Respiratory Diseases Practice Questions

Q: Which sign is most important in deciding severe pneumonia in a child?

Chest indrawing. ***Chest indrawing*** - **Chest indrawing** (or retractions) indicates increased work of breathing due to reduced lung compliance or airway obstruction, a key sign of severe pneumonia in children. - It signifies that accessory muscles are engaged to pull the chest wall inward with each breath, demonstrating significant respiratory distress. *Fast breathing* - **Fast breathing** (tachypnea) is a general sign of respiratory distress and a criterion for diagnosing pneumonia, but it alone does not differentiate severe from non-severe pneumonia. - While present in pneumonia, it doesn't indicate the same level of respiratory effort or severity as chest indrawing. *Nasal flaring* - **Nasal flaring** is an effort to decrease airway resistance by widening the nostrils during inspiration, indicating increased work of breathing. - It's a sign of respiratory distress that can occur in both moderate and severe pneumonia, but it is not as specific to severe disease as chest indrawing. *Grunting* - **Grunting** is an expiratory sound produced by partial closure of the glottis to maintain positive end-expiratory pressure, preventing alveolar collapse. - While a sign of moderate to severe respiratory distress, especially in neonates, it does not carry the same weight as chest indrawing for classifying severe pneumonia in older children by WHO guidelines.

Q: The recommended dose of cotrimoxazole for treatment of pneumonia in a child weighing 16 kg is

Three paediatric tablets twice a day. ***Three paediatric tablets twice a day*** - A paediatric cotrimoxazole tablet contains **20 mg trimethoprim + 100 mg sulfamethoxazole**. - The recommended dose for pneumonia is **4 mg/kg trimethoprim + 20 mg/kg sulfamethoxazole** twice daily. - For a 16 kg child: Required dose = **64 mg trimethoprim + 320 mg sulfamethoxazole** per dose. - Three tablets provide **60 mg trimethoprim + 300 mg sulfamethoxazole**, which is the closest appropriate dose to the calculated requirement. *One paediatric tablet twice a day* - This provides only **20 mg trimethoprim + 100 mg sulfamethoxazole** per dose. - This is **grossly inadequate** for a 16 kg child, providing less than one-third of the required dose. - Such underdosing risks treatment failure and antibiotic resistance. *Two paediatric tablets twice a day* - This provides **40 mg trimethoprim + 200 mg sulfamethoxazole** per dose. - While better than one tablet, this is still **subtherapeutic** for a 16 kg child with pneumonia. - This represents only about 60% of the recommended dose. *Four paediatric tablets twice a day* - This provides **80 mg trimethoprim + 400 mg sulfamethoxazole** per dose. - This is **slightly higher** than required but would risk unnecessary adverse effects. - Three tablets is the more appropriate choice for this weight range.

Q: A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Pneumonia. ***Pneumonia*** - A respiratory rate of 60 breaths per minute in a 3-month-old infant meets the **WHO criteria for fast breathing**, which is the primary indicator for diagnosing **pneumonia** in this age group. - The absence of chest indrawing, stridor, or convulsions means this falls under **pneumonia**, not **severe** or **very severe pneumonia**. *Very severe pneumonia* - This would be diagnosed if there were **danger signs** such as inability to feed, lethargy, or convulsions, which are explicitly stated as absent. - Presence of **stridor** in a calm child or **severe malnutrition** would also suggest very severe pneumonia, none of which are mentioned. *Severe pneumonia* - This classification requires the presence of **chest indrawing** or **stridor** in a child, which are noted as absent in the clinical presentation. - While the child has fast breathing, the lack of additional severe signs distinguishes it from severe pneumonia. *No Pneumonia* - The presence of **fast breathing** (respiratory rate of 60 in a 3-month-old) is a clear sign of respiratory distress indicating **pneumonia**, according to WHO guidelines. - If the child had a normal respiratory rate and no other signs of respiratory illness, this option might be considered.

Q: A 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. Physical examination shows rhinitis, mild cyanosis, and fever. Which of the following is the most likely etiology of this child's pulmonary infection?

Respiratory syncytial virus. ***Respiratory syncytial virus*** - **Respiratory syncytial virus (RSV)** is the most common cause of **bronchiolitis** in infants and young children, characterized by cough, wheezing, and respiratory distress. - The age of the patient (6-month-old infant) and the clinical presentation, including rhinitis, cyanosis, and fever, are highly consistent with an RSV infection. *Cytomegalovirus* - **Cytomegalovirus (CMV)** infection primarily affects immunocompromised individuals or can cause congenital infections. - While CMV can cause respiratory symptoms, it typically manifests as **pneumonitis** in infants, often without the prominent wheezing seen in this case. *Parainfluenza virus* - **Parainfluenza virus (PIV)** is a common cause of **croup** (laryngotracheobronchitis) in infants and young children, characterized by a barking cough and stridor. - While PIV can rarely cause bronchiolitis, the typical presentation described, especially with prominent wheezing, is less characteristic of PIV compared to RSV. *Adenovirus* - **Adenovirus** can cause a variety of respiratory illnesses, including pneumonia, bronchitis, and pharyngitis. - While adenovirus can cause severe respiratory infections in infants, RSV is more frequently associated with the specific constellation of severe cough, wheezing, and respiratory distress in this age group.

Q: A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

Foreign body aspiration. ***Foreign body aspiration*** - A **foreign body** partially obstructing a bronchus acts as a **one-way valve**, allowing air to enter the lung on inspiration but trapping it on expiration, leading to **hyperinflation** of the distal lung. - This is a common cause of acute respiratory distress and unilateral lung hyperinflation in children, as they frequently aspirate small objects. *Staphylococcal bronchopneumonia* - This typically presents with **consolidation** and **infiltrates** on chest X-ray, rather than hyperinflation. - While it can cause respiratory distress, it does not characteristically lead to **unilateral hyperinflation** as its primary X-ray finding. *Congenital lobar emphysema* - This causes **progressive hyperinflation of a single lobe** (typically upper or middle lobe), not the entire lung, due to abnormal bronchial cartilage or extrinsic compression. - While it can present acutely in infancy, the X-ray shows **lobar** hyperinflation with mediastinal shift, distinct from the **whole lung** hyperinflation seen with foreign body aspiration. *Aspiration pneumonia* - Aspiration pneumonia is caused by inhaling gastric contents or other substances, leading to **inflammation and infection** of the lung parenchyma. - It typically presents with **infiltrates**, **consolidation**, or **abscess formation** on X-ray, not unilateral hyperinflation.

Q: A 3 year old non-vaccinated child presented with fever and fast breathing. His mother reported that he has recently developed measles rash. CXR shown below is indicative of which infection?

Staphylococcus aureus. ***Staphylococcus aureus*** - **Post-measles pneumonia** is a serious complication, and **Staphylococcus aureus** is a common and aggressive secondary bacterial pathogen. - The CXR findings of a **necrotizing pneumonia** with a single or multiple **pneumatoceles** (air-filled cysts within the lung parenchyma) are highly suggestive of S. aureus infection, especially in a non-vaccinated child post-measles. *Streptococcal viridans* - **Streptococcus viridans** species are more typically associated with **subacute bacterial endocarditis** or dental infections, not acute necrotizing pneumonia in this context. - While they are part of the normal oral flora, they are rarely primary causes of severe community-acquired pneumonia in children. *Streptococcal pneumoniae* - **Streptococcus pneumoniae** is a very common cause of **community-acquired pneumonia** in children, often presenting as lobar pneumonia. - However, its typical presentation on CXR is **lobar consolidation or broncho-pneumonia**, and it is less frequently associated with the rapid development of **pneumatoceles** or **necrotizing pneumonia** as seen in post-measles complications, compared to *S. aureus*. *Staphylococcus Albus* - **Staphylococcus albus** is an older name for **Staphylococcus epidermidis**, which is a **coagulase-negative Staphylococcus**. - While *S. epidermidis* can cause infections, it is primarily associated with **device-related infections** (e.g., catheters, prosthetics) and is an uncommon cause of severe pneumonia, particularly necrotizing pneumonia in healthy children.

Q: The commonest cause of Bacterial Pneumonia in children is -

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** * **Streptococcus pneumoniae**, also known as pneumococcus, is globally the **most common bacterial cause of pneumonia in children**, particularly in unvaccinated populations. * It is a **gram-positive bacterium** that can cause a range of invasive and non-invasive diseases, with pneumonia being the most significant. * *Staphylococcus aureus* * While **Staphylococcus aureus** can cause pneumonia in children, especially in cases following a viral illness or in hospitalized patients, it is **less common overall** than *S. pneumoniae*. * *S. aureus* pneumonia often presents with more severe features, such as **abscess formation** and **empyema**. * *Hemophilus influenzae* * **Haemophilus influenzae type b (Hib)** used to be a major cause of bacterial pneumonia in children, but its incidence has **significantly decreased** due to widespread vaccination. * Non-typeable Haemophilus influenzae (NTHi) can still cause pneumonia, particularly in infants and children with underlying conditions, but it is not the leading cause. * *Streptococcus pyogenes* * **Streptococcus pyogenes** (Group A Strep) is primarily known for causing **pharyngitis** (strep throat), **scarlet fever**, and **skin infections**. * While it can cause pneumonia, this is a **relatively rare** presentation compared to *S. pneumoniae*.

Q: Most common bacterial cause of pneumonia in children is?

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - **_Streptococcus pneumoniae_** is the most frequent **bacterial** cause of pneumonia across all pediatric age groups, leading to **lobar pneumonia** - It accounts for the majority of bacterial pneumonia cases requiring hospitalization in children - **Vaccination** (PCV13/PCV15) has significantly reduced its incidence but it remains the leading bacterial pathogen *Staphylococcus aureus* - **_Staphylococcus aureus_** is a less common bacterial cause in children unless there are predisposing factors like **recent influenza infection**, **cystic fibrosis**, or **immunocompromised states** - When it occurs, it often presents with more severe features including **necrotizing pneumonia**, **empyema**, and **abscess formation** *RSV* - **Respiratory Syncytial Virus (RSV)** is the most common **viral** cause of lower respiratory tract infections in infants and young children, particularly **bronchiolitis** and viral pneumonia - While RSV causes more overall pneumonia cases in young children, the question asks specifically for **bacterial** causes *Klebsiella* - **_Klebsiella pneumoniae_** is an **uncommon cause** of pneumonia in otherwise healthy children - It typically affects individuals with **compromised immune systems**, **chronic lung disease**, or occurs as a **nosocomial infection**

Q: A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

Heimlich maneuver. ***Heimlich maneuver*** - The sudden onset of **aphonia** and **respiratory distress** during dinner indicates **foreign body airway obstruction** (FBAO). - The **Heimlich maneuver** is the immediate, life-saving intervention for conscious individuals with complete airway obstruction. *Emergency tracheostomy* - This is an invasive surgical procedure performed when other methods to clear the airway have failed or are not possible due to severe obstruction or trauma. - It is not the **first-line intervention** for a conscious child with FBAO. *Humidified oxygen* - While supportive of respiratory function, humidified oxygen alone will not resolve an **acute foreign body obstruction** causing aphonia and severe distress. - It does not address the underlying mechanical blockage of the airway. *Cricothyroidotomy* - This is an emergency procedure to establish an airway, typically used in adults when other methods of intubation or airway clearance have failed. - It is generally **contraindicated in children under 12** due to the risk of damaging the cricoid cartilage, which is a major part of the child's airway.

Q: A child is brought to the paediatric OPD with fever of 24 hours duration. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is-

Cystic Fibrosis. ***Cystic Fibrosis*** - Recurrent **chest infections** and **foul-smelling stools** (due to pancreatic insufficiency leading to malabsorption) are classic hallmarks of cystic fibrosis. - This genetic disorder primarily affects the **lungs** and **digestive system**, leading to thick, sticky mucus. *Crigler-Najjar Syndrome* - This syndrome is a rare genetic disorder characterized by severe **unconjugated hyperbilirubinemia**, leading to **jaundice** and potential neurological damage. - It does not typically present with recurrent chest infections or foul-smelling stools. *Maple Syrup urine Disease* - This is an **amino acid metabolism disorder** leading to the accumulation of branched-chain amino acids, characterized by a distinctive "maple syrup" odor in the urine. - It presents with neurological symptoms, feeding difficulties, and developmental delay, not primarily chest infections and foul-smelling stools. *Bilirubin Conjugation Defect* - This refers to conditions like Gilbert's syndrome or Crigler-Najjar syndrome, which cause varying degrees of **unconjugated hyperbilirubinemia** and **jaundice**. - It does not explain the recurrent respiratory infections or malabsorption symptoms like foul-smelling stools.

Question 1

Which sign is most important in deciding severe pneumonia in a child?

Accepted Answer

Chest indrawing

Answer

Fast breathing

Answer

Nasal flaring

Answer

Grunting

Question 2

The recommended dose of cotrimoxazole for treatment of pneumonia in a child weighing 16 kg is

Accepted Answer

Three paediatric tablets twice a day

Answer

Four paediatric tablets twice a day

Answer

Two paediatric tablets twice a day

Answer

One paediatric tablet twice a day

Question 3

A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Accepted Answer

Pneumonia

Answer

Very severe pneumonia

Answer

Severe pneumonia

Answer

No Pneumonia

Question 4

A 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. Physical examination shows rhinitis, mild cyanosis, and fever. Which of the following is the most likely etiology of this child's pulmonary infection?

Accepted Answer

Respiratory syncytial virus

Answer

Cytomegalovirus

Answer

Parainfluenza virus

Answer

Adenovirus

Question 5

A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

Accepted Answer

Foreign body aspiration

Answer

Staphylococcal bronchopneumonia

Answer

Congenital lobar emphysema

Answer

Aspiration pneumonia

Question 6

A 3 year old non-vaccinated child presented with fever and fast breathing. His mother reported that he has recently developed measles rash. CXR shown below is indicative of which infection?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcal viridans

Answer

Streptococcus pneumoniae

Answer

Staphylococcus Albus

Question 7

The commonest cause of Bacterial Pneumonia in children is -

Accepted Answer

Streptococcus pneumoniae

Answer

Staphylococcus aureus

Answer

Haemophilus influenzae

Answer

Streptococcus pyogenes

Question 8

Most common bacterial cause of pneumonia in children is?

Accepted Answer

Streptococcus pneumoniae

Answer

Staphylococcus aureus

Answer

RSV

Answer

Klebsiella

Question 9

A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

Accepted Answer

Heimlich maneuver

Answer

Emergency tracheostomy

Answer

Humidified oxygen

Answer

Cricothyroidotomy

Question 10

A child is brought to the paediatric OPD with fever of 24 hours duration. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is-

Accepted Answer

Cystic Fibrosis

Answer

Crigler-Najjar Syndrome

Answer

Maple Syrup urine Disease

Answer

Bilirubin Conjugation Defect

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

On this page

Practice by Chapter

Want unlimited practice?