Respiratory medicine: pulmonary alveolar proteinosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: pulmonary alveolar proteinosis

Sample item

A 38-year-old man has had progressive exertional breathlessness and a dry cough for 8 months, with mild hypoxaemia. HRCT of the chest shows ground-glass opacities with smooth interlobular septal thickening in a polygonal pattern (crazy paving). Bronchoalveolar lavage returns milky fluid containing PAS-positive lipoproteinaceous material. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Whole-lung lavage

Pulmonary alveolar proteinosis is usually autoimmune, caused by antibodies to GM-CSF that impair alveolar macrophage clearance of surfactant. The treatment for symptomatic or hypoxaemic disease is therapeutic whole-lung lavage under general anaesthesia, with inhaled GM-CSF as an emerging option. Corticosteroids are ineffective and raise the risk of opportunistic infections such as Nocardia.

Option by option

  • A. Empirical antituberculosis therapy

    Antituberculosis therapy treats tuberculosis; the milky PAS-positive lavage points to proteinosis, not infection.

  • B. Whole-lung lavage (correct)

    Whole-lung lavage physically removes the accumulated surfactant-rich material and improves oxygenation.

  • C. Prolonged high-dose prednisolone

    Corticosteroids do not help alveolar proteinosis and increase infection risk; they suit organising pneumonia or sarcoidosis.

  • D. Pirfenidone

    Pirfenidone is an antifibrotic for idiopathic pulmonary fibrosis, which does not give milky lavage fluid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Whole-lung lavage. Pulmonary alveolar proteinosis is usually autoimmune, caused by antibodies to GM-CSF that impair alveolar macrophage clearance of surfactant.

Why is "Empirical antituberculosis therapy" not the answer?

Antituberculosis therapy treats tuberculosis; the milky PAS-positive lavage points to proteinosis, not infection.

Why is "Prolonged high-dose prednisolone" not the answer?

Corticosteroids do not help alveolar proteinosis and increase infection risk; they suit organising pneumonia or sarcoidosis.

Why is "Pirfenidone" not the answer?

Pirfenidone is an antifibrotic for idiopathic pulmonary fibrosis, which does not give milky lavage fluid.

What concept does this question test?

It tests Respiratory medicine: pulmonary alveolar proteinosis in General Medicine. The treatment for symptomatic or hypoxaemic disease is therapeutic whole-lung lavage under general anaesthesia, with inhaled GM-CSF as an emerging option. Corticosteroids are ineffective and raise the risk of opportunistic infections such as Nocardia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: pulmonary alveolar proteinosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.