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Pulmonary Medicine Multiple Choice Questions
1. All the following are mast cell mediators EXCEPT
A. Tryptase
B. Chymase
C. Elastase
D. Collagenase
Answer: D
2. Difference between the alveolar and pleural pressures is termed as
A. Transthoracic pressure
B. Transpulmonary pressure
C. Trans alveolar pressure
D. Trans bronchial pressure
Answer: B
3. As per the 2019 WHO guidelines on drug resistant Tuberculosis treatment, all the following are highly effective and strongly recommended for inclusion in all oral longer regimens EXCEPT
A. Levofloxacin
B. Bedaquiline
C. Ethionamide
D. Linezolid
Answer: C
4. The minute ventilation above which route of airflow switches from predominately nasal to oronasal breathing is
A. 10L/min
B. 16L/min
C. 24L/min
D. 30L/min
Answer: D
5. Regarding honeycomb spaces in usual interstitial pneumonia (UIP) all are true EXCEPT
A. Results from parenchymal remodeling with formation of new airspaces
B. Have thickened and irregular walls
C. There will be destruction of normal airspaces
D. They have abundant and well collagenized connective tissue
Answer: C
6. Regarding Bedaquiline which is FALSE
A. Belongs to the diarylquinoline class
B. Targets the rpoB gene encoding the subunit c of the ATP synthase of Mycobacterium tuberculosis
C. Binds to the oligomeric and proteolipic subunit c of mycobacterial ATP synthase
D. Bedaquiline is rapidly absorbed orally
Answer: B
7. About Riociguat which is true
A. Stimulator of soluble guanylate cyclase (sGC)
B. Inhibitor of soluble guanylate cyclase (sGC)
C. Stimulator of Cyclic GMP (cGMP)
D. Inhibitor of cyclic GMP (cGMP)
Answer: A
8. SERAPHIN trial is related to management of
A. Lung Cancer
B. Idiopathic pulmonary fibrosis
C. COPD
D. pulmonary arterial hypertension
Answer: D
9. In cystic fibrosis select the wrong statement
A. The first genetic marker that was found to be linked to cystic fibrosis was Paraoxanase B. 60% of patients have meconium ileus as the initial manifestation
C. In CF pancreatic insufficiency a malabsorption coefficient of > 7% is considered abnormal D. T5 polymorphism expressed with R117H result in CBAVD
Answer: B
10. All the above are features of Lofgren’s syndrome except
A. Erythema nodosum
B. Bilateral hilar adenopathy
C. Polyarthritis
D. Lupus pernio
Answer: D
11. Empey’s index is
A. FEV1:PEFR ratio
B. FEV1/FVC ratio
C. FEV1/MMEF ratio
D. MMEF/FVC ratio
Answer: A
12. Diagnostic criteria for obesity hypoventilation syndrome include all except
A. BMI>30 kg/`m^(2)`
B. Daytime Pa`CO_(2)` >45mmHg
C. Daytime Pa`O_(2)` <60mmHg D. Sleep disordered breathing
Answer: C
13. Which of the following feature is not a part of the Well’s Score for predicting the probability of Pulmonary Embolism?
A. HR>100
B. Haemoptysis
C. Age>50
D. Malignancy
Answer: C
14. Which among the following is not true regarding Pulmonary veno occlusive disease?
A. Pulmonary Hypertension
B. Radiographic evidence of pulmonary edema
C. Raised PAWP
D. Lymphatic dilatation at the lung bases and pleura
Answer: C
15. McConnells sign is a sonologic sign diagnostic of :
A. Lung cancer
B. Pleural effusion
C. Pneumothorax
D. Pulmonary embolism
Answer: D
16. Which among the following pattern of calcification in a SPN is considered to increase likelihood of malignancy?
A. Popcorn
B. Diffuse
C. Stippled
D. Laminated
Answer: C
17. According to current TNM classification of Non Small Cell Ca lung, a tumor of size 6 cm in right upper lobe with a satellite nodule of 1 cm in the same lobe, subcarinal lymph node and pleural fluid cytology positive belongs to which stage?
A. T2N1M1a
B. T3N1M1a
C. T2N2M1b
D. T3N2M1a
Answer: D
18. Which of the following IHC stains is most useful for identifying adenocarcinoma of pulmonary origin from metastatic lesions?
A. Calretinin & CK5/6
B. Synaptophysin & chromogranin
C. Thyroid transcription factor & thyroglobulin
D. P63
Answer: C
19. Which is the commonest cell type of scar carcinoma?
A. Squamous cell carcinoma
B. Adeno carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Answer: B
20. Positive predictors of response to EGFR targeted therapy in lung cancer include all the following except:
A. Asian ethnicity
B. Never smokers
C. Adenocarcinoma
D. K-ras mutations
Answer: D
21. “Differentiation syndrome” is an adverse event seen during treatment with
A. Gefitinib
B. All-trans retinoic acid
C. Paclitaxel
D. Docetaxel
Answer: B
22. Searles and Mckendry diagnostic criteria is used to detect pulmonary involvement due to
A. Bleomycin
B. Cyclophosphamide
C. Methotrexate
D. Actinomycin D
Answer: C
23. Predictive postoperative lung function should be estimated for patients with and FEV1 or DLco less than
A. 80% of predicted
B. 60% of predicted
C. 50% of predicted
D. 40% of predicted
Answer: A
24. Intraoperative risk factors associated with the development of postoperative pulmonary complication is least for
A. Hip surgery
B. Head and neck surgery
C. Neurosurgery
D. Thoracic surgery
Answer: A
25. In Tsuboi classification of tumor-bronchus relationship, when the bronchus is compressed, narrowed, and displaced by the tumor, but the bronchial mucosa is intact will be categorized as which pattern
A. Type I
B. Type II
C. Type III
D. Type IV
Answer: C
26. Flexible fiber optic bronchoscopy was pioneered by
A. Gustav Kilian
B. Ikeda
C. Schieppati
D. Wang
Answer: B
27. In order to maintain procedural competence for medical thoracoscopy, minimum number of procedures to be performed yearly by operator should be
A. 2
B. 5
C. 8
D. 10
Answer: D
28. Anti TB drug which can cause metallic taste
A. Bedaquilline
B. Delamanide
C. Fluroquinolone
D. both A and C
Answer: C
29. Acid fastness is a property of all of the following organisms except
A. Rhodococcos
B. Legionella micadadei
C. Cryptococcus
D. Isospora
Answer: C
30. Treatment of LTBI can reduce the risk of progression to active disease by abou %
A. 30%
B. 60%
C. 80%
D. 90%
Answer: B
31. What is the most likely cause of pulmonary aneurysm?
A. Mycotic
B. Behcet disease
C. Traumatic
D. Congenital
Answer: A
32. Curacao diagnostic criteria is used to diagnose which of the following?
A. Henoch-Schönlein purpura
B. Wegner’s granulomatosis
C. Christmas disease
D. Hereditary hemorrhagic telengectasia
Answer: D
33. A flow volume loop is showing plateauing of the inspiratory loop only. The most likely cause is:
A. Fixed extra-thoracic obstruction
B. Variable extra-thoracic obstruction
C. Fixed intra-thoracic obstruction
D. Variable intra-thoracic obstruction
Answer: B
34. A patient with severe COPD enters a respiratory rehabilitation program. This is most likely to improve:
A. ABG’s
B. Survival
C. Exercise tolerance
D. Spirometry
Answer: C
35. Fatal asthma attacks are best predicted by:
A. Onset in childhood
B. Increased bronchodilator use
C. Smoking
D. Atopy
Answer: B
36. According to GOLD Guidelines 2019, Inhaled steroids are not considered beneficial if AEC is less than
A. 400
B. 300
C. 200
D. 100
Answer: D
37. Which of the following parameters would be needed to calculate a patient’s BODE index?
A. Pre bronchodilator FEV1%
B. Height
C. Resting PaO2
D. VO2Max
Answer: B
38. Which of the following is likely to be positive in a case of Follicular bronchiolitis?
A. Anticyclic citrullinated peptide antibody
B. Liver-kidney microsomal type 1 (LKM-1) antibody
C. ACE
D. Anti DS antibody
Answer: A
39. In a case of COPD with pulmonary hypertension (Mean PAP 50 mm Hg), which is the best form of treatment?
A. Sildenafil
B. Bosentran
C. Epoprostenol
D. None
Answer: D
40. Which among the following is the most pathognomic radiologic sign of ABPA?
A. Central bronchiectasis
B. High attenuation mucus
C. Gloved finger sign
D. Fleeting shadows
Answer: B
41. Which among the following is a marker for Type II alveolar epithelial cells
A. Caveolin 1
B. Aquaporin 5
C. Carboxypeptidase M
D. Alkaline phosphatase
Answer: D
42. Regarding cervical rib, which among the following is FLASE
A. It is bilateral in 80% of cases
B. Symptom due to compression are more prevalent in males
C. More common on the left side
D. The production of symptoms bears no relation to the size of the rib
Answer: B
43. Which among the following group is least likely to progress to active tuberculosis once infected with tubercle bacilli
A. Patients on TNF alpha inhibitors
B. Silicosis
C. Post jejunoileal bypass
D. Post renal transplant patients
Answer: A
44. Which among the following antibiotics has got good penetration to respiratory secretions
A. Cephalosporins
B. Vancomycin
C. Macrolides
D. Carbapenems
Answer: C
45. Which among the following Immunohistochemistry marker is not useful in diagnosing lung adenocarcinoma is
A. LeuM1
B. Napsin A
C. Surfactant protein A
D. TTF-1
Answer: A
46. HRCT pattern consistent with idiopathic pulmonary fibrosis are all except
A. Peribronchovascular predominance
B. Subpleural basal predominance
C. Honeycombing
D. Reticular abnormality
Answer: A
47. The drug recommended for the treatment of idiopathic pulmonary fibrosis
A. Corticosteroid
B. Nintedanib
C. N acetyl cysteine
D. Azathioprine
Answer: B
48. GAP score is used as a mortality predictor in which condition?
A. ldiopathic pulmonary fibrosis
B. COPD
C. Asthma
D. None of the above
Answer: A
49. Reversed halo sign is seen in all conditions except
A. Cryptogenic organising pneumonia
B. Mucormycosis
C. ldiopathic pulmonary fibrosis
D. Pulmonary infarction
Answer: C
50. The usual time frame for the development of radiation pneumonitis is
A. 1 week to 1 month
B. within 2 weeks
C. 6 weeks to 6 months
D. None of the above
Answer: C
51. Pemberton’s sign is used to demonstrate which disease?
A. Pulmonary embolism
B. Pleural effusion
C. Retrosternal goiter
D. Pancoast tumour
Answer: C
52. Most common location for ectopic parathyroid tumour is
A. Anterior mediastinum
B. Posterior mediastinum
C. Chest wall
D. None of above
Answer: A
53. Calcification in mediastinal neuroblastoma is
A. Rare
B. Seen in 50%
C. Seen in 80%
D. Usually do not calcify
Answer: C
54. In castlemans disease HHV 8 is implicated in patho genesis of
A. Multicentric disease
B. Unicentric disease
C. Both
D. Not associated
Answer: A
55. Which of following statements regarding Solitary fibrous tumour of pleura are true
A. Also called benign mesothelioma
B. Asbestos is a known etiologic factor
C. Even in malignant cases carries good prognosis
D. Hypoglycaemia is seen in upto 40%
Answer: B
56. In USG assessment of pleural effusion, effusion is assessed as moderate if
A. Within the area covered by 3.5 MHz curvilinear probe
B. Between the range of one to two probes
C. Between the range of one to three probes
D. Between the range of two to four probes
Answer: B
57. Which of the following USG finding is a definite sign of pneumothorax
A. Absence lung slide
B. Absence of lung pulse
C. Presence of lung point
D. Presence of A lines
Answer: C
58. Which is the worst prognostic indicator among the following regarding parapneumonic effusion
A. Pleural fluid pH ≤7.2
B. Pleural fluid LDH>3 times normal upper limit of serum LDH
C. Presence of moderate effusion
D. Pleural fluid polymorphonuclear elastase level ≥ 1500 µg/ml
Answer: B
59. Regarding TNM staging of malignant mesothelioma, which of the following is T3
A. Tumour invading ipsilateral chest wall muscle
B. Tumour invading ipsilateral cervical tissue
C. Tumour invading ipsilateral diaphragm
D. Tumour invading pericardium
Answer: A
60. Explosive pleuritis is
A. Rupture of an abscess into pleural cavity causing sudden development of pyopneumothorax
B. Rupture of infected bulla causing sudden development of pyopneumothorax
C. Rapid development of pleural effusion despite minimal pneumonia in Streptococcus pyogens infection
D. Rapid development of pleural effusion in miliary tuberculosis
Answer: C
61. Causes of acute respiratory distress in SLE patient is
A. Community acquired pneumonia
B. Acute lupus pneumonitis
C. pulmonary embolism
D. All of the above
Answer: D
62. Caplan syndrome is seen in
A. Rheumatoid arthritis
B. Systematic lupus erythematosus
C. Systemic sclerosis
D. Polymyositis dermatomyositis
Answer: A
63. The most common ILD pattern in systemic sclerosis is
A. Usual interstitial pneumonia
B. Non-specific interstitial pneumonia
C. Cryptogenic organising pneumonia
D. Diffuse alveolar damage
Answer: B
64. Birbeck granules is seen in
A. Systemic sclerosis
B. systemic lupus erythematosus
C. Sjogren’s syndrome
D. Langerhans cell histiocytosis
Answer: D
65. Black pleura sign is seen in
A. Pulmonary alveolar haemorrhage
B. Langerhans cell histiocytosis
C. Lymphangioleiomyomatosis
D. Pulmonary alveolar microlithiasis
Answer: D
66. The most common antimicrobial agent that causes pulmonary fibrosis
A. Azithromycin
B. Ciprofloxacin
C. Nitrofurantoin
D. cefepime
Answer: C
67. Most common genetic mutation seen in cystic fibrosis is
A. ΔF508
B. R117H
C. G551D
D. R227H
Answer: A
68. Oral drug ivacaftor is used in the treatment of
A. Lymphangioleiomyomatosis
B. Pulmonary alveolar proteinosis
C. Cystic fibrosis
D. Sarcoidosis
Answer: C
69. Vanishing lung syndrome is seen in which condition
A. Systemic sclerosis
B. bullous lung disease
C. diaphragm palsy
D. pulmonary alveolar proteinosis
Answer: B
70. All are used in tobacco smoking cessation except
A. Nicotine replacement therapy
B. Bupropion
C. varenicline
D. e-cigarette
Answer: D Question
71. The cut off value (confirmed by repeat ECG) of QTcF value above which all the QTc prolonging drugs should be discontinued.
A. 440ms
B. 470ms
C. 500ms
D. 520ms
Answer: C
72. TB meningitis should be treated with first line ATT for at least months
A. 6
B. 9
C. 12
D. 15
Answer: B
73. Regarding starting DRTB drugs in a HIV infected patient, pick the wrong statement
A. Unlike drug sensitive pulmonary tuberculosis, ART should be started along with DRTB drugs.
B. HIV infected DRTB patients without the benefit of ART may experience mortality rates exceeding 90%
C. For servere IRIS syndrome prednisolone is the recommended drug.
D. For all new HIV co infected patients recommended ART is FDC of TLE (Tenofovir, Lamivudine and Efavirenz)
Answer: A
74. Pick the incorrect statement regarding tubercular pleural effusion
A. Pleural fluid ADA values less than 40 U/L virtually rules out tuberculosis
B. ADA activity correlates with CD4+ T lymphocyte cell infiltration in the pleura and pleural fluid
C. Haemolysed blood in fluid sample may cause false over estimation of ADA
D. ADA1:ADA2 ratio less than 0.45 is highly suggestive of tuberculosis
Answer: C
75. The non tubercular mycobacterium proposed to have an etiological relationship with Crohns disease is
A. M.interjectum
B. M.avium subsp. Paratuberculosis
C. M.intracellulare
D. M.chimaera
Answer: B
76. Regarding VAT (ventilator associated tracheobronchitis) pick the wrong statement
A. It can be associated with fever and purulent tracheal secretions
B. There is absence of new infiltrate on chest X-ray
C. Non antibiotic treatment is recommended
D. Most common organism implicated is pneumococcus
Answer: D
77. Which of the following is a extracellular functioning PRR(Pattern Recognition Receptor)
A. TLR 6
B. TLR 3
C. NLR
D. RIG-l
Answer: A
78. The pneumonia which is often associated with bullous myringitis
A. Mycoplasma pneumonia
B. Pneumococcal pneumonia
C. Staphylococcal pneumonia
D. Legionella pneumonia
Answer: A
79. False positive beta-D glucan assay is seen with all except.
A. Intra Venous Immunoglobulin
B. Intra Venous Piperacillin-Tazobactam
C. Pseudomonas bacteraemia
D. Intra Venous Ringer lactate
Answer: D
80. Which of the following is not true regarding Anthrax
A. It is also called Brad Ford disease
B. There is no human to human transmission
C. Causative agent is a large, square ended gram negative bacilli
D. Widening of the mediastinum or prominence of hilar modes is the earliest radiological finding
Answer: C
81. Clinical pulmonary infection score is considered to be positive if it is equal to or more than
A. 4
B. 5
C. 6
D. 7
Answer: C
82. K complex is
A. Well delineated negative sharp wave followed by a positive component lasting at least 0.5 sec duration
B. Well delineated negative sharp wave followed by a positive component lasting less than 0.5 sec duration
C. Well delineated positive sharp wave followed by a negative component lasting at least 0.5 sec duration
D. Well delineated positive sharp wave followed by a negative component lasting less than 0.5 sec duration
Answer: A
83. Regarding CPAP titration in OSA, which of the following statement is correct
A. Optimal titration reduces RDI to <5 per hour for at least 15-min duration and should include supine REM sleep that is not continually interrupt by spontaneous arousals or awakenings
B. Optimal titration reduced RDI to <5 per hour for at least a 30-min duration and should include supine REM sleep that is not continually interrupted by spontaneous arousals or awakenings
C. Optimal titration reduced RDI to <5 per hour for at least a 1 hour duration and should include supine REM sleep that is not continually interrupted by spontaneous arousals or awakenings
D. Optimal titration reduces total respiratory disturbance to less than 10 in 3 hours of sleep and should include supine REM sleep that is not continually interrupted by spontaneous or awakenings
Answer: A
84. Which one of the following anticoagulant can be used without initial parenteral anticoagulation in pulmonary thromboembolism
A. Dabigatran
B. Rivaroxaban
C. Vit K antagonists
D. Apixaban
Answer: B
85. As per ACCP guidelines, in patients with a first venous thromboembolism that is an unprovoked proximal DVT of the leg or pulmonary embolism and who have a high bleeding risk, duration of anticoagulation is
A. 3 months
B. 6 months
C. 12 months
D. 24 months
Answer: A
86. Recommended dose of talc for pleurodesis in malignant effusion is
A. 2-3 gms
B. 3-4 gms
C. 4-6 gsm
D. 6-7 gsm
Answer: C
87. Which of the following is NOT a preferred recommendation for prevention of ventilator associated pneumonia
A. Drainage of sub-glottic secretions
B. Elevation of head end of bed
C. Closed suction of endotracheal tube
D. Early tracheostomy
Answer: D
88. Regarding NIV use, which of the following statement is wrong
A. Fluid overload commonly contributes to NIV failure in patients with OHS
B. Forced diuresis may be useful to prevent NIV failure in patients with OHS
C. NIV should not be used in patients with acute asthma exacerbations and AHRF
D. In patients with non-CF bronchiectasis with AHRF, NIV should not be tried
Answer: D
89. Weaning from mechanical ventilation is prolonged if the time duration is more than
A. 3 days
B. 5 days
C. 7 days
D. 10 days
Answer: C
90. Which among the following is an indication for veno venous ECMO
A. Hypoxemic respiratory failure in patients with a high risk of mortality (patients with PaO2/FlO2 < 100mm Hg with FIO2 > 90% and Murray score of 2)
B. Hypoxemic respiratory failure in patients with a high risk of mortality (patients with PaO2/FiO2 < 80 mm Hg with FlO2 > 90% and Murray score of 3 to 4)
C. Hypoxemic respiratory failure in patients with a high risk of mortality (patients with PaO2/FlO2 < 100mm Hg with FIO2 > 60% and Murray score of 3 to 4)
D. Hypoxemic respiratory failure in patients with a high risk of mortality (patients with PaO2/FlO2 < 80mm Hg with FIO2 > 60% and Murray score of 2 to 3)
Answer: B
91. Obesity hypoventilation syndrome is defined as
A. BMl ≥ 30kg/m2 and daytime awake PaCO2 ≥ 45mm Hg
B. BMl ≥ 35kg/m2 and daytime awake PaCO2 ≥ 45mm Hg
C. BMl ≥ 30kg/m2 and daytime awake PaCO2 ≥ 55mm Hg
D. BMl ≥ 35kg/m2 and daytime awake PaCO2 ≥ 50mm Hg
Answer: A
92. Regarding fluid resuscitation in septic shock which of the following statement is correct
A. Normal saline is the most preferred crystalloid
B. Colloids like Hydroxyethyl starch is preferred to maintain intravascular volume
C. Normal saline is preferred over Ringer lactate
D. When large volume is infused, normal saline may cause renal damage
Answer: D
93. Which statement is most accurate regarding pneumococcal vaccine
A. All persons ≥ 65 years should receive PPSV23
B. All persons ≥ 65 years should receive PCV13
C. All persons ≥ 65 years should first receive PPSV23 followed by PCV13
D. All persons ≥ 65 years should first receive PCV13 followed by PPSV23
Answer: D
94. Long term ventilation is defined as requirement of daily ventilator support for more than
A. 6 weeks
B. 3 months
C. 4 months
D. 6 months
Answer: B
95. Which of the following statement about clinical effect of obesity on ARDS is correct?
A. Risk of developing ARDS is decreased in obese patients
B. Risk of developing ARDS is increased in obese patients
C. Mortality from ARDS is increased in obese patients
D. Obesity has no effect on outcome of ARDS
Answer: B
96. According to ATS guidelines which among the following is the preferred option for microbiologic diagnosis of VAP
A. Noninvasive sampling with semiquantitative cultures
B. Invasive sampling with quantitative cultures
C. Noninvasive sampling with quantitative cultures
D. Mini BAL culture
Answer: A
97. Patients with scoliosis will have significant ventilator impairment if the Cobb angle is more than
A. 60 degrees
B. 75 degrees
C. 90 degrees
D. 100 degrees
Answer: D
98. In patients with acute type 1 respiratory failure, Oxygen flow should be adjusted to maintain SpO2 around
A. 88-92%
B. 94-98%
C. 90-94%
D. 92-95%
Answer: B
99. Which among the following is not a feature of nicotine withdrawal
A. Tachycardia
B. Restlessness
C. Increased appetite or weight gain
D. Difficulty concentrating
Answer: A
100. As per surviving sepsis campaign, for resuscitation of a patient with septic shock, which of the following recommendation is correct
A. At least 20mL/kg of IV crystalloid fluid be given within the first 4 hours
B. At least 20mL/kg of IV crystalloid fluid be given within the first 3 hours
C. At least 30mL/kg of IV crystalloid fluid be given within the first 4 hours
D. At least 30mL/kg of IV crystalloid fluid be given within the first 3 hours
Answer: D