Respiratory: Caplan syndrome: practice question

A Pathology 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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Pathology · Respiratory: Caplan syndrome

Sample item

A 55-year-old coal miner with seropositive rheumatoid arthritis has several well-defined peripheral lung nodules of 1 to 4 cm on chest radiography. On section the nodules show concentric dark rings of dust. What is the most likely diagnosis?

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

The answer and the reasoning

B. Caplan syndrome

Caplan syndrome is the association of rheumatoid arthritis with pneumoconiosis, here coal workers pneumoconiosis. It produces multiple peripheral necrobiotic nodules with concentric layers of dust around a necrotic centre. The nodules resemble rheumatoid nodules and often appear in a short time.

Option by option

  • A. Granulomatosis with polyangiitis

    Granulomatosis with polyangiitis causes cavitating nodules with vasculitis and c-ANCA positivity.

  • B. Caplan syndrome (correct)

    Correct. Rheumatoid disease plus dust exposure produces dusty necrobiotic nodules.

  • C. Primary pulmonary tuberculoma

    Tuberculomas show caseous necrosis with Langhans giant cells and not laminated dust.

  • D. Metastatic carcinoma

    Metastases would not show laminated dust rings or relate to rheumatoid arthritis.

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 Pathology question

What is the answer to this Pathology question?

The best answer is B, Caplan syndrome. Caplan syndrome is the association of rheumatoid arthritis with pneumoconiosis, here coal workers pneumoconiosis.

Why is "Granulomatosis with polyangiitis" not the answer?

Granulomatosis with polyangiitis causes cavitating nodules with vasculitis and c-ANCA positivity.

Why is "Primary pulmonary tuberculoma" not the answer?

Tuberculomas show caseous necrosis with Langhans giant cells and not laminated dust.

Why is "Metastatic carcinoma" not the answer?

Metastases would not show laminated dust rings or relate to rheumatoid arthritis.

What concept does this question test?

It tests Respiratory: Caplan syndrome in Pathology. It produces multiple peripheral necrobiotic nodules with concentric layers of dust around a necrotic centre. The nodules resemble rheumatoid nodules and often appear in a short time.

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: Caplan syndrome?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.