Pulmonology Practice Questions

Q: A patient presents with the clinical features of interstitial lung disease. How will you confirm the diagnosis?

CT scan. **Explanation:** **Interstitial Lung Disease (ILD)** refers to a heterogeneous group of disorders characterized by inflammation and fibrosis of the pulmonary interstitium. **Why CT scan is the correct answer:** High-Resolution Computed Tomography (HRCT) is the **gold standard** and the most definitive non-invasive investigation for confirming ILD. It provides superior spatial resolution, allowing for the visualization of specific patterns such as **honeycombing, ground-glass opacities, and reticular markings**. HRCT is essential not only for confirmation but also for identifying the specific subtype of ILD (e.g., UIP vs. NSIP) and assessing the extent of the disease. **Why other options are incorrect:** * **X-ray:** While often the initial screening tool, it lacks sensitivity. Up to 10% of patients with biopsy-proven ILD may have a normal chest X-ray. It cannot provide the structural detail needed for a definitive diagnosis. * **Bronchoscopy:** This is an invasive procedure used primarily to rule out infections or sarcoidosis via Bronchoalveolar Lavage (BAL) or transbronchial biopsy. It is not the primary tool for confirming the general diagnosis of ILD. * **MRI:** MRI has a limited role in lung parenchyma imaging due to low proton density and motion artifacts from breathing. It is not a standard diagnostic tool for ILD. **Clinical Pearls for NEET-PG:** * **PFT Pattern:** ILD typically shows a **Restrictive pattern** (Decreased TLC, Decreased FVC, and a Normal/Increased FEV1/FVC ratio) with a **Decreased DLCO**. * **Physical Exam:** Look for **"Velcro" crackles** (fine end-expiratory crepitations) and digital clubbing. * **Gold Standard for subtype:** While HRCT is the diagnostic imaging of choice, a **Surgical Lung Biopsy** remains the definitive "gold standard" for histopathological classification if HRCT is inconclusive.

Q: Which of the following is NOT a cause of exudative pleural effusion?

Liver cirrhosis. Pleural effusions are classified into **transudates** and **exudates** based on Light’s Criteria. This distinction is crucial for diagnosis [1]. **1. Why Liver Cirrhosis is the Correct Answer:** Liver cirrhosis causes a **transudative** pleural effusion (specifically termed **hepatic hydrothorax**). The underlying mechanism is a decrease in plasma oncotic pressure due to hypoalbuminemia and an increase in hydrostatic pressure. Additionally, ascitic fluid can move directly into the pleural space through small defects in the diaphragm (Bochdalek gaps). Transudates occur when systemic factors affecting fluid formation or resorption are altered, while the pleural membranes remain intact. **2. Why the other options are Exudates:** Exudates result from local inflammatory, infectious, or neoplastic processes that increase capillary permeability or cause lymphatic obstruction. * **Mesothelioma:** A primary pleural malignancy that causes exudative effusion, often hemorrhagic, due to direct pleural invasion [1]. * **Tuberculosis:** A classic cause of exudative effusion in India. It involves a delayed hypersensitivity reaction to mycobacterial antigens, leading to high protein and high ADA (Adenosine Deaminase) levels. * **Esophageal Perforation:** Leads to a "paramalignant" or "parapneumonic-like" exudative effusion [2]. It is characterized by a very low pleural fluid pH and **high amylase** levels (salivary origin) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Light’s Criteria:** Effusion is an exudate if: (1) Pleural/Serum Protein ratio >0.5, (2) Pleural/Serum LDH ratio >0.6, or (3) Pleural LDH >2/3rd the upper limit of normal serum LDH [1]. * **Most common cause of Transudate:** Congestive Heart Failure (CHF). * **Most common cause of Exudate:** Parapneumonic effusion/Pneumonia. * **High Amylase in Pleural Fluid:** Think Esophageal rupture, Pancreatitis, or Malignancy [1].

Q: Lingular lobe bronchiectasis is most commonly due to which of the following conditions?

Mycobacterium Avium intracellulare infection. The correct answer is **Mycobacterium Avium intracellulare (MAC) infection**. **Why it is correct:** MAC infection is the hallmark cause of **Lady Windermere Syndrome**. This clinical phenotype typically affects elderly, non-smoking women who chronically suppress the cough reflex. The voluntary suppression of cough leads to the stagnation of secretions in the **lingula** (left lung) and the **middle lobe** (right lung). Because these lobes have long, narrow bronchi with a relatively poor gravitational drainage, they are highly susceptible to chronic infection, leading to localized bronchiectasis in these specific segments [1]. **Why other options are incorrect:** * **Cystic Fibrosis:** Typically causes widespread, bilateral bronchiectasis that is most severe in the **upper lobes** due to higher oxygen tension and impaired clearance. * **Tuberculosis:** Post-tubercular bronchiectasis is a common sequela in India, but it characteristically involves the **apical and posterior segments of the upper lobes**, following the primary site of reactivation. * **Aspergillosis (ABPA):** Allergic Bronchopulmonary Aspergillosis classically presents with **central (proximal) bronchiectasis**, often involving the upper and middle lobes, but it is not specifically localized to the lingula. **High-Yield Clinical Pearls for NEET-PG:** * **Lady Windermere Syndrome:** Look for a triad of elderly female, chronic cough suppression, and MAC infection in the lingula/middle lobe. * **Kartagener Syndrome:** Associated with situs inversus and lower lobe bronchiectasis. * **Williams-Campbell Syndrome:** Bronchiectasis due to congenital deficiency of bronchial cartilage. * **HRCT Chest:** The gold standard investigation for diagnosing bronchiectasis (look for the "Signet ring sign") [1].

Q: A patient presents with decreased vital capacity and total lung volume. What is the most probable diagnosis?

Sarcoidosis. **Explanation:** The clinical presentation of decreased **Vital Capacity (VC)** and **Total Lung Capacity (TLC)** is the hallmark of a **Restrictive Lung Disease** pattern [1]. In restriction, lung expansion is limited, leading to a reduction in all lung volumes [1]. **1. Why Sarcoidosis is Correct:** Sarcoidosis is an interstitial lung disease (ILD) characterized by non-caseating granulomas [3]. These granulomas and subsequent fibrosis increase lung stiffness (decreased compliance), making it difficult for the lungs to expand. This results in a classic restrictive pattern on Pulmonary Function Tests (PFTs): reduced TLC, reduced VC, and a normal or increased FEV1/FVC ratio [1]. **2. Why the other options are incorrect:** * **Asthma:** This is an **obstructive** lung disease. It is characterized by a decrease in the FEV1/FVC ratio (less than 70%) [2]. While VC may decrease during an acute attack due to air trapping, the TLC is typically normal or increased (hyperinflation). * **Bronchiectasis:** This is a chronic **obstructive** airway disease involving permanent dilation of bronchi. PFTs show airflow obstruction and increased residual volume (RV). * **Cystic Fibrosis:** Primarily manifests as an **obstructive** lung disease due to thick mucus plugging and bronchiectasis, leading to hyperinflation (increased TLC) rather than restriction. **NEET-PG High-Yield Pearls:** * **Restrictive Pattern:** ↓ TLC, ↓ VC, ↓ FRC, but **Normal/↑ FEV1/FVC ratio** [1]. * **Obstructive Pattern:** ↓ FEV1, ↓ FEV1/FVC ratio (<0.7), and **↑ TLC/RV** (due to air trapping) [2]. * **Sarcoidosis PFTs:** Usually restrictive, but can show an obstructive pattern if there is endobronchial involvement. * **DLCO in Sarcoidosis:** Typically decreased due to alveolar-capillary membrane thickening.

Q: A 65-year-old man presented with hemoptysis and stage 3 clubbing. What is the probable diagnosis?

Non-small cell lung cancer. ### Explanation The combination of **hemoptysis** and **Stage 3 clubbing** in an elderly patient is a classic presentation for **Bronchogenic Carcinoma**, specifically **Non-Small Cell Lung Cancer (NSCLC)** [1]. **1. Why Non-Small Cell Lung Cancer (NSCLC) is correct:** Clubbing (Hypertrophic Pulmonary Osteoarthropathy) is a common paraneoplastic manifestation of lung malignancies [1]. Crucially, it is **frequently associated with NSCLC** (especially Adenocarcinoma and Squamous cell carcinoma). Hemoptysis in an elderly smoker is a "red flag" symptom that strongly points toward a primary endobronchial malignancy [1]. **2. Why the other options are incorrect:** * **Small Cell Lung Cancer (SCLC):** While SCLC causes hemoptysis and various paraneoplastic syndromes (like SIADH or Cushing’s), it is **rarely associated with clubbing** [1]. * **Tuberculosis (TB):** TB is a leading cause of hemoptysis; however, it typically presents with constitutional symptoms [2]. While chronic TB can cause clubbing, the association is much stronger with malignancy in this age group [2]. * **Sarcoidosis:** This typically presents with bilateral hilar lymphadenopathy and dry cough. Clubbing is **extremely rare** in sarcoidosis and only occurs in advanced Stage IV (fibrotic) disease. **Clinical Pearls for NEET-PG:** * **Stages of Clubbing:** Stage 3 is characterized by increased curvature of the nail in all dimensions (**"Parrot Beak"** appearance) and obliterated Schamroth’s window. * **Hypertrophic Osteoarthropathy (HOA):** When clubbing is associated with periostitis of long bones and joint swelling, it is most commonly due to **Adenocarcinoma** of the lung [1]. * **SCLC vs. NSCLC:** Remember, **"S"**mall cell is associated with **"S"**IADH and **"S"**yndrome of ectopic ACTH, but **NOT** usually with clubbing [1].

Question 1

A patient presents with the clinical features of interstitial lung disease. How will you confirm the diagnosis?

Accepted Answer

CT scan

Answer

X-ray

Answer

Bronchoscopy

Answer

MRI

Question 2

A 56-year-old man has experienced increased fatigue and decreased exercise tolerance for the past 2 years. On physical examination, his temperature is 37°C, pulse is 75/min, respirations are 17/min, and blood pressure is 115/75 mm Hg. On auscultation, diffuse crackles are audible. The abdomen is distended with a fluid wave, and there is bilateral pitting edema to the knees. A chest radiograph shows pulmonary edema, pleural effusions, and marked cardiomegaly. An echocardiogram shows mild tricuspid and mitral regurgitation and reduced right and left ventricular wall motion, with an ejection fraction of 30%. He experiences cerebral, renal, and splenic infarctions over the next year. Chronic use of which of the following substances has most likely produced these findings?

Accepted Answer

Ethanol

Answer

Acetaminophen

Answer

Cocaine

Answer

Lisinopril

Question 3

A 27-year-old man with a history of alcoholism and repeated bouts of aspiration pneumonia presents with high fever and pleuritic chest pain. Physical examination reveals dullness on percussion and absence of breath sounds in the right lower lung field. A chest X-ray demonstrates pleural fluid on the right side. Thoracentesis returns a thick, foul-smelling fluid. Which of the following is the most likely diagnosis?

Accepted Answer

Empyema

Answer

Chylothorax

Answer

Hemothorax

Answer

Pneumothorax

Question 4

A 35-year-old female complains of slowly progressive dyspnea. Her history is otherwise unremarkable, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. On physical exam, there is jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. ECG shows right axis deviation. A perfusion lung scan is normal with no segmental deficits. What is the most likely diagnosis in this patient?

Accepted Answer

Primary pulmonary hypertension

Answer

Recurrent pulmonary emboli

Answer

Cardiac shunt

Answer

Interstitial lung disease

Question 5

Which of the following is NOT a cause of exudative pleural effusion?

Accepted Answer

Liver cirrhosis

Answer

Mesothelioma

Answer

Tuberculosis

Answer

Esophageal perforation

Question 6

Lingular lobe bronchiectasis is most commonly due to which of the following conditions?

Accepted Answer

Mycobacterium Avium intracellulare infection

Answer

Cystic Fibrosis

Answer

Tuberculosis

Answer

Aspergillosis

Question 7

A patient presents with decreased vital capacity and total lung volume. What is the most probable diagnosis?

Accepted Answer

Sarcoidosis

Answer

Bronchiectasis

Answer

Cystic fibrosis

Answer

Asthma

Question 8

Which of the following statements is FALSE regarding flexible bronchoscopy?

Accepted Answer

Removal of foreign bodies is easier than with rigid bronchoscopy.

Answer

It does not require general anesthesia.

Answer

It can be performed at the bedside.

Answer

It allows for better visualization of the distal airway.

Question 9

A 65-year-old man presented with hemoptysis and stage 3 clubbing. What is the probable diagnosis?

Accepted Answer

Non-small cell lung cancer

Answer

Small cell lung cancer

Answer

Tuberculosis

Answer

Sarcoidosis

Question 10

Which of the following is NOT a consequence of obstructive sleep apnea?

Accepted Answer

Parasympathetic hyperstimulation

Answer

Pulmonary vasoconstriction

Answer

Systemic hypertension

Answer

Polycythemia

Pulmonology — MCQs

Pulmonology — MCQs

On this page

Practice by Chapter

Want unlimited practice?