Respiratory Diseases Practice Questions

Q: A 7-year-old child presents with acute shortness of breath that began while playing sports, characterized by paroxysms of wheezing and coughing. The child is found sitting, leaning forward, using accessory respiratory muscles, and is tachypneic and tachycardic. Auscultation reveals a prolonged expiratory phase with high-pitched wheezes. Which of the following medications will have the fastest onset of action for this acute attack?

Albuterol inhalation. **Explanation:** The clinical presentation of acute shortness of breath, wheezing, and use of accessory muscles in a 7-year-old child is classic for an **acute asthma exacerbation**. **1. Why Albuterol is correct:** Albuterol (Salbutamol) is a **Short-Acting Beta-2 Agonist (SABA)**. It is the "gold standard" for acute bronchospasm because it acts directly on the beta-2 receptors of the bronchial smooth muscle, leading to rapid relaxation and bronchodilation. When administered via inhalation (MDI with spacer or nebulization), it has an onset of action within **5 to 15 minutes**, making it the fastest-acting rescue medication among the choices. **2. Why the other options are incorrect:** * **Beclomethasone (B):** This is an Inhaled Corticosteroid (ICS). While essential for long-term control of airway inflammation, its effects take hours to days to manifest. It has no role in the immediate reversal of acute bronchoconstriction. * **Ephedrine oral (C):** Oral medications have a slower onset due to first-pass metabolism and systemic absorption. Furthermore, ephedrine is a non-selective sympathomimetic with significant cardiovascular side effects and is not used in modern asthma management. * **Salmeterol (D):** This is a Long-Acting Beta-2 Agonist (LABA). While it is a potent bronchodilator, it has a slow onset of action (15–30 minutes) and is strictly used for maintenance therapy, never as a monotherapy for acute attacks. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC)** for acute asthma: Inhaled SABA (Albuterol/Salbutamol). * **Silent Chest:** A dangerous clinical sign in severe asthma where airflow is so restricted that wheezing disappears; it indicates impending respiratory failure. * **Pulsus Paradoxus:** A drop in systolic BP >10 mmHg during inspiration, indicating severe airway obstruction. * **Ipratropium Bromide:** Often added to Albuterol in the ER for synergistic effects in moderate-to-severe exacerbations.

Q: A 3-month-old child presents with moderate fever, non-productive cough, and mild dyspnea. After a course of antibiotics, the child showed transient improvement but subsequently developed high fever, productive cough, and increased respiratory distress. Chest X-ray reveals hyperlucency, and Pulmonary Function Tests (PFTs) show an obstructive pattern. What is the most probable diagnosis?

Bronchiolitis obliterans. **Explanation:** The clinical presentation describes a classic biphasic course of **Bronchiolitis Obliterans (BO)**. BO is a chronic obstructive lung disease resulting from an insult to the lower respiratory tract (most commonly post-infectious following Adenovirus or Mycoplasma). 1. **Why it is correct:** The initial phase involves an acute respiratory infection (fever, cough). After a period of relative improvement, the child develops progressive respiratory distress due to fibrotic narrowing and occlusion of the small airways (bronchioles). The characteristic **hyperlucency** on X-ray represents air trapping, and PFTs confirm a **fixed obstructive pattern** that does not respond to bronchodilators. 2. **Why incorrect options are wrong:** * **Alveolar microlithiasis:** A rare genetic condition characterized by calcium phosphate deposits in alveoli. X-ray shows a "sandstorm" appearance (diffuse fine opacities), not hyperlucency. * **Post-viral syndrome:** This is a broad term for lingering symptoms (like a cough) after a virus. It does not typically present with high fever, severe distress, or fixed obstructive PFTs. * **Follicular bronchitis:** Usually associated with immunodeficiency or connective tissue disorders; it presents with peribronchial nodules on CT rather than diffuse hyperlucency. **NEET-PG High-Yield Pearls:** * **Most common cause:** Adenovirus (Serotypes 3, 7, 21). * **Radiology:** Look for the **"Mosaic Perfusion"** pattern on HRCT (areas of air trapping/hypoperfusion mixed with normal lung). * **Key differentiator:** Unlike asthma, the obstruction in BO is **non-reversible** with bronchodilators. * **Management:** Primarily supportive; steroids may be used in the early inflammatory phase, but the damage is often permanent.

Q: A 12-year-old boy presents with intermittent shortness of breath over the past 6 months. He is not on any medications and has no significant family history. Vitals are within normal limits and lungs are clear to auscultation. Lung function tests reveal a FEV1/FVC ratio of 82%. Which of the following would be most helpful in excluding a diagnosis of asthma in this patient?

Negative methacholine challenge. ### Explanation **Correct Answer: C. Negative methacholine challenge** The diagnosis of asthma is based on the demonstration of **reversible airway obstruction**. In this patient, the FEV1/FVC ratio is 82% (normal is typically >75-80% in children), indicating no active obstruction at the time of testing. When a patient has suggestive symptoms but normal spirometry, a **Bronchial Provocation Test** (e.g., Methacholine Challenge) is indicated. Methacholine is a cholinergic agonist that induces bronchoconstriction. A **negative result** (failure to cause a 20% drop in FEV1 at standard doses) has a very high **Negative Predictive Value (NPV)**. Therefore, it is the most helpful tool to **exclude** asthma. If the test is negative, the diagnosis of asthma is highly unlikely. **Why other options are incorrect:** * **A & D (Eosinophilia and IgE):** While asthma is often associated with atopy (Type I Hypersensitivity), many patients have "intrinsic" asthma or non-atopic phenotypes. Normal eosinophil counts and IgE levels do not rule out the disease. * **B (Allergy Skin Tests):** These identify specific triggers (sensitization) but are not diagnostic of asthma itself. Many asymptomatic individuals have positive skin tests, and many asthmatics have negative ones. --- ### High-Yield Clinical Pearls for NEET-PG: * **Gold Standard for Diagnosis:** Spirometry showing reversibility (increase in FEV1 ≥12% and ≥200 mL after bronchodilator inhalation). * **Methacholine Challenge:** Used when spirometry is normal. It is highly sensitive but lacks specificity (can be positive in allergic rhinitis or COPD). * **FEV1/FVC Ratio:** In obstructive diseases like asthma, both FEV1 and FVC decrease, but FEV1 decreases more, leading to a **decreased ratio (<0.75-0.80)**. * **Step-up Therapy:** If a patient is symptomatic on SABA alone, the next step is adding a Low-dose Inhaled Corticosteroid (ICS).

Q: A 2-year-old child presented with the following X-ray finding. What is the most likely diagnosis?

Acute laryngotracheobronchitis. ***Acute laryngotracheobronchitis*** - The **steeple sign** on AP neck X-ray shows **subglottic narrowing**, which is the hallmark radiographic finding of croup in young children. - Typically affects children aged **6 months to 6 years**, caused by **parainfluenza virus**, presenting with **barking cough**, **inspiratory stridor**, and **low-grade fever**. *Acute epiglottitis* - Shows the **thumb sign** on **lateral neck X-ray** due to swollen epiglottis, not the steeple sign seen on AP view. - More common in **older children** and presents with **high fever**, **drooling**, and **tripod positioning** rather than barking cough. *Acute pharyngitis* - Does **not cause subglottic narrowing** or steeple sign on X-ray as it primarily affects the throat/pharynx. - Presents with **sore throat** and **difficulty swallowing** without the characteristic **stridor** or **barking cough** of croup. *Parapharyngeal abscess* - X-ray would show **soft tissue swelling** and possible **airway deviation**, not the typical steeple sign of subglottic narrowing. - Presents with **high fever**, **neck stiffness**, and **muffled voice** rather than the barking cough typical of croup.

Q: What is the commonest sign of an intrabronchial foreign body in children?

Cough. **Explanation:** Foreign body aspiration (FBA) is a common pediatric emergency, most frequently occurring in children aged 1–3 years. **Why Cough is the Correct Answer:** **Cough** is the most common clinical sign and symptom of an intrabronchial foreign body, present in approximately **80–95% of cases**. When a foreign object enters the tracheobronchial tree, it triggers the cough reflex via the sensory receptors of the vagus nerve located in the larynx, trachea, and carina. While the initial "penetration syndrome" (choking and gasping) is classic, a persistent, unexplained cough remains the most consistent finding during the clinical presentation. **Analysis of Incorrect Options:** * **B. Wheeze:** While common, it is often localized or monophonic. It occurs due to partial airway obstruction but is less frequent than a cough. It is often misdiagnosed as asthma. * **C. Dyspnoea:** Shortness of breath occurs if the foreign body is large or causes significant lung collapse/obstructive emphysema, but it is not as universally present as a cough. * **D. Stridor:** This is a sign of **upper airway** (laryngeal or tracheal) obstruction. Since the question specifies an **intrabronchial** (lower airway) location, stridor is less likely than wheezing or coughing. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Cough, wheezing, and diminished breath sounds (found in only ~40% of patients). * **Most Common Site:** The **Right Main Bronchus** (due to it being wider, shorter, and more vertical than the left). * **Radiology:** Most foreign bodies are **radiolucent** (e.g., peanuts). Look for indirect signs like obstructive emphysema (hyperinflation) or atelectasis. * **Gold Standard Diagnosis/Management:** Rigid Bronchoscopy.

Q: All of the following criteria classify a child aged 11 months as having severe pneumonia, except:

Breathing rate > 40 per minute. This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for classifying respiratory infections in children aged 2 months to 5 years. ### **Why Option C is the Correct Answer** In a child aged 11 months, a breathing rate of **>40 per minute** is considered normal or "fast breathing" depending on the age bracket, but it does not define "Severe Pneumonia." According to IMNCI: * **Fast breathing** for an 11-month-old is defined as **≥50 breaths per minute**. * A rate of >40 per minute is only considered "fast breathing" for children aged **1 to 5 years**. * More importantly, tachypnea alone classifies a child as having **Pneumonia**, not **Severe Pneumonia**. ### **Analysis of Incorrect Options (Signs of Severe Pneumonia)** Options A, B, and D are all "General Danger Signs" or signs of severe respiratory distress that upgrade the classification to **Severe Pneumonia/Very Severe Disease**: * **Inability to drink or breastfeed (A):** A general danger sign indicating the child is too weak or distressed to maintain hydration/nutrition. * **Nasal flaring (B) and Grunting (D):** These are signs of significant respiratory distress. Grunting, specifically, is an expiratory sound produced against a partially closed glottis to maintain Functional Residual Capacity (FRC). * **Other signs include:** Chest indrawing (subcostal/intercostal), central cyanosis, lethargy, or convulsions. ### **High-Yield Clinical Pearls for NEET-PG** * **Fast Breathing Cut-offs:** * <2 months: ≥60/min * 2–12 months: ≥50/min * 12 months–5 years: ≥40/min * **Classification Shift:** Under the revised WHO criteria, "Chest Indrawing" now classifies a child as **Pneumonia** (treated with oral Amoxicillin), whereas "Severe Pneumonia" requires IV antibiotics and hospitalization due to the presence of general danger signs or severe distress (grunting/cyanosis).

Q: A 4-year-old child with bronchial asthma presents with 3 or more episodes of wheezing during the daytime in a week and 2 wheezing episodes during the night in a month. How will you grade this asthma?

Mild Persistent. ### Explanation The classification of asthma severity in children is based on the frequency of daytime symptoms, nighttime awakenings, and the use of rescue medications. This grading is essential for determining the initial step of management. **1. Why "Mild Persistent" is correct:** According to the GINA (Global Initiative for Asthma) and standard pediatric guidelines, asthma is classified as **Mild Persistent** when: * **Daytime symptoms:** Occur >2 times per week (but not daily). * **Nighttime symptoms:** Occur 3–4 times per month (for ages 5+) or **1–2 times per month (for ages 3 daytime episodes/week and 2 nighttime episodes/month, fitting the criteria for Mild Persistent asthma. **2. Why other options are incorrect:** * **Mild Intermittent:** Symptoms occur ≤2 days per week and nighttime awakenings are ≤2 times per month (for ages 5+) or 0 times (for ages 1 time per week (but not nightly). * **Severe Persistent:** Symptoms occur **throughout the day** and nighttime awakenings occur **7 times per week (nightly)**. **3. Clinical Pearls for NEET-PG:** * **Step-up Therapy:** For Mild Persistent asthma, the preferred treatment is **Step 2**: Low-dose Inhaled Corticosteroids (ICS) as daily controller therapy. * **Rule of Two:** If a patient uses a rescue inhaler >2 times/week or has >2 nighttime awakenings/month, their asthma is likely not well-controlled and requires a step-up in therapy. * **PFTs:** In children >5 years, FEV1 or PEFR is 80% predicted in Mild Persistent, 60-80% in Moderate, and <60% in Severe Persistent asthma.

Q: A 3-month-old child presents with biphasic stridor and barking cough. All of the following are true regarding this condition EXCEPT:

Antibiotics are used as an initial treatment.. ### Explanation The clinical presentation of **biphasic stridor** and a **barking cough** in an infant is characteristic of **Croup (Laryngotracheobronchitis)**. **1. Why Option D is the Correct Answer (The "Except"):** Croup is primarily caused by **viruses**, most commonly the **Parainfluenza virus (Type 1)**. Since the etiology is viral, **antibiotics are not indicated** as initial treatment. Management focuses on maintaining the airway using humidified oxygen, nebulized adrenaline (to reduce mucosal edema), and corticosteroids (Dexamethasone) to reduce inflammation. **2. Analysis of Other Options:** * **Option A:** On an Anteroposterior (AP) X-ray of the neck, the characteristic finding is the **"Steeple Sign"** due to subglottic narrowing. Additionally, lateral views may show hypopharyngeal dilation as the child attempts to compensate for the narrowed airway. * **Option B:** The subglottis is the narrowest part of the pediatric airway. In Croup, inflammation and edema are most intense in the **subglottic region**, leading to the classic stridor. * **Option C:** Epidemiologically, Croup shows a slight **male predominance** (approx. 1.5:1 ratio) and typically affects children between 6 months and 3 years of age. **Clinical Pearls for NEET-PG:** * **Most common cause:** Parainfluenza virus Type 1. * **X-ray Sign:** Steeple Sign (Subglottic narrowing). * **Westley Croup Score:** Used to classify severity (Mild, Moderate, Severe). * **Drug of Choice:** Dexamethasone (0.15–0.6 mg/kg) is the mainstay of treatment. * **Differential Diagnosis:** If the child is toxic-looking with high fever and no barking cough, suspect **Acute Epiglottitis** (Thumb sign on X-ray) or **Bacterial Tracheitis**.

Q: In a 3-year-old child, what respiratory rate is classified as Pneumonia?

40 breaths/min. This question tests your knowledge of the **WHO Integrated Management of Childhood Illness (IMCI)** guidelines, which are high-yield for NEET-PG. The classification of pneumonia in children is primarily based on the respiratory rate (RR) adjusted for age. ### **Why 40 breaths/min is correct:** According to IMCI criteria, "Fast Breathing" (Pneumonia) is defined based on the following age-specific thresholds: * **< 2 months:** ≥ 60 breaths/min * **2 – 12 months:** ≥ 50 breaths/min * **12 months – 5 years:** **≥ 40 breaths/min** Since the child in the question is **3 years old** (falling into the 12 months – 5 years category), a respiratory rate of **40 breaths/min** or more is the diagnostic cutoff for pneumonia. ### **Analysis of Incorrect Options:** * **Option A (30 breaths/min):** This is a normal respiratory rate for a 3-year-old. It does not meet the threshold for tachypnea. * **Option C (50 breaths/min):** This is the cutoff for infants aged **2 to 12 months**. While a 3-year-old with 50 breaths/min certainly has pneumonia, the *threshold* for classification starts at 40. * **Option D (60 breaths/min):** This is the cutoff for neonates and infants **under 2 months** of age. ### **Clinical Pearls for NEET-PG:** 1. **Classification Shift:** The WHO now classifies cases as either **Pneumonia** (fast breathing and/or chest indrawing) or **Severe Pneumonia** (presence of any "danger signs" like inability to drink, lethargy, or cyanosis). 2. **Counting Rule:** The respiratory rate must be counted for a **full 60 seconds** when the child is calm. 3. **Chest Indrawing:** If present, it signifies "Pneumonia" under revised guidelines, but if accompanied by danger signs, it is "Severe Pneumonia."

Question 1

A 7-year-old child presents with acute shortness of breath that began while playing sports, characterized by paroxysms of wheezing and coughing. The child is found sitting, leaning forward, using accessory respiratory muscles, and is tachypneic and tachycardic. Auscultation reveals a prolonged expiratory phase with high-pitched wheezes. Which of the following medications will have the fastest onset of action for this acute attack?

Accepted Answer

Albuterol inhalation

Answer

Beclomethasone inhalation

Answer

Ephedrine oral

Answer

Salmeterol inhalation

Question 2

A 3-month-old child presents with moderate fever, non-productive cough, and mild dyspnea. After a course of antibiotics, the child showed transient improvement but subsequently developed high fever, productive cough, and increased respiratory distress. Chest X-ray reveals hyperlucency, and Pulmonary Function Tests (PFTs) show an obstructive pattern. What is the most probable diagnosis?

Accepted Answer

Bronchiolitis obliterans

Answer

Alveolar microlithiasis

Answer

Post-viral syndrome

Answer

Follicular bronchitis

Question 3

A 12-year-old boy presents with intermittent shortness of breath over the past 6 months. He is not on any medications and has no significant family history. Vitals are within normal limits and lungs are clear to auscultation. Lung function tests reveal a FEV1/FVC ratio of 82%. Which of the following would be most helpful in excluding a diagnosis of asthma in this patient?

Accepted Answer

Negative methacholine challenge

Answer

Absence of peripheral blood eosinophilia

Answer

Negative allergy skin tests

Answer

Normal total serum IgE level

Question 4

A 12-year-old girl with leukemia develops a lower respiratory tract infection with hemoptysis that is shown to be due to right-sided bronchiectasis. In addition to treatment for the underlying leukemia, what management should this patient receive?

Accepted Answer

Selective antibiotics, physiotherapy, and bronchodilator therapy

Answer

Right pneumonectomy

Answer

Tracheostomy

Answer

Cough-suppressant medication

Question 5

A 2-year-old child presented with the following X-ray finding. What is the most likely diagnosis?

Accepted Answer

Acute laryngotracheobronchitis

Answer

Acute epiglottitis

Answer

Acute pharyngitis

Answer

Parapharyngeal abscess

Question 6

What is the commonest sign of an intrabronchial foreign body in children?

Accepted Answer

Cough

Answer

Wheeze

Answer

Dyspnoea

Answer

Stridor

Question 7

All of the following criteria classify a child aged 11 months as having severe pneumonia, except:

Accepted Answer

Breathing rate > 40 per minute

Answer

Inability to drink or breastfeed

Answer

Nasal flaring

Answer

Grunting

Question 8

A 4-year-old child with bronchial asthma presents with 3 or more episodes of wheezing during the daytime in a week and 2 wheezing episodes during the night in a month. How will you grade this asthma?

Accepted Answer

Mild Persistent

Answer

Moderate Persistent

Answer

Severe Persistent

Answer

Mild Intermittent

Question 9

A 3-month-old child presents with biphasic stridor and barking cough. All of the following are true regarding this condition EXCEPT:

Accepted Answer

Antibiotics are used as an initial treatment.

Answer

Hypopharyngeal dilation and subglottic stenosis may be seen on X-ray.

Answer

The condition most commonly involves the subglottis.

Answer

Males are involved more commonly than females.

Question 10

In a 3-year-old child, what respiratory rate is classified as Pneumonia?

Accepted Answer

40 breaths/min

Answer

30 breaths/min

Answer

50 breaths/min

Answer

60 breaths/min

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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