NEET-PG 2015 Practice Questions

Q: Central bronchiectasis is seen with

Cystic fibrosis. ***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.

Q: Post-tubercular bronchiectasis is most commonly seen with

Tuberculosis. ***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.

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

Quit smoking. ***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.

Q: In a patient there is dyspnea in upright position which is relieved in supine position, Diagnosis ?

Platypnea. ***Platypnea*** - **Platypnea** is defined as **dyspnea that worsens in an upright position** and improves when lying down. - This condition is often associated with **hepatopulmonary syndrome**, **intracardiac shunts** (e.g., patent foramen ovale), or **pulmonary arteriovenous malformations**, where gravity affects blood flow and gas exchange. *Tachypnea* - **Tachypnea** refers to an **abnormally rapid rate of breathing**. - It describes the *rate* of respiration, not its variation with body position. *Orthopnea* - **Orthopnea** is **dyspnea that occurs when lying flat** and is relieved by sitting or standing up [1]. - It is often seen in conditions like **heart failure**, where fluid redistribution to the lungs is exacerbated in the supine position [2]. *Paroxysmal nocturnal dyspnea* - **Paroxysmal nocturnal dyspnea (PND)** is characterized by **sudden, severe shortness of breath at night** that awakens the person from sleep [2]. - It is typically caused by **left-sided heart failure** and is relieved by sitting upright or standing, which is the opposite of the described scenario.

Q: Clicking noise in Pneumomediastinum is known as

Hamman's sign. Hamman's sign - Hamman's sign is a crunching, bubbling, or clicking sound synchronous with the heartbeat, audible on auscultation over the precordium. - It is pathognomonic for pneumomediastinum, caused by the heart beating against air-filled tissues. Traube's sign - Traube's sign refers to a pistol-shot sound heard over the femoral artery in severe aortic regurgitation [1]. - It is a vascular sign and not related to pneumomediastinum. Kussmaul's sign - Kussmaul's sign is a paradoxical rise in jugular venous pressure (JVP) during inspiration. - It is typically seen in conditions like constrictive pericarditis or right ventricular infarction, not pneumomediastinum. None of the options - This option is incorrect because Hamman's sign accurately describes the clicking noise associated with pneumomediastinum. - The other options refer to different clinical phenomena unrelated to pneumomediastinum.

Q: Which of the following is least likely to be associated with emphysema?

Type I respiratory failure. **Type I respiratory failure** - **Emphysema** primarily causes **Type II respiratory failure** (hypercapnic) due to impaired gas exchange and CO2 retention resulting from alveolar destruction and air trapping [2][4]. - While hypoxemia can occur in severe emphysema, it is the more prominent **hypercapnia** that defines its typical respiratory failure pattern, making pure Type I less likely [3][4]. *Associated with smoking* - **Cigarette smoking** is the leading cause of emphysema, directly linked to the destruction of alveolar walls and loss of elastic recoil [1]. - The inhaled toxins trigger an inflammatory response in the lungs, leading to the release of proteases that break down lung tissue [1][2]. *Barrel shaped chest* - This is a classic sign of advanced emphysema, caused by **chronic air trapping** and subsequent hyperinflation of the lungs [2]. - The diaphragm flattens, and the ribs become more horizontal, increasing the anterior-posterior diameter of the chest. *Cyanosis* - Often seen in patients with severe emphysema (especially in a subgroup referred to as "blue bloaters" for chronic bronchitis overlap) due to **significant hypoxemia** [3]. - Impaired gas exchange leads to insufficient oxygenation of hemoglobin, causing a bluish discoloration of the skin and mucous membranes [3].

Q: In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

QRS complex. ***QRS complex*** - Extra systoles, particularly **premature ventricular contractions (PVCs)**, originate in the ventricles and result in a **wide and bizarre QRS complex** on an ECG [2]. - The QRS complex represents **ventricular depolarization**, and in ventricular tachycardia, the *ventricular activity* dominates the ECG tracing [2]. *P wave* - The **P wave** represents **atrial depolarization** and is typically either absent or dissociated from the QRS complex in ventricular tachycardia [1], [2]. - Its presence or absence helps differentiate supraventricular from ventricular arrhythmias. *T wave* - The **T wave** represents **ventricular repolarization**, which typically follows the QRS complex [1]. - While it will be present, it often appears abnormal or discordant in ventricular tachycardia due to the altered ventricular depolarization. *R wave* - The **R wave** is part of the QRS complex, specifically the first positive deflection. - While an R wave is present within the QRS complex of an extrasystole, referring to the entire **QRS complex** is more accurate as it encompasses the complete ventricular depolarization in an abnormal morphology.

Q: What is the most common arrhythmia in ICU patients?

Atrial fibrillation. ***Atrial fibrillation*** - **Atrial fibrillation (AF)** is the most prevalent arrhythmia in the general population [1], and its incidence is significantly higher in critically ill patients due to various stressors. - Factors like **sepsis**, **hypoxemia**, **electrolyte imbalances**, **myocardial ischemia**, and **inflammatory states** common in the ICU are known triggers for new-onset AF. *Atrial flutter* - While atrial flutter is a common arrhythmia, its overall incidence in the ICU setting is **less frequent than atrial fibrillation**. - It often involves a **re-entrant circuit** in the right atrium [2], leading to characteristic "sawtooth" waves on ECG. *Atrial Tachycardia* - Atrial tachycardia is a form of **supraventricular tachycardia (SVT)** that originates in the atria but is **less common** than AF in the ICU [2]. - It often presents as a **regular, narrow-complex tachycardia** with discrete P waves. *Supraventricular Tachycardia* - This is a broad term encompassing arrhythmias that originate **above the ventricles** [3], including AF, atrial flutter, and atrial tachycardia. - While SVT as a category is common, **atrial fibrillation is the single most frequent specific arrhythmia** within this group in the ICU.

Q: What is the most common cause of lung abscess in comatose patients?

Oral anaerobes. Oral anaerobes - **Comatose patients** are at high risk for **aspiration** of oropharyngeal flora, which predominantly consists of anaerobic bacteria. [1] - Aspiration of these organisms, especially in compromised lung tissue, frequently leads to **necrotizing pneumonia** and subsequent abscess formation. [1] *Staph aureus* - While *Staphylococcus aureus* can cause lung abscesses, particularly in the context of **hematogenous spread** (e.g., endocarditis) or nosocomial infections, it is not the most common cause in *comatose patients* who typically aspirate oral flora. [2] - *S. aureus* lung abscesses are often associated with multiple, smaller lesions rather than a single, large abscess from aspiration. *Klebsiella* - *Klebsiella pneumoniae* can cause severe, **rapidly progressive pneumonia** that may lead to abscess formation, especially in individuals with **alcoholism** or **diabetes**. - However, it is less common than oral anaerobes as the primary cause of abscess in the general population of comatose patients, whose main risk factor is aspiration of normal oral flora. [1] *Tuberculosis* - **Mycobacterium tuberculosis** can cause cavitary lung lesions, but these are typically chronic and result from primary or reactivated tuberculosis disease, not acute aspiration. [3] - Lung abscesses caused by tuberculosis are histologically distinct from pyogenic abscesses and are characterized by **granulomatous inflammation** and caseous necrosis.

Q: Most common cause of idiopathic interstitial pneumonia is

Idiopathic pulmonary fibrosis. ***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 1

Central bronchiectasis is seen with

Accepted Answer

Cystic fibrosis

Answer

Tuberculosis

Answer

Bronchogenic carcinoma

Answer

Cystic Adenomatoid Malformation (CAM)

Question 2

Post-tubercular bronchiectasis is most commonly seen with

Accepted Answer

Tuberculosis

Answer

Pertussis

Answer

Cystic fibrosis

Answer

Kartagener syndrome

Question 3

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

Accepted Answer

Quit smoking

Answer

Bronchodilators

Answer

Low flow oxygen

Answer

Mucolytics

Question 4

In a patient there is dyspnea in upright position which is relieved in supine position, Diagnosis ?

Accepted Answer

Platypnea

Answer

Tachypnea

Answer

Orthopnea

Answer

Paroxysmal nocturnal dyspnea

Question 5

Clicking noise in Pneumomediastinum is known as

Accepted Answer

Hamman's sign

Answer

Traube's sign

Answer

Kussmaul's sign

Answer

None of the options

Question 6

Which of the following is least likely to be associated with emphysema?

Accepted Answer

Type I respiratory failure

Answer

Associated with smoking

Answer

Barrel shaped chest

Answer

Cyanosis

Question 7

In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

Accepted Answer

QRS complex

Answer

P wave

Answer

T wave

Answer

R wave

Question 8

What is the most common arrhythmia in ICU patients?

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Atrial Tachycardia

Answer

Supraventricular Tachycardia

Question 9

What is the most common cause of lung abscess in comatose patients?

Accepted Answer

Oral anaerobes

Answer

Staph aureus

Answer

Klebsiella

Answer

Tuberculosis

Question 10

Most common cause of idiopathic interstitial pneumonia is

Accepted Answer

Idiopathic pulmonary fibrosis

Answer

Organizing pneumonia

Answer

Sarcoidosis

Answer

Lipoid pneumonia

NEET-PG 2015

Internal Medicine

Microbiology

Pathology