Respiratory medicine: hypersensitivity pneumonitis: 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: hypersensitivity pneumonitis

Sample item

A 45-year-old dairy farmer has fever, cough and breathlessness starting 5 to 6 hours after handling mouldy hay, settling over the weekend and recurring on returning to work. Bronchoalveolar lavage shows marked lymphocytosis with a low CD4/CD8 ratio, and HRCT shows poorly defined centrilobular nodules. Which measure is the cornerstone of management?

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

The answer and the reasoning

A. Complete avoidance of the inciting antigen

Hypersensitivity pneumonitis (farmer's lung, from thermophilic actinomycetes in mouldy hay) is a type III and type IV immune reaction to inhaled organic antigens. Removing exposure is essential, since continued exposure leads to fibrosis; oral corticosteroids are added for severe or progressive disease. The lymphocytic lavage with a reversed CD4/CD8 ratio contrasts with the CD4-predominant lavage of sarcoidosis.

Option by option

  • A. Complete avoidance of the inciting antigen (correct)

    Antigen avoidance prevents repeated immune injury and progression to irreversible fibrosis.

  • B. Long-term inhaled long-acting beta-agonist alone

    Bronchodilators relieve airflow limitation but do not address an immune alveolitis driven by continued exposure.

  • C. Subcutaneous omalizumab

    Omalizumab targets IgE-mediated allergic asthma; this disease is mediated by immune complexes and T cells.

  • D. Prolonged oral antifungal therapy

    The reaction is immunological to spores, not an invasive fungal infection, so antifungals have no role.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Complete avoidance of the inciting antigen. Hypersensitivity pneumonitis (farmer's lung, from thermophilic actinomycetes in mouldy hay) is a type III and type IV immune reaction to inhaled organic antigens.

Why is "Long-term inhaled long-acting beta-agonist alone" not the answer?

Bronchodilators relieve airflow limitation but do not address an immune alveolitis driven by continued exposure.

Why is "Subcutaneous omalizumab" not the answer?

Omalizumab targets IgE-mediated allergic asthma; this disease is mediated by immune complexes and T cells.

Why is "Prolonged oral antifungal therapy" not the answer?

The reaction is immunological to spores, not an invasive fungal infection, so antifungals have no role.

What concept does this question test?

It tests Respiratory medicine: hypersensitivity pneumonitis in General Medicine. Removing exposure is essential, since continued exposure leads to fibrosis; oral corticosteroids are added for severe or progressive disease. The lymphocytic lavage with a reversed CD4/CD8 ratio contrasts with the CD4-predominant lavage of sarcoidosis.

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: hypersensitivity pneumonitis?

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.