Pulmonology — MCQs
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Which of the following is a common cause of respiratory failure in the immediate post-operative period?
Which ECG pattern is commonly associated with pulmonary embolism?
FEV1/FVC is decreased in:
Which of the following lung conditions are smokers more prone to?
In allergic bronchopulmonary aspergillosis, where are the lesions primarily located?
Pink puffers are typically associated with which condition?
Which of the following is least likely to cause a cavity in the lungs?
Which of the following conditions is primarily associated with alveolar hypoventilation?
An Adult with asthma presents with asthma symptoms every day and wakes up in the night approximately 2 to 3 days in a week. He can be classified as having :
Upper lobe bronchiectasis is seen in which disease?
Pulmonology Indian Medical PG Practice Questions and MCQs
Question 801: Which of the following is a common cause of respiratory failure in the immediate post-operative period?
- A. Post-operative atelectasis causing Type 1 respiratory failure due to ventilation-perfusion mismatch
- B. Pulmonary fibrosis causing Type 1 respiratory failure due to impaired gas diffusion
- C. Kyphoscoliosis causing Type 2 respiratory failure due to restrictive lung disease and hypoventilation (Correct Answer)
- D. Flail chest causing Type 1 respiratory failure due to chest wall instability and ventilation-perfusion mismatch
Explanation: ***Kyphoscoliosis causing Type 2 respiratory failure due to restrictive lung disease and hypoventilation*** - While kyphoscoliosis is a chronic condition, its impact on **respiratory mechanics** can be exacerbated post-operatively. - The already compromised chest wall and lung expansion from **restrictive lung disease** combined with **post-operative pain** and **sedation** can lead to significant **hypoventilation** and Type 2 respiratory failure [3]. *Post-operative atelectasis causing Type 1 respiratory failure due to ventilation-perfusion mismatch* - **Atelectasis** is extremely common post-operatively and can cause Type 1 respiratory failure due to **ventilation-perfusion (V/Q) mismatch** [2]. - However, it typically leads to **hypoxemia** (Type 1) rather than the primary **hypercapnia** (Type 2) seen with kyphoscoliosis and hypoventilation [1]. *Pulmonary fibrosis causing Type 1 respiratory failure due to impaired gas diffusion* - **Pulmonary fibrosis** is a chronic interstitial lung disease that primarily causes **Type 1 respiratory failure** due to thickening of the alveolar-capillary membrane and impaired gas diffusion. - It is a pre-existing condition, not an acute post-operative complication causing a sudden onset of respiratory failure unless there's an acute exacerbation. *Flail chest causing Type 1 respiratory failure due to chest wall instability and ventilation-perfusion mismatch* - **Flail chest** results from multiple rib fractures causing a segment of the chest wall to move paradoxically, severely impacting ventilation and leading to **V/Q mismatch** and **Type 1 respiratory failure**. - This is typically a consequence of **trauma** and not a common immediate post-operative complication unless the surgery itself involved significant chest wall injury.
Question 802: Which ECG pattern is commonly associated with pulmonary embolism?
- A. T wave inversion in V1-V4
- B. S1Q1T3
- C. S3Q3T1
- D. S1Q3T3 (Correct Answer)
Explanation: S1Q3T3 - The S1Q3T3 pattern is a classic ECG finding in pulmonary embolism (PE), indicating acute right heart strain [1]. - It consists of a prominent S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III [1]. T wave inversion in V1-V4 - While T wave inversions can occur in PE, particularly in the precordial leads, the absence of an S1Q3T3 pattern makes it a less specific indicator compared to S1Q3T3 [1]. - This finding is also common in other conditions like myocardial ischemia or right ventricular hypertrophy. S1Q1T3 - This is not a recognized or common ECG pattern associated with pulmonary embolism. - The specific combination of waves in this pattern does not reflect the typical acute right heart strain seen in PE. S3Q3T1 - This is not a recognized or common ECG pattern associated with pulmonary embolism. - The described complex of waves does not correspond to the physiological changes, such as acute right ventricular overload, that occur during a PE.
Question 803: FEV1/FVC is decreased in:
- A. Kyphosis and scoliosis
- B. Restrictive lung disease
- C. Pulmonary fibrosis
- D. Obstructive lung disease such as asthma (Correct Answer)
Explanation: ***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.
Question 804: Which of the following lung conditions are smokers more prone to?
- A. Pneumonia
- B. Mycobacterium tuberculosis
- C. Influenza
- D. Chronic obstructive pulmonary disease (COPD) (Correct Answer)
Explanation: ***Chronic obstructive pulmonary disease (COPD)*** - **Smoking is the leading cause** of COPD, leading to progressive airflow limitation [1]. - Toxins in cigarette smoke cause **inflammation**, **mucus hypersecretion**, and destruction of lung tissue (emphysema) [1]. *Pneumonia* - While smokers have an **increased risk of pneumonia** due to impaired mucociliary clearance and immune function, it is not as uniquely or predominantly linked to smoking as COPD [2]. - Pneumonia is an **acute infection**, whereas COPD is a chronic, progressive condition. *Influenza* - Smokers are more susceptible to severe influenza and its complications, but influenza is a **viral infection** that affects the general population [2]. - The direct and consistent causal link between smoking and influenza is not as strong as it is with COPD. *Mycobacterium tuberculosis* - Smoking can increase the risk of developing **active tuberculosis** and worsen its prognosis, likely due to dampened immune responses [2]. - However, tuberculosis is a **bacterial infection** primarily driven by exposure to an infected person, not exclusively by smoking.
Question 805: In allergic bronchopulmonary aspergillosis, where are the lesions primarily located?
- A. None of the options
- B. Pleura
- C. Bronchi and bronchioles (Correct Answer)
- D. Alveoli
Explanation: In allergic bronchopulmonary aspergillosis, where are the lesions primarily located? ***Bronchi and bronchioles*** - Allergic bronchopulmonary aspergillosis primarily affects the **airways**, particularly the **bronchi and bronchioles**, due to the hypersensitivity reaction to the Aspergillus species. - It leads to **mucous plugging** and inflammatory changes in these structures, resulting in symptoms like **cough** and **wheeze**. *All of the above* - This option is incorrect as lesions are not typically found in all structures; ABPA specifically targets the **airways**. - The disease's hallmark features are localized to the **bronchi and bronchioles**, making this option misleading. *Pleura* - While pleural involvement can occur in other pulmonary diseases, it is not characteristic of **allergic bronchopulmonary aspergillosis**. - ABPA does not typically cause **pleural effusions** or lesions in the pleura, focusing instead on airway pathology. *Alveoli* - In ABPA, the primary lesions do not occur in the **alveoli**, but rather in the **airway passages**. - While lung inflammation can affect the alveoli in other contexts, it is not a specific feature of this condition.
Question 806: Pink puffers are typically associated with which condition?
- A. Emphysema (Correct Answer)
- B. Chronic bronchitis
- C. Pneumonia
- D. Bronchiectasis
Explanation: ***Emphysema*** - Patients with **emphysema** are often referred to as "pink puffers" because they maintain relatively normal arterial oxygen tension (pink) by **pursing their lips** and using accessory muscles to forcefully exhale (puffing) [1]. - This effort to maintain adequate oxygenation and ventilation, despite severe airflow obstruction, differentiates them from "blue bloaters" [1]. - In emphysema, the loss of alveolar walls leaves small airways unsupported, which contributes to air trapping and increased expiratory effort [2]. *Chronic bronchitis* - Patients with **chronic bronchitis** are classically described as "blue bloaters" due to **hypoxemia** (causing cyanosis or "blueness") and often present with **edema** from right heart failure (bloating) [1]. - They typically have a prominent cough with **sputum production** and less respiratory distress at rest compared to emphysema patients [1]. *Pneumonia* - **Pneumonia** is an acute infection of the lung parenchyma characterized by **fever**, cough, and **dyspnea**, and does not fit the long-term clinical phenotype of "pink puffer." - It typically causes an **influx of inflammatory cells** and fluid into the alveoli, leading to impaired gas exchange. *Bronchiectasis* - **Bronchiectasis** is characterized by **permanent dilation of the bronchi** and is often associated with chronic productive cough and recurrent infections. - While it can cause chronic respiratory symptoms, it does not typically present with the "pink puffer" phenotype associated with the specific compensatory mechanisms seen in emphysema.
Question 807: Which of the following is least likely to cause a cavity in the lungs?
- A. Granulomatosis with Polyangiitis (GPA)
- B. Tuberculosis
- C. Sarcoidosis (Correct Answer)
- D. Staphylococcus aureus pneumonia
Explanation: ***Sarcoidosis*** - Sarcoidosis typically leads to **granuloma formation** in the lungs rather than cavitary lesions [1]. - It usually presents with **bilateral hilar lymphadenopathy** and interstitial lung disease, not lung cavities [1]. *Wegeners* - Wegeners (now called Granulomatosis with Polyangiitis) can cause lung cavities due to **vascular inflammation** [1]. - It typically presents with **pulmonary nodules** that may cavitate and is associated with **renal involvement** [1]. *Hydatid* - Hydatid disease is caused by **Echinococcus** species and can result in cyst formation in the lungs that may become infected and develop cavities. - The cavitary lesions are often due to secondary infections of the cysts. *Staphylococcus* - Staphylococcus can lead to lung abscesses which may cavitate, particularly in cases of **pneumonia** or **aspiration**. - It is commonly associated with **necrotizing pneumonia** and empyema, resulting in cavitary lesions.
Question 808: Which of the following conditions is primarily associated with alveolar hypoventilation?
- A. COPD
- B. Lobar pneumonia
- C. Bulbar poliomyelitis
- D. Kyphoscoliosis (Correct Answer)
- E. Bulbar poliomyelitis
- F. Central sleep apnea
Explanation: ***Kyphoscoliosis*** - **Severe kyphoscoliosis** can restrict lung expansion and thoracic cage movement, leading to **reduced tidal volume** and respiratory muscle fatigue, resulting in **alveolar hypoventilation**. [1] - The abnormal curvature of the spine mechanically impedes efficient ventilation, primarily impacting the ability to take deep breaths and clear CO2. *COPD* - While patients with **severe COPD** can develop hypoventilation, it is primarily characterized by **airway obstruction** and **ventilation-perfusion mismatch** rather than being a primary cause of hypoventilation like restrictive disorders. [1] - Initial stages often involve hyperinflation and increased work of breathing, but not necessarily alveolar hypoventilation as the primary feature. *Lobar pneumonia* - **Lobar pneumonia** causes **consolidation** of lung tissue, leading to V/Q mismatch and hypoxemia. [2] - It typically results in *hyperventilation* due to hypoxaemia and inflammation, rather than alveolar hypoventilation. [2] *Bulbar poliomyelitis* - **Bulbar poliomyelitis** affects the motor neurons of the brainstem, leading to weakness of the muscles involved in swallowing and breathing. - While it can cause respiratory failure, its primary association is with direct paralysis of respiratory muscles rather than a structural respiratory compromise like kyphoscoliosis. *Central sleep apnea* - **Central sleep apnea** involves a temporary cessation of breathing efforts due to a lack of neural output from the brainstem. - It is a disorder of respiratory control during sleep and not primarily associated with daytime alveolar hypoventilation due to a structural chest wall defect.
Question 809: An Adult with asthma presents with asthma symptoms every day and wakes up in the night approximately 2 to 3 days in a week. He can be classified as having :
- A. Intermittent Asthma
- B. Mild Persistent Asthma
- C. Moderate Persistent Asthma (Correct Answer)
- D. Severe Persistent Asthma
Explanation: ***Moderate Persistent Asthma*** - This classification is characterized by **daily asthma symptoms** [1] and **nighttime awakenings occurring 3-4 times per week**. The patient's symptoms fit this description. - The patient's presentation of daily symptoms and 2-3 nighttime awakenings per week indicates a level of severity that surpasses mild persistent asthma but does not meet the criteria for severe persistent asthma [1]. *Intermittent Asthma* - This classification involves symptoms less than **twice a week** and nighttime awakenings less than **twice a month**. - The patient's symptoms are daily, which exceeds the criteria for intermittent asthma. *Mild Persistent Asthma* - This type features symptoms more than **twice a week** but less than **daily**, and nighttime awakenings occurring 3-4 times per month [1]. - The patient experiences daily symptoms, which is more frequent than what is seen in mild persistent asthma. *Severe Persistent Asthma* - This classification involves symptoms throughout the **day** and nighttime awakenings **every night** or multiple times a week (7 nights/week). Also, the patient has a very limited activity level. - While the patient has daily symptoms, the frequency of nighttime awakenings is not severe enough to be classified as severe persistent asthma.
Question 810: Upper lobe bronchiectasis is seen in which disease?
- A. Cystic fibrosis (Correct Answer)
- B. Tuberculosis
- C. Allergic Bronchopulmonary Aspergillosis (ABPA)
- D. Silicosis
Explanation: ***Cystic fibrosis*** - **Cystic fibrosis (CF)** classically affects the upper lobes due to poor mucociliary clearance in these areas, leading to recurrent infections and subsequent bronchiectasis. - The abnormal **CFTR protein** causes thick, sticky mucus that obstructs airways, making them susceptible to damage and dilation. *Tuberculosis* - While **post-primary tuberculosis** can cause cavitation and fibrosis in the upper lobes, leading to some degree of bronchiectasis, it's not the primary or classical cause of widespread upper lobe bronchiectasis like CF. - The mechanism is typically related to **tissue destruction** and fibrosis during healing, rather than primary mucociliary dysfunction. *Allergic Bronchopulmonary Aspergillosis (ABPA)* - **ABPA** can cause central bronchiectasis, often affecting the upper lobes, due to an allergic reaction to *Aspergillus* colonizing the airways. - However, the bronchiectasis in ABPA is typically **central and mucoid impaction-related**, in contrast to the diffuse pattern seen in CF. *Silicosis* - **Silicosis** typically leads to **nodular fibrotic changes** in the upper and mid-lung zones and can cause progressive massive fibrosis. - While it can indirectly lead to some airway distortion or traction bronchiectasis due to severe fibrosis, it is not primarily characterized by bronchiectasis as a prominent feature.
Practice by Chapter
Obstructive Airway Diseases (Asthma, COPD)
Practice Questions
Interstitial Lung Diseases
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Pulmonary Infections
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Pulmonary Vascular Diseases
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Pleural Diseases
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Sleep-Disordered Breathing
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Respiratory Failure
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Mediastinal Disorders
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Occupational Lung Diseases
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Pulmonary Function Testing
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Bronchiectasis and Cystic Fibrosis
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Lung Cancer Approach
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