Respiratory Diseases Practice Questions

Q: A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Swyer-James-MacLeod syndrome. ***Swyer-James-MacLeod syndrome*** - This syndrome presents with **unilateral hyperlucent lung**, reduced vascularity, and bronchiectasis, often following a severe childhood respiratory infection, leading to air trapping and recurrent infections. - The imaging findings of **unilateral loss of lung volume**, hyperlucency, and reduced vascularity are classic for Swyer-James-MacLeod syndrome, which is also known as unilateral emphysema. *Immotile cilia syndrome* - This is a broader term that encompasses conditions like Kartagener syndrome, characterized by ciliary dysfunction leading to **recurrent sinopulmonary infections**; however, it does not typically present with unilateral hyperlucent lung or reduced vascularity. - While it causes bronchiectasis, the specific imaging findings described (unilateral hyperlucency) are not characteristic of isolated immotile cilia syndrome. *Kartagener syndrome* - This is a subgroup of primary ciliary dyskinesia that includes the classic triad of **situs inversus**, bronchiectasis, and sinusitis. The patient in the prompt has normally placed abdominal organs, ruling out situs inversus. - Although it involves recurrent pulmonary infections and bronchiectasis, the presence of **normally placed abdominal organs** and unilateral hyperlucency on imaging makes Kartagener syndrome less likely. *Mendelson syndrome* - This refers to **chemical pneumonitis** caused by the aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - It presents acutely with respiratory distress, hypoxemia, and diffuse infiltrates on imaging, which is inconsistent with the chronic presentation of recurrent infections and unilateral hyperlucency described.

Q: Which one of the following conditions does not typically present with inspiratory stridor in children?

Bronchiolitis. ***Bronchiolitis*** - This condition primarily affects the **small airways** (bronchioles) and is caused by inflammation and swelling, leading to **expiratory wheezing** and difficulty breathing, rather than inspiratory stridor. - While it can cause respiratory distress, the narrowing of the lower airways typically manifests as **wheezing and crackles**, not the harsh, high-pitched sound of inspiratory stridor associated with upper airway obstruction. *Laryngomalacia* - This is a common congenital condition characterized by the collapse of **supraglottic structures** during inspiration, leading to intermittent **inspiratory stridor** that is often worse when the infant is feeding, agitated, or supine. - The stridor is typically **soft and musical**, and usually improves spontaneously as the child grows. *Acute epiglottitis* - This is a severe and rapidly progressive bacterial infection of the **epiglottis**, which can cause significant **upper airway obstruction** and life-threatening inspiratory stridor. - Children with epiglottitis often present with a **sudden onset of high fever**, sore throat, **drooling**, and a **"tripod" position** (leaning forward with neck extended). *Croup* - This condition, typically caused by a viral infection, leads to **subglottic inflammation** and swelling, resulting in the characteristic **"barking" cough** and **inspiratory stridor**. - The stridor is due to the narrowing of the trachea below the vocal cords.

Q: A 10-year-old male child presenting with complaints of poor growth, poor appetite, short stature, clubbing, and recurrent chest infections, along with steatorrhea, is most likely diagnosed with what?

Cystic fibrosis. ***Cystic fibrosis*** - The constellation of **poor growth**, **short stature**, **recurrent chest infections**, **clubbing**, and **steatorrhea** is highly indicative of cystic fibrosis. - **Cystic fibrosis** is a genetic disorder affecting exocrine glands, leading to thick, sticky mucus that clogs the lungs and pancreas, causing malabsorption. *Celiac Disease* - **Celiac disease** primarily affects the small intestine, leading to malabsorption and poor growth. - While it can cause steatorrhea and poor growth, it does not typically present with recurrent chest infections or significant clubbing. *Biliary cirrhosis* - **Biliary cirrhosis** involves liver damage and can cause steatorrhea due to impaired bile flow. - However, it is not typically associated with recurrent chest infections or prominent clubbing unless advanced. *Bronchiectasis* - **Bronchiectasis** is characterized by permanent dilation of the bronchi, leading to chronic cough and recurrent respiratory infections. - While it can cause clubbing and recurrent chest infections, it does not directly cause steatorrhea or poor growth as a primary feature, although malnutrition can occur secondary to chronic illness.

Q: What is the most appropriate antibiotic choice for a 4-year-old unvaccinated child with epiglottitis?

Ceftriaxone or cefotaxime. ***Ceftriaxone or cefotaxime*** - **Third-generation cephalosporins** are the **first-line antibiotics** for epiglottitis in children - Provide excellent coverage against ***Haemophilus influenzae* type b (Hib)**, the most common causative organism in unvaccinated children - Effective against **both beta-lactamase producing and non-producing strains**, addressing the widespread ampicillin resistance (20-40%) - **Ceftriaxone** (50-100 mg/kg/day) or **cefotaxime** (150-200 mg/kg/day divided) are standard of care - Treatment duration is typically **7-10 days** *Immediate airway assessment and management* - While this is the **most critical priority** in epiglottitis management (life-threatening airway obstruction risk), the question specifically asks for **antibiotic choice** - Airway management is a procedural intervention, not antimicrobial therapy - In clinical practice, airway assessment comes first, but this doesn't answer the question asked *Administering a vaccine* - **Hib vaccine** is a **preventive measure**, not a treatment for active infection - Vaccination during acute epiglottitis has no therapeutic benefit - The vaccine prevents future disease but does not treat current infection *Doxycycline for 4 days* - **Not first-line therapy** for epiglottitis in any age group - **Contraindicated in children under 8 years** due to risk of permanent **tooth discoloration** and enamel hypoplasia - Poor coverage against *H. influenzae* type b - Tetracyclines are not recommended for typical bacterial causes of epiglottitis

Q: A child with recent onset of upper respiratory tract infection after 2 days presents with acute onset of breathlessness, cough, and fever. Which of the following treatments is contraindicated?

Morphine. ***Morphine (CONTRAINDICATED)*** - Morphine is a **potent respiratory depressant** and is **absolutely contraindicated** in a child with acute breathlessness and respiratory infection. - It suppresses the respiratory drive, worsening hypoxia and potentially leading to **respiratory failure**. - The sedative effects mask crucial clinical signs of deteriorating respiratory status, delaying life-saving interventions. - **Opioids should never be used** in acute respiratory distress in children. *Antipyretics (NOT contraindicated)* - **Paracetamol** or **ibuprofen** are safe and appropriate for fever management in children with respiratory infections. - They improve patient comfort without adversely affecting respiratory function. - Fever reduction helps decrease metabolic demand and oxygen consumption. *Antibiotics (NOT contraindicated)* - Indicated when **bacterial pneumonia** or bacterial superinfection complicates the viral URI. - Choice depends on clinical assessment, chest X-ray findings, and laboratory markers (elevated WBC, CRP). - Common organisms include *Streptococcus pneumoniae* and *Haemophilus influenzae*. *O2 inhalation (NOT contraindicated)* - **Essential treatment** for hypoxia (SpO2 <92-94%) in acute respiratory distress. - Delivered via nasal prongs, face mask, or high-flow nasal cannula depending on severity. - Oxygen therapy is a **life-saving intervention** and should never be withheld.

Q: Which of the following is not associated with primary ciliary dyskinesia?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** is a condition related to the thyroid gland's function and is **not directly associated** with defects in ciliary structure or function. - While other systemic conditions can coexist, there is no known mechanistic link between primary ciliary dyskinesia and thyroid dysfunction. *Sterility in males* - **Sterility in males** is a common manifestation of primary ciliary dyskinesia, as the abnormal cilia impair **sperm motility**, preventing effective fertilization. - The **flagellum of sperm** shares structural similarities with cilia, and its dysfunction leads to **immotile spermatozoa**. *Sinusitis* - **Sinusitis** is a hallmark symptom of primary ciliary dyskinesia due to impaired ciliary clearance in the **paranasal sinuses**. - The inability to effectively clear mucus leads to chronic and recurrent **sinus infections** and inflammation. *Respiratory infection* - **Recurrent respiratory infections**, including bronchitis, pneumonia, and bronchiectasis, are characteristic features of primary ciliary dyskinesia. - Defective ciliary action in the **respiratory tract** prevents proper clearance of mucus and pathogens, leading to chronic infections.

Q: The 'steeple sign' on X-ray neck (as shown in the image) is characteristically seen in which of the following diseases?

Croup. ***Croup*** - The image suggests a **steeple sign** on the X-ray neck, which corresponds to the subglottic narrowing characteristic of croup. - Croup, primarily caused by **parainfluenza virus**, leads to inflammation and edema below the vocal cords reducing the airway. *Epiglottitis* - Epiglottitis is characterized by a **"thumb sign"** on lateral neck X-ray, indicating a swollen epiglottis. - Patients with epiglottitis typically present with rapidly progressing airway obstruction, high fever, and drooling, unlike the gradual onset and barking cough of croup. *Laryngomalacia* - Laryngomalacia involves the **collapse of supraglottic structures** during inspiration, causing inspiratory stridor. - It would not typically present with the subglottic narrowing seen in the image, but rather with dynamic airway changes visualized during endoscopy. *Bronchiolitis* - Bronchiolitis involves inflammation of the **small airways (bronchioles)** and is usually diagnosed clinically, with chest X-rays showing hyperinflation or peribronchial cuffing if at all. - It primarily affects the lower respiratory tract and would not produce findings like the steeple sign on a neck X-ray.

Q: A 2-year-old male boy presenting with sudden severe dyspnea, what is the most common cause?

Foreign body. ***Foreign body aspiration*** - **Sudden onset** of severe dyspnea in a 2-year-old is highly suspicious for foreign body aspiration - Peak age group is **6 months to 3 years** when children explore objects by mouth - Classic triad: **sudden onset choking, coughing, and wheezing** - May present with unilateral wheeze, decreased breath sounds, or respiratory distress - Most common cause of sudden severe dyspnea in this age group *Bronchiolitis* - Typically presents with **gradual onset** over 2-3 days - Preceded by **prodromal upper respiratory symptoms** (rhinorrhea, cough, low-grade fever) - Peak incidence in **infants <1 year** (especially 3-6 months) - Would not cause sudden severe dyspnea without preceding symptoms *Acute severe asthma* - Can cause sudden severe dyspnea but less common in children <3 years - Usually has **history of previous wheezing episodes** or atopy - Often triggered by viral infection or allergen exposure - Bilateral wheezing with prolonged expiration *Anaphylaxis* - Causes sudden severe respiratory distress but accompanied by **systemic features** - Associated symptoms: urticaria, angioedema, hypotension, GI symptoms - Requires history of **allergen exposure** (food, drug, insect sting) - Would present with stridor (upper airway edema) rather than isolated dyspnea

Q: Most dangerous sign in lower respiratory tract infection (LRTI) in children is:

Grunting. ***Grunting*** - **Grunting** is an expiratory sound produced by partial closure of the glottis to maintain positive end-expiratory pressure (PEEP), indicating **severe respiratory distress** and **impending respiratory failure**. - This compensatory mechanism suggests significant **alveolar collapse** or **pulmonary edema** and is a **critical danger sign** requiring immediate intervention in children with LRTI. - According to WHO and IMNCI guidelines, grunting is classified as a **danger sign** warranting urgent referral and management. *Incorrect: Chest retraction* - **Chest retractions** occur when the intercostal muscles, suprasternal, or subcostal areas pull inward during inspiration due to increased negative intrathoracic pressure. - Although it is a sign of respiratory distress indicating increased work of breathing, it is less dire than grunting, which signifies a more critical phase of respiratory failure. *Incorrect: Tachypnea* - **Tachypnea** (increased respiratory rate) is an early and common sign of LRTI in children, as the body attempts to compensate for hypoxemia or increased metabolic demand. - While concerning, it is often an initial response and, by itself, is not as immediately life-threatening as grunting, which suggests severe impairment of gas exchange. *Incorrect: Abdominal breathing* - **Abdominal breathing** (or diaphragmatic breathing) is a normal compensatory mechanism in infants and young children during respiratory distress. - While it indicates increased work of breathing, it is not as dangerous as grunting, which signifies a more advanced stage of respiratory compromise.

Q: In a child with exercise-induced asthma, which action is recommended?

Prophylaxis with beta-agonist. ***Prophylaxis with beta-agonist*** - **Short-acting beta-agonists (SABAs)** like albuterol are the first-line treatment for preventing **exercise-induced bronchoconstriction** when taken 15-30 minutes before physical activity. - They work by **relaxing the smooth muscles** of the airways, opening them up and making it easier to breathe during exercise. *Prophylaxis with steroids* - **Inhaled corticosteroids** are primarily used for **long-term control** of persistent asthma, reducing airway inflammation. - They are not typically used as a **preventative measure immediately prior to exercise** for exercise-induced bronchoconstriction. *Prophylaxis with theophylline* - **Theophylline** is a bronchodilator with a **narrow therapeutic index** and significant side effects, making it a less preferred option for asthma prophylaxis. - It is generally reserved for patients who are not well-controlled on other standard therapies and requires **therapeutic drug monitoring**. *Breathing exercise* - While **breathing exercises** can be beneficial for overall lung health and managing asthma symptoms, they are not a substitute for pharmacological prophylaxis in preventing **acute exercise-induced bronchoconstriction**. - They may complement medication but do not provide the **immediate bronchodilation** needed before exercise.

Question 1

A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Accepted Answer

Swyer-James-MacLeod syndrome

Answer

Immotile cilia syndrome

Answer

Kartagener syndrome

Answer

Mendelson syndrome

Question 2

Which one of the following conditions does not typically present with inspiratory stridor in children?

Accepted Answer

Bronchiolitis

Answer

Laryngomalacia

Answer

Acute epiglottitis

Answer

Croup

Question 3

A 10-year-old male child presenting with complaints of poor growth, poor appetite, short stature, clubbing, and recurrent chest infections, along with steatorrhea, is most likely diagnosed with what?

Accepted Answer

Cystic fibrosis

Answer

Celiac Disease

Answer

Biliary cirrhosis

Answer

Bronchiectasis

Question 4

What is the most appropriate antibiotic choice for a 4-year-old unvaccinated child with epiglottitis?

Accepted Answer

Ceftriaxone or cefotaxime

Answer

Administering a vaccine

Answer

Doxycycline for 4 days

Answer

Immediate airway assessment and management

Question 5

A child with recent onset of upper respiratory tract infection after 2 days presents with acute onset of breathlessness, cough, and fever. Which of the following treatments is contraindicated?

Accepted Answer

Morphine

Answer

Antipyretics

Answer

Antibiotics

Answer

O2 inhalation

Question 6

Which of the following is not associated with primary ciliary dyskinesia?

Accepted Answer

Hypothyroidism

Answer

Sinusitis

Answer

Respiratory infection

Answer

Sterility in males

Question 7

The 'steeple sign' on X-ray neck (as shown in the image) is characteristically seen in which of the following diseases?

Accepted Answer

Croup

Answer

Epiglottitis

Answer

Laryngomalacia

Answer

Bronchiolitis

Question 8

A 2-year-old male boy presenting with sudden severe dyspnea, what is the most common cause?

Accepted Answer

Foreign body

Answer

Acute severe asthma

Answer

Bronchiolitis

Answer

Anaphylaxis

Question 9

Most dangerous sign in lower respiratory tract infection (LRTI) in children is:

Accepted Answer

Grunting

Answer

Chest retraction

Answer

Tachypnea

Answer

Abdominal breathing

Question 10

In a child with exercise-induced asthma, which action is recommended?

Accepted Answer

Prophylaxis with beta-agonist

Answer

Prophylaxis with steroids

Answer

Prophylaxis with theophylline

Answer

Breathing exercise

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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