Pulmonology Practice Questions

Q: A 30-year-old female patient complains of breathlessness for the past 5 months. Her pulmonary function tests report is as follows:

Pulmonary Fibrosis. ***Pulmonary Fibrosis*** - **Restrictive pattern** on PFTs with **reduced FVC**, **reduced TLC**, and **normal or elevated FEV1/FVC ratio** (>0.7) is characteristic of pulmonary fibrosis. - **Reduced DLCO** indicates impaired gas exchange due to **thickened alveolar walls** and **fibrotic changes** in lung parenchyma. *Asthma* - Shows **obstructive pattern** with **reduced FEV1/FVC ratio** (<0.7) and **increased TLC** due to air trapping. - DLCO is typically **normal or slightly increased** as alveolar structure remains intact. *Pulmonary Embolism* - **Does not produce characteristic PFT abnormalities** - may show normal spirometry or mild restriction. - Diagnosis relies on **CT pulmonary angiography** or **V/Q scan**, not pulmonary function tests. *Chronic Bronchitis* - **Obstructive pattern** with **reduced FEV1/FVC ratio** (<0.7) and **increased residual volume**. - **Normal or mildly reduced DLCO** as emphysematous changes are minimal compared to emphysema.

Q: All of the following test results can exclude pulmonary embolism, EXCEPT:

D-Dimer Test: Positive. ### Explanation The diagnosis of Pulmonary Embolism (PE) relies on a combination of clinical probability and objective testing. To "exclude" a diagnosis means the test result must have a high **Negative Predictive Value (NPV)**. **Why "D-Dimer Test: Positive" is the correct answer:** The D-dimer test is highly sensitive but lacks specificity. A **negative** D-dimer (in a patient with low-to-moderate clinical probability) is excellent for ruling out PE. However, a **positive** D-dimer does not confirm PE, nor does it exclude it; it simply necessitates further imaging. Many conditions (pregnancy, malignancy, inflammation, or recent surgery) can cause a false positive D-dimer. Therefore, a positive result is non-diagnostic. **Analysis of other options:** * **CT Pulmonary Angiogram (CTPA): Normal:** CTPA is the current "Gold Standard" for diagnosing PE [1]. A normal CTPA effectively excludes PE in most clinical scenarios due to its high sensitivity and specificity for clots in the pulmonary arteries. * **Perfusion Scan: Normal:** A normal perfusion scan (part of the V/Q scan) has a nearly 100% NPV. If blood flow to all segments of the lung is uniform and normal, PE is effectively ruled out. **Clinical Pearls for NEET-PG:** * **Wells’ Score:** Always the first step to determine clinical probability. * **Rule-out Criteria:** In a low-probability patient, a **negative D-dimer (<500 ng/mL)** is sufficient to stop the workup. * **Gold Standard:** CTPA is the investigation of choice [1]. However, **Pulmonary Angiography** remains the definitive "invasive" gold standard (though rarely used now). * **V/Q Scan:** Preferred in patients with renal failure (high creatinine) or severe contrast allergy [1]. * **ECG Finding:** Most common finding is **Sinus Tachycardia**; most specific (but rare) is **S1Q3T3** [1].

Q: The Bode index is used in which type of transplantation?

Lung transplantation. The **BODE Index** is a multidimensional scoring system used primarily to predict the prognosis and mortality risk in patients with **Chronic Obstructive Pulmonary Disease (COPD)** [1]. In the context of transplantation, it is a critical tool used to determine the timing and eligibility for **Lung Transplantation** [2]. The acronym **BODE** stands for: * **B: Body Mass Index (BMI)** – Points are given for BMI < 21 kg/m² [1]. * **O: Obstruction** – Measured by FEV1 (% of predicted). * **D: Dyspnea** – Measured by the mMRC (Modified Medical Research Council) scale. * **E: Exercise Capacity** – Measured by the 6-minute walk distance (6MWD). A higher BODE score (0–10) correlates with a higher risk of death. According to international guidelines, a **BODE score of 7–10** is one of the primary indications for referring a COPD patient for lung transplant evaluation [2]. **Why other options are incorrect:** * **Liver Transplantation:** Uses the **MELD** (Model for End-Stage Liver Disease) or **Child-Pugh** score for prioritization. * **Renal Transplantation:** Uses glomerular filtration rate (GFR) and time on dialysis; the **KDPI** (Kidney Donor Profile Index) is used for organ allocation. * **Heart Transplantation:** Uses the **NYHA** classification and hemodynamic parameters (e.g., VO2 max) for assessment. **High-Yield Clinical Pearls for NEET-PG:** * The BODE index is a better predictor of mortality in COPD than FEV1 alone. * **mMRC Scale:** Grade 4 dyspnea (breathless while dressing/undressing) is a key component. * **6-Minute Walk Test:** A distance of <150 meters is a strong predictor of poor outcomes.

Q: In COPD, which of the following statements is true?

FEV1/FVC < 0.7. **Explanation:** Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation. The physiological hallmark of obstructive lung diseases is an increased resistance to airflow, particularly during expiration. **1. Why Option A is Correct:** In COPD, the **Forced Expiratory Volume in 1 second (FEV1)** decreases significantly more than the **Forced Vital Capacity (FVC)** due to airway narrowing and loss of elastic recoil. According to GOLD guidelines, a post-bronchodilator **FEV1/FVC ratio of 0.7 is seen in normal individuals or patients with **Restrictive Lung Diseases** (where both FEV1 and FVC decrease proportionately, or FVC decreases more). * **Option C & D:** In COPD, air becomes trapped in the distal airspaces (air-trapping). This leads to **Hyperinflation**, which causes an **increase** in **Residual Volume (RV)**, Functional Residual Capacity (FRC), and **Total Lung Capacity (TLC)**. Decreased RV and TLC are characteristic features of restrictive diseases like Interstitial Lung Disease (ILD). **High-Yield Clinical Pearls for NEET-PG:** * **Flow-Volume Loop:** In COPD, the expiratory limb shows a characteristic **"scooped-out" appearance**. * **Diffusion Capacity (DLCO):** Decreased in Emphysema (due to alveolar destruction) but typically normal in Chronic Bronchitis. * **Compliance:** Lung compliance is **increased** in emphysema due to the loss of elastic fibers.

Q: Which of the following signs will not be present in pleural effusion?

Hyper resonance in the affected side. **Explanation:** In pleural effusion, the accumulation of fluid in the pleural space acts as a physical barrier between the lung parenchyma and the chest wall. This fluid layer absorbs vibrations and displaces air-filled lung tissue, leading to specific physical findings. **Why Hyper-resonance is the Correct Answer:** Hyper-resonance is a percussion note associated with **increased air** in the pleural space (e.g., Pneumothorax) [2] or hyperinflation of the lungs (e.g., Emphysema) [1]. In pleural effusion, the presence of fluid replaces air, resulting in a **stony dull** percussion note, not hyper-resonance. Therefore, hyper-resonance will not be present on the affected side. **Analysis of Other Options:** * **Stony dullness:** This is the hallmark percussion finding of pleural effusion. The fluid is much denser than air-filled lung tissue, producing a flat, "stony" sound. * **Absent breath sounds:** The fluid layer insulates the chest wall from the sounds generated in the airways, leading to significantly diminished or totally absent breath sounds over the effusion. * **Diminished vocal fremitus:** Vocal fremitus (palpable vibrations) depends on the transmission of sound through the lung to the chest wall. Fluid reflects these vibrations, leading to decreased or absent fremitus. **Clinical Pearls for NEET-PG:** * **Skodaic Resonance:** A high-yield sign where hyper-resonance is heard *above* the level of the effusion due to compensatory hyperinflation of the lung tissue. * **Ellis S-shaped curve:** The characteristic upper border of dullness in a moderate pleural effusion. * **Mediastinal Shift:** In large effusions, the trachea and apex beat are shifted to the **opposite** side (contralateral shift) [3]. * **Aegophony:** Heard at the upper border of the effusion (E to A change).

Question 1

A 30-year-old female patient complains of breathlessness for the past 5 months. Her pulmonary function tests report is as follows:

Accepted Answer

Pulmonary Fibrosis

Answer

Asthma

Answer

Pulmonary Embolism

Answer

Chronic Bronchitis

Question 2

All of the following test results can exclude pulmonary embolism, EXCEPT:

Accepted Answer

D-Dimer Test: Positive

Answer

CT pulmonary angiogram: Normal

Answer

Perfusion scan: Normal

Answer

None of the above

Question 3

A 64-year-old woman is found to have a left-sided pleural effusion on chest x-ray. Analysis of the pleural fluid reveals a ratio of concentration of total protein in pleural fluid to serum of 0.38, a lactate dehydrogenase (LDH) level of 125 IU, and a ratio of LDH concentration in pleural fluid to serum of 0.46. Which of the following disorders is most likely in this patient?

Accepted Answer

Congestive heart failure

Answer

Uremia

Answer

Pulmonary embolism

Answer

Sarcoidosis

Question 4

A 50-year-old woman presents with a 4-week history of fever, shortness of breath, and dry cough. She reports that her chest feels 'tight.' The patient is a pigeon fancier. Blood tests show leukocytosis and neutrophilia, an elevated erythrocyte sedimentation rate, and increased levels of immunoglobulins and C-reactive protein. A lung biopsy reveals poorly formed granulomas composed of epithelioid macrophages and multinucleated giant cells. Which of the following is the most likely diagnosis?

Accepted Answer

Hypersensitivity pneumonitis

Answer

Actinomycosis

Answer

Goodpasture syndrome

Answer

Wegener granulomatosis

Question 5

An adolescent girl presents with symmetrical, red, tender swellings in her shins and arthralgia. X-ray reveals hilar and paratracheal lymphadenopathy. She is clinically suspected to have sarcoidosis. What is the next step in the diagnosis?

Accepted Answer

Mediastinal lymph node biopsy

Answer

24-hour urine calcium estimation

Answer

CT thorax

Answer

Follow up with 3-monthly CXR

Question 6

The Bode index is used in which type of transplantation?

Accepted Answer

Lung transplantation

Answer

Liver transplantation

Answer

Renal transplantation

Answer

Heart transplantation

Question 7

In COPD, which of the following statements is true?

Accepted Answer

FEV1/FVC < 0.7

Answer

FEV1/FVC > 0.7

Answer

RV is decreased

Answer

TLC is decreased

Question 8

A 45-year-old patient on methotrexate develops respiratory symptoms. What is the most likely diagnosis?

Accepted Answer

Nonspecific interstitial pneumonia

Answer

Bacterial pneumonia

Answer

Tuberculosis secondary to drug therapy

Question 9

Which of the following findings is NOT typically seen in lung function tests for emphysema?

Accepted Answer

Increased diffusion capacity for carbon monoxide (DLCO)

Answer

Decreased vital capacity

Answer

Increased total lung capacity

Answer

Decreased FEV1/FVC ratio

Question 10

Which of the following signs will not be present in pleural effusion?

Accepted Answer

Hyper resonance in the affected side

Answer

Stony dullness

Answer

Absent breath sounds

Answer

Diminished vocal fremitus

Pulmonology — MCQs

Pulmonology — MCQs

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