Pulmonology 04 July 2026 question bank

 

#1. A lung biopsy from a 35-year-old post-COVID pneumonia patient shows widespread Type I pneumocyte destruction with hyperplasia of cuboidal cells lining the alveoli, which stain positive for surfactant protein B. Which embryological cell type do the hyperplastic cuboidal cells represent?

#2. A 2-year-old with recurrent pneumonias and bronchiectasis has absent outer dynein arms on ciliary EM. Nasal NO is markedly reduced. Genetic testing confirms a DNAI1 mutation. During normal lung development, ciliated airway epithelial cells first appear during which phase?

#3. A 32-week neonate develops progressive respiratory distress with bilateral pleural effusions. Thoracocentesis yields milky fluid with triglycerides >110 mg/dL and >80% lymphocytes. Cardiac anatomy is normal. Congenital chylothorax most likely results from a defect in which embryological process?

#4. A term neonate has no cry, cannot be intubated transorally, but is briefly stabilised via an oesophago-tracheal connection on emergency bronchoscopy. CXR shows a gasless chest with gas in the oesophagus and stomach. Tracheal agenesis most likely results from a defect at which embryological stage?

#5. A 6-month-old has recurrent respiratory infections and stridor. CT shows a well-defined fluid-filled mediastinal cyst adjacent to the oesophagus at the level of the carina, not communicating with the airway. Which embryological error most likely explains this finding?

#6. A 36-week neonate has severe respiratory failure on HFOV. Antenatal USS showed bilateral renal agenesis and marked oligohydramnios from 16 weeks. The face shows Potter sequence features. Why does oligohydramnios cause pulmonary hypoplasia?

#7. A 4-year-old with situs inversus totalis has had recurrent otitis media since infancy and now presents with bronchiectasis. Nasal brushings show absent inner dynein arms on electron microscopy. Which embryological process is disrupted in PCD that explains situs inversus?

#8. A 4-month-old has biphasic stridor since birth. Bronchoscopy shows a soft, elliptical tracheal lumen that collapses circumferentially with respiration. Tracheal rings appear incomplete, forming C-shapes. Tracheal rings and cartilage are derived from which embryological tissue?

#9. A term neonate has absent breath sounds on the left, a scaphoid abdomen, and bowel sounds in the left chest. CXR confirms left-sided bowel loops in the thorax with mediastinal shift to the right. Failure of which embryological structure to close results in the most common form of congenital diaphragmatic hernia?

#10. A researcher knocks out VEGF-A specifically in lung epithelium in a mouse model. The pups die at birth with hypoxaemia. Histology shows absent pulmonary capillaries and simplified saccules. What is the primary role of VEGF-A in normal lung development?

#11. A fetus at 18 weeks is found on MRI to have severely small lungs bilaterally. Amniocentesis reveals a missense mutation in the SOX2 transcription factor gene. SOX2 expression in the developing lung is most critical for which process?

#12. A 6-year-old with cystic fibrosis undergoes bronchoscopy showing thick secretions plugging segmental bronchi. Biopsy shows marked goblet cell hyperplasia and hypertrophied submucosal glands. Submucosal glands of the bronchi are derived from which embryological process?

#13. During surgical repair of a pericardial defect in a 2-year-old, the surgeon notes the heart is partially herniated into the left pleural cavity. No diaphragmatic defect is found. Which embryological failure accounts for this finding?

#14. A 3-month-old presents with neonatal respiratory distress since birth, hypothyroidism, and hypotonia. Lung biopsy shows diffuse alveolar simplification and absent surfactant proteins B and C on immunostaining. Which transcription factor, when mutated, explains this combination of lung, thyroid, and neurological findings?

#15. A neonate with a maternal history of prolonged NSAID use in the third trimester presents with severe hypoxaemia unresponsive to oxygen. Echocardiogram shows right-to-left shunting across the PDA and foramen ovale. Which embryological vessel, if it fails to dilate at birth, causes the haemodynamic picture described?

#16. A 23-week neonate is born following preterm labour. Despite maximal respiratory support, the infant dies at 12 hours. Post-mortem histology shows immature mesenchyme, no visible alveolar capillary membrane, and absent lamellar bodies. Which developmental phase is most accurately represented by this histology?

#17. A 6-month-old ex-28-weeker is reviewed in neonatal follow-up. CXR shows diffuse haziness. Lung biopsy reveals simplified alveoli with reduced secondary septation and dysmorphic capillaries. Which phase of lung development involves secondary septation to form true alveoli?

#18. A term neonate develops rapidly progressive respiratory failure unresponsive to exogenous surfactant. Genetic testing reveals a homozygous frameshift mutation in the SFTPB gene. Lung pathology shows PAP-like alveolar filling. Which function does SP-B primarily serve in surfactant biology?

#19. A 2-month-old has recurrent left-sided pneumonias. CXR shows a markedly elevated left hemidiaphragm moving paradoxically on fluoroscopy. Phrenic nerve conduction studies are normal. Diaphragmatic eventration is best explained by failure of which embryological process?

#20. A 9-month-old has persistent stridor and recurrent respiratory infections. Barium swallow shows posterior oesophageal indentation. CT angiography confirms a double aortic arch encircling the trachea and oesophagus. Double aortic arch results from persistence of which embryological vascular structure?

#21. A neonate is delivered by emergency caesarean for fetal distress. At birth there is no cry, no air entry bilaterally, and the infant cannot be intubated beyond the glottis. Congenital laryngeal atresia results from failure of which embryological process?

#22. A term neonate develops severe refractory hypoxaemia at 12 hours. Echo shows suprasystemic pulmonary pressures. Lung biopsy shows misaligned pulmonary veins adjacent to pulmonary arteries and bronchioles, with reduced alveolar capillaries. Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) most likely results from disruption of which signalling pathway?

#23. A neonate has a large Bochdalek hernia repaired at day 3. Post-repair, the child has persistently weak respiratory effort and poor cough despite normal neurological assessment. Which embryological structure contributes the muscular component of the diaphragm?

#24. A term neonate develops progressive hypoxia at 48 hours. Lung biopsy shows expansion of the alveolar interstitium by cells with abundant clear cytoplasm and glycogen on PAS staining. Surfactant protein levels are normal. Pulmonary interstitial glycogenosis (PIG) is thought to represent a defect in which developmental process?

#25. A 12-year-old with a family history of epistaxis and telangiectasias develops progressive exertional dyspnoea and platypnoea-orthodeoxia. Bubble contrast echo confirms intrapulmonary right-to-left shunting. Pulmonary AVMs in hereditary haemorrhagic telangiectasia result from mutations affecting which signalling pathway?

#26. A term neonate develops respiratory distress not responding to surfactant. Lung biopsy under EM shows Type II pneumocytes with abnormally small, dense lamellar bodies with absent phospholipid content. Homozygous ABCA3 mutation is confirmed. What is the primary role of the ABCA3 transporter in pulmonary development?

#27. Antenatal ultrasound at 20 weeks shows an absent right lung with mediastinal shift to the right. Maternal drug exposure is absent and chromosomal microarray is normal. Arrest of which process at the earliest embryonic stage best explains complete unilateral lung agenesis?

#28. A neonate presents with stridor and cyanosis during feeds. Endoscopy reveals an H-type fistula at the level of the upper trachea with no oesophageal atresia. The H-type TOF forms due to incomplete closure of which structure?

#29. A 3-year-old has recurrent chest infections. CT confirms herniation of omentum through an anterior diaphragmatic defect just right of the xiphoid process. The foramen of Morgagni hernia occurs due to failure of fusion of which diaphragmatic components?

#30. A 28-week premature neonate is intubated at birth due to respiratory distress. Chest X-ray shows bilateral ground-glass opacification. At autopsy, histology reveals immature alveolar sacs with cuboidal epithelium and minimal surfactant. At what week of gestation does the respiratory diverticulum first bud from the foregut endoderm?

#31. A researcher studying congenital pulmonary airway malformation (CPAM) identifies overexpression of fibroblast growth factor 10 (FGF10) in lung tissue of a 20-week fetus. FGF10 signalling from the mesenchyme primarily drives which phase of lung development?

#32. Lung biopsy from a 5-year-old with interstitial lung disease shows loss of nonciliated bronchiolar epithelial cells with compensatory goblet cell metaplasia. CC16 (Club cell secretory protein) is reduced in BAL. Club cells (formerly Clara cells) are derived embryologically from which progenitor?

#33. A 4-week-old infant has recurrent lower respiratory tract infections. CT shows a non-functioning lung mass in the left lower lobe with arterial supply from the descending thoracic aorta. The mass does not communicate with the bronchial tree. Which best distinguishes intralobar from extralobar pulmonary sequestration embryologically?

#34. A 3-year-old investigated for recurrent wheeze and hypoxic episodes has a lung biopsy showing clusters of neuroendocrine cells (NEBs) with dense-core granules — more numerous than normal. Pulmonary neuroendocrine cells are derived from which embryological source?

#35. A 6-year-old girl has a cardiac murmur and mild pulmonary hypertension. CXR shows dextroposition of the heart, a small right lung, and a curvilinear opacity along the right heart border. CT confirms anomalous right pulmonary venous drainage into the IVC below the diaphragm. Scimitar syndrome results from which embryological anomaly?

#36. A 30-week neonate on CPAP has a 40% oxygen requirement. Gastric aspirate shows absent lamellar bodies. Mother received a single course of antenatal betamethasone 3 days prior to delivery. Which cell type is responsible for synthesising and secreting pulmonary surfactant?

#37. A 2-day-old neonate has respiratory distress. CXR shows a cystic mass in the right lower lobe. CT confirms multiple cysts of varying size communicating with the bronchial tree. No systemic arterial supply is identified. CPAM most likely results from a defect in which embryological process?

#38. A 6-week-old has progressive respiratory distress. CXR shows hyperinflation of the left upper lobe with mediastinal shift right and compression of the left lower lobe. Bronchoscopy reveals a soft, collapsible left upper lobe bronchus. Congenital lobar emphysema most commonly results from which structural defect?

#39. A neonate presents with cyanosis immediately after birth. Echo shows all four pulmonary veins draining into the right atrium via a common confluence. No other cardiac abnormalities are identified. TAPVD results from failure of which embryological event?

#40. A term neonate presents with excessive oral secretions, coughing with feeds, and cyanotic episodes. A nasogastric tube coils in the upper chest on X-ray. Polyhydramnios was noted antenatally. Failure of which embryological process most directly leads to the most common type of tracheoesophageal fistula?

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