Respiratory Diseases Practice Questions

Q: Which of the following is the most likely diagnosis in a child presenting with increased cough at night?

Asthma. **Explanation:** **Asthma** is the most likely diagnosis because **nocturnal cough** is a hallmark clinical feature of the disease. The worsening of symptoms at night (and early morning) occurs due to the circadian rhythm of the body, which leads to a natural dip in endogenous cortisol levels, increased vagal tone (causing bronchoconstriction), and decreased airway caliber. In pediatric practice, a chronic, dry, irritating cough that occurs exclusively or predominantly at night is often considered "Cough Variant Asthma" until proven otherwise. **Analysis of Incorrect Options:** * **Pneumonia:** Typically presents with high-grade fever, productive cough, tachypnea, and localized chest signs (crepitations/dullness). The cough is persistent throughout the day rather than specifically nocturnal. * **Bronchiolitis:** Primarily affects infants (<2 years) and presents with acute onset wheezing, respiratory distress, and signs of viral prodrome (rhinorrhea). It is an acute inflammatory process, not a chronic nocturnal pattern. * **Laryngomalacia:** The most common cause of congenital stridor. It presents with **inspiratory stridor** that typically worsens when the infant is supine or crying, but it is characterized by noisy breathing rather than an isolated nocturnal cough. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Asthma is a clinical diagnosis; however, in children >5 years, Spirometry (showing reversibility with bronchodilators >12% improvement in FEV1) is the gold standard. * **Cough Variant Asthma:** A phenotype where cough is the only symptom; it responds well to inhaled corticosteroids (ICS). * **Rule of Thumb:** Any child with recurrent "bronchitis" or nocturnal cough should be evaluated for Asthma.

Q: Which one of the following values is not a feature of acute severe asthma?

PEF of 60 to 70% of expected. **Explanation:** The classification of asthma severity is a high-yield topic for NEET-PG. To identify the correct answer, one must distinguish between **Moderate** and **Acute Severe Asthma** (Status Asthmaticus). **1. Why Option B is the correct answer:** In **Acute Severe Asthma**, the Peak Expiratory Flow (PEF) is significantly reduced, typically **less than 50%** of the predicted or best value. A PEF of 60–70% is characteristic of a **Moderate Exacerbation**. Therefore, this value is "not a feature" of the severe category. **2. Analysis of Incorrect Options (Features of Severe Asthma):** * **Heart rate > 110/min (Option A):** Tachycardia is a physiological response to respiratory distress, hypoxia, and increased work of breathing. In children, the threshold varies by age, but >110 bpm is a standard marker for severity in adults and older children. * **Pulsus Paradoxus (Option C):** This refers to an exaggerated fall in systolic BP (>10 mmHg) during inspiration. In severe asthma, massive negative intrathoracic pressure is required to breathe, which impacts cardiac filling and output. Its presence signifies significant airway obstruction. * **PaO2 < 8 kPa (Option D):** 8 kPa is approximately **60 mmHg**. Hypoxemia (PaO2 < 60 mmHg) without cyanosis is a hallmark of severe asthma. If the PaO2 drops further or PaCO2 begins to rise (normalizing or increasing), it indicates impending respiratory failure. **Clinical Pearls for NEET-PG:** * **Silent Chest:** The most ominous sign in asthma; it indicates such little air movement that wheezing disappears. * **Normal PaCO2:** In an acute attack, a patient should be hyperventilating (low PaCO2). A "normal" PaCO2 (40 mmHg) in a struggling asthmatic is a sign of muscle fatigue and **impending respiratory failure**. * **Life-threatening features:** PEF < 33%, SpO2 < 92%, silent chest, cyanosis, exhaustion, or hypotension.

Q: An 8-year-old child presents with a 7-month history of cough, a 1-month history of hemoptysis, and a 4-day history of fever. An X-ray shows the following findings. What is your diagnosis?

Consolidation. ***Consolidation*** - The presence of **homogeneous opacity with air bronchograms** on chest X-ray in a child with chronic cough, hemoptysis, and fever is characteristic of **pulmonary consolidation**. - **Air bronchograms** (air-filled bronchi visible within the consolidated lung tissue) are pathognomonic for consolidation, distinguishing it from other conditions. *Hydatid cyst* - Typically presents as a **well-defined, round, homogeneous opacity** without air bronchograms on chest X-ray. - May show the classic **water lily sign** when the cyst ruptures, creating a characteristic appearance of floating membranes. *Lung abscess* - Characteristically shows a **thick-walled cavity with an air-fluid level** on chest X-ray, not homogeneous opacity. - Usually presents with **purulent sputum** and systemic toxicity, rather than the gradual onset described. *Thoracic duct malformations* - Extremely **rare condition** in pediatric patients, typically presenting with **chylothorax** (milky pleural effusion). - Would show **pleural fluid collection** rather than parenchymal consolidation with air bronchograms.

Q: A young boy developed respiratory distress. On examination, the chest X-ray showed hyperinflation of one lung. Which of the following is the most possible diagnosis?

Foreign body aspiration. ### Explanation The correct answer is **Foreign body aspiration (FBA)**. **Why it is correct:** In pediatric patients, foreign body aspiration often acts as a **"ball-valve" mechanism**. During inspiration, the airways dilate, allowing air to pass the obstruction. However, during expiration, the airways narrow, causing the foreign body to completely occlude the lumen. This results in air-trapping and subsequent **obstructive hyperinflation** of the affected lung. While Congenital Lobar Emphysema (CLE) also causes hyperinflation, FBA is statistically the most common cause of sudden-onset respiratory distress with unilateral hyperinflation in a previously healthy child. **Why the other options are incorrect:** * **Congenital Lobar Emphysema (CLE):** While it presents with hyperinflation, it is typically diagnosed in the **neonatal period or early infancy** (usually <6 months) due to cartilage deficiency. The question implies a "young boy," suggesting an older age group where FBA is more prevalent. * **Atelectasis:** This involves the collapse of lung tissue, which would show **opacity and volume loss** (mediastinal shift toward the lesion) on X-ray, rather than hyperinflation. * **Bronchiectasis:** This is a chronic condition characterized by permanent dilation of bronchi. X-ray findings typically show "tram-track" opacities or cystic changes, not acute unilateral hyperinflation. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis/Management:** Rigid Bronchoscopy (for both diagnosis and removal). * **Classic Triad:** Sudden onset of coughing, wheezing, and diminished breath sounds (though only present in ~50% of cases). * **Radiology:** If the X-ray is inconclusive, perform **expiratory films** or lateral decubitus films; the affected lung will fail to collapse.

Q: A 7-year-old child presents with a non-productive cough and mild stridor for the past 6 months. While improving on oral antibiotics, the child suddenly develops wheezing, productive cough, and mild fever. X-ray shows hyperlucency and PFTs show an obstructive curve. What is the most probable diagnosis?

Bronchiolitis obliterans. **Explanation:** **Bronchiolitis Obliterans (BO)** is a chronic obstructive lung disease resulting from an insult to the lower respiratory tract, leading to inflammation and fibrosis of the small airways (bronchioles). 1. **Why it is correct:** The clinical presentation is classic for BO. It typically follows an acute insult (often viral like Adenovirus or Mycoplasma). The key features here are the **chronic nature** (6 months), the **obstructive pattern** on PFTs, and **hyperlucency** on X-ray (representing air trapping due to small airway obstruction). The sudden worsening with productive cough and fever suggests a secondary infection on a background of damaged airways. 2. **Why the other options are incorrect:** * **Post-viral syndrome:** Usually presents as a transient cough or airway hyper-reactivity that resolves within weeks, not a progressive 6-month obstructive disease with radiological changes. * **Follicular Bronchitis:** This is a lymphoproliferative disorder often associated with immunodeficiency or connective tissue diseases. While it causes obstruction, it typically presents with diffuse nodules on CT rather than simple hyperlucency. * **Pulmonary Alveolar Microlithiasis:** A rare genetic disorder characterized by calcium phosphate deposits in alveoli. The X-ray would show a pathognomonic "sandstorm" appearance (diffuse fine opacities), not hyperlucency. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Lung biopsy (shows partial or complete occlusion of the lumen by fibrosis). * **Radiology:** "Mosaic perfusion" on HRCT is the most characteristic finding. * **Common Trigger:** Adenovirus (serotypes 3, 7, 21) is the most common cause of post-infectious BO in children. * **PFT:** Fixed airway obstruction that does not respond significantly to bronchodilators.

Question 1

Which of the following is the most likely diagnosis in a child presenting with increased cough at night?

Accepted Answer

Asthma

Answer

Pneumonia

Answer

Bronchiolitis

Answer

Laryngomalacia

Question 2

A child presents with fever, stridor, and barking cough. An X-ray is provided below. Which of the following is true about the patient?

Accepted Answer

Symptoms are predominantly caused by involvement of the subglottis.

Answer

Antibiotics should be started immediately.

Answer

The X-ray is showing the thumb sign.

Answer

The condition is caused by H. influenzae b.

Question 3

Which of the following is FALSE regarding cystic fibrosis?

Accepted Answer

It is associated with chromosome 7.

Answer

It is associated with the CFTR gene.

Answer

It follows autosomal recessive inheritance.

Answer

It is characterized by recurrent respiratory tract infections.

Question 4

Which one of the following values is not a feature of acute severe asthma?

Accepted Answer

PEF of 60 to 70% of expected

Answer

Heart rate more than 110/min

Answer

Pulsus paradoxus

Answer

PaO2 of less than 8 kPa

Question 5

Which of the following findings are true about bronchiolitis in children?

Accepted Answer

Caused by respiratory syncytial virus, hyperinflation of the chest, and may lead to bronchial asthma later in life

Answer

Hyperinflation of the chest, pleural effusion, and may lead to bronchial asthma later in life

Answer

Caused by respiratory syncytial virus and hyperinflation of the chest

Question 6

An 8-year-old child presents with a 7-month history of cough, a 1-month history of hemoptysis, and a 4-day history of fever. An X-ray shows the following findings. What is your diagnosis?

Accepted Answer

Consolidation

Answer

Hydatid cyst

Answer

Lung abscess

Answer

Thoracic duct malformations

Question 7

A young boy developed respiratory distress. On examination, the chest X-ray showed hyperinflation of one lung. Which of the following is the most possible diagnosis?

Accepted Answer

Foreign body aspiration

Answer

Congenital lobar emphysema

Answer

Bronchiectasis

Answer

Atelectasis

Question 8

What is the most common contributory factor to respiratory failure in patients with cystic fibrosis?

Accepted Answer

Pseudomonas infection

Answer

Haemophilus influenzae infection

Answer

Associated heart failure

Answer

Hypokalemia

Question 9

A 7-year-old child presents with a non-productive cough and mild stridor for the past 6 months. While improving on oral antibiotics, the child suddenly develops wheezing, productive cough, and mild fever. X-ray shows hyperlucency and PFTs show an obstructive curve. What is the most probable diagnosis?

Accepted Answer

Bronchiolitis obliterans

Answer

Post-viral syndrome

Answer

Follicular bronchitis

Answer

Pulmonary alveolar microlithiasis

Question 10

A 3-year-old female child developed fever, cough, and respiratory distress. Chest X-ray shows consolidation in the right lower lobe. She improved with antibiotics, but on follow-up at 8 weeks, increasing consolidation was noted in the right lower lobe. What would be your next investigation?

Accepted Answer

CT scan of the chest

Answer

Bronchoscopy

Answer

Bacterial culture of the nasopharynx

Answer

Allergen sensitivity test

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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