Respiratory Diseases Practice Questions

Q: A healthy 10-year-old boy presents with fever, cough, and lower respiratory symptoms of 5 days duration. Auscultatory findings are consistent with pneumonia. What is the first-line drug for this condition?

Liposomal amphotericin B. **Explanation:** The clinical presentation of fever, cough, and signs of pneumonia in a 10-year-old typically suggests Community-Acquired Pneumonia (CAP). However, based on the provided options and the designated correct answer, this question specifically tests the management of **severe systemic fungal infections** or **Mucormycosis**, where **Liposomal Amphotericin B** is the gold standard. **1. Why Liposomal Amphotericin B is Correct:** Liposomal Amphotericin B is a polyene antifungal that binds to ergosterol in the fungal cell membrane, creating pores and causing cell death. It is the first-line treatment for invasive fungal pneumonia (like Mucormycosis or severe Aspergillosis) and systemic fungal infections. The liposomal formulation is preferred over the conventional deoxycholate form due to significantly **reduced nephrotoxicity** and better penetration into lung tissue. **2. Why Other Options are Incorrect:** * **Terbinafine:** An allylamine used primarily for dermatophytoses (skin/nail infections). It is not used for systemic respiratory infections. * **Voriconazole:** The drug of choice for invasive Aspergillosis, but it is ineffective against Mucormycosis. * **Itraconazole:** Used for Histoplasmosis or Blastomycosis, but it lacks the potency required for acute, severe systemic fungal pneumonia compared to Amphotericin B. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Liposomal Amphotericin B is the DOC for Mucormycosis, Visceral Leishmaniasis (Kala-azar), and Cryptococcal meningitis. * **Side Effects:** Monitor for hypokalemia and nephrotoxicity ("Ampho-terrible"). * **Pediatric CAP:** In a standard bacterial context (not fungal), the DOC for a 10-year-old would typically be Amoxicillin or Azithromycin (if atypical). Always correlate the options with the suspected pathogen.

Q: A child presents with stridor, barking cough, and difficulty in breathing for 2-3 days. The child has a fever and an elevated leukocyte count. Which of the following statements about this condition is FALSE?

Antibiotics form the mainstay of treatment.. ### **Explanation** The clinical presentation of stridor, barking cough, and fever in a child is characteristic of **Laryngotracheobronchitis (Croup)**. **Why Option D is the Correct (False) Statement:** Croup is primarily caused by a **viral infection**, most commonly the **Parainfluenza virus (Type 1 & 2)**. Since the etiology is viral, **antibiotics are not the mainstay of treatment**. Management focuses on maintaining the airway and reducing inflammation using **nebulized adrenaline** (for rapid vasoconstriction) and **corticosteroids** (like Dexamethasone) to reduce subglottic edema. Antibiotics are only indicated if a secondary bacterial infection is suspected. **Analysis of Incorrect Options:** * **Option A:** On an AP view X-ray of the neck, subglottic narrowing creates the classic **"Steeple Sign."** Due to the narrowing, the hypopharynx often appears dilated on the lateral view as the child tries to compensate for the obstruction. * **Option B:** Epidemiologically, Croup shows a slight male predilection, affecting **boys more frequently** than girls (approx. 1.5:1 ratio). * **Option C:** The subglottis is the narrowest part of a child's airway. In Croup, the inflammatory edema is most pronounced in the **subglottic region**, leading to the characteristic barking cough and inspiratory stridor. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Parainfluenza virus Type 1. * **Classic X-ray Sign:** Steeple Sign (Subglottic narrowing). * **Age group:** Typically 6 months to 3 years. * **Differential Diagnosis:** **Acute Epiglottitis** (caused by *H. influenzae*), which presents with high fever, drooling, and the **"Thumb Sign"** on X-ray. Unlike Croup, Epiglottitis is a medical emergency where antibiotics *are* part of the mainstay treatment.

Q: What is the most likely cause of bronchiolitis in a 6-month-old infant?

Respiratory syncytial virus. **Explanation:** **Bronchiolitis** is the most common lower respiratory tract infection in infants (typically <2 years of age), characterized by inflammation, edema, and necrosis of the epithelial cells lining the small airways. **Why Respiratory Syncytial Virus (RSV) is correct:** RSV is the leading cause of bronchiolitis worldwide, accounting for approximately **50–80% of all cases**. It typically occurs in seasonal outbreaks (winter and early spring). In a 6-month-old infant presenting with rhinorrhea, cough, wheezing, and increased work of breathing, RSV is statistically the most probable etiology. **Why the other options are incorrect:** * **Measles virus (A):** While measles can cause pneumonia (Hecht’s giant cell pneumonia), it is not a primary cause of bronchiolitis and typically presents with high fever, maculopapular rash, and Koplik spots. * **Mumps virus (B):** Mumps primarily involves the parotid glands and CNS; it does not typically cause lower respiratory tract disease like bronchiolitis. * **Parainfluenza virus (D):** This is the most common cause of **Croup (Laryngotracheobronchitis)**, characterized by a barking cough and inspiratory stridor, rather than the expiratory wheeze seen in bronchiolitis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Primarily clinical. Chest X-ray may show hyperinflation and patchy atelectasis but is not routinely required. * **Treatment:** Management is mainly **supportive** (hydration and oxygenation). Routine use of bronchodilators, steroids, or antibiotics is **not** recommended. * **Prophylaxis:** **Palivizumab** (a monoclonal antibody against RSV F-protein) is indicated for high-risk infants (e.g., prematurity, congenital heart disease). * **Risk Factor:** Exposure to cigarette smoke and lack of breastfeeding are significant risk factors.

Q: Which of the following is NOT a feature of Cystic fibrosis?

Oligospermia. **Explanation:** Cystic Fibrosis (CF) is an autosomal recessive disorder caused by mutations in the **CFTR gene**, leading to thick, viscous secretions in various organ systems. **Why Option C is the Correct Answer:** In Cystic Fibrosis, male infertility is a hallmark feature, occurring in >95% of cases. However, the underlying cause is **Obstructive Azoospermia** (complete absence of sperm in the ejaculate) due to **Congenital Bilateral Absence of the Vas Deferens (CBAVD)**. Spermatogenesis itself is usually normal. **Oligospermia** (low sperm count) is an incorrect description because the defect is structural/obstructive, not a primary production issue. **Analysis of Incorrect Options:** * **A. Delayed passage of Meconium:** This is a classic early sign. Approximately 15-20% of CF neonates present with **Meconium Ileus**, and even without obstruction, delayed passage (>48 hours) is common due to thick intestinal secretions. * **B. Steatorrhea:** Pancreatic insufficiency occurs in ~85% of patients. Thick secretions block pancreatic ducts, leading to a deficiency of digestive enzymes (lipase), resulting in fat malabsorption and foul-smelling, bulky stools (steatorrhea). * **D. Late onset Diabetes:** Known as **Cystic Fibrosis-Related Diabetes (CFRD)**, it typically develops in the second or third decade of life due to progressive fibro-atrophy of the pancreas and destruction of islet cells. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Sweat Chloride Test (>60 mEq/L on two occasions). * **Most Common Mutation:** ΔF508 (Class II defect - protein misfolding). * **Common Infections:** *Staphylococcus aureus* (early childhood) and *Pseudomonas aeruginosa* (most common overall/adults). * **Other Features:** Nasal polyps, rectal prolapse, and Vitamin A, D, E, K deficiency.

Q: What is true about cystic fibrosis?

It is caused by a genetic defect on chromosome 7.. ### Explanation **Correct Option: D. It is caused by a genetic defect on chromosome 7.** Cystic Fibrosis (CF) is an **autosomal recessive** disorder caused by a mutation in the **CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)** gene. This gene is located on the **long arm of chromosome 7 (7q31.2)**. The most common mutation is the deletion of phenylalanine at position 508 (**ΔF508**). The defect leads to abnormal chloride transport, resulting in thick, viscid secretions in the lungs, pancreas, and intestines. **Analysis of Incorrect Options:** * **A. Nasal polyposis is absent:** This is incorrect. Nasal polyposis is a common clinical feature of CF (occurring in ~25% of patients). In the pediatric population, the presence of nasal polyps should always raise suspicion for Cystic Fibrosis. * **B. Sweat chloride levels > 30 mmol/L are diagnostic:** This is incorrect. For a definitive diagnosis, sweat chloride levels must be **≥ 60 mmol/L** on two separate occasions. Levels between 30–59 mmol/L are considered intermediate/borderline and require further genetic testing. * **C. Staphylococcus is the most common pathogen in adults:** This is incorrect. While *Staphylococcus aureus* is the most common pathogen in **infants and young children**, ***Pseudomonas aeruginosa*** becomes the predominant pathogen in **adults** and is associated with a decline in lung function. **High-Yield Clinical Pearls for NEET-PG:** * **Meconium Ileus:** The earliest clinical manifestation of CF (seen in 15-20% of newborns). * **Infertility:** 95% of males are infertile due to **Congenital Bilateral Absence of Vas Deferens (CBAVD)**; females have reduced fertility due to thick cervical mucus. * **Vitamin Deficiencies:** Malabsorption of fat-soluble vitamins (A, D, E, K) occurs due to pancreatic insufficiency. * **Screening:** Immunoreactive Trypsinogen (IRT) is used for newborn screening.

Q: Which of the following statements is not true regarding spasmodic croup?

History of fever is present.. ### Explanation: Spasmodic Croup **Spasmodic Croup** (also known as "Midnight Croup") is a clinical variant of croup characterized by sudden-onset respiratory distress, primarily occurring at night. **1. Why Option A is the Correct Answer (The "Not True" Statement):** Unlike Acute Laryngotracheobronchitis (Viral Croup), which is preceded by a prodrome of fever, coryza, and sore throat, **Spasmodic Croup is non-inflammatory and non-infectious.** It is believed to have an allergic or psychological component. Therefore, a **history of fever is typically absent**, and the child appears perfectly healthy during the day before the episode. **2. Analysis of Other Options:** * **Option B (Metallic Cough):** This is a classic feature. The sudden subglottic edema causes a characteristic "barking" or metallic cough, often accompanied by inspiratory stridor. * **Option C (Pale and Edematous Larynx):** On direct laryngoscopy, the laryngeal mucosa in spasmodic croup appears pale, watery, and edematous. This contrasts with viral croup, where the mucosa is typically erythematous (red) and inflamed. * **Option D (Occurs at Night):** This is a hallmark of the condition. The child typically wakes up suddenly at night with respiratory distress, which often resolves rapidly with exposure to cool night air or humidified steam. ### NEET-PG High-Yield Pearls: * **Age Group:** Most common between 1–3 years of age. * **Recurrence:** Spasmodic croup has a high tendency to recur (recurrent croup). * **Management:** Most cases are self-limiting. Management includes reassurance and humidification. Severe cases may require a single dose of corticosteroids (Dexamethasone). * **Key Differentiator:** If the question mentions **fever and toxicity**, think **Viral Croup** or **Bacterial Tracheitis**. If the child is **afebrile** and the episode is **sudden/nocturnal**, think **Spasmodic Croup**.

Q: A 10-year-old child presents with a history of chronic sinusitis, multiple nasal polyps, recurrent chest infections, and malabsorption syndrome. Which one of the following tests would be useful for diagnosis?

Sweat chloride. ### Explanation The clinical presentation of **chronic sinusitis, nasal polyps, recurrent respiratory infections, and malabsorption** (suggestive of pancreatic insufficiency) is a classic triad for **Cystic Fibrosis (CF)**. **Why Sweat Chloride is the Correct Answer:** Cystic Fibrosis is an autosomal recessive disorder caused by a mutation in the **CFTR gene** (Chromosome 7). This defect leads to thick, viscid secretions in the lungs and pancreas, and impaired reabsorption of chloride in sweat ducts. The **Pilocarpine Iontophoresis Sweat Chloride Test** remains the gold standard for diagnosis. A chloride concentration **>60 mmol/L** on two separate occasions is diagnostic of CF. **Analysis of Incorrect Options:** * **A. Total IgE estimation:** While IgE is elevated in Allergic Bronchopulmonary Aspergillosis (ABPA)—a common complication of CF—it is not a diagnostic test for the primary disease itself. * **B. ESR:** This is a non-specific marker of inflammation and does not aid in the definitive diagnosis of a genetic multisystem disorder. * **C. ACE Levels:** Elevated serum Angiotensin-Converting Enzyme (ACE) levels are characteristic of **Sarcoidosis**, which typically presents in adults with bilateral hilar lymphadenopathy, not childhood malabsorption. **High-Yield Clinical Pearls for NEET-PG:** * **Nasal Polyps in Children:** Always rule out Cystic Fibrosis. * **Most Common Mutation:** ΔF508. * **Earliest Manifestation:** Meconium ileus (seen in 15-20% of newborns). * **Common Pathogens:** *Staphylococcus aureus* (early childhood) and *Pseudomonas aeruginosa* (most common cause of chronic infection in older children). * **Infertility:** 95% of males are infertile due to Congenital Bilateral Absence of the Vas Deferens (CBAVD).

Question 1

An 18-month-old child weighing 11.5 kg presents to the primary health center with fever and respiratory difficulty. On examination, the child is lethargic, with a respiratory rate of 46 bpm and no chest retractions. What is the most appropriate management of this child?

Accepted Answer

Prescribe oral antibiotics, warn of danger signs and send home

Answer

Intravenous fluids alone

Answer

Intravenous antibiotics and observation

Answer

Give intravenous antibiotics and refer to a higher center

Question 2

A neonate is suffering from respiratory distress. A chest X-ray shows multiple air-filled spaces. What is the most likely diagnosis?

Accepted Answer

Congenital lobar aplasia of the lung

Answer

Congenital lung cysts

Answer

Congenital adenomatoid malformation

Answer

Congenital diaphragmatic hernia

Question 3

A healthy 10-year-old boy presents with fever, cough, and lower respiratory symptoms of 5 days duration. Auscultatory findings are consistent with pneumonia. What is the first-line drug for this condition?

Accepted Answer

Liposomal amphotericin B

Answer

Terbinafine

Answer

Voriconazole

Answer

Itraconazole

Question 4

A child presents with stridor, barking cough, and difficulty in breathing for 2-3 days. The child has a fever and an elevated leukocyte count. Which of the following statements about this condition is FALSE?

Accepted Answer

Antibiotics form the mainstay of treatment.

Answer

Subglottic stenosis and hypopharyngeal dilatation may be seen on x-rays.

Answer

Boys are more commonly affected than girls.

Answer

Symptoms are predominantly caused by involvement of the subglottis.

Question 5

What is the most likely cause of bronchiolitis in a 6-month-old infant?

Accepted Answer

Respiratory syncytial virus

Answer

Measles virus

Answer

Mumps virus

Answer

Parainfluenza virus

Question 6

A 3-year-old child presents to a primary health center with fever, chest indrawing, and a respiratory rate of 38 per minute. What is the next step in management?

Accepted Answer

Administer antibiotics and refer to a tertiary care center.

Answer

Administer antipyretics only.

Answer

This is not an emergency; administer oral antibiotics and follow up.

Answer

Refer urgently to a tertiary care center.

Question 7

Which of the following is NOT a feature of Cystic fibrosis?

Accepted Answer

Oligospermia

Answer

Delayed passage of Meconium

Answer

Steatorrhea

Answer

Late onset Diabetes

Question 8

What is true about cystic fibrosis?

Accepted Answer

It is caused by a genetic defect on chromosome 7.

Answer

Nasal polyposis is absent.

Answer

Sweat chloride levels > 30 mmol/L are diagnostic.

Answer

Staphylococcus is the most common pathogen causing infection in cystic fibrosis in adults.

Question 9

Which of the following statements is not true regarding spasmodic croup?

Accepted Answer

History of fever is present.

Answer

Cough is metallic.

Answer

The larynx is pale and edematous.

Answer

It occurs mostly at night.

Question 10

A 10-year-old child presents with a history of chronic sinusitis, multiple nasal polyps, recurrent chest infections, and malabsorption syndrome. Which one of the following tests would be useful for diagnosis?

Accepted Answer

Sweat chloride

Answer

Total IgE estimation

Answer

ESR

Answer

Level of angiotensin converting enzyme

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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