Respiratory Diseases Practice Questions

Q: All of the following are used in the acute attack of asthma in a 4-year-old child, except:

Sedatives. In the management of acute asthma, the primary goal is to relieve airway obstruction and reduce inflammation. **Why Sedatives are Contraindicated (Correct Answer):** Sedatives (such as benzodiazepines or promethazine) are strictly contraindicated in acute asthma. They cause **respiratory center depression**, which can lead to hypoventilation, hypercapnia, and respiratory failure. In a child struggling to breathe, anxiety is often a physiological sign of hypoxia; suppressing this drive can be fatal. **Explanation of Other Options:** * **Salbutamol (Short-Acting Beta-2 Agonist):** This is the **first-line treatment** (Gold Standard) for acute attacks. It acts rapidly to cause bronchodilation by relaxing airway smooth muscle. * **Corticosteroids:** These are essential in acute management to reduce airway inflammation and edema. They prevent late-phase reactions and reduce the risk of relapse. Systemic steroids (oral or IV) are typically used in acute exacerbations. * **Theophylline:** While no longer first-line due to a narrow therapeutic index and side effects, intravenous Aminophylline/Theophylline can be used as an **add-on therapy** in severe refractory asthma (Status Asthmaticus) that does not respond to initial bronchodilators. **Clinical Pearls for NEET-PG:** * **Drug of Choice (Acute):** Inhaled Salbutamol (via MDI with spacer or nebulization). * **Most sensitive indicator of severity:** Use of accessory muscles and inability to speak in full sentences. * **Silent Chest:** A grave clinical sign indicating minimal air entry; it is a medical emergency. * **Magnesium Sulfate:** Used intravenously in severe cases for its smooth muscle relaxant properties.

Q: A 3-year-old, well-immunized male child presents with sore throat, fever, noisy breathing, and inability to swallow for the past four hours. Examination reveals a toxic, tachypneic child with inspiratory stridor, suprasternal, supraclavicular, and intercostal retractions during inspiration. What is the most likely diagnosis?

Acute Epiglottitis. **Explanation:** The clinical presentation of a **toxic-looking** child with a rapid onset of high fever, sore throat, **drooling (inability to swallow)**, and inspiratory stridor is classic for **Acute Epiglottitis**. This is a life-threatening pediatric emergency involving inflammation of the supraglottic structures. The "4 Ds" (Drooling, Dysphagia, Distress, and Dysphonia) are hallmark signs. Despite being well-immunized (which reduces the risk of *H. influenzae* type b), other pathogens like *Streptococcus pyogenes* or *Staphylococcus aureus* can still cause the condition. **Why other options are incorrect:** * **Acute Laryngotracheobronchitis (Croup):** Typically presents with a "barking" cough, hoarseness, and a slower prodrome of URI symptoms. The child is usually not "toxic" or drooling. * **Diphtheria:** Characterized by a slow onset, low-grade fever, and a thick, grey, adherent **pseudomembrane** on the tonsils/pharynx. It does not typically cause the acute, fulminant respiratory distress seen here. * **Bronchopneumonia:** Presents with cough, rales/crepitations, and expiratory wheezing rather than inspiratory stridor. Stridor indicates an upper airway obstruction. **NEET-PG High-Yield Pearls:** * **X-ray Finding:** Lateral neck X-ray shows the **"Thumb sign"** (swollen epiglottis). * **Management:** The priority is **airway stabilization** (intubation) in a controlled environment (OR). Do not examine the throat with a tongue depressor, as it may trigger fatal laryngospasm. * **Positioning:** Children often assume the **"Tripod position"** (leaning forward on hands) to maximize airway diameter.

Q: What is the most likely etiology in a 10-month-old child with a 7-day history of high-grade fever, exhibiting the following X-ray findings, and not responding to ceftriaxone?

Staphylococcus aureus. ***Staphylococcus aureus*** - Characteristic X-ray findings in infants include **pneumatoceles**, **empyema**, and **pyopneumothorax**, which are pathognomonic for staphylococcal pneumonia. - Failure to respond to **ceftriaxone** suggests **MRSA**, as ceftriaxone does not provide adequate coverage against methicillin-resistant strains. *Streptococcus pneumoniae* - Typically responds well to **ceftriaxone** therapy, making this unlikely given the treatment failure described. - Usually presents with **lobar consolidation** on chest X-ray without the characteristic cavitary lesions or pneumatoceles seen with staph infections. *Mycoplasma* - Predominantly affects **school-age children** and adolescents, not typically seen in 10-month-old infants. - Presents with **atypical pneumonia** symptoms including gradual onset, dry cough, and bilateral interstitial infiltrates rather than high-grade fever and cavitary lesions. *Respiratory Syncytial Virus* - Causes **bronchiolitis** with hyperinflation and peribronchial thickening on chest X-ray, not lobar pneumonia with cavitary changes. - Typically presents with **wheezing**, **rhinorrhea**, and **cough** rather than high-grade fever and pneumonic consolidation.

Q: An infant has a positive newborn screening test for cystic fibrosis. What cutoff of sweat chloride concentration confirms cystic fibrosis?

Sweat chloride > 60 mEq/L. **Explanation:** The diagnosis of Cystic Fibrosis (CF) is primarily confirmed using the **Quantitative Pilocarpine Iontophoresis Test (QPIT)**, commonly known as the Sweat Chloride Test. In CF, a defect in the CFTR protein prevents the reabsorption of chloride in the sweat ducts, leading to abnormally high concentrations of salt in the sweat. **1. Why Option D is Correct:** According to the current clinical guidelines (Cystic Fibrosis Foundation), a **sweat chloride concentration of ≥ 60 mmol/L (or mEq/L)** on two separate occasions is considered diagnostic for Cystic Fibrosis in individuals of all ages, including infants identified via newborn screening. **2. Analysis of Incorrect Options:** * **Option A (< 30 mEq/L):** This is considered the **normal** range. CF is highly unlikely at this level. * **Option B & C (30–59 mEq/L):** This range is classified as **Intermediate (Borderline)**. It is not diagnostic of CF but requires further evaluation, such as repeat sweat testing or CFTR genetic mutation analysis (extended sequencing). **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Sweat Chloride Test (QPIT) remains the gold standard for diagnosis. * **Newborn Screening:** Usually involves testing for **Immunoreactive Trypsinogen (IRT)**. If elevated, it is followed by DNA testing or sweat testing. * **False Positives:** Conditions like Adrenal Insufficiency, Ectodermal Dysplasia, Nephrogenic Diabetes Insipidus, and Malnutrition can occasionally cause elevated sweat chloride. * **Genetics:** CF is an Autosomal Recessive disorder; the most common mutation is **ΔF508** on Chromosome 7. * **Clinical Triad:** Chronic sinopulmonary disease, pancreatic insufficiency (steatorrhea), and high sweat chloride levels.

Q: A 1-month-old infant presents with cough and sneezing, a respiratory rate of 40 per minute, and no chest indrawing. What is the most appropriate management?

Frequent breastfeeding. This question tests your ability to classify and manage acute respiratory infections (ARI) in young infants based on the **IMNCI (Integrated Management of Neonatal and Childhood Illness)** guidelines. ### **Explanation** According to IMNCI guidelines, a child aged **0–2 months** with a cough and cold is evaluated based on respiratory rate and signs of distress. * **Normal Respiratory Rate:** In an infant <2 months, a rate of **<60 breaths per minute** is considered normal. * **Signs of Severity:** The absence of fast breathing (≥60 bpm), chest indrawing, or "danger signs" (lethargy, convulsions, persistent vomiting, or inability to feed) classifies this case as **"No Pneumonia: Cough or Cold."** For "No Pneumonia," the management is supportive. **Frequent breastfeeding** is the priority to prevent dehydration, provide immunological support, and soothe the throat. Mothers are advised to keep the nose clear and return if symptoms worsen. ### **Why Other Options are Incorrect** * **A & B (Urgent referral/IV antibiotics):** These are indicated for "Very Severe Disease" (e.g., chest indrawing, grunting, or danger signs). This infant is hemodynamically stable with a normal respiratory rate. * **D (Oral antibiotic syrup):** Antibiotics are indicated for "Pneumonia" (fast breathing). Since this infant's rate is 40 bpm (normal), antibiotics are unnecessary and contribute to resistance. ### **High-Yield Clinical Pearls for NEET-PG** * **IMNCI Cut-offs for Fast Breathing:** * <2 months: ≥60 bpm * 2–12 months: ≥50 bpm * 12 months–5 years: ≥40 bpm * **Chest Indrawing:** In infants <2 months, mild chest indrawing is common; only **severe** chest indrawing is a sign of serious illness. * **Key Management:** For simple cough/cold, avoid over-the-counter cough suppressants in infants; focus on hydration and warmth.

Q: What is the recommended treatment for chlamydial pneumonia?

Erythromycin. **Explanation:** **Chlamydial pneumonia** (caused by *Chlamydia trachomatis*) typically presents in infants aged 1–3 months with a characteristic "staccato cough," tachypnea, and hyperinflation on X-ray, often preceded by neonatal conjunctivitis. **1. Why Erythromycin is Correct:** *Chlamydia trachomatis* is an obligate intracellular bacterium, meaning it lacks a traditional peptidoglycan cell wall. Therefore, it is highly susceptible to **Macrolides**, which inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit. **Erythromycin** (50 mg/kg/day for 14 days) is the traditional drug of choice. It effectively clears the nasopharyngeal carriage and treats the pneumonia. **2. Why the Other Options are Incorrect:** * **Ceftriaxone (B) and Penicillin (C):** These are Beta-lactam antibiotics that act by inhibiting cell wall synthesis. Since *Chlamydia* lacks a typical cell wall, these drugs are entirely ineffective. * **Sulphonamide (D):** While some older texts mention sulfonamides for certain chlamydial infections, they are not the first-line treatment for pneumonia in infants due to the risk of kernicterus and lower efficacy compared to macrolides. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Afebrile illness + Staccato cough + Peripheral eosinophilia (≥400 cells/mm³). * **Association:** About 50% of infants with chlamydial pneumonia have a history of neonatal conjunctivitis (inclusion blennorrhea). * **Alternative:** Azithromycin is increasingly used due to a shorter course and better GI tolerance. * **Caution:** Systemic Erythromycin in infants <2 weeks old is associated with an increased risk of **Infantile Hypertrophic Pyloric Stenosis (IHPS)**; patients should be monitored for symptoms of projectile vomiting.

Question 1

All of the following are used in the acute attack of asthma in a 4-year-old child, except:

Accepted Answer

Sedatives

Answer

Theophylline

Answer

Corticosteroids

Answer

Salbutamol

Question 2

A 4-month-old infant presents with cough and a respiratory rate greater than 60/min, with no chest retractions. What is the appropriate management according to the Integrated Management of Childhood Illness (IMNCI) protocol?

Accepted Answer

Administer oral antibiotics, explain danger signs, and schedule a follow-up.

Answer

Administer intramuscular antibiotics and refer urgently.

Answer

Explain danger signs and schedule a follow-up.

Answer

Administer intramuscular antibiotics and hospitalize.

Question 3

A 3-year-old, well-immunized male child presents with sore throat, fever, noisy breathing, and inability to swallow for the past four hours. Examination reveals a toxic, tachypneic child with inspiratory stridor, suprasternal, supraclavicular, and intercostal retractions during inspiration. What is the most likely diagnosis?

Accepted Answer

Acute Epiglottitis

Answer

Acute Laryngotracheobronchitis

Answer

Diphtheria

Answer

Bronchopneumonia

Question 4

A 14-year-old boy presented with chronic diarrhea and weight loss. History reveals that he has repeated attacks of respiratory tract infections with Pseudomonas aeruginosa. His younger brother died from a severe respiratory infection at the age of 7. Which of the following agents is most likely to improve this patient's condition?

Accepted Answer

Pancreatic lipase

Answer

Octreotide

Answer

Metronidazole

Answer

Loperamide

Question 5

What is the MOST suitable management for a 2-year-old child presenting with cough for 5 days? On examination, the respiratory rate is 40/minute. The child is well-nourished, active, and feeding well.

Accepted Answer

Advise mother to provide home care.

Answer

Start cotrimoxazole in age-appropriate doses.

Answer

Start with the first dose of intramuscular ampicillin.

Answer

None of the above.

Question 6

What is the most likely etiology in a 10-month-old child with a 7-day history of high-grade fever, exhibiting the following X-ray findings, and not responding to ceftriaxone?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Mycoplasma

Answer

Respiratory Syncytial Virus

Question 7

An infant has a positive newborn screening test for cystic fibrosis. What cutoff of sweat chloride concentration confirms cystic fibrosis?

Accepted Answer

Sweat chloride > 60 mEq/L

Answer

Sweat chloride > 30 mEq/L

Answer

Sweat chloride > 40 mEq/L

Answer

Sweat chloride > 50 mEq/L

Question 8

A 1-month-old infant presents with cough and sneezing, a respiratory rate of 40 per minute, and no chest indrawing. What is the most appropriate management?

Accepted Answer

Frequent breastfeeding

Answer

Urgent referral to hospital

Answer

Intravenous antibiotics

Answer

Oral antibiotic syrup

Question 9

A 6-year-old boy presented with recurrent chest infections. Sweat chloride test showed raised values. What is the next best investigation to confirm the diagnosis?

Accepted Answer

Nasal electrode potential difference

Answer

72-hour fecal fat estimation

Answer

CT chest

Answer

DNA analysis of delta F-508 mutation

Question 10

What is the recommended treatment for chlamydial pneumonia?

Accepted Answer

Erythromycin

Answer

Ceftriaxone

Answer

Penicillin

Answer

Sulphonamide

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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