FCPS IMM Pulmonology MCQs: High-Yield Practice Questions & Prep

Sample FCPS IMM Medicine pulmonology MCQs on TB, pneumonia, COPD, asthma, pulmonary embolism and pleural disease, with explanations.

Pulmonology questions in IMM lean on tuberculosis, pneumonia, COPD, asthma, pulmonary embolism and pleural disease. The vignettes usually hinge on one discriminating detail: an organism, a blood gas value or an X-ray sign. Here is a practice set with explanations.

Sample Pulmonology MCQs

1. In a patient with ARDS, what is the pathophysiological cause of oedema?

A) Decreased oncotic pressure
B) Capillary leakage ✅
C) Increased osmotic pressure
D) Increased hydrostatic pressure
E) Increased oncotic pressure

Why: ARDS results from diffuse alveolar-capillary damage with increased permeability, so protein-rich fluid leaks into the alveoli (non-cardiogenic oedema) despite normal hydrostatic pressure.

2. An asthmatic patient with severe shortness of breath is being assessed. Which investigation should be ordered next?

A) ABGs ✅
B) Echo
C) CXR
D) ECG

Why: In severe acute asthma, arterial blood gases assess for hypoxia and rising PaCO2 (a normal or high PaCO2 signals impending respiratory failure). A chest X-ray is reserved for suspected pneumothorax or infection.

3. A 27-year-old with pulmonary TB has developed a tram-track appearance on CXR. What is the most likely diagnosis?

A) Silicosis
B) Acute interstitial pneumonia
C) Abscess
D) Bronchiectasis ✅
E) ABPA

Why: Parallel tram-track lines from thickened, dilated bronchi are a feature of bronchiectasis, a recognised sequel of pulmonary tuberculosis.

4. A 55-year-old smoker with a 20 pack-year history has breathlessness. PFTs show FEV1 1.4 L (predicted 3.3), FVC 1.7 L (predicted 4.5) and FEV1/FVC 32%. What is the diagnosis?

A) Bronchiectasis
B) Bronchiolitis obliterans
C) Asthma
D) COPD ✅

Why: A post-bronchodilator FEV1/FVC below 70% in a smoker with persistent breathlessness defines COPD. Severe airflow limitation with a ratio of 32% is typical.

5. Which is most likely associated with cystic fibrosis in an adult patient?

A) Spontaneous remission
B) Haemoptysis ✅
C) Rectal polyps
D) Normal exocrine function

Why: Adults with cystic fibrosis develop bronchiectasis with chronic infection, which commonly causes haemoptysis. Exocrine pancreatic insufficiency is present in most patients.

6. A textile mill worker has gradually worsening breathlessness for a year and feels well on holidays. What is the most likely diagnosis?

A) Idiopathic pulmonary fibrosis
B) Silicosis
C) Allergic asthma
D) Occupational asthma ✅

Why: Symptoms that improve away from work implicate an occupational exposure, and in textile workers this is typically an occupational (byssinosis-type) asthma. Silicosis and IPF do not remit on holiday.

7. A female has dry cough and breathlessness for four weeks. CT chest shows lower lobe fibrosis and PFTs show a restrictive pattern. What is the diagnosis?

A) Fibrosing alveolitis (idiopathic pulmonary fibrosis) ✅
B) Sarcoidosis
C) Histiocytosis
D) Extrinsic allergic alveolitis

Why: Basal, subpleural fibrosis with a restrictive pattern is typical of idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis), which shows a UIP pattern on HRCT.

8. A 75-year-old smoker has haemoptysis and cough with serum calcium of 18 mg/dL. CXR shows a well-defined hilar opacity. What might he have?

A) Adenocarcinoma
B) Solitary nodule
C) Small cell carcinoma
D) Squamous cell carcinoma ✅

Why: Hypercalcaemia from PTH-related peptide is a paraneoplastic feature of squamous cell carcinoma, which typically presents as a central hilar mass in smokers.

How to Approach Pulmonology for IMM

Memorise the standard TB regimen and the specific toxicity of each first-line drug.
For COPD and asthma exacerbations, know the blood gas thresholds that push you to non-invasive ventilation.
Pair each pneumonia organism with its classic clue: rusty sputum, travel and hotel stay, haemolysis, aspiration.

Browse every Pulmonology question on its own: Pulmonology MCQs.

Keep Practising

These questions come from HighYield's FCPS IMM Medicine QBank, which holds over 2,400 clinical-vignette MCQs with an explanation for every answer. The first 20 questions are free in Tutor mode, so you can judge the explanation quality before unlocking the full bank.