheezing** and a history of **asthma** specifically points to an **obstructive process** rather than a blend of both, as asthma's pathology is rooted in airway obstruction [1]. - While some complex lung conditions can have elements of both, the prominent features described here are characteristic of **obstructive lung disease**.

Q: FEV1/FVC is decreased in:

Obstructive lung disease such as asthma. ***Obstructive lung disease such as asthma*** - In **obstructive lung diseases**, there is difficulty with **airflow out of the lungs**, leading to a disproportionate decrease in **FEV1** compared to FVC [1]. - This results in a **reduced FEV1/FVC ratio**, which is a hallmark of conditions like asthma and COPD [1]. *Kyphosis and scoliosis* - These are **restrictive lung conditions** due to chest wall deformities, which typically show a reduced FVC but a **normal or increased FEV1/FVC ratio**. - The primary problem is reduced lung volume, not airflow obstruction. *Restrictive lung disease* - In general, **restrictive lung diseases** are characterized by **reduced lung volumes** (decreased FVC) but **preserved or even increased airflow rates**. - Therefore, the **FEV1/FVC ratio** is usually **normal or elevated**, not decreased. *Pulmonary fibrosis* - **Pulmonary fibrosis** is a type of **restrictive lung disease** where lung tissue becomes stiff and scarred, leading to decreased lung volumes. - While FVC is decreased, the **FEV1/FVC ratio typically remains normal or even increases** because both FEV1 and FVC decrease proportionally, or FEV1 decreases less.

Q: Lights criteria is used for

Diagnosing pleural effusions. ***Diagnosing pleural effusions*** - **Light's criteria** is a set of guidelines used to differentiate between an exudative and a transudative **pleural effusion** [1]. - It involves comparing the levels of protein and lactate dehydrogenase (LDH) in pleural fluid to those in serum [1]. *Diagnosing pericardial effusions* - **Pericardial effusions** are typically evaluated using echocardiography and clinical assessment, not Light's criteria. - The focus for pericardial effusions is often on their size, hemodynamic impact, and underlying cause, rather than protein/LDH ratios. *Diagnosing ascites* - **Ascites**, the accumulation of fluid in the peritoneal cavity, is evaluated using the **serum-ascites albumin gradient (SAAG)** to differentiate causes, not Light's criteria. - **Light's criteria** are specific to pleural fluid analysis [1]. *Diagnosing increased intracranial tension* - **Increased intracranial tension (ICT)** is diagnosed by clinical signs, imaging (CT/MRI), and direct intracranial pressure monitoring. - This condition involves brain physiology and is unrelated to effusions or fluid analysis parameters used in Light's criteria.

Q: Brock's syndrome is associated with which lobe of the lung?

Middle lobe of the right lung. ***Middle lobe of the right lung*** - **Brock's syndrome** specifically refers to chronic or recurrent collapse/consolidation of the **right middle lobe**. [1] - It is often caused by **bronchial obstruction** due to compression from enlarged lymph nodes or recurrent infections. [2] *Lower lobe of the right lung* - While other conditions can affect the **right lower lobe**, it is not specifically associated with Brock's syndrome. - Collapse or consolidation in this lobe would typically be referred to by its anatomical location rather than this eponymous syndrome. *Upper lobe of the left lung* - Conditions affecting the **left upper lobe** have distinct etiologies and are not designated as Brock's syndrome. [3] - This lobe is frequently affected in **tuberculosis** and other specific pathologies. *Lower lobe of the left lung* - The **left lower lobe** is a common site for various pulmonary pathologies but not for Brock's syndrome. - Its involvement typically points towards different diagnostic considerations.

Question 1

Which sinus is most commonly affected in sinusitis?

Accepted Answer

Maxillary sinus

Answer

Frontal sinus

Answer

Ethmoid sinus

Answer

Sphenoid sinus

Question 2

A patient with known sarcoidosis presents with dyspnea and a dry cough. A chest X-ray shows bilateral hilar lymphadenopathy. What is the most appropriate next step in management?

Accepted Answer

High-resolution CT scan of the chest

Answer

Bronchoscopy with biopsy

Answer

Serum ACE levels

Answer

Immediate initiation of glucocorticoids

Question 3

In a patient with obstructive lung disease, which parameter is typically reduced during spirometry testing?

Accepted Answer

Forced expiratory volume in 1 second (FEV1)

Answer

Residual volume (RV)

Answer

Forced vital capacity (FVC)

Answer

Total lung capacity (TLC)

Question 4

Which ECG pattern is observed in pulmonary embolism?

Accepted Answer

S1Q3T3

Answer

S3Q3T1

Answer

S1Q1T3

Answer

S3Q3T3

Question 5

Inspiratory stridor is typically associated with which type of airway lesion?

Accepted Answer

Supraglottic lesions

Answer

Subglottic lesions

Answer

Tracheal lesions

Answer

Bronchial lesions

Question 6

In which of the following conditions is oxygen therapy generally not considered useful?

Accepted Answer

Severe laryngeal obstruction

Answer

Acute asthma exacerbation

Answer

Bacterial pneumonia

Answer

Pulmonary fibrosis

Question 7

A patient presents with symptoms of wheezing, shortness of breath, and a history of asthma. Which of the following conditions does this most likely signify?

Accepted Answer

Obstructive lung disease

Answer

Normal lung function

Answer

Restrictive lung disease

Answer

Both

Question 8

FEV1/FVC is decreased in:

Accepted Answer

Obstructive lung disease such as asthma

Answer

Kyphosis and scoliosis

Answer

Restrictive lung disease

Answer

Pulmonary fibrosis

Question 9

Lights criteria is used for

Accepted Answer

Diagnosing pleural effusions

Answer

Diagnosing pericardial effusions

Answer

Diagnosing ascites

Answer

Diagnosing increased intracranial tension

Question 10

Brock's syndrome is associated with which lobe of the lung?

Accepted Answer

Middle lobe of the right lung

Answer

Lower lobe of the right lung

Answer

Upper lobe of the left lung

Answer

Lower lobe of the left lung

Pulmonology — MCQs

Pulmonology — MCQs

On this page

Practice by Chapter

Want unlimited practice?