Pulmonology — MCQs

Pulmonology Indian Medical PG Practice Questions and MCQs

Question 821: In evaluation of a case of immotile nasal cilia, which of the following investigations should prove useful?

A. Rhinogram
B. Sweat sodium levels
C. Nitric oxide test (Correct Answer)
D. Xray nasal and paranasal sinuses

Explanation: Nitric oxide test - A low nasal nitric oxide (nNO) concentration is a key diagnostic criterion for Primary Ciliary Dyskinesia (PCD), a genetic disorder characterized by immotile or dyskinetic cilia [1]. - Nasal NO is significantly reduced in PCD patients due to impaired ciliary function, making this test highly useful for screening. *Rhinogram* - A rhinogram is a radiographic imaging technique primarily used to visualize the nasal cavity and paranasal sinuses, often to detect structural abnormalities or foreign bodies. - It does not directly assess ciliary function or provide information about ciliary motility. *Sweat sodium levels* - Elevated sweat chloride or sodium levels are the diagnostic hallmark of cystic fibrosis, a genetic condition primarily affecting mucus production. - While cystic fibrosis can cause respiratory symptoms, it does not directly lead to immotile nasal cilia in the same manner as PCD. *Xray nasal and paranasal sinuses* - An X-ray of the nasal and paranasal sinuses can reveal structural issues, such as sinus opacification or polyps, which may accompany ciliary dysfunction. - However, it does not provide direct information about the motility or structural integrity of the cilia themselves.

Question 822: In a patient with COPD, what is the best management option?

A. Quit smoking (Correct Answer)
B. Bronchodilators
C. Low flow oxygen
D. Mucolytics

Explanation: ***Quit smoking*** - **Smoking cessation** is the single most effective intervention for slowing the progression of **COPD** and improving lung function [1]. - It reduces exacerbation rates and improves overall mortality, making it the cornerstone of management [1]. *Bronchodilators* - **Bronchodilators** (e.g., beta-agonists, anticholinergics) are crucial for symptomatic relief by opening airways, but they do not alter the disease progression [1]. - While essential for managing symptoms, they are not the "best" in terms of modifying the disease course. *Low flow oxygen* - **Oxygen therapy** is indicated for patients with **severe hypoxemia** (PaO2 < 55 mmHg or SaO2 < 88%) to improve survival and quality of life [2]. - It is a supportive treatment for advanced disease and does not prevent or slow the progression of COPD itself. *Mucolytics* - **Mucolytics** may be used in some patients with COPD and chronic productive cough to reduce sputum viscosity and improve clearance. - Their benefit is primarily symptomatic, and they do not have a significant impact on disease progression or mortality.

Question 823: Which of the following is the common cause of respiratory failure type 2 ?

A. Chronic bronchitis exacerbation (Correct Answer)
B. Acute attack asthma
C. ARDS
D. Pneumonia

Explanation: ***Chronic bronchitis exacerbation*** - **Chronic bronchitis** is a common cause of **Type 2 respiratory failure**, characterized by **hypercapnia** (elevated CO2) due to impaired alveolar ventilation [1]. - An exacerbation worsens **airflow obstruction** and leads to increased work of breathing and CO2 retention [1]. *Acute attack asthma* - While severe asthma can cause respiratory failure, it typically presents initially as **Type 1 (hypoxemic)**, with severe bronchospasm and V/Q mismatch [2]. - **Hypercapnia** in asthma is a sign of **severe, impending respiratory collapse** rather than the primary cause of respiratory failure. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a classic cause of **Type 1 (hypoxemic) respiratory failure**, characterized by widespread inflammation and fluid accumulation in the lungs [2]. - ARDS primarily involves impaired oxygenation rather than CO2 elimination issues, unless it progresses to severe stages with significant muscle fatigue. *Pneumonia* - **Pneumonia** predominantly causes **Type 1 (hypoxemic) respiratory failure** due to consolidation and V/Q mismatch in affected lung areas, leading to impaired oxygen diffusion [2]. - While severe, widespread pneumonia can eventually lead to ventilatory failure, its initial and primary impact is on oxygenation.

Question 824: Post-tubercular bronchiectasis is most commonly seen with

A. Pertussis
B. Cystic fibrosis
C. Kartagener syndrome
D. Tuberculosis (Correct Answer)

Explanation: ***Tuberculosis*** - **Tuberculosis (TB)**, particularly childhood TB, is a leading cause of post-infectious bronchiectasis, especially in regions with high TB prevalence [1]. - The inflammatory and destructive processes associated with TB infection in the lungs can lead to irreversible dilation and damage of the bronchi [1]. *Pertussis* - While **pertussis** can cause severe respiratory inflammation and chronic cough, it is a less common cause of widespread, irreversible bronchiectasis compared to tuberculosis [1]. - The damage caused by pertussis is typically more acute and less likely to lead to long-term structural changes like those seen in post-tubercular bronchiectasis. *Cystic fibrosis* - **Cystic fibrosis** is a genetic disorder that causes thick, sticky mucus to build up in the lungs, leading to chronic infections and bronchiectasis [1]. - However, post-tubercular bronchiectasis refers specifically to bronchiectasis developing *after* a tuberculosis infection, not as a primary genetic condition. *Kartagener syndrome* - **Kartagener syndrome** is a genetic disorder characterized by defects in ciliary function, leading to impaired mucociliary clearance and recurrent respiratory infections, which can result in bronchiectasis [1]. - Similar to cystic fibrosis, this is a primary genetic cause of bronchiectasis, distinct from bronchiectasis occurring as a sequela of tuberculosis.

Question 825: Central bronchiectasis is seen with

A. Cystic fibrosis (Correct Answer)
B. Tuberculosis
C. Bronchogenic carcinoma
D. Cystic Adenomatoid Malformation (CAM)

Explanation: ***Cystic fibrosis*** - **Cystic Fibrosis (CF)** is a genetic disorder commonly associated with **central bronchiectasis**, particularly affecting the upper lobes and central airways. - The abnormal mucus production in CF leads to chronic infection, inflammation, and eventual **dilation of the bronchi**, prominent in the central regions. *Bronchogenic carcinoma* - **Bronchogenic carcinoma** can cause **post-obstructive bronchiectasis** distal to the tumor due to airway obstruction and reduced clearance. - However, the bronchiectasis tends to be **localized** to the segment supplied by the obstructed bronchus, rather than being diffusely central. *Tuberculosis* - **Tuberculosis (TB)** can lead to bronchiectasis, often affecting the **upper lobes** and causing localized airway damage. - While TB can cause changes in the bronchi, it is typically linked with **focal or segmental bronchiectasis** resulting from inflammatory destruction, not diffuse central bronchiectasis like CF. *Cystic Adenomatoid Malformation (CAM)* - **Cystic Adenomatoid Malformation (CAM)** is a **congenital lung lesion** with abnormal airway development, but it does not primarily involve bronchiectasis. - CAM is characterized by **cystic structures** or abnormal lung tissue, not the permanent dilation of the bronchi seen in typical bronchiectasis.

Question 826: Which of the following is not a clinical feature of Bronchiectasis?

A. Hemoptysis
B. Chest pain
C. Night sweats (Correct Answer)
D. Productive cough

Explanation: ***Night sweats*** - While **night sweats** can be present in chronic infections, they are not considered a primary or defining clinical feature directly associated with the pathology of bronchiectasis itself. - They are more commonly linked with systemic conditions like **tuberculosis** or malignancy, which would require alternative diagnostic pathways. *Hemoptysis* - **Hemoptysis** (coughing up blood) is a common and often alarming symptom of bronchiectasis due to the inflammation and damage to the bronchial walls and underlying vasculature [1]. - Blood vessels in damaged airways are prone to rupture, leading to bleeding, which can range from blood-streaked sputum to massive hemorrhage [1]. *Chest pain* - **Chest pain** can occur in bronchiectasis, often related to the chronic cough, pleural inflammation, or musculoskeletal strain from persistent coughing. - It can also be a symptom if there's an associated infection or inflammation extending to the pleura. *Productive cough* - A **chronic productive cough** with significant amounts of purulent sputum is the hallmark symptom of bronchiectasis [1]. - This is due to the impaired mucociliary clearance and chronic infection within the dilated, damaged airways .

Question 827: The physiological marker of the last stage of acute asthma is

A. Hypocapnia
B. Hyperoxia
C. Alkalosis
D. Increased carbon dioxide levels (Hypercapnia) (Correct Answer)

Explanation: ***Increased carbon dioxide levels (Hypercapnia)*** - In severe, acute asthma, **air trapping** and **muscle fatigue** lead to inadequate ventilation and impaired gas exchange [1]. - This results in a buildup of carbon dioxide in the blood, indicating impending **respiratory failure** and a critical stage of the asthma exacerbation [3]. *Hypocapnia* - **Hypocapnia**, or low blood CO2, is common in the **early stages** of an asthma attack due to **tachypnea** (rapid breathing) in an effort to compensate [1]. - As the condition worsens, the ability to ventilate adequately diminishes, leading to CO2 retention [3]. *Hyperoxia* - **Hyperoxia** means abnormally high levels of oxygen in the blood, which is generally not a physiological marker of acute asthma. - Patients with acute asthma typically experience **hypoxemia** (low oxygen levels) due to ventilation-perfusion mismatch [1]. *Alkalosis* - **Respiratory alkalosis** (high pH due to low CO2) can occur in the early stages as patients **hyperventilate**. - However, in the late stages, as CO2 builds up (**hypercapnia**), the patient shifts towards **respiratory acidosis** (low pH), which is a sign of severe compromise [2], [3].

Question 828: Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?

A. A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.
B. A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation. (Correct Answer)
C. Residual Volume (RV) is normal.
D. Total Lung Capacity (TLC) is decreased.

Explanation: ***A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation.*** [1] - This is the **hallmark diagnostic criterion** for COPD, confirming persistent **airflow obstruction** that is not fully reversible. [1] - The threshold typically used is **< 0.70** or below the **fifth percentile** of the lower limit of normal (LLN). *A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.* - An FEV1/FVC ratio **above the threshold** indicates the absence of significant **airflow obstruction**, but does not automatically guarantee normal lung function as other parameters like **FEV1** could be affected. - This measurement would suggest a **restrictive lung disease** or **normal lung function**, depending on other spirometry values. *Residual Volume (RV) is normal.* - In COPD, **air trapping** due to airflow obstruction leads to an **increased Residual Volume (RV)**, not a normal RV. - An elevated RV reflects **hyperinflation** of the lungs, a characteristic feature of emphysema and chronic bronchitis. *Total Lung Capacity (TLC) is decreased.* - COPD is characterized by **hyperinflation**, which typically results in an **increased Total Lung Capacity (TLC)** as the lungs become more distended. - A **decreased TLC** would be indicative of a **restrictive lung disease**, which is different from obstructive patterns seen in COPD.

Question 829: What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?

A. Rebreathing in paper bag (Correct Answer)
B. IPPV
C. Normal saline
D. Acetazolamide

Explanation: ***Rebreathing in paper bag*** - This helps to **increase the inspired CO2 concentration**, thereby correcting the hypocapnia (low CO2) caused by hyperventilation. - It's a simple, non-invasive method to raise arterial PCO2 and normalize blood pH in acute respiratory alkalosis. *IPPV* - **Intermittent positive pressure ventilation (IPPV)** would further reduce CO2 by assisting ventilation and is typically used for respiratory *acidosis* or failure [1]. - This intervention would worsen the patient's respiratory alkalosis rather than alleviating it. *Normal saline* - **Normal saline** administration is primarily used for volume expansion or to correct electrolyte imbalances; it does not directly address respiratory alkalosis. - It would not correct the underlying issue of excessive CO2 exhalation. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces bicarbonate reabsorption and is used to treat metabolic alkalosis or as a diuretic. - It would not be an immediate or appropriate solution for acute respiratory alkalosis and might even worsen the acid-base balance if used improperly.

Question 830: Which of the following is not an obstructive lung disease?

A. Emphysema
B. Interstitial fibrosis (Correct Answer)
C. Asthma
D. Bronchitis

Explanation: ***Interstitial fibrosis*** - **Interstitial fibrosis** is a **restrictive lung disease**, characterized by **reduced lung elasticity** and lung volumes, rather than airway obstruction [1]. - In this condition, the **lung tissue becomes scarred and stiff**, making it difficult to expand fully during inspiration [1]. *Emphysema* - **Emphysema** is a classic **obstructive lung disease** caused by the destruction of the **alveolar walls**, leading to enlarged air spaces and loss of elastic recoil [3]. - This destruction results in **airflow limitation**, particularly during exhalation, as airways collapse prematurely. *Asthma* - **Asthma** is an **obstructive lung disease** characterized by **reversible airway inflammation**, bronchoconstriction, and increased mucus production [2]. - These factors lead to **episodic airflow obstruction**, making it difficult to breathe, especially during exacerbations [2]. *Bronchitis* - **Bronchitis**, particularly **chronic bronchitis**, is an **obstructive lung disease** defined by chronic inflammation of the bronchi. - This inflammation causes **mucus hypersecretion** and narrowing of the airways, leading to persistent cough and airflow limitation.

Practice by Chapter

Obstructive Airway Diseases (Asthma, COPD)

Practice Questions

Interstitial Lung Diseases

Practice Questions

Pulmonary Infections

Practice Questions

Pulmonary Vascular Diseases

Practice Questions

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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