Pulmonology Practice Questions

Q: Eggshell calcification of hilar lymph nodes is associated with which condition?

Silicosis. **Explanation:** **Silicosis (Correct Answer):** Eggshell calcification is a classic radiological hallmark of silicosis [1]. It occurs when inhaled crystalline silica particles are ingested by alveolar macrophages, leading to inflammation and fibrosis. These particles migrate to the hilar and mediastinal lymph nodes, causing peripheral calcification of the nodes while the center remains relatively clear, creating the "eggshell" appearance. This finding is seen in approximately 5% of silicosis patients. **Why other options are incorrect:** * **Asbestosis:** Characterized by pleural plaques (most common finding), subpleural linear densities, and "ferruginous bodies" (asbestos fibers coated with iron) [1]. It typically involves the lower lobes and does not cause eggshell calcification. * **Byssinosis:** Caused by cotton, flax, or hemp dust. It is a clinical diagnosis characterized by "Monday morning chest tightness." It does not produce distinct radiological calcifications. * **Anthracosis:** Associated with Coal Workers' Pneumoconiosis (CWP). While it causes "black lung" and progressive massive fibrosis, the lymph node calcification, if present, is usually solid or amorphous rather than the peripheral eggshell pattern [1]. **NEET-PG High-Yield Pearls:** * **Silicosis & TB:** Silicosis significantly increases the risk of Tuberculosis (Silicotuberculosis) because silica impairs macrophage function. * **Radiology:** Silicosis typically involves the **upper lobes** with nodular opacities [1]. * **Differential Diagnosis for Eggshell Calcification:** While Silicosis is the most common cause, it can also be seen in **Sarcoidosis** (rarely), treated Lymphoma, and Amyloidosis. * **Pathology:** Look for "Silicotic nodules" showing whorled collagen fibers under polarized light.

Q: Kallmann syndrome is characterized by which of the following?

All of the above. The question refers to **Kartagener Syndrome**, which is a specific subset of **Primary Ciliary Dyskinesia (PCD)**. It is an autosomal recessive disorder characterized by a classic clinical triad: **Situs inversus, Chronic sinusitis, and Bronchiectasis.** 1. **Situs Inversus (Option A):** During embryonic development, normal ciliary beating is required for the proper left-right positioning of internal organs. Defective cilia lead to a 50% chance of random organ orientation, resulting in situs inversus (reversal of organs). 2. **Bronchiectasis and Sinusitis (Option B):** Cilia are essential for the "mucociliary escalator." In PCD, impaired ciliary motility leads to poor clearance of mucus from the respiratory tract, causing recurrent infections, chronic sinusitis, and permanent dilation of the bronchi (bronchiectasis). 3. **Male Infertility (Option C):** The structural defect (most commonly a lack of **dynein arms**) that affects respiratory cilia also affects the flagella of spermatozoa. This results in immotile sperm, leading to infertility. **Note on Nomenclature:** While the prompt mentions "Kallmann syndrome" (which is actually Hypogonadotropic Hypogonadism with Anosmia) [1], the options and the marked correct answer clearly describe **Kartagener Syndrome**. In the context of NEET-PG, this is a common "trap" or typo; always prioritize the clinical triad presented in the options. **High-Yield Clinical Pearls for NEET-PG:** * **Genetic Defect:** Most commonly mutations in *DNAI1* and *DNAH5* genes. * **Diagnostic Test:** Screening with **Nasal Nitric Oxide (nNO)** levels (low in PCD); gold standard is **Electronic Microscopy** of ciliary ultrastructure or genetic testing. * **Dextrocardia:** Often the first clue on a chest X-ray (heart apex on the right). * **Female Fertility:** Can also be reduced due to impaired ciliary action in the fallopian tubes.

Q: Precapillary Pulmonary hypertension is caused by all EXCEPT:

Mitral stenosis. **Explanation:** Pulmonary Hypertension (PH) is hemodynamically classified into two main types based on the site of resistance: **Pre-capillary** and **Post-capillary**. 1. **Why Mitral Stenosis is the correct answer:** Mitral stenosis is a classic cause of **Post-capillary PH** (WHO Group 2). In this condition, the narrowing of the mitral valve leads to increased pressure in the left atrium, which is transmitted backward into the pulmonary veins and then the pulmonary capillaries. Hemodynamically, this is characterized by an elevated **Pulmonary Capillary Wedge Pressure (PCWP >15 mmHg)**. 2. **Why the other options are incorrect (Pre-capillary causes):** Pre-capillary PH occurs when the pathology is located *before* the pulmonary capillaries (PCWP remains normal, ≤15 mmHg). * **Primary Pulmonary Hypertension (Idiopathic PAH):** Involves intrinsic remodeling of the pulmonary arteries (WHO Group 1). * **Pulmonary Vasculitis:** Causes inflammation and narrowing of the arterial bed (WHO Group 1). * **Thromboembolism:** Leads to Chronic Thromboembolic Pulmonary Hypertension (CTEPH) by physically obstructing the arterial flow (WHO Group 4). **High-Yield Clinical Pearls for NEET-PG:** * **Hemodynamic Definition:** Pre-capillary PH is defined by a Mean Pulmonary Artery Pressure (mPAP) >20 mmHg AND a PCWP ≤15 mmHg. * **WHO Groups:** * **Group 1:** PAH (Idiopathic, Drugs, Connective Tissue Disease). * **Group 2:** Left Heart Disease (Mitral/Aortic valve disease, Heart Failure) — **Most common cause of PH overall.** * **Group 3:** Lung Disease/Hypoxia (COPD, ILD). * **Group 4:** CTEPH. * **Group 5:** Multifactorial. * **Groups 1, 3, and 4 are all Pre-capillary.** Only Group 2 is Post-capillary.

Q: A 55-year-old male presented with history suggestive of Fever of Unknown Origin (FUO). He had multiple firm, discrete cervical lymphadenopathy. Serum angiotensin-converting enzyme was elevated in this patient. What is the most likely diagnosis?

Sarcoidosis. ### Explanation **Correct Answer: C. Sarcoidosis** The clinical presentation of persistent fever (FUO), cervical lymphadenopathy, and an **elevated Serum Angiotensin-Converting Enzyme (SACE)** level is a classic triad pointing towards **Sarcoidosis** [1]. * **Pathophysiology:** Sarcoidosis is a multisystem granulomatous disease characterized by non-caseating granulomas. The epithelioid cells within these granulomas produce ACE; hence, elevated SACE levels serve as a surrogate marker for the total body granuloma burden (though it lacks high specificity). * **Lymphadenopathy:** While bilateral hilar lymphadenopathy is most common, peripheral involvement (cervical, axillary) occurs in up to 30% of cases [1]. **Why other options are incorrect:** * **Non-Hodgkin’s Lymphoma (A) & CLL (D):** While both present with lymphadenopathy and fever (B-symptoms), they are typically associated with elevated LDH or specific peripheral smear/flow cytometry findings. They do not characteristically cause elevated SACE levels. * **Kikuchi Disease (B):** Also known as histiocytic necrotizing lymphadenitis, it presents with fever and cervical lymphadenopathy in younger patients. However, it is a self-limiting condition and is not associated with elevated SACE. **NEET-PG High-Yield Pearls:** 1. **SACE Levels:** Elevated in Sarcoidosis, but also seen in Gaucher’s disease, Leprosy, Hyperthyroidism, and Silicosis. 2. **Kveim-Siltzbach Test:** A historical skin test for Sarcoidosis (now rarely used). 3. **Biopsy Gold Standard:** Shows **non-caseating granulomas** with Asteroid bodies or Schaumann bodies. 4. **Lofgren’s Syndrome:** A specific acute presentation of Sarcoidosis consisting of the triad: Erythema nodosum, Bilateral hilar lymphadenopathy, and Arthralgia [1]. 5. **Hypercalcemia:** Occurs in Sarcoidosis due to 1-alpha-hydroxylase activity in macrophages, which increases Vitamin D activation [1].

Q: Which of the following is not found as a presentation of sarcoidosis?

Myocardial infarction. Explanation: Sarcoidosis is a multisystem, chronic granulomatous disease of unknown etiology characterized by the formation of **non-caseating granulomas**. While it can affect almost any organ, its cardiovascular manifestations are specific. **Why Myocardial Infarction (Option B) is the Correct Answer:** Myocardial Infarction (MI) is typically caused by atherosclerotic plaque rupture or coronary artery occlusion. Sarcoidosis does not directly cause typical MI. While cardiac sarcoidosis involves the infiltration of granulomas into the myocardium, it leads to restrictive cardiomyopathy, heart failure, or conduction defects rather than acute coronary syndrome. **Analysis of Incorrect Options:** * **A. Erythema Nodosum:** This is a classic cutaneous manifestation of sarcoidosis [1]. When seen alongside bilateral hilar lymphadenopathy and arthralgia, it is known as **Löfgren syndrome**, which carries a favorable prognosis [1]. * **C. Arrhythmias:** Cardiac sarcoidosis most commonly involves the basal septum. Granulomatous infiltration and subsequent scarring disrupt the electrical conduction system, leading to heart blocks, ventricular arrhythmias, and sudden cardiac death [1]. * **D. CNS Involvement (Neurosarcoidosis):** Occurs in about 5–10% of patients. The most common presentation is **Cranial Nerve VII (Facial nerve) palsy** [1]. It can also cause meningitis, diabetes insipidus, and hypothalamic dysfunction [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Lungs:** 90% of cases show bilateral hilar lymphadenopathy [1]. * **Eyes:** Anterior uveitis is the most common ocular finding [1]. * **Heerfordt’s Syndrome:** Uveitis, Parotid swelling, and Facial nerve palsy. * **Diagnosis:** Elevated Serum ACE levels (non-specific) and biopsy showing non-caseating granulomas. * **Asteroid bodies** and **Schaumann bodies** are characteristic microscopic findings within the granulomas.

Q: Which of the following statements is NOT true regarding Macleod's Syndrome?

It is unilateral emphysema.. **Explanation:** **Macleod’s Syndrome** (also known as **Swyer-James Syndrome**) is a rare sequela of childhood post-infectious bronchiolitis obliterans. It is characterized by the inflammation and fibrosis of small airways, leading to air trapping and distal lung destruction. **Why Option C is the correct answer (The "NOT true" statement):** While Macleod’s syndrome is often colloquially called "unilateral emphysema," it is **not a true emphysema**. In true emphysema, there is permanent destruction of alveolar walls [2]. In Macleod’s syndrome, the primary pathology is bronchiolitis obliterans; the hyperlucency seen on imaging is due to **air trapping** and **reduced vascular perfusion** (hypoplasia), not the destruction of alveolar septa. Therefore, calling it "unilateral emphysema" is pathologically inaccurate. **Analysis of other options:** * **Option A:** Correct statement. As explained above, it is a form of obstructive lung disease/bronchiolitis, not true acinar destruction. * **Option B:** Correct statement. The initial insult (usually viral pneumonia like Adenovirus or Measles) typically occurs in early childhood (**before age 8**) [1], while the lungs are still developing. * **Option D:** Incorrect statement (making it a "true" fact about the disease). The pulmonary artery on the affected side is **hypoplastic** (small), not hyperplastic. This occurs due to reflex vasoconstriction in response to chronic hypoxia in the under-ventilated lung. **NEET-PG High-Yield Pearls:** * **Radiology:** Characterized by a **unilateral hyperlucent lung** with a small or normal-sized hilum. * **CT Scan:** Shows "mosaic attenuation" and air trapping on expiration. * **Etiology:** Most commonly follows **Adenovirus type 7** or Mycoplasma infection. * **Key Differential:** Congenital lobar emphysema (usually presents in neonates) and Pulmonary Artery Agenesis.

Q: A 54-year-old female patient undergoes a routine insurance physical examination. Chest x-ray revealed bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following diseases should be suspected?

Sarcoidosis. The clinical presentation of an asymptomatic patient with incidental **bilateral hilar lymphadenopathy** [1] on chest X-ray and biopsy showing **non-caseating granulomas** (negative for acid-fast bacilli and fungi) is the classic "textbook" description of **Sarcoidosis**. **Why Sarcoidosis is correct:** Sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by the formation of non-caseating granulomas. Stage I sarcoidosis often presents as asymptomatic bilateral hilar lymphadenopathy (BHL) [1]. The diagnosis is one of exclusion; therefore, negative stains for tuberculosis (AFB) and fungal infections are crucial to confirm the diagnosis. **Why the other options are incorrect:** * **Caroli’s Disease:** A rare congenital disorder characterized by cystic dilatation of the intrahepatic bile ducts. It presents with jaundice or cholangitis, not pulmonary findings. * **Raynaud’s Disease:** A vascular disorder characterized by episodic vasospasm of the digits in response to cold or stress. It does not cause hilar masses or granulomas. * **Scleroderma (Systemic Sclerosis):** While it can cause Interstitial Lung Disease (ILD) and pulmonary hypertension, it does not typically present with isolated bilateral hilar granulomata. **High-Yield Clinical Pearls for NEET-PG:** * **Löfgren Syndrome:** A specific acute presentation of sarcoidosis consisting of the triad: Erythema nodosum, Bilateral hilar lymphadenopathy, and Polyarthritis/Arthralgia [1]. * **Heerfordt Syndrome (Uveoparotid Fever):** Parotid enlargement, Facial nerve palsy, and Anterior uveitis. * **Biochemical Marker:** Elevated **Serum ACE (Angiotensin-Converting Enzyme)** levels are seen in 60-80% of active cases. * **Pathology:** Look for **Asteroid bodies** or **Schaumann bodies** within the giant cells of the granuloma. * **Kveim-Siltzbach Test:** An older, specific skin test for sarcoidosis (rarely used now).

Q: Type 1 respiratory failure is characterized by which of the following?

Low PaO2 and normal PCO2. Respiratory failure is clinically defined as the inability of the respiratory system to maintain adequate gas exchange [1]. It is categorized into two primary types based on arterial blood gas (ABG) patterns: **1. Why Option A is Correct:** **Type 1 Respiratory Failure (Hypoxemic)** is characterized by **Hypoxemia (PaO2 < 60 mmHg)** with a **normal or low PaCO2 (normocapnia or hypocapnia)** [1]. The primary pathophysiology involves a failure of oxygenation, usually due to **V/Q mismatch** (the most common cause) or **intrapulmonary shunting** [2]. Because CO2 is 20 times more diffusible than oxygen, the patient can initially compensate for hypoxia by increasing minute ventilation (hyperventilation), which keeps the PCO2 normal or even low [2]. Common causes include pneumonia, pulmonary edema, ARDS, and pulmonary embolism. **2. Why the Other Options are Incorrect:** * **Option B (Low PaO2 and high PCO2):** This describes **Type 2 Respiratory Failure (Hypercapnic/Ventilatory failure)**. This occurs when alveolar ventilation is inadequate to excrete the CO2 produced by the body [1]. Common causes include COPD, neuromuscular disorders (e.g., Guillain-Barré), and CNS depression. * **Option C & D:** These do not fit the clinical definition of respiratory failure. Respiratory failure, by definition, requires the presence of hypoxemia (PaO2 < 60 mmHg) while breathing room air [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Type 3 Respiratory Failure:** Perioperative respiratory failure (due to atelectasis). * **Type 4 Respiratory Failure:** Associated with shock (hypoperfusion of respiratory muscles). * **The A-a Gradient:** In Type 1 failure due to intrinsic lung disease, the Alveolar-arterial (A-a) gradient is **increased**. In Type 2 failure due to extrapulmonary causes (like opioid overdose), the A-a gradient remains **normal**.

Q: A 75-year-old lady with severe chronic obstructive pulmonary disease (COPD) presents with acute breathlessness. The chest X-ray shows no focal consolidation. She is afebrile, but D-dimers are markedly elevated. Which of the following is the best investigation to diagnose this condition?

CT pulmonary angiography. **Explanation:** The clinical presentation of acute breathlessness, a clear chest X-ray (no consolidation), and markedly elevated D-dimers in an elderly patient strongly suggests **Acute Pulmonary Embolism (PE)**. **1. Why CT Pulmonary Angiography (CTPA) is the Correct Answer:** CTPA is currently the **gold standard and investigation of choice** for diagnosing pulmonary embolism. It allows direct visualization of emboli as filling defects within the pulmonary arteries. In this patient, the absence of focal consolidation on X-ray helps rule out pneumonia, making a vascular event more likely. CTPA is preferred due to its high sensitivity, specificity, and ability to provide alternative diagnoses if PE is absent. **2. Why Other Options are Incorrect:** * **MRI (A):** While it can detect PE, it is not the first-line investigation due to long acquisition times, lower resolution for peripheral vessels, and difficulty in monitoring unstable patients. * **Ventilation-Perfusion (V/Q) Scan (B):** Although used when CTPA is contraindicated (e.g., renal failure), it is **unreliable in COPD patients**. Underlying lung disease causes pre-existing ventilation defects, leading to "indeterminate" or "non-diagnostic" results. * **High-Resolution CT (HRCT) Thorax (C):** HRCT is used to evaluate interstitial lung disease and parenchyma (e.g., bronchiectasis, fibrosis). It is not designed to evaluate the pulmonary vasculature for clots. **Clinical Pearls for NEET-PG:** * **Gold Standard for PE:** CT Pulmonary Angiography. * **Best Initial Test for PE:** Chest X-ray (usually normal; done to rule out other causes). * **Westermark Sign:** Focal oligemia (hyperlucency) distal to an embolus on CXR. * **Hampton’s Hump:** Wedge-shaped opacity representing pulmonary infarction. * **Investigation of choice in Pregnancy/Renal Failure:** V/Q scan or Doppler Ultrasound of leg veins (to avoid radiation/contrast).

Question 1

Eggshell calcification of hilar lymph nodes is associated with which condition?

Accepted Answer

Silicosis

Answer

Asbestosis

Answer

Byssinosis

Answer

Anthracosis

Question 2

Kallmann syndrome is characterized by which of the following?

Accepted Answer

All of the above

Answer

Situs inversus

Answer

Bronchiectasis and sinusitis

Answer

Male infertility

Question 3

Precapillary Pulmonary hypertension is caused by all EXCEPT:

Accepted Answer

Mitral stenosis

Answer

Pulmonary vasculitis

Answer

Primary pulmonary hypertension

Answer

Thromboembolism

Question 4

A 55-year-old male presented with history suggestive of Fever of Unknown Origin (FUO). He had multiple firm, discrete cervical lymphadenopathy. Serum angiotensin-converting enzyme was elevated in this patient. What is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Non-Hodgkin's lymphoma

Answer

Kikuchi disease

Answer

Chronic lymphocytic leukemia

Question 5

A 29-year-old anxious lady presents with a history of progressive breathlessness and exercise intolerance for four months. Her FVC is 90% and FEV1/FVC is 86%. Oxygen saturation after exercise dropped from 92% to 86%. What is the likely diagnosis?

Accepted Answer

Primary pulmonary hypertension

Answer

Primary alveolar hypoventilation

Answer

Anxiety disorder

Answer

Interstitial lung disease

Question 6

Which of the following is not found as a presentation of sarcoidosis?

Accepted Answer

Myocardial infarction

Answer

Erythema nodosum

Answer

Arrhythmias

Answer

CNS involvement

Question 7

Which of the following statements is NOT true regarding Macleod's Syndrome?

Accepted Answer

It is unilateral emphysema.

Answer

It is not a true emphysema.

Answer

It occurs before 8 years of age.

Answer

The pulmonary artery on the affected side is hyperplastic.

Question 8

A 54-year-old female patient undergoes a routine insurance physical examination. Chest x-ray revealed bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following diseases should be suspected?

Accepted Answer

Sarcoidosis

Answer

Caroli's disease

Answer

Raynaud's disease

Answer

Scleroderma

Question 9

Type 1 respiratory failure is characterized by which of the following?

Accepted Answer

Low PaO2 and normal PCO2

Answer

Low PaO2 and high PCO2

Answer

Normal PaO2 and high PCO2

Answer

High PaO2 and high PCO2

Question 10

A 75-year-old lady with severe chronic obstructive pulmonary disease (COPD) presents with acute breathlessness. The chest X-ray shows no focal consolidation. She is afebrile, but D-dimers are markedly elevated. Which of the following is the best investigation to diagnose this condition?

Accepted Answer

CT pulmonary angiography

Answer

MRI

Answer

Ventilation-perfusion (V/Q) scan

Answer

High-resolution CT thorax

Pulmonology — MCQs

Pulmonology — MCQs

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