Respiratory medicine: pulmonary Langerhans cell histiocytosis: 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 Langerhans cell histiocytosis

Sample item

A 28-year-old heavy smoker has a dry cough, dyspnoea and a spontaneous pneumothorax. HRCT shows bizarre-shaped cysts and nodules in the upper and mid zones with sparing of the costophrenic angles. Biopsy shows cells with Birbeck granules. What is the most important first step in management?

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

The answer and the reasoning

C. Smoking cessation

Pulmonary Langerhans cell histiocytosis is strongly linked to cigarette smoking, and stopping smoking can lead to stabilisation or regression of disease. Immunosuppression is reserved for refractory or progressive disease and transplantation for end-stage disease.

Option by option

  • A. Pulsed cyclophosphamide

    Cytotoxic therapy is for refractory disease, not an initial step.

  • B. A prolonged course of oral prednisolone

    Steroids have no proven benefit as first-line therapy.

  • C. Smoking cessation (correct)

    Correct. Smoking cessation is the cornerstone and may lead to regression.

  • D. Referral for lung transplantation

    Transplantation is for advanced respiratory failure.

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 C, Smoking cessation. Pulmonary Langerhans cell histiocytosis is strongly linked to cigarette smoking, and stopping smoking can lead to stabilisation or regression of disease.

Why is "Pulsed cyclophosphamide" not the answer?

Cytotoxic therapy is for refractory disease, not an initial step.

Why is "A prolonged course of oral prednisolone" not the answer?

Steroids have no proven benefit as first-line therapy.

Why is "Referral for lung transplantation" not the answer?

Transplantation is for advanced respiratory failure.

What concept does this question test?

It tests Respiratory medicine: pulmonary Langerhans cell histiocytosis in General Medicine. Immunosuppression is reserved for refractory or progressive disease and transplantation for end-stage disease.

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 Langerhans cell histiocytosis?

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.