Pulmonology Practice Questions

Q: Which of the following is NOT a common cause of acute exacerbation of COPD?

Staphylococcus aureus. **Explanation:** Acute Exacerbation of COPD (AECOPD) is primarily triggered by respiratory tract infections (viral or bacterial) and environmental pollutants. **Why Staphylococcus aureus is the correct answer:** While *Staphylococcus aureus* can cause severe pneumonia, it is **not** a common or typical cause of routine AECOPD. It is generally seen only in specific subsets of patients, such as those with severe structural lung damage, recent hospitalization, or as a secondary infection following Influenza [1]. In the context of standard NEET-PG questions, it is considered an "atypical" or rare cause compared to the primary trio of respiratory pathogens. **Analysis of Incorrect Options:** * **Haemophilus influenzae (Option C):** This is the **most common** bacterial cause of AECOPD. It is a Gram-negative coccobacillus frequently isolated from the sputum of COPD patients. * **Streptococcus pneumoniae (Option A):** A very common cause of both community-acquired pneumonia and AECOPD [1]. It is a Gram-positive diplococcus. * **Moraxella catarrhalis (Option B):** The third most common bacterial pathogen involved in AECOPD, particularly in patients with more advanced airflow obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Most common trigger overall:** Viral infections (Rhinovirus is the most frequent). * **Most common bacterial trigger:** *Haemophilus influenzae*. * **Cardinal Symptoms of AECOPD (Anthonisen Criteria):** Increase in dyspnea, increase in sputum volume, and increase in sputum purulence. * **Management Priority:** Inhaled bronchodilators (SABA/SAMA), systemic corticosteroids, and antibiotics if purulence is present. * **Indications for Antibiotics:** Increased sputum purulence plus one other cardinal symptom.

Q: A 55-year-old man, who has been on bed rest for the past 10 days, complains of breathlessness and chest pain. The chest X-ray is normal. What is the next step in investigation?

Lung ventilation-perfusion scan. **Explanation:** The clinical presentation of sudden onset breathlessness and chest pain in a patient with prolonged immobilization (10 days of bed rest) is highly suggestive of **Pulmonary Embolism (PE)**. **Why Option A is correct:** In a patient suspected of PE where the **Chest X-ray (CXR) is normal**, the next diagnostic step is a **Lung Ventilation-Perfusion (V/Q) scan**. A normal CXR is a classic finding in PE (though non-specific), and the V/Q scan identifies the "mismatch"—areas of the lung that are ventilated but not perfused due to an arterial clot. While CT Pulmonary Angiography (CTPA) is now the gold standard in many centers, the V/Q scan remains the preferred traditional answer in the context of a normal CXR and is highly sensitive for excluding PE. **Why other options are incorrect:** * **B. Pulmonary Angiography:** This is the **Gold Standard** (most accurate) investigation but is invasive and reserved for cases where non-invasive tests are inconclusive. It is not the immediate "next step." * **C. Pulmonary Venous Wedge Angiography:** This is used to measure pulmonary capillary wedge pressure or visualize pulmonary veins; it has no role in diagnosing acute PE. * **D. Echocardiography:** While useful to see right heart strain or bedside assessment in unstable patients, it is not the definitive diagnostic step for PE. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CXR finding in PE:** Normal (or non-specific atelectasis/effusion). * **Classic CXR signs (Rare):** Westermark sign (focal oligemia) and Hampton’s hump (wedge-shaped opacity). * **ECG finding:** Most common is Sinus Tachycardia; most specific is S1Q3T3. * **Gold Standard:** Invasive Pulmonary Angiography. * **Investigation of choice (Modern):** CT Pulmonary Angiography (CTPA).

Question 1

Which of the following is NOT a common cause of acute exacerbation of COPD?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Moraxella catarrhalis

Answer

Haemophilus influenzae

Question 2

What is the most common cause of unilateral diaphragmatic paralysis?

Accepted Answer

Surgical trauma

Answer

Poliomyelitis

Answer

Polyneuritis

Answer

Tumour

Question 3

A 55-year-old male presents with a history of hand swelling and shortness of breath. On examination, facial plethora and distended neck veins were noted. Which is the most probable structure involved to cause these symptoms?

Accepted Answer

Superior vena cava obstruction

Answer

Pulmonary embolism

Answer

Congestive heart failure

Answer

Pneumonia

Question 4

A 45-year-old male with a history of alcohol abuse and periodontal disease presents with a spiking fever and chills. Physical examination reveals signs of lung consolidation. A chest x-ray shows a cavity in the right lower lobe with an air/fluid level. Based upon the clinical presentation, which of the following would be the most likely causative organism?

Accepted Answer

Anaerobic bacteria

Answer

Aspergillus fumigatus

Answer

Entamoeba histolytica

Answer

Staphylococcus aureus

Question 5

A 47-year-old female with a history of Antiphospholipid antibody syndrome, who has been non-compliant with warfarin, presents with deep vein thrombosis and dyspnea. She is hypotensive and tachypneic. CT of the chest shows a saddle embolus. She does not respond to heparin and fluids. Echocardiogram shows RV hypokinesis. Which of the following is the appropriate management?

Accepted Answer

Recombinant tissue plasminogen activator

Answer

Urgent referral for surgical embolectomy

Answer

Continue administration of fluids and heparin

Answer

Add lepirudin

Question 6

Which of the following is the most potent stimulus for the development of cor pulmonale in patients with chronic obstructive pulmonary disease?

Accepted Answer

Hypoxia

Answer

Obliteration of the pulmonary vascular bed

Answer

Alveolar membrane damage

Answer

Left ventricular failure

Question 7

Which of the following is NOT true about sarcoidosis?

Accepted Answer

Strongly positive tuberculin test

Answer

Bilateral symmetrical hilar adenopathy

Answer

Arthralgias

Answer

Increased ACE levels

Question 8

Serum angiotensin-converting enzyme may be raised in all of the following, except?

Accepted Answer

Bronchogenic carcinoma

Answer

Sarcoidosis

Answer

Silicosis

Answer

Berylliosis

Question 9

Type IV respiratory failure best relates to which of the following?

Accepted Answer

Hypoperfusion of respiratory muscles

Answer

Alveolar hypoventilation

Answer

Alveolar flooding

Answer

Lung atelectasis

Question 10

A 55-year-old man, who has been on bed rest for the past 10 days, complains of breathlessness and chest pain. The chest X-ray is normal. What is the next step in investigation?

Accepted Answer

Lung ventilation-perfusion scan

Answer

Pulmonary angiography

Answer

Pulmonary venous wedge angiography

Answer

Echocardiography

Pulmonology — MCQs

Pulmonology — MCQs

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