Pulmonology — MCQs
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FEV1/FVC is decreased in:
Lights criteria is used for
Brock's syndrome is associated with which lobe of the lung?
Which of the following is a common cause of respiratory failure in the immediate post-operative period?
Pink puffers are typically associated with which condition?
In allergic bronchopulmonary aspergillosis, where are the lesions primarily located?
Which of the following is least likely to cause a cavity in the lungs?
Which of the following conditions is primarily associated with alveolar hypoventilation?
An Adult with asthma presents with asthma symptoms every day and wakes up in the night approximately 2 to 3 days in a week. He can be classified as having :
Upper lobe bronchiectasis is seen in which disease?
Pulmonology Indian Medical PG Practice Questions and MCQs
Question 801: FEV1/FVC is decreased in:
- A. Kyphosis and scoliosis
- B. Restrictive lung disease
- C. Pulmonary fibrosis
- D. Obstructive lung disease such as asthma (Correct Answer)
Explanation: ***Obstructive lung disease such as asthma*** - In **obstructive lung diseases**, there is difficulty with **airflow out of the lungs**, leading to a disproportionate decrease in **FEV1** compared to FVC [1]. - This results in a **reduced FEV1/FVC ratio**, which is a hallmark of conditions like asthma and COPD [1]. *Kyphosis and scoliosis* - These are **restrictive lung conditions** due to chest wall deformities, which typically show a reduced FVC but a **normal or increased FEV1/FVC ratio**. - The primary problem is reduced lung volume, not airflow obstruction. *Restrictive lung disease* - In general, **restrictive lung diseases** are characterized by **reduced lung volumes** (decreased FVC) but **preserved or even increased airflow rates**. - Therefore, the **FEV1/FVC ratio** is usually **normal or elevated**, not decreased. *Pulmonary fibrosis* - **Pulmonary fibrosis** is a type of **restrictive lung disease** where lung tissue becomes stiff and scarred, leading to decreased lung volumes. - While FVC is decreased, the **FEV1/FVC ratio typically remains normal or even increases** because both FEV1 and FVC decrease proportionally, or FEV1 decreases less.
Question 802: Lights criteria is used for
- A. Diagnosing pleural effusions (Correct Answer)
- B. Diagnosing pericardial effusions
- C. Diagnosing ascites
- D. Diagnosing increased intracranial tension
Explanation: ***Diagnosing pleural effusions*** - **Light's criteria** is a set of guidelines used to differentiate between an exudative and a transudative **pleural effusion** [1]. - It involves comparing the levels of protein and lactate dehydrogenase (LDH) in pleural fluid to those in serum [1]. *Diagnosing pericardial effusions* - **Pericardial effusions** are typically evaluated using echocardiography and clinical assessment, not Light's criteria. - The focus for pericardial effusions is often on their size, hemodynamic impact, and underlying cause, rather than protein/LDH ratios. *Diagnosing ascites* - **Ascites**, the accumulation of fluid in the peritoneal cavity, is evaluated using the **serum-ascites albumin gradient (SAAG)** to differentiate causes, not Light's criteria. - **Light's criteria** are specific to pleural fluid analysis [1]. *Diagnosing increased intracranial tension* - **Increased intracranial tension (ICT)** is diagnosed by clinical signs, imaging (CT/MRI), and direct intracranial pressure monitoring. - This condition involves brain physiology and is unrelated to effusions or fluid analysis parameters used in Light's criteria.
Question 803: Brock's syndrome is associated with which lobe of the lung?
- A. Middle lobe of the right lung (Correct Answer)
- B. Lower lobe of the right lung
- C. Upper lobe of the left lung
- D. Lower lobe of the left lung
Explanation: ***Middle lobe of the right lung*** - **Brock's syndrome** specifically refers to chronic or recurrent collapse/consolidation of the **right middle lobe**. [1] - It is often caused by **bronchial obstruction** due to compression from enlarged lymph nodes or recurrent infections. [2] *Lower lobe of the right lung* - While other conditions can affect the **right lower lobe**, it is not specifically associated with Brock's syndrome. - Collapse or consolidation in this lobe would typically be referred to by its anatomical location rather than this eponymous syndrome. *Upper lobe of the left lung* - Conditions affecting the **left upper lobe** have distinct etiologies and are not designated as Brock's syndrome. [3] - This lobe is frequently affected in **tuberculosis** and other specific pathologies. *Lower lobe of the left lung* - The **left lower lobe** is a common site for various pulmonary pathologies but not for Brock's syndrome. - Its involvement typically points towards different diagnostic considerations.
Question 804: Which of the following is a common cause of respiratory failure in the immediate post-operative period?
- A. Post-operative atelectasis causing Type 1 respiratory failure due to ventilation-perfusion mismatch
- B. Pulmonary fibrosis causing Type 1 respiratory failure due to impaired gas diffusion
- C. Kyphoscoliosis causing Type 2 respiratory failure due to restrictive lung disease and hypoventilation (Correct Answer)
- D. Flail chest causing Type 1 respiratory failure due to chest wall instability and ventilation-perfusion mismatch
Explanation: ***Kyphoscoliosis causing Type 2 respiratory failure due to restrictive lung disease and hypoventilation*** - While kyphoscoliosis is a chronic condition, its impact on **respiratory mechanics** can be exacerbated post-operatively. - The already compromised chest wall and lung expansion from **restrictive lung disease** combined with **post-operative pain** and **sedation** can lead to significant **hypoventilation** and Type 2 respiratory failure [3]. *Post-operative atelectasis causing Type 1 respiratory failure due to ventilation-perfusion mismatch* - **Atelectasis** is extremely common post-operatively and can cause Type 1 respiratory failure due to **ventilation-perfusion (V/Q) mismatch** [2]. - However, it typically leads to **hypoxemia** (Type 1) rather than the primary **hypercapnia** (Type 2) seen with kyphoscoliosis and hypoventilation [1]. *Pulmonary fibrosis causing Type 1 respiratory failure due to impaired gas diffusion* - **Pulmonary fibrosis** is a chronic interstitial lung disease that primarily causes **Type 1 respiratory failure** due to thickening of the alveolar-capillary membrane and impaired gas diffusion. - It is a pre-existing condition, not an acute post-operative complication causing a sudden onset of respiratory failure unless there's an acute exacerbation. *Flail chest causing Type 1 respiratory failure due to chest wall instability and ventilation-perfusion mismatch* - **Flail chest** results from multiple rib fractures causing a segment of the chest wall to move paradoxically, severely impacting ventilation and leading to **V/Q mismatch** and **Type 1 respiratory failure**. - This is typically a consequence of **trauma** and not a common immediate post-operative complication unless the surgery itself involved significant chest wall injury.
Question 805: Pink puffers are typically associated with which condition?
- A. Emphysema (Correct Answer)
- B. Chronic bronchitis
- C. Pneumonia
- D. Bronchiectasis
Explanation: ***Emphysema*** - Patients with **emphysema** are often referred to as "pink puffers" because they maintain relatively normal arterial oxygen tension (pink) by **pursing their lips** and using accessory muscles to forcefully exhale (puffing) [1]. - This effort to maintain adequate oxygenation and ventilation, despite severe airflow obstruction, differentiates them from "blue bloaters" [1]. - In emphysema, the loss of alveolar walls leaves small airways unsupported, which contributes to air trapping and increased expiratory effort [2]. *Chronic bronchitis* - Patients with **chronic bronchitis** are classically described as "blue bloaters" due to **hypoxemia** (causing cyanosis or "blueness") and often present with **edema** from right heart failure (bloating) [1]. - They typically have a prominent cough with **sputum production** and less respiratory distress at rest compared to emphysema patients [1]. *Pneumonia* - **Pneumonia** is an acute infection of the lung parenchyma characterized by **fever**, cough, and **dyspnea**, and does not fit the long-term clinical phenotype of "pink puffer." - It typically causes an **influx of inflammatory cells** and fluid into the alveoli, leading to impaired gas exchange. *Bronchiectasis* - **Bronchiectasis** is characterized by **permanent dilation of the bronchi** and is often associated with chronic productive cough and recurrent infections. - While it can cause chronic respiratory symptoms, it does not typically present with the "pink puffer" phenotype associated with the specific compensatory mechanisms seen in emphysema.
Question 806: In allergic bronchopulmonary aspergillosis, where are the lesions primarily located?
- A. None of the options
- B. Pleura
- C. Bronchi and bronchioles (Correct Answer)
- D. Alveoli
Explanation: In allergic bronchopulmonary aspergillosis, where are the lesions primarily located? ***Bronchi and bronchioles*** - Allergic bronchopulmonary aspergillosis primarily affects the **airways**, particularly the **bronchi and bronchioles**, due to the hypersensitivity reaction to the Aspergillus species. - It leads to **mucous plugging** and inflammatory changes in these structures, resulting in symptoms like **cough** and **wheeze**. *All of the above* - This option is incorrect as lesions are not typically found in all structures; ABPA specifically targets the **airways**. - The disease's hallmark features are localized to the **bronchi and bronchioles**, making this option misleading. *Pleura* - While pleural involvement can occur in other pulmonary diseases, it is not characteristic of **allergic bronchopulmonary aspergillosis**. - ABPA does not typically cause **pleural effusions** or lesions in the pleura, focusing instead on airway pathology. *Alveoli* - In ABPA, the primary lesions do not occur in the **alveoli**, but rather in the **airway passages**. - While lung inflammation can affect the alveoli in other contexts, it is not a specific feature of this condition.
Question 807: Which of the following is least likely to cause a cavity in the lungs?
- A. Granulomatosis with Polyangiitis (GPA)
- B. Tuberculosis
- C. Sarcoidosis (Correct Answer)
- D. Staphylococcus aureus pneumonia
Explanation: ***Sarcoidosis*** - Sarcoidosis typically leads to **granuloma formation** in the lungs rather than cavitary lesions [1]. - It usually presents with **bilateral hilar lymphadenopathy** and interstitial lung disease, not lung cavities [1]. *Wegeners* - Wegeners (now called Granulomatosis with Polyangiitis) can cause lung cavities due to **vascular inflammation** [1]. - It typically presents with **pulmonary nodules** that may cavitate and is associated with **renal involvement** [1]. *Hydatid* - Hydatid disease is caused by **Echinococcus** species and can result in cyst formation in the lungs that may become infected and develop cavities. - The cavitary lesions are often due to secondary infections of the cysts. *Staphylococcus* - Staphylococcus can lead to lung abscesses which may cavitate, particularly in cases of **pneumonia** or **aspiration**. - It is commonly associated with **necrotizing pneumonia** and empyema, resulting in cavitary lesions.
Question 808: Which of the following conditions is primarily associated with alveolar hypoventilation?
- A. COPD
- B. Lobar pneumonia
- C. Bulbar poliomyelitis
- D. Kyphoscoliosis (Correct Answer)
- E. Bulbar poliomyelitis
- F. Central sleep apnea
Explanation: ***Kyphoscoliosis*** - **Severe kyphoscoliosis** can restrict lung expansion and thoracic cage movement, leading to **reduced tidal volume** and respiratory muscle fatigue, resulting in **alveolar hypoventilation**. [1] - The abnormal curvature of the spine mechanically impedes efficient ventilation, primarily impacting the ability to take deep breaths and clear CO2. *COPD* - While patients with **severe COPD** can develop hypoventilation, it is primarily characterized by **airway obstruction** and **ventilation-perfusion mismatch** rather than being a primary cause of hypoventilation like restrictive disorders. [1] - Initial stages often involve hyperinflation and increased work of breathing, but not necessarily alveolar hypoventilation as the primary feature. *Lobar pneumonia* - **Lobar pneumonia** causes **consolidation** of lung tissue, leading to V/Q mismatch and hypoxemia. [2] - It typically results in *hyperventilation* due to hypoxaemia and inflammation, rather than alveolar hypoventilation. [2] *Bulbar poliomyelitis* - **Bulbar poliomyelitis** affects the motor neurons of the brainstem, leading to weakness of the muscles involved in swallowing and breathing. - While it can cause respiratory failure, its primary association is with direct paralysis of respiratory muscles rather than a structural respiratory compromise like kyphoscoliosis. *Central sleep apnea* - **Central sleep apnea** involves a temporary cessation of breathing efforts due to a lack of neural output from the brainstem. - It is a disorder of respiratory control during sleep and not primarily associated with daytime alveolar hypoventilation due to a structural chest wall defect.
Question 809: An Adult with asthma presents with asthma symptoms every day and wakes up in the night approximately 2 to 3 days in a week. He can be classified as having :
- A. Intermittent Asthma
- B. Mild Persistent Asthma
- C. Moderate Persistent Asthma (Correct Answer)
- D. Severe Persistent Asthma
Explanation: ***Moderate Persistent Asthma*** - This classification is characterized by **daily asthma symptoms** [1] and **nighttime awakenings occurring 3-4 times per week**. The patient's symptoms fit this description. - The patient's presentation of daily symptoms and 2-3 nighttime awakenings per week indicates a level of severity that surpasses mild persistent asthma but does not meet the criteria for severe persistent asthma [1]. *Intermittent Asthma* - This classification involves symptoms less than **twice a week** and nighttime awakenings less than **twice a month**. - The patient's symptoms are daily, which exceeds the criteria for intermittent asthma. *Mild Persistent Asthma* - This type features symptoms more than **twice a week** but less than **daily**, and nighttime awakenings occurring 3-4 times per month [1]. - The patient experiences daily symptoms, which is more frequent than what is seen in mild persistent asthma. *Severe Persistent Asthma* - This classification involves symptoms throughout the **day** and nighttime awakenings **every night** or multiple times a week (7 nights/week). Also, the patient has a very limited activity level. - While the patient has daily symptoms, the frequency of nighttime awakenings is not severe enough to be classified as severe persistent asthma.
Question 810: Upper lobe bronchiectasis is seen in which disease?
- A. Cystic fibrosis (Correct Answer)
- B. Tuberculosis
- C. Allergic Bronchopulmonary Aspergillosis (ABPA)
- D. Silicosis
Explanation: ***Cystic fibrosis*** - **Cystic fibrosis (CF)** classically affects the upper lobes due to poor mucociliary clearance in these areas, leading to recurrent infections and subsequent bronchiectasis. - The abnormal **CFTR protein** causes thick, sticky mucus that obstructs airways, making them susceptible to damage and dilation. *Tuberculosis* - While **post-primary tuberculosis** can cause cavitation and fibrosis in the upper lobes, leading to some degree of bronchiectasis, it's not the primary or classical cause of widespread upper lobe bronchiectasis like CF. - The mechanism is typically related to **tissue destruction** and fibrosis during healing, rather than primary mucociliary dysfunction. *Allergic Bronchopulmonary Aspergillosis (ABPA)* - **ABPA** can cause central bronchiectasis, often affecting the upper lobes, due to an allergic reaction to *Aspergillus* colonizing the airways. - However, the bronchiectasis in ABPA is typically **central and mucoid impaction-related**, in contrast to the diffuse pattern seen in CF. *Silicosis* - **Silicosis** typically leads to **nodular fibrotic changes** in the upper and mid-lung zones and can cause progressive massive fibrosis. - While it can indirectly lead to some airway distortion or traction bronchiectasis due to severe fibrosis, it is not primarily characterized by bronchiectasis as a prominent feature.
Practice by Chapter
Obstructive Airway Diseases (Asthma, COPD)
Practice Questions
Interstitial Lung Diseases
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Pulmonary Infections
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Pulmonary Vascular Diseases
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Pleural Diseases
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Sleep-Disordered Breathing
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Respiratory Failure
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Mediastinal Disorders
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Occupational Lung Diseases
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Pulmonary Function Testing
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Bronchiectasis and Cystic Fibrosis
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Lung Cancer Approach
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