Restrictive Pulmonary Diseases — MCQs
Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').
Which of the following statements is false regarding restrictive cardiomyopathy?
Shrinking Lung Syndrome is seen in:
Which of the following is markedly decreased in restrictive lung disease?
Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
Most common cause of idiopathic interstitial pneumonia is
A CT scan shows the 'crazy paving' pattern in both lungs. Which bronchoalveolar lavage finding would confirm pulmonary alveolar proteinosis?
Type 3 respiratory failure occurs due to ?
Which of the following diseases is most strongly associated with exposure to asbestos?
A CT scan shows the 'crazy paving' pattern in both lungs. Which bronchoalveolar lavage finding would confirm pulmonary alveolar proteinosis?
Restrictive Pulmonary Diseases Indian Medical PG Practice Questions and MCQs
Question 1: Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').
- A. Cricoarytenoid arthritis
- B. Pleural effusion
- C. Pulmonary hypertension
- D. None of the options (Correct Answer)
Explanation: ***None of the options*** - All listed conditions—**cricoarytenoid arthritis**, **pleural effusion**, and **pulmonary hypertension**—are recognized extra-articular manifestations or complications of **rheumatoid arthritis (RA)** [1]. - Rheumatoid arthritis is a systemic inflammatory disease that can affect multiple organ systems beyond the joints. *Cricoarytenoid arthritis* - This condition involves inflammation of the **cricoarytenoid joint** in the larynx, leading to **hoarseness**, stridor, or even airway obstruction. - It is a known, though less common, upper airway manifestation of **rheumatoid arthritis**. *Pleural effusion* - **Rheumatoid pleuritis** commonly presents as a **pleural effusion**, often unilateral [1]. - Analysis of **rheumatoid pleural fluid** typically shows low glucose, high LDH, and sometimes rheumatoid factor. *Pulmonary hypertension* - **Pulmonary hypertension** in RA can result from various mechanisms, including **interstitial lung disease**, vasculitis, or chronic thromboembolism [1]. - It is a serious complication associated with increased morbidity and mortality in **rheumatoid arthritis** patients.
Question 2: Which of the following statements is false regarding restrictive cardiomyopathy?
- A. Left ventricular hypertrophy is present.
- B. Filling pressure is decreased. (Correct Answer)
- C. In the early phase, systolic function is impaired.
- D. Heart failure is predominantly right-sided.
Explanation: Filling pressure is decreased. - In restrictive cardiomyopathy, the ventricles become stiff and noncompliant, impairing filling. - This leads to increased filling pressures (e.g., elevated left and right atrial pressures) as the heart attempts to fill adequately. Left ventricular hypertrophy is present. - Left ventricular hypertrophy is common in restrictive cardiomyopathy, particularly in conditions like amyloidosis and sarcoidosis, where infiltrative processes thicken the ventricular walls. - While the chambers are not dilated, the walls can be abnormally thick due to underlying pathology. In the early phase, systolic function is impaired. - In the early stages of restrictive cardiomyopathy, systolic function is typically preserved. The primary defect is diastolic dysfunction—impaired ventricular filling. - Systolic dysfunction may develop in later stages as the underlying disease progresses or due to severe volume overload. Heart failure is predominantly right-sided. - Right-sided heart failure symptoms (e.g., peripheral edema, ascites, jugular venous distension) are often prominent in restrictive cardiomyopathy. - Due to the rigid and non-compliant ventricles inhibiting filling, both ventricles are affected, but systemic venous congestion often dominates the clinical picture.
Question 3: Shrinking Lung Syndrome is seen in:
- A. SLE (Correct Answer)
- B. Rheumatoid Arthritis
- C. Scleroderma
- D. Sarcoidosis
Explanation: ***SLE*** - **Shrinking lung syndrome (SLS)** is a rare but recognized pulmonary manifestation of **systemic lupus erythematosus (SLE)** [1]. - It is characterized by **dyspnea**, **pleuritic chest pain**, and elevated diaphragms with reduced lung volumes, often without significant interstitial lung disease [1]. *Rheumatoid Arthritis* - While **rheumatoid arthritis** can cause various lung manifestations like **interstitial lung disease (ILD)**, pleural effusions, and rheumatoid nodules, **shrinking lung syndrome** is not typically associated with it [2]. - Lung disease in RA often involves **pulmonary fibrosis** or bronchiolitis, differing from the restrictive physiology of SLS. *Scleroderma* - **Scleroderma (Systemic Sclerosis)** commonly affects the lungs, primarily leading to **interstitial lung disease (ILD)** and **pulmonary hypertension** [1]. - **Shrinking lung syndrome**, with its characteristic restrictive pattern and elevated diaphragms, is not a typical presentation of lung involvement in scleroderma. *Sarcoidosis* - **Sarcoidosis** is characterized by the formation of **non-caseating granulomas**, primarily affecting the lungs and lymph nodes. - Lung involvement in sarcoidosis typically presents as **interstitial lung disease** or nodular infiltrates, not the distinct features of **shrinking lung syndrome** [3].
Question 4: Which of the following is markedly decreased in restrictive lung disease?
- A. FVC (Correct Answer)
- B. RV
- C. FEV1/FVC
- D. FEV1
Explanation: ***FVC*** - In **restrictive lung disease**, there is a reduction in lung volume due to various causes, leading to a markedly decreased **Forced Vital Capacity (FVC)**. - **FVC** directly measures the total amount of air a person can exhale after a maximal inhalation, which is inherently limited in restrictive conditions. - This is the **hallmark finding** in restrictive lung disease and the most clinically significant decrease. *FEV1* - While **FEV1** (Forced Expiratory Volume in 1 second) is also decreased in restrictive lung disease, its decrease is proportional to the FVC decrease. - A decrease in FEV1 alone is less specific, as it could also indicate obstructive lung disease. - The key is that both FEV1 and FVC decrease together, maintaining a normal or increased ratio. *FEV1/FVC* - The **FEV1/FVC ratio** is typically **normal or even increased** in restrictive lung disease, as both FEV1 and FVC decrease proportionally or FEV1 decreases slightly less. - A decreased FEV1/FVC ratio is characteristic of **obstructive lung disease**, not restrictive. *RV* - **Residual Volume (RV)** is also **decreased** in restrictive lung disease, along with all other lung volumes (TLC, VC, FRC). - However, RV is not measured by standard spirometry and requires body plethysmography or gas dilution techniques. - While RV does decrease, **FVC** is the more clinically significant and readily measurable parameter that is "markedly decreased" and defines restrictive disease on routine pulmonary function testing.
Question 5: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
- A. A-3, B-4, C-2, D-1
- B. A-1, B-4, C-3, D-2 (Correct Answer)
- C. A-4, B-2, C-3, D-1
- D. A-2, B-4, C-3, D-1
Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.
Question 6: Most common cause of idiopathic interstitial pneumonia is
- A. Idiopathic pulmonary fibrosis (Correct Answer)
- B. Organizing pneumonia
- C. Sarcoidosis
- D. Lipoid pneumonia
Explanation: ***Idiopathic pulmonary fibrosis (IPF)*** - This is the **most common** form of idiopathic interstitial pneumonia, accounting for approximately **50-60% of all IIP cases** - Represents the **most severe** IIP subtype with poor prognosis - Characterized by progressive **usual interstitial pneumonia (UIP) pattern** with fibroblastic foci and honeycombing - Presents with progressive dyspnea, dry cough, and restrictive lung disease *Organizing pneumonia* - While **Cryptogenic Organizing Pneumonia (COP)** is a form of idiopathic interstitial pneumonia, it is **much less common than IPF** [1] - Characterized by **intra-alveolar granulation tissue (Masson bodies)** [1] - Better prognosis and steroid-responsive compared to IPF [1] *Sarcoidosis* - This is **NOT classified as an idiopathic interstitial pneumonia** - It is a separate **multisystem granulomatous disease** with **non-caseating granulomas** - Has a distinct etiology related to altered immune response - Does not belong to the IIP classification system *Lipoid pneumonia* - This is **NOT an idiopathic interstitial pneumonia** - Results from **aspiration of lipid substances** causing exogenous lipoid pneumonia - Has a **known extrinsic cause**, therefore not "idiopathic" - Not part of the IIP classification **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 330-331.
Question 7: A CT scan shows the 'crazy paving' pattern in both lungs. Which bronchoalveolar lavage finding would confirm pulmonary alveolar proteinosis?
- A. Milky fluid with PAS-positive material (Correct Answer)
- B. Hemosiderin-laden macrophages
- C. Eosinophilia >25%
- D. CD4/CD8 ratio >3.5
Explanation: ***Milky fluid with PAS-positive material*** - A **milky, turbid bronchoalveolar lavage (BAL) fluid** is characteristic of **pulmonary alveolar proteinosis (PAP)** due to the accumulation of lipoproteinaceous material [1]. - **Periodic Acid-Schiff (PAS) staining** confirms the presence of this **glycoprotein-rich surfactant material**, which reacts positively [1]. *Hemosiderin-laden macrophages* - These are indicative of **pulmonary hemorrhage**, not PAP. - They are commonly seen in conditions like **Goodpasture syndrome** or **idiopathic pulmonary hemosiderosis**. *Eosinophilia >25%* - Significant **eosinophilia in BAL fluid** is a hallmark of **eosinophilic pneumonia**, a different interstitial lung disease. - It suggests an **allergic or hypersensitivity reaction** in the lungs. *CD4/CD8 ratio >3.5* - An **elevated CD4/CD8 ratio** in BAL fluid is highly suggestive of **sarcoidosis**, a granulomatous inflammatory disease. - This ratio reflects the **lymphocyte population** in the alveoli, not lipoproteinaceous accumulation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 703-705.
Question 8: Type 3 respiratory failure occurs due to ?
- A. Post-operative atelectasis (Correct Answer)
- B. Kyphoscoliosis
- C. Flail chest
- D. Pulmonary fibrosis
Explanation: ***Post-operative atelectasis*** - **Type 3 respiratory failure**, also known as **perioperative respiratory failure**, is characterized by hypoxemia occurring typically after surgery. - **Atelectasis**, the collapse of lung tissue, is a common cause of hypoxemia in the post-operative period due to shallow breathing, pain, and anesthesia affecting lung volumes. *Kyphoscoliosis* - This condition leads to a **restrictive lung disease** due to chest wall deformity, causing chronic respiratory failure. [1] - It more typically results in **Type 2 respiratory failure** (hypercapnic) due to impaired ventilation over time. [1] *Flail chest* - Flail chest is a severe chest wall injury causing paradoxical movement, leading to **acute respiratory failure**. - It is often associated with **Type 1 (hypoxemic)** or **Type 2 (hypercapnic)** respiratory failure due to trauma-induced lung injury and impaired mechanics. *Pulmonary fibrosis* - This is a progressive interstitial lung disease causing **restrictive ventilatory defect** and impaired gas exchange. - It leads to chronic **Type 1 respiratory failure** (hypoxemic) as the lung tissue becomes stiff and scarred.
Question 9: Which of the following diseases is most strongly associated with exposure to asbestos?
- A. Silicosis
- B. Byssinosis
- C. Asbestosis (Correct Answer)
- D. Anthracosis
Explanation: ***Asbestosis*** - **Asbestosis** is a chronic lung disease caused by inhaling **asbestos fibers**, leading to diffuse interstitial fibrosis. - Exposure to asbestos is the direct and primary cause of this specific condition, as reflected in its name. *Silicosis* - **Silicosis** is a lung disease resulting from the inhalation of **crystalline silica dust**, commonly seen in mining, quarrying, and sandblasting. - It is not directly linked to asbestos exposure but rather to silica exposure. *Byssinosis* - **Byssinosis** is an occupational lung disease caused by exposure to dust from **cotton, flax, or hemp**, primarily affecting textile workers. - Symptoms include chest tightness and shortness of breath, which improve on days away from exposure, and it is unrelated to asbestos. *Anthracosis* - **Anthracosis** is the accumulation of **carbon dust** in the lungs, typically from inhaling smoke or coal dust, and is a component of coal worker's pneumoconiosis. - While it involves dust inhalation, it is not specifically associated with asbestos exposure.
Question 10: A CT scan shows the 'crazy paving' pattern in both lungs. Which bronchoalveolar lavage finding would confirm pulmonary alveolar proteinosis?
- A. Milky fluid with PAS-positive material (Correct Answer)
- B. Hemosiderin-laden macrophages
- C. Eosinophilia >25%
- D. CD4/CD8 ratio >3.5
Explanation: ***Milky fluid with PAS-positive material*** - **Pulmonary alveolar proteinosis (PAP)** is characterized by the accumulation of **surfactant lipids and proteins** in the alveoli, leading to a milky, turbid appearance of the BAL fluid [1]. - The accumulated material in PAP stains positive with **periodic acid-Schiff (PAS)**, confirming the presence of glycoprotein [1]. *Hemosiderin-laden macrophages* - These macrophages are indicative of **previous alveolar hemorrhage**, where red blood cells have extravasated into the alveoli and have been phagocytosed. - This finding is common in conditions like **diffuse alveolar hemorrhage** or chronic heart failure with pulmonary congestion, not PAP. *Eosinophilia >25%* - Marked eosinophilia in BAL fluid (typically >25% of total cells) is characteristic of **chronic eosinophilic pneumonia** or **allergic bronchopulmonary aspergillosis (ABPA)**. - While PAP can sometimes have a mild increase in eosinophils, it is not the diagnostic hallmark. *CD4/CD8 ratio >3.5* - An elevated CD4/CD8 ratio in BAL fluid is primarily associated with **sarcoidosis**, reflecting the predominantly helper T-cell lymphocytic alveolitis. - This finding is not specific to PAP and does not represent the pathological accumulation of lipoproteinaceous material. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 703-705.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free