Pulmonology Practice Questions

Q: Kartagener syndrome is not associated with which of the following?

Subluxation of lens. **Explanation:** **Kartagener Syndrome** is a subset of **Primary Ciliary Dyskinesia (PCD)**, an autosomal recessive disorder characterized by the structural and functional impairment of cilia. The classic triad of Kartagener syndrome includes **Situs inversus, Bronchiectasis, and Sinusitis.** 1. **Why Subluxation of Lens is the Correct Answer:** Subluxation of the lens (Ectopia lentis) is not a feature of Kartagener syndrome. It is typically associated with connective tissue disorders like **Marfan syndrome** (upward dislocation) or **Homocystinuria** (downward dislocation). Ciliary dysfunction in Kartagener syndrome affects motile cilia, whereas lens stability depends on zonular fibers (fibrillin), which are unrelated to ciliary motility. 2. **Analysis of Incorrect Options:** * **Situs inversus (Option A):** Occurs in 50% of patients with PCD. During embryogenesis, normal ciliary beat is required for the left-right patterning of internal organs. Absent ciliary function leads to random organ placement. * **Bronchiectasis (Option C):** Impaired mucociliary clearance leads to chronic endobronchial infections, resulting in permanent dilation of the bronchi. * **Sinusitis (Option D):** Ciliary dysfunction in the paranasal sinuses prevents mucus drainage, leading to chronic inflammation and recurrent infections. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad:** Bronchiectasis + Sinusitis + Situs Inversus. * **Infertility:** Common in males due to immotile spermatozoa (flagella are modified cilia) and in females due to impaired ciliary action in the fallopian tubes. * **Diagnosis:** Screening via **Nasal Nitric Oxide (nNO)** levels (low in PCD). Gold standard is **Digital High-Speed Videomicroscopy** or Electron Microscopy (showing absence of dynein arms). * **Genetics:** Most common defect is the absence of **outer dynein arms**.

Q: All of the following are causes of transudative pleural effusion EXCEPT:

Rheumatoid arthritis. **Explanation:** The differentiation between transudative and exudative pleural effusions is a high-yield topic for NEET-PG, typically governed by **Light’s Criteria**. **Why Rheumatoid Arthritis (RA) is the correct answer:** Rheumatoid arthritis causes an **exudative** pleural effusion [1]. The underlying mechanism is local inflammation of the pleura (pleuritis), which increases capillary permeability, allowing proteins and cells to leak into the pleural space [2]. * **High-Yield Fact:** RA pleural fluid is characteristically associated with **very low glucose levels (<30 mg/dL)**, low pH, and high LDH [1]. **Analysis of Incorrect Options (Transudative Causes):** Transudates occur due to systemic factors altering hydrostatic or oncotic pressure, without primary pleural disease. * **Nephrotic Syndrome:** Causes decreased plasma oncotic pressure due to severe hypoalbuminemia, leading to fluid leakage. * **Constrictive Pericarditis:** Increases systemic venous hydrostatic pressure, forcing fluid into the pleural space. * **Myxedema (Hypothyroidism):** While it can occasionally be exudative, it is a classic recognized cause of transudative effusion (often multifactorial, involving increased capillary permeability or decreased lymphatic drainage). **NEET-PG Clinical Pearls:** 1. **Most common cause of Transudate:** Congestive Heart Failure (CHF). 2. **Most common cause of Exudate:** Bacterial pneumonia (Parapneumonic effusion) and Malignancy. 3. **Meigs’ Syndrome:** Triad of benign ovarian tumor (fibroma), ascites, and pleural effusion (usually transudative). 4. **Superior Vena Cava (SVC) Obstruction:** Can cause both transudative and exudative effusions.

Q: Bilateral pleural plaques and pulmonary fibrosis involving bases is a hallmark of which condition?

Asbestosis. The clinical presentation of bilateral pleural plaques and basal pulmonary fibrosis is the classic hallmark of **Asbestosis**. 1. **Why Asbestosis is correct:** Asbestos fibers are inhaled and deposited in the distal airways and alveoli. Unlike many other pneumoconioses, asbestos primarily affects the **lower lobes (bases)** [1]. The most specific radiographic finding for asbestos exposure is **pleural plaques** (calcified or non-calcified), typically involving the parietal pleura and the diaphragm. When interstitial fibrosis occurs due to these fibers, the condition is termed Asbestosis [1]. 2. **Why other options are incorrect:** * **Silicosis:** Characteristically involves the **upper lobes** [2]. It presents with "eggshell calcification" of hilar lymph nodes and nodular opacities, not isolated pleural plaques [2]. * **Scleroderma:** While it causes basal pulmonary fibrosis (NSIP pattern), it is a systemic autoimmune disease and does **not** cause pleural plaques. * **Byssinosis:** Caused by cotton dust exposure. It is an airway disease (occupational asthma/bronchitis) characterized by "Monday chest tightness" and does not cause pleural plaques or significant interstitial fibrosis. **High-Yield Pearls for NEET-PG:** * **Pathognomonic finding:** Ferruginous bodies (asbestos bodies) seen on Prussian blue stain (iron-coated fibers) [1]. * **Most common malignancy:** Bronchogenic carcinoma (risk is synergistically increased with smoking). * **Most specific malignancy:** Mesothelioma (rare, but highly associated with asbestos; smoking does *not* increase risk). * **Imaging:** HRCT shows subpleural curvilinear lines and honeycombing in advanced stages [1].

Q: Hypersensitivity pneumonitis is caused by which of the following?

Bagassosis. Explanation: Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, is an immunologically mediated inflammation of the lung parenchyma (alveoli and bronchioles) caused by intense or repeated inhalation of organic dusts or certain chemicals. Why Bagassosis is correct: Bagassosis is a classic example of HP caused by inhalation of thermophilic actinomycetes (specifically Thermoactinomyces sacchari) found in moldy sugar cane residue (bagasse). It involves a Type III (immune complex) and Type IV (cell-mediated) hypersensitivity reaction. Other common examples include Farmer’s lung (moldy hay) and Bird fancier’s lung (avian proteins) [1]. Why the other options are incorrect: * Coal worker's pneumoconiosis (A) and Silicosis (C): These are Pneumoconioses, which are restrictive lung diseases caused by the inhalation of inorganic mineral dusts (coal dust and silica, respectively). Unlike HP, these are not primarily immunological "allergic" reactions but rather chronic fibrotic responses to mineral particles. * Sarcoidosis (D): This is a multisystem granulomatous disease of unknown etiology. While it shares some radiological features with HP (like ground-glass opacities or nodules), it is not triggered by a specific external organic allergen. High-Yield Clinical Pearls for NEET-PG: * Histopathology: HP typically shows non-caseating, poorly formed (loose) granulomas and "triad" of bronchiolitis, interstitial pneumonitis, and fibrosis [1]. * Radiology: Acute HP shows ground-glass opacities [1]; Chronic HP shows a "Headcheese sign" (mosaic attenuation) on HRCT. In cases of acute HP, the chest X-ray typically shows ill-defined patchy airspace shadowing [1]. * Management: The most crucial step is the removal of the offending antigen. Steroids are used for symptomatic relief in acute/subacute stages.

Q: Bilateral symmetrical hilar lymphadenopathy is seen in:

Sarcoidosis. ### Explanation **Correct Answer: A. Sarcoidosis** **Why Sarcoidosis is Correct:** Bilateral symmetrical hilar lymphadenopathy (BHL) is the classic radiological hallmark of **Sarcoidosis**, occurring in approximately 90% of patients [1]. It is most commonly seen in **Stage I** (BHL alone) and **Stage II** (BHL with parenchymal infiltrates) of the disease. The nodes are typically discrete, non-adherent, and do not cause bronchial obstruction. When BHL is accompanied by right paratracheal lymphadenopathy, it forms the characteristic **"1-2-3 Sign"** (Garland’s triad) on a chest X-ray. **Why Other Options are Incorrect:** * **Tuberculosis (TB):** While TB is a common cause of lymphadenopathy, it is typically **unilateral** or asymmetrical. Bilateral involvement is rare and usually suggests primary TB in children or immunocompromised states, but it lacks the classic symmetry of Sarcoidosis. * **Leprosy:** This is primarily a disease of the peripheral nerves and skin. It does not typically involve the hilar lymph nodes. * **Wegener's Granulomatosis (GPA):** Pulmonary involvement in GPA usually manifests as multiple, bilateral, cavitating nodules or pulmonary hemorrhage. Hilar lymphadenopathy is an uncommon finding in GPA. **High-Yield Clinical Pearls for NEET-PG:** * **Löfgren Syndrome:** A specific acute presentation of Sarcoidosis consisting of the triad: **BHL + Erythema Nodosum + Migratory Polyarthritis** (usually involving ankles) [1]. * **Differential Diagnosis for BHL:** Apart from Sarcoidosis, consider Lymphoma (usually asymmetrical/bulky), Silicosis (may show "eggshell calcification"), and Coccidioidomycosis. * **Staging:** Sarcoidosis is staged using the **Scadding Scale** (Stage 0-IV) based on chest X-ray findings.

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

Oral anaerobes. **Explanation:** The most common cause of lung abscess is the **aspiration of oropharyngeal secretions** [1] containing **oral anaerobes** (e.g., *Peptostreptococcus*, *Fusobacterium*, and *Prevotella*). This typically occurs in patients with predispositions such as poor dentition (gingivitis), altered consciousness (alcoholism, seizures), or swallowing dysfunction [1, 2]. The aspirated material settles in dependent segments of the lung, leading to necrotizing pneumonia and subsequent abscess formation. **Analysis of Options:** * **A. Staphylococcus aureus:** While a common cause of necrotizing pneumonia and multiple small abscesses (especially post-influenza or via hematogenous spread), it is less frequent than anaerobic aspiration in the general population [3]. * **C. Klebsiella:** A classic cause of "Friedlander’s pneumonia" characterized by "currant jelly sputum" and tissue necrosis. It is common in chronic alcoholics but remains less frequent than mixed anaerobic infections [2]. * **D. Tuberculosis:** *Mycobacterium tuberculosis* typically causes "cavitation" rather than a pyogenic abscess. While a major differential in India, it is classified separately from primary lung abscesses [2]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common site:** The **posterior segment of the right upper lobe** and the **superior segment of the right lower lobe** (due to the vertical nature of the right main bronchus). 2. **Clinical Clue:** Foul-smelling (putrid) sputum is highly suggestive of anaerobic infection. 3. **Treatment of Choice:** **Clindamycin** [4] or Beta-lactam/Beta-lactamase inhibitor combinations (e.g., Piperacillin-Tazobactam). 4. **Air-fluid level:** The classic radiological finding on a chest X-ray.

Question 1

A 50-year-old male smoker presents with chronic shortness of breath. Physical examination reveals a pulse of 110 bpm, normal temperature, respirations of 30/min with accessory muscle use and pursed-lip breathing, and blood pressure of 110/78 mm Hg. Cardiac examination shows the apex beat medial to the midclavicular line, and lung examination reveals generalized decreased breath sounds. Arterial blood gases on room air show a pH of 7.38, PCO2 of 47 mm Hg, and PO2 of 67 mm Hg. Pulmonary function tests show FVC 2.80 L (67% of predicted), FEV1 1.56 L (50% of predicted), FEV1/FVC ratio of 56%, TLC 134% of predicted, RV 170% of predicted, and DLCO 43% of predicted. There is no reversibility with bronchodilators. What is the most likely diagnosis?

Accepted Answer

Emphysema

Answer

Bronchial asthma with status asthmaticus

Answer

Chronic bronchitis

Answer

Tuberous sclerosis

Question 2

A patient presents with a pH of 7.2, pO2 of 46, and pCO2 of 80. What condition do these arterial blood gas values indicate?

Accepted Answer

Acute exacerbation of asthma

Answer

Idiopathic pulmonary fibrosis

Answer

Cystic fibrosis

Answer

Allergic bronchopulmonary aspergillosis (ABPA)

Question 3

Kartagener syndrome is not associated with which of the following?

Accepted Answer

Subluxation of lens

Answer

Situs inversus

Answer

Bronchiectasis

Answer

Sinusitis

Question 4

All of the following are causes of transudative pleural effusion EXCEPT:

Accepted Answer

Rheumatoid arthritis

Answer

Nephrotic syndrome

Answer

Constrictive pericarditis

Answer

Myxedema

Question 5

Bilateral pleural plaques and pulmonary fibrosis involving bases is a hallmark of which condition?

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

Scleroderma

Answer

Byssinosis

Question 6

Which of the following collagen disorders is NOT commonly associated with pulmonary fibrosis?

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Progressive systemic sclerosis

Answer

Rheumatoid arthritis

Question 7

A 25-year-old male with Sturge Weber syndrome and HBS positive status presents with high-grade fever, chills, rigor, followed by pleuritic chest pain. He also reports cough, breathlessness, and yellow sputum. A chest X-ray shows non-homogenous opacity in the right lower zone with an air bronchogram. What is the most likely diagnosis in this setting?

Accepted Answer

Pneumonia

Answer

Pulmonary infarction

Answer

Pulmonary hemorrhage

Answer

Pulmonary hypertension

Question 8

Hypersensitivity pneumonitis is caused by which of the following?

Accepted Answer

Bagassosis

Answer

Coal worker's pneumoconiosis

Answer

Silicosis

Answer

Sarcoidosis

Question 9

Bilateral symmetrical hilar lymphadenopathy is seen in:

Accepted Answer

Sarcoidosis

Answer

Tuberculosis

Answer

Leprosy

Answer

Wegener's granulomatosis

Question 10

What is the most common cause of lung abscess?

Accepted Answer

Oral anaerobes

Answer

Staphylococcus aureus

Answer

Klebsiella

Answer

Tuberculosis

Pulmonology — MCQs

Pulmonology — MCQs

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