Pulmonology — MCQs

Pulmonology Indian Medical PG Practice Questions and MCQs

Question 871: A 40-year-old man presented with repeated episodes of bronchospasm and hemoptysis. Chest X-ray revealed perihilar bronchiectasis. The most likely diagnosis is

A. Sarcoidosis
B. Idiopathic pulmonary fibrosis
C. Extrinsic allergic alveolitis
D. Bronchopulmonary aspergillosis (Correct Answer)

Explanation: ***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.

Question 872: Which of the following is NOT a characteristic feature of sarcoidosis?

A. Panda sign
B. Erythema marginatum (Correct Answer)
C. Egg shell calcification
D. Hilar lymphadenopathy

Explanation: ***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].

Question 873: Which of the following is NOT a contributing factor to pulmonary hypertension in COPD?

A. High lung volume
B. Hypoxia
C. Pulmonary vasoconstriction
D. Bronchoconstriction (Correct Answer)

Explanation: ***Bronchoconstriction*** - While common in COPD, **bronchoconstriction primarily increases airway resistance** and affects airflow, not directly pulmonary vascular pressure. - It does not directly cause the **remodeling** or **vasoconstriction** of pulmonary arteries that leads to sustained pulmonary hypertension. *Hypoxia* - **Chronic alveolar hypoxia** in COPD is a major driver of pulmonary hypertension by causing **pulmonary vasoconstriction**. - It also contributes to vascular remodeling, leading to sustained increases in pulmonary vascular resistance. *Pulmonary vasoconstriction* - **Hypoxia-induced pulmonary vasoconstriction** [1] is a primary and immediate response in the lungs that leads to increased pulmonary arterial pressure. - Over time, chronic vasoconstriction contributes to **vascular remodeling**, further exacerbating pulmonary hypertension. *High lung volume* - The **hyperinflation** characteristic of COPD can compress pulmonary capillaries and small vessels [2], leading to increased pulmonary vascular resistance. - This extrinsic compression contributes mechanically to the elevated pulmonary pressures seen in these patients.

Question 874: Pulmonary embolism is most commonly caused by:

A. Deep vein thrombosis (DVT) of the leg (Correct Answer)
B. Fat embolism from pelvic fracture
C. Cardiac emboli from heart disease
D. Increased pulmonary pressure (a consequence of PE)

Explanation: ***Deep vein thrombosis (DVT) of the leg*** - **Deep vein thrombosis (DVT)** in the leg is the most common source of emboli that travel to the lungs, leading to pulmonary embolism [1]. - The thrombus breaks off from the deep veins, typically in the **lower extremities**, and propagates through the venous system to the pulmonary arteries [1]. *Increased pulmonary pressure (a consequence of PE)* - **Increased pulmonary pressure** is a physiological consequence of a significant pulmonary embolism, as blood flow is obstructed, but it is not the cause of the embolism itself. - This option describes a **downstream effect**, rather than the origin of the embolus. *Fat embolism from pelvic fracture* - **Fat embolisms** can occur after long bone fractures (especially pelvic or femur fractures) and surgeries, but they are a less common cause of PE compared to DVT. - While they can lead to pulmonary symptoms, the mechanism involves **fat globules** entering the circulation, distinct from a thrombus. *Cardiac emboli from heart disease* - **Cardiac emboli** typically originate from the heart (e.g., from atrial fibrillation, mural thrombi after myocardial infarction, or valvular disease) and usually cause **systemic emboli** leading to strokes or limb ischemia. - While rare, paradoxal emboli can occur via a patent foramen ovale but are not the leading cause of "pulmonary" embolism.

Question 875: Which statement is true regarding pneumothorax?

A. Absent breath sounds (Correct Answer)
B. Decreased percussion note
C. Tracheal tug
D. Always needs chest tube insertion

Explanation: ***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 876: Which of the following statements about pulmonary embolism is false?

A. Most commonly presents within 2 weeks (Correct Answer)
B. Pulmonary embolism often arises from deep vein thrombosis in the legs.
C. Dyspnea is the most common symptom
D. Longer survival time generally indicates a better chance of recovery.

Explanation: Most commonly presents within 2 weeks - This statement is **false** because while pulmonary embolism can occur at any time, its onset is not restricted to or "most commonly presents" within a two-week period. - The timing of presentation can vary widely depending on the predisposing factors and the specific event leading to the embolus formation and migration. *Dyspnea is the most common symptom* - **Dyspnea** (shortness of breath) is indeed the **most frequent symptom** reported by patients experiencing pulmonary embolism. - This symptom often occurs acutely and can range from mild to severe, correlating with the size and location of the embolism. *Pulmonary embolism often arises from deep vein thrombosis in the legs.* - The vast majority of **pulmonary emboli (PEs)** originate from **deep vein thromboses (DVTs)**, particularly those located in the large veins of the legs and pelvis [1, 2]. - These clots can detach and travel through the venous system to the heart and then into the pulmonary arteries [2]. *Longer survival time generally indicates a better chance of recovery.* - Patients who survive longer after a pulmonary embolism are more likely to have received timely treatment and may have experienced a less severe embolic event or have better underlying health. - Prolonged survival after the initial acute phase suggests the patient has overcome the immediate life-threatening aspects and is on the path to recovery, potentially with less long-term sequelae.

Question 877: Hamman's sign is seen in:

A. Pericardial effusion
B. Superior vena cava obstruction
C. Thyrotoxicosis
D. Pneumomediastinum (Correct Answer)

Explanation: ***Pneumomediastinum*** - **Hamman's sign** is a classic auscultatory finding in pneumomediastinum, characterized by **crunching, bubbling, or clicking sounds synchronized with the heartbeat**. - These sounds are heard due to the presence of **air in the mediastinum** being displaced by the contracting heart. *Pericardial effusion* - **Pericardial effusion** involves fluid accumulation around the heart, which typically causes muffled heart sounds and, in severe cases, signs of **cardiac tamponade**. - It does not produce the characteristic **crunching sound** associated with Hamman's sign. *Superior vena cava obstruction* - **Superior vena cava obstruction** is characterized by symptoms like **facial swelling**, **distended neck veins**, and dyspnea due to impaired venous return. - It does not lead to the presence of air in the mediastinum or the specific auscultatory findings of Hamman's sign. *Thyrotoxicosis* - **Thyrotoxicosis** is a hypermetabolic state with symptoms such as **tachycardia**, palpitations, and heat intolerance. - While it affects the cardiovascular system, it does not involve the presence of air in the mediastinum or the development of Hamman's sign.

Question 878: Hemoptysis is said to be massive when it exceeds what amount in 24 hours?

A. 400mL
B. 500mL
C. 600mL (Correct Answer)
D. 800mL

Explanation: 600mL - Hemoptysis is considered **massive** when the volume of blood expectorated exceeds **600 mL within a 24-hour period**, or **100 mL per hour**, indicating a life-threatening emergency. - This threshold is crucial because it significantly increases the risk of **airway obstruction** and **hypovolemic shock**, which requires immediate medical intervention. *400mL* - While 400 mL in 24 hours is a significant amount of bleeding, it is generally not classified as **massive hemoptysis** according to most clinical definitions. - Significant hemoptysis can still be dangerous and require investigation, but it does not meet the criteria for immediately life-threatening massive hemoptysis. *500mL* - This volume is close to the threshold for massive hemoptysis but is still typically not the **definitive cutoff** used in clinical practice. - It would still warrant aggressive management and consideration for interventions like bronchoscopy or embolization. *800mL* - While certainly a severe amount, 800 mL in 24 hours **exceeds** the generally accepted definition of massive hemoptysis. - The 600 mL threshold is based on the point at which there is a critical risk of **asphyxiation** or **hemodynamic instability** [1].

Question 879: Which of the following is the least likely cause of bronchiectasis?

A. Pneumonia
B. Primary TB (Correct Answer)
C. Inhaled foreign body
D. Chronic aspiration

Explanation: Primary TB - While post-primary (reactivation) tuberculosis can lead to **bronchiectasis**, primary tuberculosis is less commonly a direct cause of established, widespread bronchiectasis in the acute phase. - Primary TB more often causes **lymphadenopathy** and localized parenchymal disease, with bronchiectasis being a rarer, late complication if airway obstruction or severe destruction occurs. *Pneumonia* - Severe or recurrent bacterial pneumonias can cause **irreversible damage** to the bronchial walls, leading to dilation and fibrosis, which is characteristic of bronchiectasis [1]. - The inflammatory process and **mucociliary dysfunction** during pneumonia contribute to ongoing infection and structural changes [1]. *Inhaled foreign body* - A persistent **foreign body** in the airway can cause localized obstruction, leading to chronic inflammation, infection, and subsequent dilation of the bronchi distal to the obstruction [1]. - This recurrent infection and inflammation weaken the bronchial walls over time, defining localized bronchiectasis. *Chronic aspiration* - **Recurrent aspiration** of gastric contents or oral secretions causes repeated injury and inflammation to the bronchial epithelium. - This chronic irritation and potential for bacterial colonization damage the airway walls, predisposing to **bronchial dilation** and infection, characteristic of bronchiectasis.

Question 880: Patient with pulmonary parenchymal fibrosis (PPF) who complains of breathing difficulty, is tachycardic, and tachypneic, and has a Batwing sign present on X-ray. What is the possible reason?

A. Transfusion-related lung injury
B. Acute renal failure due to tubular acidosis
C. Hemolysis leading to hemoglobinuria
D. Due to fluid overload in a patient with pulmonary parenchymal fibrosis (Correct Answer)

Explanation: ***Due to fluid overload in a patient with pulmonary parenchymal fibrosis*** - The presence of the **Batwing sign** (or butterfly pattern) on X-ray is characteristic of **pulmonary edema**, which is often caused by fluid overload. - In a patient with pre-existing **pulmonary parenchymal fibrosis (PPF)**, even moderate fluid overload can rapidly exacerbate respiratory symptoms and lead to acute pulmonary decompensation due to reduced lung compliance and impaired gas exchange. *Transfusion-related lung injury* - **Transfusion-related acute lung injury (TRALI)** typically presents with acute hypoxemia and bilateral infiltrates, which could resemble pulmonary edema, but often occurs within 6 hours of transfusion and is not directly linked to pre-existing pulmonary fibrosis in this context. - While TRALI can cause pulmonary edema, the scenario provided gives no information about recent transfusions, making fluid overload a more direct and common cause given the X-ray findings. *Acute renal failure due to tubular acidosis* - **Renal tubular acidosis** primarily affects acid-base balance and electrolyte levels, usually not directly causing acute, severe pulmonary symptoms or the "Batwing sign" unless there's associated severe fluid retention due to overall renal failure. - While acute renal failure can lead to fluid overload, tubular acidosis specifically points to a primary metabolic derangement rather than direct pulmonary involvement or the characteristic X-ray finding. *Hemolysis leading to hemoglobinuria* - **Hemolysis** can cause anemia and, in severe cases, acute kidney injury due to hemoglobinuria, but it does not directly explain acute respiratory distress, tachycardia, tachypnea, or a "Batwing sign" on chest X-ray. - These pulmonary findings are indicative of **fluid accumulation in the lungs**, which is not a direct consequence of hemolysis itself.

Practice by Chapter

Obstructive Airway Diseases (Asthma, COPD)

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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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