Respiratory Diseases Practice Questions

Q: A 6-month-old baby presents with a respiratory rate of 54/min and retractions. How should the doctor at a Primary Health Centre manage this case?

Classify as pneumonia, start oral antibiotics.. This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for managing Acute Respiratory Infections (ARI). ### **1. Why Option D is Correct** According to IMNCI guidelines, the classification of respiratory distress in a child aged 2 months to 5 years is based on specific clinical signs: * **Fast Breathing:** In a 6-month-old, a respiratory rate (RR) of **≥50 breaths/min** is defined as fast breathing. This patient has a RR of 54/min. * **Chest Indrawing (Retractions):** The presence of lower chest indrawing without "danger signs" classifies the case as **Pneumonia**. * **Management:** For "Pneumonia," the protocol is to provide **oral Amoxicillin** (80 mg/kg/day for 5 days) and home care advice. Referral is not required unless danger signs are present. ### **2. Why Other Options are Incorrect** * **Option A & B:** These classifications are reserved for **"Severe Pneumonia."** This requires the presence of at least one **General Danger Sign** (inability to drink/breastfeed, persistent vomiting, lethargy/unconsciousness, or convulsions) or **Stridor** in a calm child. Since none are mentioned, injectable antibiotics and urgent referral are not indicated. * **Option C:** Oxygen therapy is indicated for Severe Pneumonia (SpO2 <90-92%). For non-severe pneumonia, oral antibiotics are the primary intervention. ### **3. Clinical Pearls for NEET-PG** * **RR Cut-offs for Fast Breathing:** * <2 months: ≥60/min * 2–12 months: **≥50/min** * 12 months–5 years: ≥40/min * **Drug of Choice:** Oral **Amoxicillin** is now the first-line treatment for pneumonia in the community (replacing Cotrimoxazole). * **Key Sign:** Lower chest indrawing must be persistent to be clinically significant. If only intercostal retractions are present, it is still classified as pneumonia.

Q: A 9-year-old boy with moderately persistent, well-controlled asthma is currently using short-acting beta-agonists, daily inhaled steroids, and a leukotriene inhibitor. He presents with white patches on his buccal mucosa. What is the next best step?

Rinse his mouth after using inhaled medications. **Explanation:** The clinical presentation of white patches on the buccal mucosa in a patient using inhaled corticosteroids (ICS) is classic for **Oropharyngeal Candidiasis (Oral Thrush)**. **1. Why Option B is Correct:** Inhaled corticosteroids, while effective for asthma, can cause local immunosuppression in the oral cavity. This allows for the overgrowth of *Candida albicans*. The most effective preventive measure and the immediate next step in management is to advise the patient to **rinse their mouth and gargle with water** after each use of the ICS inhaler. Using a **spacer device** also helps by reducing the amount of drug deposited in the oropharynx and increasing delivery to the lower airways. **2. Why Other Options are Incorrect:** * **Option A & C:** While oral thrush can be a sign of systemic immunosuppression (like HIV or primary immunodeficiency), it is a known and common local side effect of ICS. In a patient with well-controlled asthma on steroids, the medication is the most likely culprit; invasive testing is not indicated unless the infection is refractory or recurrent despite proper technique. * **Option D:** Discontinuing asthma medications is dangerous and could lead to a life-threatening exacerbation. The asthma is "well-controlled," meaning the current regimen is effective and should be maintained with better administration technique. **Clinical Pearls for NEET-PG:** * **Local side effects of ICS:** Oral candidiasis, dysphonia (due to vocal cord myopathy), and reflex cough. * **Prevention:** "Rinse and Spit" technique and use of a Valved Holding Chamber (Spacer). * **Treatment:** If symptomatic, topical antifungal agents like **Nystatin** suspension or **Clotrimazole** troches are used. * **Systemic effects of ICS:** Though rare at standard doses, high doses in children can lead to transient growth deceleration and adrenal suppression.

Q: A 2-year-old male child presents with cough, high-grade fever, and rapid breathing for the past 7 days. On examination, the respiratory rate is 50/min, and visible chest indrawing is present. What is the next appropriate line of management?

Home management with Amoxicillin.. ### Explanation This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for the classification and management of pneumonia. #### Why Option B is Correct: According to IMNCI guidelines, a child aged 2 months to 5 years with a cough/difficulty breathing is classified based on clinical signs: 1. **Pneumonia:** Presence of **fast breathing** (RR ≥ 40/min for ages 1–5 years) OR **chest indrawing**. 2. **Severe Pneumonia:** Presence of any **danger signs** (inability to drink, persistent vomiting, convulsions, lethargy, or stridor in a calm child). In this case, the child has fast breathing (50/min) and chest indrawing but **no danger signs**. Under the revised WHO/IMNCI criteria, "Chest Indrawing" is now classified as **Pneumonia** (not severe pneumonia) and can be managed at **home with oral Amoxicillin** (40 mg/kg/dose twice daily for 5 days). #### Why Other Options are Wrong: * **Option A & D:** These are inappropriate because the child meets the criteria for pneumonia. Ignoring the need for antibiotics increases the risk of progression to respiratory failure. * **Option C:** Hospitalization (IV antibiotics) is reserved for **Severe Pneumonia** (presence of danger signs) or if the child fails to respond to oral antibiotics. #### High-Yield Clinical Pearls for NEET-PG: * **Fast Breathing Cut-offs:** * < 2 months: ≥ 60/min * 2–12 months: ≥ 50/min * 12 months–5 years: ≥ 40/min * **First-line antibiotic:** Oral Amoxicillin is the gold standard for community-acquired pneumonia in children. * **Key Change:** Previously, chest indrawing signified "Severe Pneumonia" requiring hospitalization. Current guidelines classify it as "Pneumonia" manageable at home to reduce the hospital burden.

Q: Which of the following is NOT a cause of stridor in infants?

Bronchiolitis. **Explanation:** The fundamental concept to distinguish these conditions is the **anatomical location** of the airway obstruction. **Stridor** is a high-pitched, predominantly inspiratory sound caused by turbulent airflow through a partially obstructed **upper airway** (above the thoracic inlet, i.e., larynx, pharynx, or trachea). * **Why Bronchiolitis is the correct answer:** Bronchiolitis is a **lower respiratory tract infection** affecting the small airways (bronchioles). Obstruction in the lower airways results in **wheezing** (a high-pitched polyphonic expiratory sound) rather than stridor. Since it does not involve the upper airway, it is not a cause of stridor. **Analysis of Incorrect Options:** * **Laryngomalacia:** The most common cause of congenital stridor. It involves collapse of supraglottic structures during inspiration. * **Croup (Laryngotracheobronchitis):** The most common cause of acute stridor in children (6 months to 3 years), characterized by subglottic edema and a "barking" cough. * **Retropharyngeal Abscess:** An upper airway emergency where pus accumulation in the prevertebral space narrows the pharyngeal lumen, leading to inspiratory stridor, drooling, and neck stiffness. **High-Yield Clinical Pearls for NEET-PG:** * **Inspiratory Stridor:** Indicates obstruction at or above the vocal cords (e.g., Laryngomalacia, Epiglottitis). * **Biphasic Stridor:** Indicates subglottic or glottic obstruction (e.g., Croup, Subglottic stenosis). * **Expiratory Stridor (or Wheeze):** Indicates tracheobronchial obstruction (e.g., Foreign body in bronchus, Bronchiolitis). * **Steeple Sign:** Classic X-ray finding in Croup (subglottic narrowing). * **Thumb Sign:** Classic X-ray finding in Epiglottitis (swollen epiglottis).

Q: A 7-week-old preterm infant, who was intubated for 2 weeks and weaned off oxygen at 3 weeks of age, presents with recent onset of hypoxia, respiratory distress, wheezes, and runny nose. A chest radiograph reveals patchy infiltrates and hyper-expansion in both lung fields. Her 2-year-old sibling has an upper respiratory infection. What is the most likely diagnosis for this clinical scenario?

Bronchiolitis. **Explanation:** The clinical presentation is a classic case of **Acute Bronchiolitis**, likely caused by Respiratory Syncytial Virus (RSV). The key diagnostic clues are the **acute onset** of respiratory distress (wheezing, hypoxia) following a viral prodrome (runny nose) and exposure to an ill contact (the sibling). While the infant has a history of prematurity and mechanical ventilation, the fact that she was successfully weaned off oxygen at 3 weeks of age and remained asymptomatic until now makes a chronic condition less likely than an acute infection. The chest X-ray findings of **hyper-expansion and patchy infiltrates** are characteristic of air trapping seen in bronchiolitis. **Why other options are incorrect:** * **Bronchopulmonary Dysplasia (BPD):** Defined as the need for supplemental oxygen at 36 weeks post-menstrual age. This infant was off oxygen by 3 weeks of age, ruling out BPD. * **Respiratory Distress Syndrome (RDS):** This occurs immediately after birth in preterm infants due to surfactant deficiency. It does not present for the first time at 7 weeks of age. * **Pulmonary Interstitial Emphysema (PIE):** This is a complication of mechanical ventilation where air leaks into the interstitium; it occurs while the patient is on a ventilator, not weeks after extubation. **Clinical Pearls for NEET-PG:** * **Most common cause:** RSV (Respiratory Syncytial Virus). * **Risk Factors for severe disease:** Prematurity, congenital heart disease, and chronic lung disease. * **Radiology:** Hyperinflation, flattened diaphragm, and peribronchial cuffing. * **Management:** Primarily supportive (hydration and oxygen). Bronchodilators and steroids are generally not recommended. * **Prophylaxis:** Palivizumab (monoclonal antibody) is indicated for high-risk preterm infants.

Q: A 4-year-old child presents with sudden onset of sore throat, hoarseness, and difficulty in breathing. The patient has a high temperature, is drooling, and prefers to lean forward. What is the most likely diagnosis?

Acute epiglottitis. **Explanation:** The clinical presentation described is a classic "textbook" case of **Acute Epiglottitis**, a life-threatening medical emergency. The diagnosis is based on the **"4 Ds"**: Drooling, Dysphagia, Distress, and Dysphonia (muffled "hot potato" voice). The child’s preference to lean forward (the **Tripod position**) is a compensatory mechanism to maintain airway patency. The sudden onset and high-grade fever help differentiate it from viral causes like Croup. **Why the other options are incorrect:** * **Bronchiolitis:** Typically affects infants (<2 years) and presents with lower respiratory symptoms like wheezing and fine crackles, following a viral prodrome. * **Streptococcal pharyngitis:** While it causes sore throat and fever, it does not typically cause acute respiratory distress, drooling, or airway obstruction. * **Whooping cough (Pertussis):** Characterized by paroxysmal bouts of coughing followed by an inspiratory "whoop." It does not present with acute upper airway obstruction or drooling. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Historically *Haemophilus influenzae* type b (Hib) was the most common cause; however, incidence has dropped significantly due to vaccination. * **Radiology:** Lateral neck X-ray shows the **"Thumb sign"** (swollen epiglottis). * **Management:** The priority is **airway stabilization** (intubation or tracheostomy) in a controlled environment (OR). Never examine the throat with a tongue depressor, as it may trigger fatal laryngospasm. * **Definitive Diagnosis:** Direct laryngoscopy (showing a "cherry-red" epiglottis).

Q: A 5-year-old child weighing 20 kgs presents with a respiratory rate of 54 breaths per minute. Based on these findings, how would this condition be classified regarding pneumonia?

Pneumonia. ### Explanation The classification of respiratory infections in children is a high-yield topic based on the **WHO Integrated Management of Childhood Illness (IMCI)** guidelines. **1. Why "Pneumonia" is the correct answer:** The classification is primarily based on the child's age and the presence of **fast breathing** or **chest indrawing**. For a child aged 12 months to 5 years, fast breathing is defined as a respiratory rate (RR) of **≥ 40 breaths per minute**. * **Patient Data:** Age 5 years, RR 54 bpm. * Since 54 is greater than 40, and there is no mention of "danger signs" or "chest indrawing," the child is classified as having **Pneumonia**. **2. Why other options are incorrect:** * **No pneumonia:** This classification is for children with a cough or cold but a normal respiratory rate (< 40 bpm for this age group). * **Severe pneumonia:** This requires the presence of **chest indrawing** (subcostal retraction) or any **general danger signs** (inability to drink/breastfeed, persistent vomiting, lethargy/unconsciousness, or convulsions). Fast breathing alone does not qualify as severe. * **Very severe pneumonia:** This term was used in older guidelines; current IMCI guidelines categorize cases with danger signs simply as "Severe Pneumonia/Very Severe Disease." **3. NEET-PG High-Yield Pearls:** * **Fast Breathing Cut-offs:** * < 2 months: ≥ 60 bpm * 2–12 months: ≥ 50 bpm * 12 months–5 years: ≥ 40 bpm * **Treatment:** According to IMCI, "Pneumonia" is treated with **Oral Amoxicillin** (40 mg/kg/dose twice daily) for 5 days at home. "Severe Pneumonia" requires hospitalization and **IV Ampicillin and Gentamicin**. * **Note:** Weight (20 kg) is provided to distract you; the classification depends on age and clinical signs, not weight.

Q: What is the most common lobe involved in congenital lobar emphysema?

Left upper lobe. **Explanation:** **Congenital Lobar Emphysema (CLE)**, also known as Congenital Lobar Overinflation, is a developmental anomaly characterized by the progressive overdistension of one or more pulmonary lobes. This occurs due to a "ball-valve" mechanism, where air enters during inspiration but cannot escape during expiration, leading to air trapping and compression of the surrounding lung tissue. **1. Why Left Upper Lobe (LUL) is Correct:** The **Left Upper Lobe** is the most frequently affected site, accounting for approximately **40–50%** of all cases. The exact reason for this predilection is not fully understood, but it is often associated with localized bronchomalacia (deficiency of bronchial cartilage) or extrinsic vascular compression (e.g., by a patent ductus arteriosus or anomalous pulmonary artery). **2. Analysis of Incorrect Options:** * **Right Middle Lobe (RML):** This is the second most common site, involved in about **30–35%** of cases. * **Right Upper Lobe (RUL):** This is the third most common site, involved in approximately **20%** of cases. * **Lower Lobes:** Involvement of the lower lobes (Left or Right) is extremely rare (less than 1–5%). **3. NEET-PG High-Yield Clinical Pearls:** * **Presentation:** Most infants present within the first 6 months of life with respiratory distress, wheezing, and asymmetrical chest expansion. * **Radiology:** The classic X-ray finding is a **hyperlucent, overdistended lobe** with a mediastinal shift to the contralateral side and depression of the ipsilateral diaphragm. * **Management:** Surgical lobectomy is the definitive treatment for symptomatic patients. * **Key Association:** Up to 10% of patients with CLE have associated **congenital heart disease** (most commonly VSD or PDA).

Question 1

A 6-month-old baby presents with a respiratory rate of 54/min and retractions. How should the doctor at a Primary Health Centre manage this case?

Accepted Answer

Classify as pneumonia, start oral antibiotics.

Answer

Classify as very severe pneumonia and refer immediately.

Answer

Classify as severe pneumonia, start injectable antibiotic and then refer.

Answer

Classify as pneumonia and start oxygen therapy.

Question 2

A 9-year-old boy with moderately persistent, well-controlled asthma is currently using short-acting beta-agonists, daily inhaled steroids, and a leukotriene inhibitor. He presents with white patches on his buccal mucosa. What is the next best step?

Accepted Answer

Rinse his mouth after using inhaled medications

Answer

HIV testing

Answer

Measurement of serum immunoglobulins

Answer

Discontinuation of all asthma medications

Question 3

An 8-year-old girl is brought into the physician's office in mild respiratory distress. She has a history of allergies to cats and wool, and her parents state that she has recurrent episodes of upper respiratory tract infections. Physical examination shows expiratory wheezes, use of accessory respiratory muscles, and a hyperresonant chest to percussion. Analysis of arterial blood gases discloses respiratory alkalosis, and the peripheral eosinophil count is increased. What is the appropriate diagnosis?

Accepted Answer

Asthma

Answer

Acute bronchiolitis

Answer

Cystic fibrosis

Answer

Kartagener syndrome

Question 4

A 2-year-old male child presents with cough, high-grade fever, and rapid breathing for the past 7 days. On examination, the respiratory rate is 50/min, and visible chest indrawing is present. What is the next appropriate line of management?

Accepted Answer

Home management with Amoxicillin.

Answer

Home management with Paracetamol.

Answer

Hospital management with antibiotics.

Answer

Reassurance.

Question 5

A 12-year-old child presents with bilateral nasal polyps. His mother complains of a salty taste on the child's skin while kissing. What condition should be investigated?

Accepted Answer

Cystic fibrosis

Answer

Rhinosporidiosis

Answer

Angiofibroma

Answer

Antrochoanal polyp

Question 6

Which of the following is NOT a cause of stridor in infants?

Accepted Answer

Bronchiolitis

Answer

Croup

Answer

Laryngomalacia

Answer

Retropharyngeal abscess

Question 7

A 7-week-old preterm infant, who was intubated for 2 weeks and weaned off oxygen at 3 weeks of age, presents with recent onset of hypoxia, respiratory distress, wheezes, and runny nose. A chest radiograph reveals patchy infiltrates and hyper-expansion in both lung fields. Her 2-year-old sibling has an upper respiratory infection. What is the most likely diagnosis for this clinical scenario?

Accepted Answer

Bronchiolitis

Answer

Bronchopulmonary dysplasia

Answer

Respiratory distress syndrome (hyaline membrane disease)

Answer

Pulmonary interstitial emphysema

Question 8

A 4-year-old child presents with sudden onset of sore throat, hoarseness, and difficulty in breathing. The patient has a high temperature, is drooling, and prefers to lean forward. What is the most likely diagnosis?

Accepted Answer

Acute epiglottitis

Answer

Bronchiolitis

Answer

Streptococcal pharyngitis

Answer

Whooping cough

Question 9

A 5-year-old child weighing 20 kgs presents with a respiratory rate of 54 breaths per minute. Based on these findings, how would this condition be classified regarding pneumonia?

Accepted Answer

Pneumonia

Answer

No pneumonia

Answer

Severe pneumonia

Answer

Very severe pneumonia

Question 10

What is the most common lobe involved in congenital lobar emphysema?

Accepted Answer

Left upper lobe

Answer

Right upper lobe

Answer

Right middle lobe

Answer

Left lower lobe

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

On this page

Practice by Chapter

Want unlimited practice?