Asthma in Children — MCQs
A patient with a history of asthma presents with worsening cough and eosinophilia. CXR shows fleeting infiltrates. Diagnosis?
During the discharge of a COVID patient treated with steroids and remdesivir, which of the following will you inform him about? 1. Repeat RT-PCR after 7 days of discharge 2. Watch for the persistence of Anosmia 3. Watch for headache and nasal discharge 4. Monitor glucose levels 5. Watch for Sinusitis symptoms
In a patient with clinical signs of asthma, which of the following tests will confirm the diagnosis?
In a child with exercise-induced asthma, which action is recommended?
Which of the following is not typically used for the immediate treatment of acute asthma?
What is the most appropriate method for administering asthma treatment to an infant under one year of age?
Omalizumab is indicated for which of the following conditions?
A child has a rash. His family history is positive for asthma. What could be the most probable diagnosis?
A 5-year-old child presents with perivascular IgA deposition and neutrophilic collection. There is an erythematous rash on the lower limbs and non-blanching purpura. The likely diagnosis in the child is:
What is a characteristic feature of Systemic Juvenile Idiopathic Arthritis?
Asthma in Children Indian Medical PG Practice Questions and MCQs
Question 1: A patient with a history of asthma presents with worsening cough and eosinophilia. CXR shows fleeting infiltrates. Diagnosis?
- A. Sarcoidosis
- B. Allergic bronchopulmonary aspergillosis (Correct Answer)
- C. TB
- D. COPD
Explanation: ***Allergic bronchopulmonary aspergillosis (ABPA)*** - The combination of **asthma**, **eosinophilia**, and **fleeting pulmonary infiltrates** on CXR is highly suggestive of ABPA, an allergic response to *Aspergillus fumigatus* in the airways. - Patients typically experience **worsening lower respiratory symptoms** like cough and wheezing, often with mucus plugging. *Sarcoidosis* - Characterized by **non-caseating granulomas** and can cause pulmonary infiltrates, but **eosinophilia is not a typical feature** [1]. - While it can involve the lungs, it usually presents with **hilar lymphadenopathy**, constitutional symptoms, and hypercalcemia, which are not described. *TB* - Presents with cough, fever, night sweats, and weight loss, and CXR often shows **upper lobe infiltrates, cavities**, or effusions. - While it can cause pulmonary infiltrates, **eosinophilia is not a characteristic finding**, and a history of asthma is not a direct predisposing factor [2]. *COPD* - Primarily caused by **smoking** and is defined by **persistent airflow limitation**. - While it can present with chronic cough, **eosinophilia and fleeting infiltrates are not typical features**; infiltrates in COPD usually suggest an exacerbation with infection or other complications.
Question 2: During the discharge of a COVID patient treated with steroids and remdesivir, which of the following will you inform him about? 1. Repeat RT-PCR after 7 days of discharge 2. Watch for the persistence of Anosmia 3. Watch for headache and nasal discharge 4. Monitor glucose levels 5. Watch for Sinusitis symptoms
- A. 1,3 and 4
- B. 3,4 and 5 (Correct Answer)
- C. 2,3 and 4
- D. 1,2,3,4 and 5
Explanation: **3, 4, and 5** - For patients treated with **steroids**, it is crucial to monitor **glucose levels** due to the potential for steroid-induced hyperglycemia [1]. - Symptoms like **headache** and **nasal discharge** (and by extension **sinusitis symptoms**) could indicate conditions like **mucormycosis**, a serious fungal infection seen in immunocompromised COVID-19 patients, especially those having received steroids. *1, 3, and 4* - A **repeat RT-PCR after 7 days** of discharge is generally not recommended as per current guidelines, as viral shedding can persist without infectivity. - While monitoring for headache, nasal discharge, and glucose levels is appropriate, omitting the direct vigilance for **sinusitis symptoms** is less comprehensive. *2, 3, and 4* - While **anosmia** (loss of smell) can persist post-COVID, it is primarily a lingering symptom of the infection itself and typically resolves spontaneously, not usually requiring specific discharge instructions for monitoring its persistence to prevent complications. - The focus should be on new or worsening symptoms that might indicate post-COVID complications or secondary infections. *1, 2, 3, 4, and 5* - Including **repeat RT-PCR** and solely "watch for the persistence of Anosmia" without emphasizing resolution or specific actions makes this option less pertinent for discharge advice. - The priority for discharge instructions should be preventable complications and warning signs of serious conditions.
Question 3: In a patient with clinical signs of asthma, which of the following tests will confirm the diagnosis?
- A. > 200 ml increase in FEV1 after Methacholine
- B. Increase in FEV1/FVC
- C. Diurnal variation in PEF > 20 percent (Correct Answer)
- D. Reduction of FEV1 > 20% after bronchodilators
Explanation: ***Diurnal variation in PEF > 20 percent*** - A significant **diurnal variation in peak expiratory flow (PEF)**, typically greater than 20%, indicates **variable airflow obstruction** characteristic of asthma. - This variability reflects **bronchial hyperresponsiveness**, where airways constrict in response to triggers throughout the day. *Increase in FEV1/FVC* - An increase in the **FEV1/FVC ratio** would suggest an improvement in lung function, not the presence of obstructive lung disease like asthma, where this ratio is typically reduced. - A normal or increased FEV1/FVC ratio would rule out an obstructive pattern. *> 200 ml increase in FEV1 after Methacholine* - An increase in FEV1 after **methacholine** challenge is an indicator of responsiveness to bronchodilators, which is consistent with asthma, but it is typically measured *after* a bronchodilator, not after a bronchoconstrictor like methacholine. - The methacholine challenge test is used to induce bronchoconstriction in suspected asthma, where a *decrease* in FEV1 (typically 20%) at low dose methacholine confirms hyperresponsiveness. *Reduction of FEV1 > 20% after bronchodilators* - A reduction in **FEV1 after bronchodilators** would indicate a worsening of airway obstruction, which is contrary to the expected response in asthma where bronchodilators improve FEV1. - In asthma, a significant *increase* in FEV1 after bronchodilator administration is expected, demonstrating **reversibility** of airflow obstruction.
Question 4: In a child with exercise-induced asthma, which action is recommended?
- A. Prophylaxis with steroids
- B. Prophylaxis with theophylline
- C. Breathing exercise
- D. Prophylaxis with beta-agonist (Correct Answer)
Explanation: ***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 5: Which of the following is not typically used for the immediate treatment of acute asthma?
- A. Prednisolone
- B. Ipratropium bromide
- C. Salmeterol (Correct Answer)
- D. Salbutamol
Explanation: ***Salmeterol*** - **Salmeterol** is a **long-acting beta-2 agonist (LABA)**, typically used for **maintenance therapy** in asthma to prevent symptoms, not for immediate relief of an acute attack. - Its **slow onset of action** makes it unsuitable for the rapid bronchodilation required during an acute asthma exacerbation. *Prednisolone* - **Prednisolone** is an **oral corticosteroid** used in acute asthma exacerbations to reduce inflammation and prevent relapse. - While it has a delayed onset of action, it is a crucial component of immediate management to control the underlying inflammation. *Salbutamol* - **Salbutamol** is a **short-acting beta-2 agonist (SABA)**, which is the **first-line treatment** for immediate relief of acute asthma symptoms. - It acts rapidly to **bronchodilate** the airways, improving airflow within minutes. *Ipratropium bromide* - **Ipratropium bromide** is a **short-acting muscarinic antagonist (SAMA)** that can be used in conjunction with SABAs for acute severe asthma. - It provides **additional bronchodilation** by blocking acetylcholine's effects on bronchial smooth muscle.
Question 6: What is the most appropriate method for administering asthma treatment to an infant under one year of age?
- A. MDI with Mask (no spacer)
- B. Nebulizer therapy
- C. MDI with Spacer (no mask)
- D. MDI with Spacer and Mask (Correct Answer)
Explanation: ***MDI with Spacer and Mask*** - For infants and young children, a **metered-dose inhaler (MDI)** used with a **spacer** and a **well-fitting mask** is the **most appropriate** method for delivering asthma medication. - The spacer helps to reduce the velocity of the aerosol and allows the infant to inhale the medication over several breaths, while the mask ensures the medication is delivered to the airways without significant loss. - This method is **portable**, **convenient**, and **cost-effective** for routine outpatient management. *MDI with Spacer (no mask)* - While a spacer is crucial for optimizing drug delivery from an MDI, an infant cannot effectively seal their lips around a spacer mouthpiece for proper inhalation. - This method would result in significant **medication loss** and insufficient dose delivery to the lungs. *MDI with Mask (no spacer)* - An MDI used directly with a mask without a spacer leads to inefficient drug delivery due to the **high velocity** of the aerosol spray. - The medication impinges on the back of the throat and face, reducing the amount that reaches the small airways. *Nebulizer therapy* - Nebulizers are also an **acceptable and effective option** for infants, particularly in acute settings or when families find them easier to use. - However, they are **time-consuming** (typically 10-15 minutes per treatment), require a power source or batteries, and are less portable than MDI systems. - For **routine outpatient management**, an MDI with spacer and mask is generally **preferred** due to its convenience, portability, and comparable efficacy when used correctly.
Question 7: Omalizumab is indicated for which of the following conditions?
- A. Multiple myeloma
- B. Psoriasis
- C. Bronchial asthma (Correct Answer)
- D. Rheumatoid arthritis
Explanation: ***Bronchial asthma*** - Omalizumab is an **anti-IgE antibody** that binds to circulating IgE, preventing it from binding to mast cells and basophils, thus reducing allergic reactions. - It is specifically approved for the treatment of **moderate to severe persistent asthma** in patients over 6 years old whose symptoms are inadequately controlled by inhaled corticosteroids. *Multiple myeloma* - Multiple myeloma is a **plasma cell malignancy** affecting bone marrow, for which omalizumab has no approved indication. - Treatment typically involves **chemotherapy**, proteasome inhibitors, immunomodulatory drugs, and stem cell transplantation. *Psoriasis* - Psoriasis is a **chronic inflammatory skin condition** primarily treated with agents targeting inflammatory pathways such as TNF-alpha, IL-17, or IL-23, not IgE. - Common psoriasis medications include **topical corticosteroids**, phototherapy, and systemic biologics like adalimumab or ustekinumab. *Rheumatoid arthritis* - Rheumatoid arthritis is an **autoimmune disease** causing chronic joint inflammation, primarily treated with DMARDs (disease-modifying antirheumatic drugs) and TNF inhibitors. - **IgE does not play a significant role** in the pathogenesis of rheumatoid arthritis, making omalizumab ineffective for this condition.
Question 8: A child has a rash. His family history is positive for asthma. What could be the most probable diagnosis?
- A. Seborrheic dermatitis
- B. Atopic dermatitis (Correct Answer)
- C. Allergic contact dermatitis
- D. Erysipelas
Explanation: ***Atopic dermatitis*** - The presence of a rash in a child with a family history of **asthma** strongly suggests atopic dermatitis, as it is part of the **atopic triad** (eczema, asthma, allergic rhinitis). - Atopic dermatitis often presents with **erythematous, pruritic patches** and plaques, commonly affecting flexural areas like the antecubital and popliteal fossae, as well as the face and neck in younger children. *Seborrheic dermatitis* - This condition typically presents with **greasy, yellowish scales** on an erythematous base, often affecting areas rich in sebaceous glands such as the scalp, face (nasolabial folds), and chest. - While it can occur in infants, it does not have the strong association with a family history of asthma seen in atopic dermatitis. *Allergic contact dermatitis* - This rash results from an **exposure to an allergen**, leading to a localized, erythematous, and pruritic eruption, often with vesicles or bullae, at the site of contact. - The history does not provide information about a specific allergen exposure, and while it could produce a similar-looking rash, the family history of asthma points more strongly to atopic diathesis. *Erysipelas* - Erysipelas is a superficial skin infection, usually caused by *Streptococcus pyogenes*, presenting as a **well-demarcated, intensely erythematous, warm, and painful rash** with a raised border. - This is an **acute bacterial infection** and would typically be accompanied by systemic symptoms like fever and chills, which are not mentioned in the child's presentation.
Question 9: A 5-year-old child presents with perivascular IgA deposition and neutrophilic collection. There is an erythematous rash on the lower limbs and non-blanching purpura. The likely diagnosis in the child is:
- A. Henoch - schonlein purpura (Correct Answer)
- B. Wegener's granulomatosis
- C. Giant cell vasculitis
- D. Kawasaki disease
Explanation: ***Henoch - schonlein purpura*** - Characterized by **perivascular IgA deposition** and **neutrophilic infiltrates** [1], leading to purpura, especially in children. - Presents with **non-blanching purpura** on lower extremities, often accompanied by abdominal pain and arthralgia. *Wegner's granulomatosis* - Typically affects **adults** and is associated with **granulomatous inflammation** and respiratory symptoms, not common in young children. - Involves the **upper and lower respiratory tracts**, along with renal manifestations, differing significantly from this presentation. *Kawasaki disease* - Primarily presents with **fever**, **rash**, and lymphadenopathy; coronary artery involvement is a key concern. - The rash in Kawasaki typically does **not present** as purpura and is not associated with prominent IgA deposition. *Giant cell vasculitis* - Generally affects older adults and presents with **temporal headaches**, vision changes, and scalp tenderness. - **Purpura** and IgA deposition are not features of this condition, making it inappropriate for this child's symptoms. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 278-279.
Question 10: What is a characteristic feature of Systemic Juvenile Idiopathic Arthritis?
- A. Uveitis is a feature
- B. It occurs after 16 years of age
- C. NSAIDs are contraindicated
- D. RA factor is negative (Correct Answer)
Explanation: ### Explanation **Systemic Juvenile Idiopathic Arthritis (sJIA)**, also known as Still’s disease, is a unique subtype of JIA characterized by prominent extra-articular features. **Why the correct answer is right:** In sJIA, the **Rheumatoid Factor (RF) is characteristically negative**. Unlike the polyarticular subtype (which can be RF positive), sJIA is considered an autoinflammatory disease rather than a classic autoimmune disease. Diagnosis is clinical, based on the presence of arthritis in one or more joints associated with (or preceded by) a fever of at least 2 weeks' duration that is daily ("quotidian") for at least 3 days, accompanied by features like an evanescent salmon-pink rash, lymphadenopathy, or serositis. **Analysis of Incorrect Options:** * **A. Uveitis is a feature:** This is incorrect for sJIA. Chronic anterior uveitis is a classic complication of **Oligoarticular JIA** (especially if ANA positive). Uveitis is very rare in the systemic subtype. * **B. It occurs after 16 years of age:** By definition, JIA must have an onset **before the age of 16**. If similar symptoms occur after 16, it is termed Adult-Onset Still’s Disease (AOSD). * **C. NSAIDs are contraindicated:** This is false. NSAIDs are often the **first-line** symptomatic treatment for pain and fever in JIA, though systemic steroids or biologics (IL-1 and IL-6 inhibitors) are usually required for definitive control. **High-Yield Clinical Pearls for NEET-PG:** * **Fever Pattern:** Classic "Quotidian" fever (spikes once daily, usually in the evening, returning to baseline). * **Laboratory Markers:** Marked leukocytosis, thrombocytosis, and highly elevated ESR/CRP. * **Ferritin:** Extremely high ferritin levels are common and can signal the onset of **Macrophage Activation Syndrome (MAS)**, a life-threatening complication of sJIA. * **Biologics of Choice:** Tocilizumab (IL-6 inhibitor) and Anakinra/Canakinumab (IL-1 inhibitors).
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free