Foreign Body Aspiration — MCQs

10 questions

A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

The most common passage for foreign body aspiration is:

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

Which of the following is an ideal method to prevent aspiration pneumonia?

Stridor in an infant is most commonly due to:

The incidence of a foreign body being aspirated into the right lung is higher than into the left lung. All of the following statements support this, EXCEPT?

What is the pathophysiological mechanism behind the increased risk of pelvic inflammatory disease with intrauterine device (IUD) insertion?

Q10

Swiping of the oral cavity should not be done in foreign body aspiration in children because:

Foreign Body Aspiration Indian Medical PG Practice Questions and MCQs

Question 1: A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

A. Staphylococcal bronchopneumonia
B. Foreign body aspiration (Correct Answer)
C. Congenital lobar emphysema
D. Aspiration pneumonia

Explanation: ***Foreign body aspiration*** - A **foreign body** partially obstructing a bronchus acts as a **one-way valve**, allowing air to enter the lung on inspiration but trapping it on expiration, leading to **hyperinflation** of the distal lung. - This is a common cause of acute respiratory distress and unilateral lung hyperinflation in children, as they frequently aspirate small objects. *Staphylococcal bronchopneumonia* - This typically presents with **consolidation** and **infiltrates** on chest X-ray, rather than hyperinflation. - While it can cause respiratory distress, it does not characteristically lead to **unilateral hyperinflation** as its primary X-ray finding. *Congenital lobar emphysema* - This causes **progressive hyperinflation of a single lobe** (typically upper or middle lobe), not the entire lung, due to abnormal bronchial cartilage or extrinsic compression. - While it can present acutely in infancy, the X-ray shows **lobar** hyperinflation with mediastinal shift, distinct from the **whole lung** hyperinflation seen with foreign body aspiration. *Aspiration pneumonia* - Aspiration pneumonia is caused by inhaling gastric contents or other substances, leading to **inflammation and infection** of the lung parenchyma. - It typically presents with **infiltrates**, **consolidation**, or **abscess formation** on X-ray, not unilateral hyperinflation.

Question 2: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

A. FB in larynx
B. Angioneurotic edema (Correct Answer)
C. Parapharyngeal abscess
D. FB bronchus

Explanation: Andioneurotic edema - The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1]. - This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2]. *FB in larynx* - While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3]. - A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3]. *Parapharyngeal abscess* - A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario. - The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess. *FB bronchus* - A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck. - Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.

Question 3: The most common passage for foreign body aspiration is:

A. Left main bronchus
B. Right main bronchus (Correct Answer)
C. Bronchioles
D. Alveoli

Explanation: ***Right main bronchus*** - The **right main bronchus** is wider, shorter, and more vertically aligned with the trachea compared to the left main bronchus. - This anatomical configuration makes it the path of least resistance for aspirated foreign bodies. *Left main bronchus* - The **left main bronchus** branches off the trachea at a more acute angle and is narrower and longer. - These anatomical features make aspiration into the left main bronchus less common. *Bronchioles* - While foreign bodies can eventually reach the **bronchioles**, the initial aspiration typically occurs into the larger main bronchi. - Smaller foreign bodies might pass further down, but the primary entry point is usually a main bronchus. *Alveoli* - Foreign bodies are highly unlikely to directly reach the **alveoli** upon aspiration due to their small size and the extensive branching of the tracheobronchial tree. - Aspiration usually lodges in larger airways before reaching such distal structures.

Question 4: A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

A. Acute Laryngotracheobronchitis (Correct Answer)
B. Acute Bacterial Tracheitis
C. Acute Epiglottitis
D. Foreign Body aspiration

Explanation: ***Acute Laryngotracheobronchitis*** - The combination of **low-grade fever** and **stridor** in a 2-year-old child strongly suggests **croup**, which is medically known as acute laryngotracheobronchitis. - Croup is characterized by **inflammation** of the larynx, trachea, and bronchi, often presenting with a **barking cough** and inspiratory stridor. The X-ray image would show the characteristic **steeple sign**. *Acute Bacterial Tracheitis* - This is a more severe bacterial infection that can present with stridor but typically shows **higher fever**, **toxic appearance**, and rapid clinical deterioration. - Unlike croup, bacterial tracheitis patients appear **more ill** and may have **purulent secretions** requiring more aggressive management. *Acute Epiglottitis* - A serious condition characterized by **rapid onset of high fever**, **dysphagia**, drooling, and a **"tripod" position**, which are not indicated by the given symptoms. - The stridor in epiglottitis is typically quieter and may indicate more severe airway obstruction compared to the characteristic stridor of croup. *Foreign Body aspiration* - While foreign body aspiration can cause stridor, it is typically an **acute event** with a sudden onset of choking, coughing, and respiratory distress. - There is no mention of a choking episode or sudden onset, and a low-grade fever is less typical for an uncomplicated foreign body aspiration.

Question 5: A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

A. Right superior lobe
B. Right lower lobe (Correct Answer)
C. Left lower lobe
D. Right middle lobe

Explanation: ***Right lower lobe*** - Due to the **angle** of the right main bronchus, which is less acute than the left, aspirated foreign bodies, like a peanut, tend to preferentially enter the **right bronchial tree**. - Within the right lung, foreign bodies are most commonly found in the **right lower lobe** because its **bronchus is the most direct continuation** of the right main bronchus, especially in an upright position. *Right superior lobe* - While material can go into the right lung, the **right upper lobe bronchus** branches off at a more acute angle, making aspiration into this lobe less common than into the lower lobes when a person is in an upright or semi-recumbent position. - Aspiration into the superior lobes is more common with specific body positions or in cases of massive aspiration. *Right middle lobe* - The **right middle lobe bronchus** is smaller and branches off at an angle that is less favorable for direct aspiration compared to the right lower lobe. - Aspiration to this lobe is less frequent than to the lower lobes. *Left lower lobe* - The **left main bronchus** is narrower and branches off at a much more acute angle from the trachea compared to the right main bronchus. - This anatomical difference makes aspiration into the left lung, including the **left lower lobe**, significantly less common than into the right lung.

Question 6: Which of the following is an ideal method to prevent aspiration pneumonia?

A. Full stomach
B. Increase the intra abdominal pressure
C. Inhalational anesthetic
D. Endotracheal tube (cuffed) (Correct Answer)

Explanation: ***Endotracheal tube (cuffed)*** - A cuffed endotracheal tube forms a **seal** in the trachea, effectively preventing aspiration of gastric contents or oral secretions into the lungs. - This method is particularly crucial before and during surgical procedures involving general anesthesia, where normal airway protective reflexes are abolished. *Full stomach* - A **full stomach** significantly increases the risk of aspiration, as there is more gastric content available to be regurgitated into the airway. - This is a contraindication for immediate induction of general anesthesia and often necessitates a rapid sequence intubation. *Increase the intra abdominal pressure* - Increasing **intra-abdominal pressure** (e.g., due to obesity, insufflation for laparoscopy) can push gastric contents towards the esophagus, thereby increasing the risk of reflux and aspiration. - This effect is undesirable and directly contributes to aspiration risk rather than preventing it. *Inhalational anesthetic* - **Inhalational anesthetics** depress airway reflexes, making the patient more susceptible to aspiration. - While they are essential for maintaining anesthesia, they do not prevent aspiration; rather, other measures like intubation are necessary to counteract their effects.

Question 7: Stridor in an infant is most commonly due to:

A. Laryngomalacia (Correct Answer)
B. Foreign body aspiration
C. Diphtheria
D. Acute epiglottitis

Explanation: ***Laryngomalacia*** - **Laryngomalacia** is the most common cause of **congenital inspiratory stridor** in infants, resulting from supraglottic laryngeal structures collapsing inward during inspiration. - The stridor is typically **worse when crying, feeding, or lying supine** and usually improves spontaneously by 12-18 months of age. *Foreign body aspiration* - While foreign body aspiration can cause **acute stridor**, it is an event-specific occurrence, not a persistent condition from birth, and often presents with **sudden onset choking and respiratory distress**. - Its incidence is higher in **toddlers and older children** who are mobile and exploring their environment, rather than infants. *Diphtheria* - **Diphtheria** is a rare cause of stridor due to widespread vaccination and is characterized by a **"bull neck"** and a **pseudomembrane in the pharynx**, which is distinct from the typical presentation of laryngomalacia. - The stridor associated with Diphtheria is typically progressive and can lead to severe **respiratory obstruction and systemic toxicity**. *Acute epiglottitis* - **Acute epiglottitis** typically presents with sudden onset of **high fever, dysphagia, drooling, and muffled voice** in older children, rather than stridor from birth in an infant. - Due to **Hib vaccine**, acute epiglottitis is now very rare and its stridor is usually rapidly progressive and life-threatening.

Question 8: The incidence of a foreign body being aspirated into the right lung is higher than into the left lung. All of the following statements support this, EXCEPT?

A. Tracheal bifurcation directs the foreign body to the right lung
B. Right lung is shorter and wider than left lung (Correct Answer)
C. Right inferior lobar bronchus is in continuation with the right principal bronchus
D. Right principal bronchus is more vertical than the left bronchus

Explanation: ***Right lung is shorter and wider than left lung*** - This statement, while anatomically true, does **NOT directly explain** why foreign bodies preferentially enter the right lung - The dimensions of the **lung parenchyma itself** (shorter due to the diaphragm being pushed up by the liver, and wider) are unrelated to aspiration patterns - What determines aspiration is the **bronchial tree geometry** (angle, diameter, verticality), not the overall lung size - This is the EXCEPTION - it's a true anatomical fact but doesn't support the aspiration phenomenon *Incorrect - Tracheal bifurcation directs the foreign body to the right lung* - This statement DOES support higher right aspiration, so it cannot be the answer - The **carina angle** and bifurcation geometry favor the right side, directing foreign bodies preferentially to the right main bronchus - This is a key anatomical reason for the higher incidence *Incorrect - Right inferior lobar bronchus is in continuation with the right principal bronchus* - This statement DOES support higher right aspiration - After the right superior lobar bronchus branches off, the **intermediate bronchus** continues more directly toward the inferior lobe - This creates a straighter pathway from trachea → right main bronchus → intermediate bronchus → inferior lobar bronchus - Foreign bodies follow this direct path, often lodging in the right inferior lobe *Incorrect - Right principal bronchus is more vertical than the left bronchus* - This statement DOES support higher right aspiration - The right main bronchus diverges at approximately **25 degrees** from vertical, while the left diverges at **45 degrees** - This more vertical orientation makes the right bronchus a more direct continuation of the trachea - Gravity and airflow naturally direct aspirated material down this straighter path

Question 9: What is the pathophysiological mechanism behind the increased risk of pelvic inflammatory disease with intrauterine device (IUD) insertion?

A. Inhibition of local immune responses by copper
B. Introduction of vaginal bacteria during insertion procedure (Correct Answer)
C. Direct trauma to endometrial tissue
D. Enhancement of bacterial adhesion by IUD string

Explanation: ***Introduction of vaginal bacteria during insertion procedure*** - The **insertion process itself** can introduce bacteria from the vagina and cervix into the uterine cavity, leading to an **ascending infection**. - This risk is primarily associated with the **first 2-3 weeks post-insertion**, after which the risk significantly decreases and is not directly related to the IUD's presence. *Inhibition of local immune responses by copper* - **Copper IUDs** actually induce a **local inflammatory response** in the endometrium, which is part of their contraceptive mechanism. - This inflammation helps to prevent sperm survival and ovum implantation, rather than inhibiting immune responses. *Direct trauma to endometrial tissue* - While insertion can cause minor trauma, this **trauma itself does not directly cause PID** but rather provides a potential entry point for bacteria if disinfection protocols are not meticulously followed. - The risk of infection is primarily from the introduction of bacteria rather than the tissue damage. *Enhancement of bacterial adhesion by IUD string* - Although the **IUD string** could theoretically serve as a pathway for bacteria, studies have not definitively shown it to be a significant independent risk factor for PID beyond the initial insertion period. - The primary risk factor is the **bacterial translocation during the insertion procedure**, not ongoing bacterial ascent via the string.

Question 10: Swiping of the oral cavity should not be done in foreign body aspiration in children because:

A. It can trigger vomiting and aspiration
B. Leads to inadvertently pushing the foreign body deep into the respiratory system (Correct Answer)
C. It is not effective in removing foreign bodies from children
D. It may cause trauma to the oral cavity and throat

Explanation: **Leads to inadvertently pushing the foreign body deep into the respiratory system** - Forceful or blind **finger sweeps** in children can dislodge a foreign body from a superficial position and push it further into the hypopharynx or trachea, potentially causing **complete airway obstruction**. - This maneuver is particularly risky in infants and young children due to their smaller and more **fragile airways**. - Current pediatric basic life support (BLS) guidelines explicitly advise **against blind finger sweeps** in children with foreign body airway obstruction. *It may cause trauma to the oral cavity and throat* - While trauma can occur, such as **lacerations** or **abrasions** to the soft tissues, it is a secondary concern. - The primary and most dangerous risk is the complete **airway obstruction** from pushing the object deeper into the respiratory tract. *It is not effective in removing foreign bodies from children* - The ineffectiveness is a valid point, but the main reason for avoiding it is the inherent danger. - Even if it were effective in some cases, the risk of worsening the airway obstruction is too high to recommend it as a routine intervention. *It can trigger vomiting and aspiration* - While gagging and stimulation can occur with oral manipulation, this is not the primary concern in foreign body aspiration. - The immediate risk of pushing an already-aspirated object deeper into the airway takes precedence over the theoretical risk of triggering vomiting.

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