| Post Name | Assistant Professor in Respiratory Medicine |
|---|---|
| Department | Medical Education |
| Question Paper Code | 131/2026/OL |
| Category Code | 688/2025 |
| Date of Test | 16 July 2026 |
| Exam Type | Online Examination |
| Total Questions | 100 |
1
Which ļ¬ssure is present in both the right and left lungs and separates the lower lobe from the upper lobe ?
Answer
C. Oblique ļ¬ssure
2
During EBUS-TBNA, which lymph node station is located immediately below the carina and is accessible from either main bronchus ?
Answer
B. Station 7
3
Nerandomilast is a recently approved drug for the treatment of Idiopathic Pulmonary Fibrosis. What is the mechanism of action?
Answer
B. Phosphodiesterase 4B inhibitor
4
The antibiotic which should be avoided in Methicillin Resistant Staphylococcus aureus (MRSA) pneumonia is
Answer
D. Daptomycin
5
Which type of lung malignancy is characterized by a rapid tumour doubling time, high growth fraction, early development of widespread metastases and a high initial response to chemotherapy ?
Answer
D. Small cell lung carcinoma
6
The presence of Curschmann spirals and Charcot-Leyden crystals in sputum is most suggestive of
Answer
B. Eosinophilic airway inļ¬ammation
7
Which of the following biologics has been incorporated into GOLD 2026 as an add-on therapy for selected patients with eosinophilic COPD and recurrent exacerbations ?
Answer
C. Dupilumab
8
Pre-XDR TB is deļ¬ned as MDR/RR-TB with additional resistance to
Answer
C. Any Fluoroquinolone
9
Pulmonary capillary wedge pressure (PCWP) most closely reļ¬ects :
Answer
C. Left atrial pressure
10
A study follows a group of smokers and non-smokers over 10 years to determine the incidence of lung cancer. This is an example of
Answer
A. Cohort study
11
Which of the following represents the preferred "Track 1" reliever therapy for adults with asthma, according to Global Initiative for Asthma (GINA) strategy ?
Answer
B. As-needed low-dose inhaled corticosteroid (ICS)-formoterol
12
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), spirometric criterion is mandatory to conļ¬rm the presence of persistent airļ¬ow limitation indicative of COPD is
Answer
B. Post-bronchodilator FEV 1/FVC < 0.70
13
Which investigation serves as the "gold standard" for the deļ¬nitive diagnosis of bronchiectasis ?
Answer
B. High-Resolution Computed Tomography (HRCT) of the thorax
14
A 24-year-old female presents with acute dyspnea and inspiratory wheeze. Her ļ¬ow-volume loop demonstrates truncation of the inspiratory limb with a preserved expiratory loop. What is the most likely diagnosis ?
Answer
C. Vocal cord dysfunction (Inducible laryngeal obstruction)
15
A 48 year-old female patient with severe, uncontrolled asthma despite adherence to high-dose ICS-LABA therapy undergoes further testing. Laboratory tests reveal a blood eosinophil count (BEC) of 450 cells/ĀµL. Which of the following monoclonal antibodies directly binds to and neutralizes Interleukin-5 (IL-5) ?
Answer
C. Mepolizumab
16
In the pharmacological follow-up algorithm for COPD, the latest GOLD updates strongly advise against the withdrawal of Inhaled Corticosteroids (ICS) in patients receiving triple therapy if their Blood Eosinophil Count (BEC) exceeds which of the following thresholds ?
Answer
C. 300 cells/ĀµL
17
In pulmonary rehabilitation program for patients with advanced COPD, which component possesses the highest level of evidence for improving dyspnea, exercise tolerance and health-related quality of life ?
Answer
A. Supervised aerobic and resistance exercise training
18
According to the GINA assessment of adult patients presenting with ādiļ¬cult- to-treatā asthma (those uncontrolled on high-dose ICS-LABA), what approximate percentage of the total asthma population is found to have true āsevere asthmaā after addressing non- adherence, poor inhaler technique and comorbidities ?
Answer
D. 3.7%
19
The 2025 GOLD report emphasizes early diagnostic concepts to identify individuals at risk of developing overt COPD. Which of the following spirometric patterns accurately deļ¬nes the condition termed āPRISmā (Preserved Ratio Impaired Spirometry) ?
Answer
B. Post-bronchodilator FEV1/FVC > 0.70 with FEV1 < 80% predicted
20
A 38-year-old male non-smoker with a long-standing history of Rheumatoid Arthritis presents with progressive, irreversible airļ¬ow obstruction on spirometry (FEV1/FVC 0.55, FEV1 45% predicted). HRCT of the thorax reveals a prominent mosaic attenuation pattern on inspiratory images with nodules, with no evidence of traction bronchiectasis or honeycombing. Which histopathological lesion is most consistent with this clinical and radiological presentation ?
Answer
C. Constrictive bronchiolitis (Bronchiolitis obliterans)
21
Targeted therapy used in ALK fusion positive non-small cell lung cancer is
Answer
A. Alectinib
22
LENT score is used to predict survival in patients with
Answer
D. Malignant pleural eļ¬usion
23
As part of lung cancer screening in a 55 year old male, low dose CT thorax was taken. It showed subsolid nodule of 7 mm size in right upper lobe. What is the optimal duration for which the nodule should be followed up with serial CT imaging ?
Answer
Question Cancelled
24
The most common cause of paraneoplastic syndrome in lung malignancy characterised by hypercalcaemia is due to
Answer
B. Ectopic secretion of parathyroid hormone related protein
25
64 year old male smoker with lung cancer T4N2M1 was prescribed immune checkpoint inhibitors. Histologic subtype that responds to immune checkpoint inhibitors
Answer
D. All of the above
26
EBUS-TBNA can be used for mediastinal staging in the following lymph node stations as per International Association for the Study of Lung Cancer (IASLC) except
Answer
D. LN station-9
27
Recommended initial therapy for advanced non-small cell lung cancer lacking a driver mutation and PD-L1 expression <50% is
Answer
C. PD-1/PD-L1 check point inhibitor with platinum based doublet chemotherapy
28
40 year old female presented with cough and hemoptysis of 1 month duration ā Bronchoscopy revealed intraluminal lesion left main bronchus-histopathologic examination showed neuroendocrine tumor with following features ā mitotic rate of 8 per 2 mm2 and Ki 67 index of 10%. Most probable diagnosis is
Answer
B. Atypical carcinoid
29
Pattern of calciļ¬cation in lung nodule suggestive of malignancy is
Answer
C. Eccentric
30
As per TNM classiļ¬cation of lung cancer, presence of a tumor nodule in the same lobe as primary tumour is considered as
Answer
A. T3 tumour
31
All are true regarding procalcitonin, except
Answer
B. IFN-Y trigger release of procalcitonin
32
āRound pneumoniaā is associated with all, except
Answer
Question Cancelled
33
Quellung reaction was used to diagnose infection with
Answer
A. S. pneumoniae
34
Quinolones are well suited to treat respiratory infections, because i. It has good oral bioavailability ii. Good tissue penetration iii. No post antibiotic eļ¬ect iv. Tissue level better than serum level Choose most appropriate response.
Answer
C. i, ii and iv
35
All are true regarding S. pneumoniae urinary antigen testing, except
Answer
A. Not aļ¬ected by recent pneumococcal vaccination
36
Most common pathogen associated with atypical pneumonia
Answer
B. M. pneumoniae
37
All are true about Telavancin, except
Answer
C. Safe in those with renal impairment
38
āSteepleā sign is associated with
Answer
A. Croup
39
Hantavirus pulmonary syndrome is associated with all, except
Answer
C. Upper respiratory symptoms are usually present
40
Which of the following is most eļ¬ective prophylactic drug for pneumocystis jirovecii infection ?
Answer
A. Trimethoprim-Sulfamethoxazole
41
Under the INDEX-TB guidelines (Guidelines on Extrapulmonary Tuberculosis for India endorsed by NTEP), which of the following clinical scenarios correctly applies the diagnostic standards, interpretations of Cerebrospinal Fluid (CSF) panels, corticosteroid dosing or treatment durations for Central Nervous System Tuberculosis (CNS TB) ?
Answer
C. Contrast MRI reveals a multilocular ring-enhancing lesion in the parietal lobe of a 29- year patient with focal neurological deļ¬cits. Stereotactic biopsy conļ¬rms a CNS tuberculoma. As per guidelines intensive phase must consist of standard HRZE and total duration of ATT must be extended to a minimum of 9 to 12 months initially, with repeat neuroimaging used to dynamically guide the endpoint.
42
A 28-year-old male was diagnosed with Pulmonary Tuberculosis and found to have INH mono-resistance. He was initiated on the standard 6-month regimen consisting of Levoļ¬oxacin, Rifampicin, Ethambutol and Pyrazinamide (Lfx-R-E-Z). At the end of month 4, his sputum smear was positive and no clinical or radiological improvement, marking a treatment failure. An immediate molecular re-evaluation (CBNAAT/Xpert) is ordered. While awaiting the detailed Second-Line Line Probe Assay results, the CBNAAT conļ¬rms that the M tuberculosis strain remains Rifampicin Sensitive. As per the latest Indian guidelines, what is the next most appropriate programmatic management step for this patient ?
Answer
B. Declare him a āprobable MDR-TB caseā and immediately initiate the 6-month, all-oral BPaLM regimen (Bedaquiline, Pretomanid, Linezolid, Moxiļ¬oxacin)
43
A 34-year-old lady is diagnosed with Pulmonary Tuberculosis. Baseline LPA reveals INH mono-resistance with conļ¬rmed sensitivity to Rifampicin and Fluoroquinolones. She was initiated on the standard 6-month daily H-mono/poly-resistance regimen consisting of Levoļ¬oxacin, Rifampicin, Ethambutol and Pyrazinamide (Lfx-R-E-Z) Three weeks into treatment, she presents to the clinic with palpitation. ECG reveals a QTc prolongation of 520 ms. A repeat ECG conļ¬rms the ļ¬nding. Her serum electrolytes are within normal limits. The clinical team decides to permanently discontinue Levoļ¬oxacin due to cardiotoxicity. As per the latest Indian NTEP guidelines, what is the most appropriate modiļ¬cation to her treatment regimen ?
Answer
D. Replace Levoļ¬oxacin with Linezolid and extend duration to 9 months
44
A 36-year-old male with pulmonary tuberculosis is being evaluated for suspected drug resistance after failing an initial treatment course. A First-Line Line Probe Assay (FL-LPA) is performed on his sputum sample. The microbiology laboratory returns the following precise band hybridization readout for the strip : ā¢ Control Bands : Conjugate Control (Con), Ampliļ¬cation Control (Amp) and MTB Complex Control (TUB) are all Present (+) ā¢ rpoB Region : All Wild-Type bands Absent (-); all Mutation bands absent (-) ā¢ katG Region : All Wild-Type bands present (+); Mutation band is Absent (-) ā¢ inhA Region : Wild-Type band is Absent (-); Mutation band 1 is Present (+) Based on this speciļ¬c LPA readoubt and the latest NTEP diagnostic algorithms, how should this patientās resistance proļ¬le be classiļ¬ed and what is the immediate therapeutic implication ?
Answer
C. He has Multidrug-Resistant TB (MDR-TB); the absence of all rpoB WT bands infers Rifampicin resistance, while the inhA mutation conļ¬rms isoniazid resistance, requiring immediate transition to an MDR-TB treatment pathway (preferably the BPaLM regimen)
45
A 55-year-old male with underlying bronchiectasis is diagnosed with Mycobacterium abscessus pulmonary disease. The microbiological report identiļ¬es the isolate as M. abscessus subspecies abscessus. Drug Susceptibility Testing (DST) and molecular sequencing reveal a point mutation in the 23S rRNA gene conferring resistance to macrolides. According to the 2020 ATS/ERS/IDSA guidelines for the treatment of non-tuberculous mycobacterial pulmonary disease, what is the speciļ¬c recommendation for the multidrug treatment regimen for this patient ?
Answer
B. Initiate a multidrug regimen that includes at least 4 active drugs with proven in vitro susceptibility (e.g. Amikacin and Imipenem/Cefoxitin) in the initial phase and omit the macrolide as an active drug, continuing treatment for at least 12 months post-culture conversion
46
A 34-year-old male PLHIV is found to have biopsy-conļ¬rmed, drug-susceptible cervical lymph node tuberculosis. His baseline CD4 count is 320 cells/mm3. He has not yet been started on antiretroviral therapy. According to the current Indian national guidelines (NTEP/NACO), which of the following is the most appropriate management plan for this patient ?
Answer
B. Initiate a 6-month daily ATT regimen (2HRZE + 4HRE); defer ART initiation for 2 to 8 weeks and add an additional standalone dose of Dolutegravir 50 mg twelve hours apart from the regular ļ¬xed-dose combination of TLD
47
A 29-year-old female living with HIV (baseline CD4 count : 32 cells/ mm3) was initiated on a standard daily 6-month ATT (2HRZE + 4HRE) for microbilogically conļ¬rmed, drug-susceptible right cervical lymph node tuberculosis. Two weeks later, she was started on a Dolutegravir based antiretroviral therapy regimen with appropriate double-dose DTG correction. Three weeks after starting ART, she returns to the clinic reporting a painful, rapidly expanding swelling on the right side of her neck and a new low-grade fever. On clinical examination, the right cervical lymph node has increased from 2 cm to 5 cm, is exquisitely tender, ļ¬uctuant, and the ovelying skin is erythematous. Her systemic evaluation is otherwise unremarkable, and a repeat sputum smear is negative for acid-fast bacilli. Which of the following represents the most appropriate next step in the clinical management of this patient ?
Answer
C. Continue both ATT and ART unchanged ; perform a needle aspiration of the ļ¬uctuant lymph node to prevent skin necrosis, and oļ¬er reassurance with symptomatic NSAIDs
48
A 45-year-old male with bilateral extensive microbiologically conļ¬rmed drug- sensitive pulmonary tuberculosis is on treatment with daily FDC regimen 2HRZE/4HRE. At the end of week 3 of the Intensive Phase, he presents to the clinic with progressive nausea, anorexia, and mild icterus. His baseline Liver Function Tests (LFT) were entirely normal. Current laboratory investigation reveal ā¢ Total Bilirubin : 3.2 mg/dL ā¢ Aspartate Aminotransferase (AST) : 165 U/L ā¢ Alanine Aminotransferase (ALT) : 150 U/L ā¢ Alkaline Phosphatase (ALP) : 110 U/L According to the NTEP quidelines for the management of anti-TB drug-induced hepatotoxicity, which of the following is the most appropriate next step in clinical management ?
Answer
A. Stop the entire FDC regimen immediately. Start a non-hepatotoxic modiļ¬ed regimen containing Ethambutol, Levoļ¬oxacin, and Streptomycin/Amikacin, and monitor LFT weekly.
49
A 35-year-old male is diagnosed with extensive pulmonary MDR-TB. His pre- treatment baseline evaluation reveals a Hemoglobin level of 7.0 g/dL and severe renal impairment (Creatinine 3.5 mg). According to the latest NTEP DRTB guidelines, which of the following is the most appropriate treatment strategy for this patient ?
Answer
C. Initiate an individualized 18-20 month Longer Oral Regimen, completely avoiding Linezolid and adjusting companion drug dosages based on renal function
50
A 68-year-old lady presents with chronic cough, fatigue and low-grade fever over the last 8 months. High-resolution chest CT reveals bilateral bronchiectasis with multiple small, tree-in-bud nodular inļ¬ltrates in the middle lobe and lingula, but no evidence of pulmonary cavities. Sputum AFB smears and cultures are positive for macrolide-susceptible Mycobacterium avium complex. According to the latest ATS/IDSA guidelines, which of the following is the most appropriate initial management strategy ?
Answer
B. Initiate a three-times weekly (intermittent) 3-drug regimen consisting of Azithromycin Rifampin, and Ethambutol and continue treatment for at least 12 months post-sputum culture conversion
51
Under the current NTEP guidelines of India, which of the following clinical scenarios accurately depicts the appropriate deployment, interpretation, or subsequent management sequence of the Cy-TB skin test ?
Answer
C. A 32-year-old person exhibits a 7 mm in duration 48 hours after injection. Clinical and radiological evaluation completely rules out active pulmonary and extra-pulmonary TB. He is classiļ¬ed as an eligible candidate for Tuberculosis Preventive Treatment
52
Under the INDEX-TB guidelines, which of the following statements correctly evaluates the diagnostic workup, interpretation of pleural biomarkers, molecular testing or treatment protocols for Tuberculous Pleural Eļ¬usion (TPE) ?
Answer
D. Xpert MTB/RIF should not be routinely used as a standalone diagnostic tool for pleural TB due to its modest sensitivity on pleural ļ¬uid ; instead, an integrated approach combining exudative ļ¬uid characteristics, a Lymphocyte-to- Neutrophil Ratio (LNR) >.075, and elevated ADA (>40 U/L) should guide the diagnosis, followed by a standard 6-month ATT regimen
53
Which of the following statements accurately describes the molecular detection capabilities of the Xpert MTB/XDR assay compared to the Second-Line Line Probe Assay (SL-LPA/Genotype MTBDRsl v2)
Answer
B. Xpert MTB/XDR detects mutations conferring resistance to Isoniazid, Fluoroquinolones, Second-line Injectables, and Ethionamide, whereas SL-LPA only detects resistance to Fluoroquinolones and Second-line Injectables
54
Which of the following genetic conļ¬gurations identiļ¬ed via rapid molecular testing strictly contra indicates the deployment of the newly WHO- approved and FDA-recommended 4-month shortened regimen (Rifapentine- Moxiļ¬oxacin-Isoniazid-Pyrazinamide [HPMZ]) for a patient with pulmonary tuberculosis ?
Answer
B. A mutation detected within the gyrA gene
55
Which of the following is not a major criterion to diagnose fat embolism syndrome ?
Answer
A. Long bone fracture
56
Which of the following is a feature of ocular sarcoidosis ? i) Uveitis is more commonly posterior ii) Mutton-fat keratic precipitates iii) May present dramatically with blindness
Answer
B. ii and iii
57
Which of the following is the most common inherited risk factor for venous thromboembolism ?
Answer
B. Factor V Leiden mutation
58
Which of the following cellular mechanisms best describes the primary defect in the pathogenesis of pulmonary alveolar proteinosis ?
Answer
C. Impaired terminal diļ¬erentiation of alveolar macrophages resulting in a failure to catabolize surfactant lipids and proteins
59
A 48-year-old female with a history of Non-Speciļ¬c Interstitial Pneumonia (NSIP) secondary to Rheumatoid Arthritis presents with an increase in exertional dyspnea for the past one year. Her spirometry shows a decline in Forced Vital Capacity (FVC) from 50% predicted to 45% predicted, while her Diļ¬using Capacity of the Lung for Carbon Monoxide (DLCO) has dropped from 60% to 45% of the predicted value. Which of the following statement is correct regarding her lung function test ?
Answer
D. 25% relative decline in DLCO
60
Which of the following is not a feature of Pulmonary Langerhans Cell Histiocytosis ?
Answer
C. Predilection for male sex
61
A 30-year-old female presents with progressive exertional dyspnea. Transthoracic echocardiography demonstrates a peak tricuspid regurgitation velocity of 3.0 m/ s with ļ¬attened interventricular septum. Right heart catheterization reveals a mean Pulmonary Artery Pressure (mPAP) of 24 mmHg, a Pulmonary Artery Wedge Pressure (PAWP) of 12 mmHg and a Pulmonary Vascular Resistance (PVR) of 2.6 Wood Units (WU). How should this patientās hemodynamic proļ¬le be classiļ¬ed ?
Answer
B. Pre-capillary Pulmonary Hypertension
62
Which of the following is considered the earliest radiological sign of congestive heart failure and hydrostatic pulmonary edema in a chest X-ray PA view ?
Answer
D. Cephalization
63
Which is the oral anticoagulant that is recommended in established thrombotic antiphospholipid antibody syndrome with acute pulmonary embolism ?
Answer
A. Warfarin
64
Which of the following histopathological features on a lung biopsy would be most characteristic of Granulomatosis with Polyangiitis ?
Answer
A. Necrotizing vasculitis aļ¬ecting small-to-medium vessels, geographic necrosis and poorly-formed granulomas with giant cells
65
Which of the following physiological changes is PRIMARILY responsible for the āright shiftā of the Oxygen-Haemoglobin dissociation curve during initial acclimatization to high altitude ?
Answer
C. Increased 2,3-DPG levels
66
Bronchopulmonary sequestration (BPS) is a congenital lung malformation where the anomalous arterial supply typically arises from
Answer
C. Descending aorta
67
The mechanism of action of Omalizumab in severe asthma is
Answer
B. Binding to IgE preventing it from attaching to FceRI
68
Primary ciliary dyskinesia (PCD) classically presents with situs inversus, bronchiectasis and male infertility. The most commonly mutated gene encoding dynein heavy chain is
Answer
B. DNAH5
69
According to the 5 Aās model of smoking cessation counselling, what is the correct sequential order of the steps ?
Answer
A. Ask ā Advise ā Assess ā Assist ā Arrange
70
Which outdoor air pollutant is formed as a SECONDARY pollutant in the lower atmosphere via photochemical reactions involving nitrogen oxides (NOx) and volatile organic compounds (VOCs) ?
Answer
C. Ground-level Ozone (O3)
71
All of the following statements are correct regarding drug induced lung diseases except
Answer
B. Penicillamine may enhance collagen formation
72
The āphotographic negative of pulmonary oedemaā pattern on chest X-ray is CHARACTERISTIC of which condition ?
Answer
C. Chronic Eosinophilic Pneumonia (CEP)
73
A 55-year-old former textile worker is referred for medicolegal respiratory impairment evaluation. Spirometry : FVC 72% pred, FEV1 61% pred, FEV1/FVC 0.65. Post- bronchodilator : FEV1 65% pred. DLCO : 62% pred. 6-minute walk test : 385 meters with SpO2 nadir 88% on room air. According to ATS 2022 guidelines for respiratory impairment classiļ¬cation, which category best describes this patientās impairment ?
Answer
Question Cancelled
74
A 38-year-old mushroom farmer presents with recurrent episodes of fever, myalgia and dyspnea 4 ā 6 hours after working in the mushroom-growing sheds, with spontaneous improvement over 24 ā 48 hours on leaving the environment. HRCT shows diļ¬use bilateral ground-glass opacities with centrilobular nodules and areas of mosaic attenuation. Lung biopsy would MOST likely show
Answer
B. Poorly formed, non-necrotizing peribronchiolar granulomas
75
Formula for calculating Predicted Body Weight (PBW) for males is
Answer
B. 50 + {2.3 Ć (height in inches ā 60)}
76
Post cardiac surgery pleural eļ¬usion is characterized by all of the following except
Answer
B. Usually left sided and massive eļ¬usion
77
According to the Berlin deļ¬nition, ARDS must develop within
Answer
C. 1 week of a known clinical insult or worsening respiratory symptoms
78
All of the following are correct regarding HFNC except
Answer
D. Decreases PEEP
79
Non breathing mask for oxygen therapy has got which one of the following ?
Answer
C. Both inspired gas and expired gas one ā way valve
80
Regarding catheter use, FACTT Trial showed that pulmonary artery catheters
Answer
D. Did not improve outcomes and had more complications
81
A patient with severe ARDS is ventilated with tidal volume 6 mL/kg predicted body weight. Which ventilatory parameter is speciļ¬cally targeted to reduce alveolar overdistension ?
Answer
B. Plateau pressure
82
Complicated parapneumonic eļ¬usion is most likely associated with
Answer
C. Pleural ļ¬uid pH < 7.20
83
Which procedure carries the highest risk of iatrogenic pneumothorax ?
Answer
C. Transbronchial cryobiopsy
84
The Nuss procedure is used to treat
Answer
C. Pectus excavatum
85
A 34-year-old male with a history of persistent, dry cough is evaluated. Irritation of the external auditory canal with a cotton swab accidentally triggers a vigorous cough ļ¬t (Arnoldās nerve reļ¬ex). Which cranial nerve serves as the aļ¬erent pathway for this speciļ¬c cough reļ¬ex loop ?
Answer
D. Cranial Nerve X (Vagus Nerve)
86
A patient with severe bronchiectasis produce copious, foul-smelling, layered purulent sputum. The profound recruitment and activation of neutrophils within the airway lumina, responsible for this thick sputum, is primarily driven by which chemotactic factor found in high concentration ?
Answer
B. Interleukin-8 (IL-8)
87
A 38-year-old patient reports severe excessive daytime somnolence despite 8 hours of bed partner-veriļ¬ed quiet sleep. A lumbar puncture reveals low cerebrospinal ļ¬uid (CSF) levels of Hypocretin-1 (Orexin-A). This speciļ¬c biomarker deļ¬ciency directly localizes the patientās somnolence to pathology in which area of brain ?
Answer
B. Lateral hypothalamic area (LHA) neurons
88
What does the curtain sign in thoracic ultrasound indicate ?
Answer
B. Normal lung sliding during respiration
89
The most common DNA modiļ¬cation is
Answer
D. Methylation of cytosine residues
90
Which of the following is the most common genetic mutation responsible for cystic ļ¬brosis ?
Answer
A. A deletion of three base pair leading to the loss of phenylalanine
91
Which of the following represents the primary biological challenge in delivering gene therapy to the lungs for the treatment of cystic ļ¬brosis ?
Answer
C. Thick mucus blocking vector access to epithelial cells
92
A 58-year-old male with severe chronic obstructive pulmonary disease (COPD) presents with central cyanosis. Which of the following statements best describes the physiological basis of cyanosis ?
Answer
C. Central cyanosis typically reļ¬ects an arterial oxygen saturation (SaO2) below 85% in a patient with normal haemoglobin
93
A 34-year old nurse is brought to the emergency department after an accidental overdose of a topical benzocaine spray used for an endoscopic procedure. She is deeply cyanotic but her arterial oxygen tension (PaO2) on a room air arterial blood gas (ABG) is normal at 95 mmHg. Which of the following best explains this clinical presentation ?
Answer
B. Oxidation of ferrous iron (Fe2+) to ferric iron (Fe3+) within haemoglobin has produced met-haemoglobin, which cannot bind oxygen
94
A 71-year-old female with severe pulmonary arterial hypertension (PAH) and corpulmonale is admitted with refractory peripheral oedema. Despite high-dose intravenous loop diuretic therapy (furosemide), her 24-hour urine output remains low. Lab results show a serum sodium of 131 mEq/L and a rising serum creatinine. Which physiological mechanism explains this ādiuretic resistanceā in advanced right heart failure ?
Answer
A. High right atrial pressure elevates renal venous pressure, increasing intracapsular hydrostatic pressure and directly blunting the glomerular ļ¬ltration rate (GFR)
95
A 64-year-old female presents with progressive dyspnoea. Her spirometry shows a restrictive pattern with a reduced FVC. Body plethysmography is performed to determine absolute lung volumes. To calculate the thoracic gas volume (VTG) at functional residual capacity (FRC) using Boyleās law, at which point in the respiratory cycle is the airway shutter typically closed ?
Answer
A. At the end of a normal, unforced expiration
96
A 48-year-old female with systemic sclerosis undergoes pulmonary function testing. Her DLCO is signiļ¬cantly reduced at 42% of predicted, while her alveolar volume (VA) measured during the single-breath manoeuvre is only mildly reduced. Which of the following biological or technical factors would artiļ¬cially elevate a single-breath DLCO measurement ?
Answer
C. An undiagnosed left-to-right intracardiac shunt
97
An 8-year-old child with suspected asthma is unable to perform acceptable spirometry manoeuvres. The clinician opts for Impulse Oscillometry (IOS) during quiet breathing. The results show an elevated total respiratory resistance at 5 Hz (R5) and a normal resistance at 20 Hz (R20), leading to a high R5-R20 diļ¬erence. What is the anatomical localization and pathophysiological meaning of this ļ¬nding ?
Answer
B. Small airway resistance and peripheral airway dysfunction
98
A 32-year-old female with diļ¬cult-to-control asthma is being evaluated for biological therapy. Her FENO level is measured at 48 parts per billion (ppb). Which of the following statements correctly pairs the interpretation of this FENO value with a factor that can falsely lower it ?
Answer
B. Indicates signiļ¬cant Type 2 (eosinophilic) airway inļ¬ammation ; falsely lowered by recent cigarette smoking
99
During a large-volume therapeutic thoracentesis, a clinician utilizes manometry to monitor pleural pressure. Which of the following pressure changes or patterns indicates that the patients is at high risk for re-expansion pulmonary edema (RPE) or trapped lung, necessitating immediate termination of the procedure ?
Answer
C. A precipitous drop in pleural pressure to below ā20 cm H2O accompanied by chest discomfort
100
Under the INDEX-TB guidelines, which of the following is true regarding the diagnostic approach, diļ¬erentiation from Cronh's disease, or treatment duration for Gastrointestinal Tuberculosis ?
Answer
D. Colonoscopy with biopsy is critical for diļ¬erentiating Crohn's disease from Intestinal TB ; ļ¬nding conļ¬uent, large, multiple transverse ulcers predominantly in the ileocecal region, combined with multiple caseating granulomas on histology, strongly establishes a diagnosis of Intestinal TB
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