Respiratory medicine: bronchiolitis obliterans after transplant: 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: bronchiolitis obliterans after transplant

Sample item

A 38-year-old man 14 months after allogeneic stem cell transplantation for leukaemia has progressive dry cough and breathlessness. The chest radiograph is clear, spirometry shows an FEV1/FVC ratio of 0.55 with no bronchodilator response, and expiratory CT shows mosaic attenuation with air trapping. What is the diagnosis?

APneumocystis jirovecii pneumonia with ground-glass shadowsBObliterative bronchiolitis from chronic graft-versus-host diseaseCCryptogenic organising pneumonia with migratory shadowsDIdiopathic pulmonary fibrosis with basal honeycombing

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

The answer and the reasoning

B. Obliterative bronchiolitis from chronic graft-versus-host disease

Obliterative bronchiolitis is the typical pulmonary manifestation of chronic graft-versus-host disease. It causes fixed airflow obstruction with a normal chest radiograph and air trapping on expiratory CT. It is also seen after lung transplantation, where it is called bronchiolitis obliterans syndrome.

Option by option

A. Pneumocystis jirovecii pneumonia with ground-glass shadows
Pneumocystis pneumonia causes hypoxia with diffuse ground-glass opacities and presents earlier in the immunosuppressed.
B. Obliterative bronchiolitis from chronic graft-versus-host disease (correct)
Correct. Fixed obstruction, clear film and air trapping after transplantation indicate obliterative bronchiolitis.
C. Cryptogenic organising pneumonia with migratory shadows
Organising pneumonia causes patchy consolidation and a restrictive defect, and it responds to steroids.
D. Idiopathic pulmonary fibrosis with basal honeycombing
Pulmonary fibrosis shows restrictive physiology with basal reticulation and honeycombing.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Obliterative bronchiolitis from chronic graft-versus-host disease. Obliterative bronchiolitis is the typical pulmonary manifestation of chronic graft-versus-host disease.

Why is "Pneumocystis jirovecii pneumonia with ground-glass shadows" not the answer?

Pneumocystis pneumonia causes hypoxia with diffuse ground-glass opacities and presents earlier in the immunosuppressed.

Why is "Cryptogenic organising pneumonia with migratory shadows" not the answer?

Organising pneumonia causes patchy consolidation and a restrictive defect, and it responds to steroids.

Why is "Idiopathic pulmonary fibrosis with basal honeycombing" not the answer?

Pulmonary fibrosis shows restrictive physiology with basal reticulation and honeycombing.

What concept does this question test?

It tests Respiratory medicine: bronchiolitis obliterans after transplant in General Medicine. It causes fixed airflow obstruction with a normal chest radiograph and air trapping on expiratory CT. It is also seen after lung transplantation, where it is called bronchiolitis obliterans syndrome.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: bronchiolitis obliterans after transplant?

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.