Pulmonology Practice Questions

Q: Pleural fluid with low glucose is seen in all of the following conditions EXCEPT?

Tuberculosis. In the context of NEET-PG, "low pleural fluid glucose" is typically defined as a level **<60 mg/dL** (or a pleural fluid/serum glucose ratio <0.5). This occurs due to either increased metabolic consumption of glucose by bacteria/cells or impaired transport across the pleural membrane. **Why Tuberculosis is the Correct Answer (in this context):** While Tuberculosis (TB) is traditionally listed among causes of low pleural glucose, it is **not** characteristically low in the majority of cases. In TB pleurisy, glucose levels are usually similar to serum levels. It only drops significantly in very chronic or severe cases. When compared to the other options—where low glucose is a hallmark diagnostic feature—TB is the "least likely" or the "exception" in standard MCQ patterns. **Analysis of Other Options:** * **Rheumatoid Arthritis (RA):** Characteristically has the **lowest** glucose levels among all pleural effusions (often **<30 mg/dL**). This is due to a specific defect in glucose transport. A low pH suggests infection but may also be seen in rheumatoid arthritis [1]. * **Empyema:** Low glucose is expected because active bacterial metabolism and high leukocyte activity consume glucose rapidly [1]. Simple aspiration provides information on the colour and texture of fluid and these alone may immediately suggest an empyema [1]. * **Mesothelioma:** Malignancies (including Mesothelioma and metastatic carcinoma) cause low glucose due to high metabolic demand by tumor cells and thickened pleura hindering transport [1]. **NEET-PG High-Yield Pearls:** 1. **Lowest Glucose ( 40 U/L).

Q: Which of the following statements is FALSE regarding Idiopathic Pulmonary Fibrosis?

Bronchoalveolar lavage shows eosinophils.. ### Explanation **Idiopathic Pulmonary Fibrosis (IPF)** is a chronic, progressive fibrosing interstitial pneumonia of unknown etiology, primarily affecting older adults [1]. It is histologically characterized by the **Usual Interstitial Pneumonia (UIP)** pattern [1]. **Why Option C is False:** Bronchoalveolar lavage (BAL) in IPF typically shows a mild increase in **neutrophils** (up to 70-90% of cases) and occasionally a slight increase in eosinophils, but it is **not** a diagnostic or characteristic feature. A significant eosinophilia in BAL would instead point toward diagnoses like Eosinophilic Pneumonia or Churg-Strauss syndrome. In modern practice, BAL is mainly used to exclude other conditions (like infection or malignancy) rather than to confirm IPF [1]. **Analysis of Other Options:** * **Option A:** Smoking is a well-established environmental risk factor for IPF, along with metal/wood dust exposure and chronic micro-aspiration [1]. * **Option B:** IPF is a **non-granulomatous** disease. The presence of granulomas would suggest alternative diagnoses like Sarcoidosis or Hypersensitivity Pneumonitis. * **Option D:** The hallmark radiological (HRCT) and pathological finding of IPF/UIP is **subpleural, basal-predominant fibrosis** with honeycombing and traction bronchiectasis [1]. **NEET-PG High-Yield Pearls:** * **Clinical Sign:** "Velcro" crackles on auscultation and digital clubbing [1]. * **HRCT Gold Standard:** Subpleural reticular opacities and **honeycombing** [1]. * **Histology:** Temporal heterogeneity (coexistence of old collagen fibrosis and active **fibroblastic foci**). * **Management:** Pirfenidone and Nintedanib (antifibrotic agents) slow disease progression; Lung transplant is the only definitive cure [1].

Q: Bronchiectasis with predominantly upper lobe involvement is characteristic of which condition?

Cystic fibrosis. ### Explanation **Correct Answer: C. Cystic Fibrosis** **Why it is correct:** Bronchiectasis is the permanent dilation of bronchi due to a cycle of infection and inflammation. The anatomical distribution of bronchiectasis is a high-yield diagnostic clue. **Cystic Fibrosis (CF)** is the classic cause of **upper lobe predominant** bronchiectasis [1]. This occurs because the thick, inspissated mucus characteristic of CF leads to impaired mucociliary clearance, which is most pronounced in the upper lobes where ventilation-perfusion ratios and oxygen tension are higher, favoring the growth of pathogens like *Pseudomonas aeruginosa* [1]. **Analysis of Incorrect Options:** * **A. Granulomatosis with polyangiitis:** While it can cause pulmonary nodules, cavitations, and alveolar hemorrhage, it is not a primary cause of localized upper-lobe bronchiectasis. * **B. Hypogammaglobulinemia:** Immunodeficiency syndromes (like CVID) typically cause **lower lobe** bronchiectasis due to the effects of gravity on secretions and recurrent aspiration-like patterns of infection. * **D. Alpha-1 antitrypsin deficiency:** This condition characteristically causes **panacinar emphysema** with a marked predilection for the **lower lobes (basal distribution)**. **NEET-PG High-Yield Pearls:** * **Upper Lobe Bronchiectasis:** Cystic Fibrosis, ABPA (Allergic Bronchopulmonary Aspergillosis - usually central), and Tuberculosis (post-tubercular) [1]. * **Lower Lobe Bronchiectasis:** Post-infectious (viral/bacterial), Hypogammaglobulinemia, and Recurrent aspiration. * **Middle Lobe/Lingula:** Primary Ciliary Dyskinesia (Kartagener Syndrome) and MAC (*Mycobacterium avium* complex/Lady Windermere syndrome). * **Signet Ring Sign:** The classic radiological finding on HRCT where the dilated bronchus is larger than its accompanying pulmonary artery.

Q: Which of the following correlates well with the severe type of bronchial asthma exacerbation?

Usual use of accessory muscles of respiration. The severity of an acute asthma exacerbation is categorized into mild, moderate, severe, and life-threatening based on clinical and physiological parameters. **1. Why Option D is Correct:** The **use of accessory muscles** (sternocleidomastoid, scalene) and **suprasternal retractions** are hallmark clinical signs of a **severe asthma exacerbation**. These signs indicate that the work of breathing has significantly increased to overcome high airway resistance and lung hyperinflation [1]. In severe cases, the patient often speaks in single words rather than sentences and prefers sitting upright (orthopnea). **2. Why the Other Options are Incorrect:** * **Option A (Bradycardia):** In severe asthma, the heart rate is typically **tachycardic (>120 bpm)** due to stress and sympathetic overactivity [1]. Bradycardia is a "near-fatal" or **life-threatening** sign, indicating impending respiratory arrest and exhaustion. * **Option B (Pulsus Paradoxus):** Pulsus paradoxus (an exaggerated drop in systolic BP during inspiration) is a feature of severe asthma, but the value must be **greater than 25 mmHg**. A value less than 10 mmHg is considered normal. * **Option C (Tachypnea):** While tachypnea is present, a respiratory rate **less than 30/min** usually points toward a mild-to-moderate exacerbation. In **severe asthma**, the RR is typically **>30/min**. **Clinical Pearls for NEET-PG:** * **Silent Chest:** The most ominous sign in asthma; it indicates such severe airflow limitation that no wheeze is heard. * **ABG in Asthma:** Initially, patients show Respiratory Alkalosis (low $PaCO_2$) due to hyperventilation. A **"Normal" $PaCO_2$** in a distressed patient is a danger sign, indicating muscle fatigue and transition to respiratory failure [2]. * **PEFR:** A Peak Expiratory Flow Rate **<50%** of the predicted/personal best defines a severe attack [1].

Question 1

A 29-year-old unmarried female presents with dyspnea. Her chest X-ray is normal, FVC is 92%, FEV1/FVC is 89%, and DLCO is 59% of normal. On exercise, her oxygen saturation drops from 92% to 86%. What is the likely diagnosis?

Accepted Answer

Primary pulmonary hypertension

Answer

Alveolar hypoventilation

Answer

Interstitial lung disease

Answer

Anxiety

Question 2

Which of the following conditions are associated with transudative pleural effusion?

Accepted Answer

Myxedema

Answer

Chylothorax

Answer

Dialysis-related effusion

Answer

Nephrotic syndrome

Question 3

Pleural fluid with low glucose is seen in all of the following conditions EXCEPT?

Accepted Answer

Tuberculosis

Answer

Empyema

Answer

Mesothelioma

Answer

Rheumatoid arthritis

Question 4

A 45-year-old female presents with hemoptysis and cough. The hemoptysis started 2 weeks ago, followed by fever and cough. X-rays showed left upper lobe consolidation. Antibiotics were administered. The fever improved, but the cough and hemoptysis persisted. BP 110/72 mmHg, Pulse 70/min. Bronchoscopy shows a mass filling the left bronchus. What is the likely diagnosis?

Accepted Answer

Carcinoid

Answer

Hamartoma

Answer

Pulmonary tuberculosis

Answer

Sarcoidosis

Question 5

Which of the following statements is FALSE regarding Idiopathic Pulmonary Fibrosis?

Accepted Answer

Bronchoalveolar lavage shows eosinophils.

Answer

Smoking is a predisposing factor.

Answer

It is a non-granulomatous condition.

Answer

Subpleural fibrosis is a characteristic finding.

Question 6

Recognized features of asbestosis do not include which of the following?

Accepted Answer

Parenchymal interstitial fibrosis

Answer

Calcification of pleura

Answer

Clubbing of fingers

Answer

Restrictive pattern of ventilatory defect shown by pulmonary function

Question 7

Pneumatoceles are seen in which of the following conditions?

Accepted Answer

Klebsiella pneumonia

Answer

Pneumococcal pneumonia

Answer

Mycoplasma pneumonia

Answer

Streptococcal pneumonia

Question 8

Bronchiectasis with predominantly upper lobe involvement is characteristic of which condition?

Accepted Answer

Cystic fibrosis

Answer

Granulomatosis with polyangiitis

Answer

Hypogammaglobulinemia

Answer

Alpha-1 antitrypsin deficiency

Question 9

Which of the following correlates well with the severe type of bronchial asthma exacerbation?

Accepted Answer

Usual use of accessory muscles of respiration

Answer

Bradycardia with HR less than 100/min

Answer

Pulsus paradoxus less than 10/min

Answer

Tachypnea with RR less than 30/min

Question 10

A 23-year-old man is experiencing a flare of his asthma. He is using his salbutamol inhaler more frequently than usual and despite increasing his inhaled steroids he is still short of breath. Previously, his asthma was considered mild with no severe exacerbations requiring oral steroids or hospitalization. With the current flare, he is experiencing recurrent episodes of bronchial obstruction, fever, malaise, and expectoration of brownish mucous plugs. On examination, there is bilateral wheezing. The heart, abdomen, neurologic, and skin exams are normal. A CXR reveals upper lobe pulmonary infiltrates; the eosinophil count is 3000/mL, and serum precipitating antibodies to Aspergillus are positive. Which of the following is the most likely diagnosis?

Accepted Answer

Allergic bronchopulmonary aspergillosis

Answer

Ascaris infestation

Answer

Churg-Strauss allergic granulomatosis

Answer

Loeffler syndrome

Pulmonology — MCQs

Pulmonology — MCQs

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