Respiratory Diseases Practice Questions

Q: An 18-month-old child presents with a history of fever and cough. On examination, the weight is 11.5 kg, respiratory rate is 46/min, and there is no chest indrawing. What is the most appropriate management?

Oral amoxicillin for 5 days and send home.. ### Explanation This question tests the clinical application of the **IMNCI (Integrated Management of Neonatal and Childhood Illness)** guidelines for the management of Acute Respiratory Infections (ARI). **1. Why Option C is Correct:** The child’s classification is **Pneumonia** (Non-severe). According to IMNCI criteria for a child aged 2 months to 5 years: * **Fast breathing** is defined as a respiratory rate (RR) $\geq$ 40/min (for ages 12 months to 5 years). * Since this 18-month-old has an **RR of 46/min** but **no chest indrawing** and no "danger signs," they are classified as having Pneumonia. * **Management:** The standard treatment for non-severe pneumonia is **Oral Amoxicillin** (40 mg/kg/day in two divided doses) for **5 days**. The child can be managed at home with instructions on supportive care and when to return. **2. Why Other Options are Incorrect:** * **Options A & B:** These are reserved for **Severe Pneumonia** or **Very Severe Disease**, characterized by chest indrawing or "General Danger Signs" (inability to drink/breastfeed, persistent vomiting, lethargy/unconsciousness, or convulsions). This child does not meet these criteria. * **Option D:** Home remedies (like soothing the throat with honey) are indicated for "No Pneumonia" (Cough/Cold), where the RR is < 40/min and no indrawing is present. **3. High-Yield Clinical Pearls for NEET-PG:** * **Cut-off for Fast Breathing:** * < 2 months: $\geq$ 60/min * 2–12 months: $\geq$ 50/min * 12 months–5 years: $\geq$ 40/min * **Drug of Choice:** Oral Amoxicillin has replaced Cotrimoxazole as the first-line drug for pneumonia in the revised IMNCI guidelines. * **Follow-up:** A child treated for pneumonia at home must be reassessed after **2 days** (48 hours).

Q: A 20-day-old neonate presents with non-passage of meconium, rectal prolapse, poor growth, and delayed maturation. The neonate has been hospitalized for 10 days due to a respiratory tract infection. On examination, increased anteroposterior diameter of the chest, generalized hyperresonance, scattered coarse crackles, digital clubbing, a protuberant abdomen, and decreased muscle mass are noted. X-ray and USG of the abdomen were performed. Which of the following drugs can be used in the treatment of the disease suggested by these findings, except?

None of the above. ### **Explanation** The clinical presentation of delayed meconium passage, rectal prolapse, failure to thrive (poor growth/decreased muscle mass), and recurrent respiratory infections (increased AP diameter, crackles, clubbing) in a neonate is a classic description of **Cystic Fibrosis (CF)**. **1. Why the Correct Answer is "None of the above":** The question asks which drug **cannot** be used (except) for the treatment of CF. However, all the listed options (A, B, and C) are established components of CF management. Therefore, "None of the above" is the correct choice because all three drugs are actually used in treatment. **2. Analysis of Options:** * **Ivacaftor (Option A):** A CFTR potentiator that improves the function of the defective chloride channel. It is specifically used for patients with "gating" mutations (like G551D). * **Dornase alpha (Option B):** A recombinant human DNase that breaks down extracellular DNA in the thick mucus of CF patients, reducing sputum viscosity and improving lung function. * **Mannitol (Option C):** Inhaled hypertonic mannitol acts as an osmotic agent that draws water into the airway surface liquid, facilitating mucociliary clearance. **3. Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Sweat Chloride Test (Value >60 mEq/L). * **Most Common Mutation:** ΔF508 (Class II mutation - protein misfolding). * **Gastrointestinal Hallmark:** Meconium ileus (earliest manifestation) and Pancreatic Insufficiency (leading to steatorrhea and fat-soluble vitamin deficiency). * **Radiology:** "Finger-in-glove" appearance due to mucoid impaction. * **Microbiology:** *Staphylococcus aureus* is the most common pathogen in early childhood; *Pseudomonas aeruginosa* becomes dominant in older children/adults.

Q: Which one of the following causes Pectus carinatum?

Childhood asthma. **Explanation:** **Pectus carinatum** (pigeon chest) is a chest wall deformity characterized by the outward protrusion of the sternum and ribs. **Why Childhood Asthma is correct:** Chronic, severe childhood asthma leads to recurrent airway obstruction and hyperinflation of the lungs. During growth, the persistent increased work of breathing and the use of accessory muscles exert chronic outward pressure on the developing, pliable thoracic cage. This mechanical stress results in the permanent outward bowing of the sternum. In contrast, **Pectus excavatum** (funnel chest) is often associated with conditions like Marfan syndrome or rickets. **Analysis of Incorrect Options:** * **Pulmonary Emphysema:** While emphysema causes a **"Barrel Chest"** (increased anteroposterior diameter due to air trapping), it is typically a disease of adults. Pectus carinatum specifically refers to a structural deformity occurring during the developmental years of the skeletal system. * **Atelectasis:** This involves lung collapse, which leads to a *decrease* in thoracic volume. If chronic and unilateral, it may cause a flattening or indrawing of the chest wall on the affected side, not a protrusion. * **Lobar Pneumonia:** This is an acute infectious process. Structural bony deformities like pectus carinatum require chronic, long-term mechanical stress and do not result from short-term inflammatory conditions. **High-Yield Clinical Pearls for NEET-PG:** * **Harrison’s Sulcus:** A horizontal groove along the lower border of the thorax (at the insertion of the diaphragm), often seen in children with chronic asthma or rickets. * **Barrel Chest:** Characteristic of COPD/Emphysema (Ratio of AP to Transverse diameter becomes 1:1). * **Rachitic Rosary:** Knobby deformities at the costochondral junctions, pathognomonic for Rickets.

Q: The first child of a normal couple was diagnosed to have cystic fibrosis. What is the percentage of the chances for the second child to be affected?

25%. **Explanation:** **1. Why Option C is correct:** Cystic Fibrosis (CF) is an **Autosomal Recessive (AR)** disorder caused by mutations in the CFTR gene. In this scenario, since the couple is "normal" (phenotypically healthy) but has an affected child, both parents must be **obligate carriers** (Heterozygous, Aa). According to Mendelian genetics, a cross between two carriers (Aa x Aa) results in: * 25% chance of being affected (aa) * 50% chance of being a carrier (Aa) * 25% chance of being genetically normal (AA) Therefore, for every subsequent pregnancy, there is a **1 in 4 (25%)** chance of the child being affected. **2. Why other options are incorrect:** * **Option A (50%):** This would be the risk if one parent was affected (aa) and the other was a carrier (Aa), or in Autosomal Dominant conditions where one parent is affected. * **Option B (0%):** This is incorrect because both parents carry the recessive allele; the risk is never zero in subsequent pregnancies. * **Option D (100%):** This would only occur if both parents were affected by the disease (aa x aa). **Clinical Pearls for NEET-PG:** * **Most common mutation in CF:** ΔF508 (Class II defect - protein misfolding). * **Gold Standard Diagnosis:** Sweat Chloride Test (Value >60 mEq/L is diagnostic). * **Common presentation:** Recurrent pneumonia, pancreatic insufficiency, and meconium ileus (earliest manifestation). * **Other AR disorders to remember:** Sickle Cell Anemia, Thalassemia, Phenylketonuria, and Wilson’s Disease. * **Recurrence Risk:** In AR disorders, the risk remains 25% for *each* pregnancy, regardless of the outcome of previous siblings.

Q: An 18-month-old child presents with low-grade fever, stridor, and barking cough. A chest X-ray was taken. What is the line of treatment?

Single dose of dexamethasone. **Explanation:** The clinical presentation of low-grade fever, barking cough, and inspiratory stridor in an 18-month-old is classic for **Croup (Laryngotracheobronchitis)**, most commonly caused by the Parainfluenza virus. The characteristic X-ray finding (implied) is the **"Steeple Sign,"** representing subglottic narrowing. **Why Dexamethasone is correct:** Corticosteroids are the mainstay of treatment for Croup. A **single dose of Dexamethasone** (0.15 mg/kg to 0.6 mg/kg, orally or parenterally) reduces laryngeal mucosal edema. It has been shown to decrease the severity of symptoms, reduce the need for hospitalization, and shorten the duration of stay. In moderate to severe cases, nebulized L-epinephrine is added for rapid symptomatic relief. **Why other options are incorrect:** * **A. Third-generation cephalosporins:** These are used for **Acute Epiglottitis** (caused by *H. influenzae*), which presents with high fever, drooling, and a "Thumb sign" on X-ray. Croup is viral and does not require antibiotics. * **B. Heimlich's maneuver:** This is the emergency management for **Foreign Body Aspiration**, which typically presents with sudden-onset choking and unilateral wheezing, not a prodromal fever. * **C. Reassurance:** While mild croup can be managed at home, "reassurance" alone is insufficient as Dexamethasone is now recommended for even mild cases to prevent progression. **NEET-PG High-Yield Pearls:** * **Most common cause:** Parainfluenza virus Type 1. * **X-ray Sign:** Steeple sign (Subglottic narrowing) on AP view. * **Age group:** 6 months to 3 years. * **Scoring system:** Westley Croup Score is used to assess severity. * **Key differentiator:** Epiglottitis has a "cherry-red epiglottis" and no barking cough; Croup has a barking cough and subglottic edema.

Q: In a child with exercise-induced asthma, which of the following is the most appropriate prophylactic treatment?

Prophylaxis with montelukast. **Explanation:** **Why Montelukast is the Correct Answer:** Exercise-induced bronchoconstriction (EIB) is primarily mediated by the release of **leukotrienes** and mast cell degranulation triggered by the inhalation of cool, dry air. **Montelukast**, a Leukotriene Receptor Antagonist (LTRA), is highly effective for long-term prophylaxis in children with exercise-induced asthma. It provides a sustained protective effect (up to 24 hours) and, unlike beta-agonists, does not lead to the development of tachyphylaxis (tolerance) with daily use. In the context of pediatric management, it is often preferred for its oral administration and systemic efficacy in preventing exercise-related symptoms. **Analysis of Incorrect Options:** * **Option A (Inhaled Corticosteroids):** While ICS are the gold standard for *chronic persistent asthma*, they are not the specific first-line choice for isolated exercise-induced symptoms unless the patient has underlying daily asthma. * **Option B (Short-acting Beta-agonists - SABA):** SABAs (like Salbutamol) are excellent for *immediate* pre-exercise prevention (taken 15–30 minutes before). However, frequent use leads to **tachyphylaxis**, reducing their duration of action and effectiveness over time. * **Option D (Breathing exercises):** While helpful as an adjunct therapy to improve lung capacity, they cannot prevent the biochemical inflammatory cascade that causes EIB. **NEET-PG High-Yield Pearls:** * **Diagnosis:** EIB is diagnosed by a **≥10-15% drop in FEV1** after a standardized exercise challenge. * **Drug of Choice for Acute Prevention:** SABA is the most effective for *immediate* protection, but **Montelukast** is the preferred *prophylactic* agent for long-term control in children to avoid tolerance. * **Cromolyn Sodium:** Another option for EIB (stabilizes mast cells), but less commonly used now due to the superior efficacy of LTRAs and SABAs.

Question 1

An 18-month-old child presents with a history of fever and cough. On examination, the weight is 11.5 kg, respiratory rate is 46/min, and there is no chest indrawing. What is the most appropriate management?

Accepted Answer

Oral amoxicillin for 5 days and send home.

Answer

Intravenous antibiotics at the PHC and observe.

Answer

Give the first dose of intravenous antibiotics and refer to a higher center.

Answer

Home remedies.

Question 2

A 20-day-old neonate presents with non-passage of meconium, rectal prolapse, poor growth, and delayed maturation. The neonate has been hospitalized for 10 days due to a respiratory tract infection. On examination, increased anteroposterior diameter of the chest, generalized hyperresonance, scattered coarse crackles, digital clubbing, a protuberant abdomen, and decreased muscle mass are noted. X-ray and USG of the abdomen were performed. Which of the following drugs can be used in the treatment of the disease suggested by these findings, except?

Accepted Answer

None of the above

Answer

Ivacaftor

Answer

Dornase alpha (Pulmozyme)

Answer

Mannitol

Question 3

Which one of the following causes Pectus carinatum?

Accepted Answer

Childhood asthma

Answer

Pulmonary emphysema

Answer

Atelectasis

Answer

Lobar pneumonia

Question 4

Which organism most commonly causes bronchitis in children?

Accepted Answer

Haemophilus influenzae

Answer

Respiratory Syncytial Virus (RSV)

Answer

Mycoplasma pneumoniae

Answer

Epstein-Barr Virus (EBV)

Question 5

The first child of a normal couple was diagnosed to have cystic fibrosis. What is the percentage of the chances for the second child to be affected?

Accepted Answer

25%

Answer

50%

Answer

0%

Answer

100%

Question 6

An 18-month-old child presents with low-grade fever, stridor, and barking cough. A chest X-ray was taken. What is the line of treatment?

Accepted Answer

Single dose of dexamethasone

Answer

Third-generation cephalosporins

Answer

Heimlich's maneuver

Answer

Reassurance

Question 7

What is the preferred inhalation method for a 3-year-old child with bronchial asthma?

Accepted Answer

Metered Dose Inhaler (MDI) with a spacer and a face mask

Answer

Metered Dose Inhaler (MDI) with a spacer

Answer

Metered Dose Inhaler (MDI) directly

Answer

Rotary capsule (Rotacap)

Question 8

A child with a known history of bronchial asthma presents with respiratory distress, a respiratory rate of 48/min, and can speak barely two words. Nebulized salbutamol was administered, after which the child could speak a sentence, but SpO2 fell from 95% to 85%. What is the most likely explanation for this clinical scenario?

Accepted Answer

Ventilation-perfusion mismatch due to increased dead space ventilation

Answer

Intra-thoracic shunting

Answer

Adverse effect of salbutamol

Answer

Faulty pulse oximeter reading

Question 9

In a child with exercise-induced asthma, which of the following is the most appropriate prophylactic treatment?

Accepted Answer

Prophylaxis with montelukast

Answer

Prophylaxis with inhaled corticosteroids

Answer

Prophylaxis with a short-acting beta-agonist taken just before exercise

Answer

Breathing exercises

Question 10

An 11-month-old child presents with a respiratory rate of 58 per minute and cough, without chest indrawing. What is the next step in management?

Accepted Answer

Antibiotic with home care

Answer

Reassurance to the parent

Answer

Urgent referral to a hospital

Answer

Nasal saline drops

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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