MCQs on Other Lung Diseases

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

A 30-year-old woman, recently migrated from China to Australia, is undergoing a health assessment. Before coming to Australia, she had been working in a cotton mill for 18 months and describes that upon start of the workweek she developed chest tightness, shortness of breath, cough, and wheeze. These symptoms eased up through the week, were almost absent in weekends, and started over the next workweek. Physical examination including a thorough examination of the chest and lungs are inconclusive. Her chest x-ray is normal as is her pulmonary function tests. Which one of the following could be the most likely diagnosis?

A) Anxiety.
B) Berylliosis.
C) Byssiniosis.
D) Silicosis.
E) Occupational asthma.

Correct Answer: C) Byssiniosis.

Byssinosis is a form of occupational lung disease classically seen in workers exposed to raw cotton dust, especially in spinning or carding sections of cotton mills. The condition is caused by endotoxins found in the cotton dust, which leads to bronchoconstriction. The key diagnostic clue in this patient is the temporal pattern of symptoms: worsening at the beginning of the workweek and improving by the weekend, a hallmark feature of byssinosis.

This distinguishes it from occupational asthma (option E), which does not typically follow this “Monday chest tightness” pattern. Although both conditions may be relieved by bronchodilators, the consistent improvement of symptoms over the week strongly points toward byssinosis.

(Option A) Anxiety may cause nonspecific chest symptoms but lacks the clear work-related temporal correlation seen here.
(Option B) Berylliosis occurs with beryllium exposure, often seen in the aerospace or electronics industries—not cotton mills—and follows a different clinical course.
(Option D) Silicosis results from inhalation of silica dust, often in mining or sandblasting, and typically shows radiographic abnormalities, which are absent in this case.
(Option E) Occupational asthma usually shows variable airflow obstruction on pulmonary function testing and lacks the characteristic temporal pattern.

In this case, the history of cotton exposure, symptom pattern, and normal investigations outside symptomatic periods strongly support a diagnosis of byssinosis.

Question 2

A 45-year-old non-smoker man comes to your practice with complaint of progressive dyspnea. He has worked in an insulating factory for the last 15 years. Significant physical findings on physical examination are clubbing, peripheral cyanosis, and inspiratory crackles. A chest X-ray shows bilateral calcified opacities in both lung fields. For further visualization of the lesions, you order a high resolution CT scan of the chest. The CT is remarkable for calcified pleural plaques and small opacities in middle lung fields. There is no history of weight loss. Which one of the following is the most likely diagnosis?

A) Pleural effusion
B) Mesothelioma
C) Asbestosis
D) Small cell lung cancer
E) Squamous cell lung cancer

Correct Answer: C) Asbestosis

Explanation:
The history, clinical findings, and radiological characteristics are consistent with nodular asbestosis, which is common in people with a history of asbestos exposure. The absence of weight loss makes bronchogenic carcinomas less likely.

Asbestosis is highly associated with both nonmalignant and malignant lung disease. Chest X-ray and spiral CT scan in patients with asbestosis show calcified pleural plaques suggestive of asbestos exposure.

Pleural mesothelioma (option B) is associated with pleural thickening, calcification, pleuritic chest pain, weight loss, and recurrent pleural effusions. While asbestos exposure is linked to mesothelioma, the most common malignancy associated with asbestosis is bronchogenic carcinoma, not mesothelioma.

Bronchogenic lung cancers usually occur after 20 years of asbestos exposure. However, without weight loss and lack of tumor findings on imaging, cancers such as small cell lung cancer (option D) or squamous cell lung cancer (option E) are less likely.

Pleural effusion (option A) can cause shortness of breath but typically presents with dullness to percussion over affected areas and would not be missed on both CXR and CT scan.

Question 3

A 20-year-old man presents to the Emergency Department with complaints of cough, fever, joint pain, and malaise for the past few days. He denies night sweats, weight loss, and chills. He does not smoke. On examination, painful raised erythematous rashes are observed over his anterior tibia. The rest of the physical exam is inconclusive. A chest X-ray is done that shows bilateral hilar lymphadenopathy. Which one of the following is the most likely diagnosis?

A) Bronchiectasis
B) Chronic obstructive pulmonary disease (COPD)
C) Tuberculosis
D) Lung cancer
E) Sarcoidosis

Correct Answer: E) Sarcoidosis

Explanation:
Fever, malaise, joint pain, cough, and bilateral hilar lymphadenopathy are highly suggestive of sarcoidosis. The painful raised nodules over the anterior tibia are consistent with erythema nodosum, which further supports the diagnosis.

Sarcoidosis is a systemic disease of unknown etiology, histologically characterized by non-caseating granulomas in the lung and other organs. It typically presents in young adults (20–30 years), and is more common in people of African descent.

Two acute sarcoid syndromes include:

Löfgren syndrome: erythema nodosum, arthritis, and hilar lymphadenopathy
Heerfordt-Waldenström syndrome: fever, parotid gland enlargement, uveitis, and facial palsy

Option A) Bronchiectasis usually presents with copious sputum and recurrent infections—not seen in this case.
Option B) COPD may cause cough but does not present with joint pain or rash.
Option C) Tuberculosis can cause cough, fever, and erythema nodosum, but lacks supporting risk factors or imaging findings; TB typically shows more asymmetric or cavitary findings.
Option D) Lung cancer is very unlikely in a healthy young non-smoker, and does not commonly present with erythema nodosum or arthritis.

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3. Respiratory Module

3.1 Asthma & COPD

3.2 Pulmonary Vascular Diseases

3.3 Pleural Diseases

3.4 Lung Cancer

3.5 Other Lung Diseases