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Multiple Choice Questions (MCQs) on Bullous Emphysema

Here is a set of 10 MCQs on Bullous Emphysema, including references from Radiopaedia, RadiologyKey, and PubMed resources with connections to Radiographics, ATS, AJR, and Radiology. Each question has one correct answer and an explanation with links to references.

Question 1

What is the definition of a bulla in bullous emphysema?
A. Air-filled space >5 cm in diameter with a thick wall
B. Air-filled space >1 cm in diameter with a thin wall
C. Fluid-filled cavity with an epithelial lining
D. Air-filled space ?1 cm in diameter

Correct Answer: B. Air-filled space >1 cm in diameter with a thin wall
Explanation: Bullae are large, air-filled spaces greater than 1 cm in diameter with thin walls, formed due to alveolar wall destruction. They are a hallmark feature of bullous emphysema.
References:

Question 2

Which condition is most commonly associated with bullous emphysema?
A. Alpha-1 antitrypsin deficiency
B. Chronic bronchitis
C. Cigarette smoking
D. Pulmonary fibrosis

Correct Answer: C. Cigarette smoking
Explanation: Cigarette smoking is the most common cause of emphysema, including the bullous subtype, due to chronic inflammation and protease-antiprotease imbalance.
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Question 3

What is the primary mechanism leading to bullae formation in bullous emphysema?
A. Excessive mucus production
B. Recurrent infections
C. Protease-antiprotease imbalance and alveolar wall destruction
D. Hyperplasia of bronchial epithelium

Correct Answer: C. Protease-antiprotease imbalance and alveolar wall destruction
Explanation: Protease-antiprotease imbalance, often triggered by smoking or genetic conditions like alpha-1 antitrypsin deficiency, leads to the destruction of alveolar walls and the formation of bullae.
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Question 4

Which subtype of emphysema is most associated with bullous formation?
A. Centrilobular emphysema
B. Panlobular emphysema
C. Paraseptal emphysema
D. Irregular emphysema

Correct Answer: C. Paraseptal emphysema
Explanation: Paraseptal emphysema predominantly affects the distal airspaces near the pleura and interlobular septa, leading to bullae formation.
References:

Question 5

What is the most common complication of bullous emphysema?
A. Pulmonary hypertension
B. Lung cancer
C. Spontaneous pneumothorax
D. Bronchiectasis

Correct Answer: C. Spontaneous pneumothorax
Explanation: Thin-walled bullae near the pleura are prone to rupture, leading to air leakage into the pleural space and spontaneous pneumothorax.
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Question 6

What is the gold standard imaging modality for evaluating bullous emphysema?
A. Chest X-ray
B. MRI
C. High-resolution computed tomography (HRCT)
D. Ultrasound

Correct Answer: C. High-resolution computed tomography (HRCT)
Explanation: HRCT is the imaging modality of choice for detecting and characterizing bullae, their size, distribution, and associated complications.
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Question 7

Which anatomical factor in young, thin men predisposes them to bullous emphysema and pneumothorax?
A. Wider pleural space
B. Narrow anteroposterior (AP) chest diameter
C. Reduced blood flow to the apices
D. Hyperactive bronchial glands

Correct Answer: B. Narrow anteroposterior (AP) chest diameter
Explanation: Narrow AP chest dimensions create a more acute lung apex angle, concentrating mechanical forces in the apices, predisposing these regions to bullous formation and pneumothorax.
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Question 8

What distinguishes bullae from cysts on imaging?
A. Bullae have an epithelial lining, whereas cysts do not.
B. Bullae are thin-walled spaces with remnants of alveolar structures, while cysts are discrete with no internal architecture.
C. Bullae are always fluid-filled, while cysts are air-filled.
D. Bullae are surrounded by thick fibrous walls, while cysts are not.

Correct Answer: B. Bullae are thin-walled spaces with remnants of alveolar structures, while cysts are discrete with no internal architecture.
Explanation: Bullae arise from emphysematous destruction and retain some alveolar remnants, while cysts are typically discrete, lined structures unrelated to alveolar destruction.
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Question 9

Which physical forces are thought to predispose the lung apices to bullous formation?
A. Increased transpulmonary pressure gradient and mechanical stress
B. Decreased vascular perfusion
C. Reduced compliance in the lung base
D. Increased mucus production in the airways

Correct Answer: A. Increased transpulmonary pressure gradient and mechanical stress
Explanation: The apices experience greater transpulmonary pressure and mechanical stress, predisposing them to alveolar wall destruction and bullous formation.
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Question 10

What is a key indication for surgical intervention (bullectomy) in bullous emphysema?
A. Large bullae causing compression of functional lung tissue
B. Increased mucus production
C. Presence of mild airflow obstruction
D. Development of chronic bronchitis

Correct Answer: A. Large bullae causing compression of functional lung tissue
Explanation: Bullectomy is indicated when large bullae compress adjacent functional lung tissue, impairing ventilation and causing significant symptoms.
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