Respiratory Diseases Practice Questions

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."

Q: "Steeple sign" on X-ray in children is most likely indicative of which condition?

Croup. **Explanation:** The **"Steeple sign"** (also known as the wine bottle sign) is a classic radiological finding seen on an anteroposterior (AP) view of the neck X-ray. It represents **subglottic narrowing** caused by edema and inflammation of the larynx and trachea. This narrowing gives the airway the appearance of a pointed church steeple. **1. Why Croup is Correct:** Croup, or **Laryngotracheobronchitis**, is most commonly caused by the **Parainfluenza virus (Type 1)**. The inflammation is localized to the subglottic region (just below the vocal cords). Clinically, it presents with a characteristic "barking cough," inspiratory stridor, and hoarseness in children aged 6 months to 3 years. **2. Why Incorrect Options are Wrong:** * **Vocal cord paralysis:** This is a functional or neurological issue. While it can cause stridor, it does not typically produce the symmetric subglottic narrowing seen on X-ray. * **Streptococcal pharyngitis:** This involves inflammation of the oropharynx and tonsils. X-rays are usually normal or show soft tissue swelling in the tonsillar area, not the subglottic airway. * **Asthma:** This is a lower airway disease characterized by bronchospasm and wheezing. X-rays typically show hyperinflation or are normal; they do not show upper airway narrowing. **High-Yield Clinical Pearls for NEET-PG:** * **Thumb Sign:** Seen on a lateral neck X-ray in **Epiglottitis** (caused by *H. influenzae* type B). * **Management of Croup:** Mild cases are treated with a single dose of **Dexamethasone**. Severe cases (stridor at rest) require **Nebulized Epinephrine** (L-epinephrine or Racemic). * **Westley Croup Score:** Used to clinically assess the severity of the condition. * **Omega-shaped Epiglottis:** A characteristic finding in **Laryngomalacia**, the most common cause of congenital stridor.

Q: What is true regarding bronchiolitis obliterans without cyanosis?

Continuous oxygen therapy is the mainstay of treatment. **Explanation:** **Bronchiolitis Obliterans (BO)** is a chronic obstructive lung disease characterized by the inflammation and fibrosis of the terminal bronchioles, leading to luminal narrowing. In children, it most commonly occurs as a post-infectious complication (Post-Infectious Bronchiolitis Obliterans or PIBO). **Why Option C is Correct:** The management of PIBO is primarily **supportive**. Because the airway damage is structural and irreversible (fibrosis), the goal is to maintain adequate oxygenation and manage complications. **Continuous oxygen therapy** is the mainstay for patients with chronic hypoxemia to prevent pulmonary hypertension and cor pulmonale. **Analysis of Incorrect Options:** * **Option A:** The most common viral cause of PIBO is **Adenovirus** (specifically types 3, 7, and 21), not parainfluenza. Adenovirus is notorious for causing necrotizing bronchiolitis. * **Option B:** Ribavirin is an antiviral used specifically for **Respiratory Syncytial Virus (RSV)** bronchiolitis in high-risk infants. It has no role in the management of Bronchiolitis Obliterans, which is a late-stage fibrotic process. * **Option D:** Bronchodilators like **Ipratropium bromide** or Albuterol are frequently used in BO to manage the reversible component of airway obstruction. They are **not contraindicated**, though their efficacy varies among patients. **High-Yield Clinical Pearls for NEET-PG:** * **Radiology:** Characterized by the **"Mosaic attenuation pattern"** on HRCT (areas of air trapping due to bronchiolar obstruction). * **Diagnosis:** Gold standard is a lung biopsy, but it is often diagnosed clinically based on a history of severe pneumonia followed by persistent wheezing and obstructive patterns on PFTs. * **Swyer-James-MacLeod Syndrome:** A radiological manifestation of PIBO involving a small, hyperlucent lung with decreased vascularity.

Q: A 2-year-old boy presented with cough, fever, and difficulty in breathing. His respiratory rate is 50/min. There is no chest indrawing. Auscultation of the chest reveals bilateral crepitations. What is the most probable diagnosis?

Pneumonia. ### Explanation This question is based on the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for the classification of cough and cold in children aged 2 months to 5 years. **1. Why "Pneumonia" is the correct answer:** According to IMNCI criteria, the classification is based on the presence of **fast breathing** or **chest indrawing**. * For a child aged 12 months to 5 years, fast breathing is defined as a **Respiratory Rate (RR) ≥ 40 breaths/min**. * In this case, the child is 2 years old with an RR of 50/min (fast breathing) but **no chest indrawing**. This specific combination classifies the condition as **Pneumonia**. **2. Why other options are incorrect:** * **No Pneumonia:** This is classified when there is no fast breathing and no chest indrawing. The child would typically have only a cough or cold. * **Severe Pneumonia:** This requires the presence of **chest indrawing**. Since the question explicitly states there is no chest indrawing, this option is ruled out. * **Very Severe Pneumonia (Severe Disease):** This classification is used when any **"General Danger Sign"** is present (e.g., inability to drink/breastfeed, lethargy, unconsciousness, convulsions, or stridor in a calm child). None of these are mentioned. **3. NEET-PG High-Yield Pearls:** * **Fast Breathing Thresholds (IMNCI):** * < 2 months: ≥ 60/min * 2–12 months: ≥ 50/min * 12 months–5 years: ≥ 40/min * **Auscultation:** While bilateral crepitations support a diagnosis of lower respiratory tract involvement, the IMNCI classification relies primarily on clinical signs (RR and indrawing) for rapid field diagnosis. * **Treatment:** Pneumonia (non-severe) is treated with oral Amoxicillin (40 mg/kg/dose twice daily for 5 days) at home, whereas Severe Pneumonia requires hospitalization and IV Ampicillin/Gentamicin.

Q: All of the following are useful for treating acute bronchial asthma in children except?

Sodium Cromoglycate inhalation. **Explanation:** The management of acute bronchial asthma focuses on immediate reversal of airway obstruction and hypoxia. **Why Sodium Cromoglycate is the correct answer:** Sodium Cromoglycate is a **Mast Cell Stabilizer**. It works by preventing the degranulation of mast cells and the subsequent release of inflammatory mediators (like histamine). However, it has **no bronchodilatory properties** and is ineffective once an attack has started. It is used strictly for **prophylaxis** (long-term control) to prevent exercise-induced or allergen-induced asthma. In an acute emergency, it may even worsen bronchospasm due to its irritant powder nature. **Analysis of incorrect options:** * **100% Oxygen:** Hypoxia is a common complication of acute asthma. Maintaining oxygen saturation (SpO2 >94%) is a first-line priority in emergency management. * **Salbutamol:** This is a Short-Acting Beta-2 Agonist (SABA) and the **drug of choice** for acute exacerbations. It provides rapid bronchodilation by relaxing airway smooth muscle. * **Hydrocortisone:** Systemic corticosteroids are indicated in moderate-to-severe acute asthma to reduce airway inflammation and edema, and to upregulate beta-receptors, preventing late-phase reactions. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (Acute Attack):** Inhaled Salbutamol (SABA). * **Most effective long-term control:** Inhaled Corticosteroids (ICS) like Fluticasone or Budesonide. * **Status Asthmaticus:** If refractory to initial treatment, IV Magnesium Sulfate is often the next step. * **Ipratropium Bromide:** An anticholinergic often added to Salbutamol in the first hour of a severe attack for synergistic effects.

Q: An infant presented to OPD with features of respiratory distress. The X-ray is shown below. The most probable organism is?

S. aureus. ***S. aureus*** - **Pneumatoceles** (thin-walled air cysts) on chest X-ray are **pathognomonic** for staphylococcal pneumonia in infants. - S. aureus commonly causes **necrotizing pneumonia** with **cavitation** and **pneumothorax** formation in pediatric patients. *S. pyogenes* - Typically causes **pharyngitis** and **cellulitis** rather than severe pneumonia with cavitary lesions. - Chest X-ray findings usually show **lobar consolidation** without pneumatoceles or cavitation. *Klebsiella* - Commonly affects **immunocompromised adults** and causes **upper lobe consolidation** with **bulging fissures**. - Rarely causes **pneumatoceles** in infants; more associated with **thick, bloody sputum** production. *E. coli* - Primarily causes **neonatal sepsis** and **meningitis** rather than primary pneumonia in infants. - When it causes pneumonia, it typically presents as **diffuse infiltrates** without characteristic pneumatocele formation.

Q: What is the drug of choice for the prophylaxis of Bronchiolitis in a child with heart disease?

Palivizumab. **Explanation:** **Bronchiolitis** is most commonly caused by the **Respiratory Syncytial Virus (RSV)**. In infants with underlying risk factors such as congenital heart disease (CHD) or prematurity, RSV infection can lead to severe respiratory failure. **Why Palivizumab is the Correct Answer:** Palivizumab is a **humanized monoclonal antibody** directed against the F (fusion) protein of RSV. It provides passive immunity by preventing the virus from entering the host cells. It is specifically indicated for the **prophylaxis** (not treatment) of RSV in high-risk groups, including: 1. Infants with hemodynamically significant **Congenital Heart Disease**. 2. Preterm infants (<35 weeks gestation). 3. Infants with Chronic Lung Disease of prematurity (Bronchopulmonary Dysplasia). **Analysis of Incorrect Options:** * **A. Ribavirin:** This is an antiviral agent formerly used for the *treatment* of severe RSV, but its use is now limited due to toxicity and lack of proven benefit in mortality. It is not used for prophylaxis. * **B. Doxycycline:** A tetracycline antibiotic used for atypical pneumonias (like Mycoplasma); it has no role in treating or preventing viral bronchiolitis. * **D. Penicillin V:** An antibiotic used for Gram-positive bacterial infections (e.g., Streptococcal pharyngitis); it is ineffective against RSV. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** Palivizumab is administered **Intramuscularly (IM)** once a month during the RSV season (usually 5 doses). * **Diagnosis:** Bronchiolitis is a clinical diagnosis; the most common sign is **wheezing** preceded by upper respiratory symptoms. * **Treatment:** The mainstay of treatment for acute bronchiolitis is **supportive care** (hydration and oxygenation). Steroids and bronchodilators are generally not recommended.

Question 1

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 2

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 3

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

Question 4

A seven-year-old child presents with recurrent chest infections and exocrine pancreatic insufficiency, raising suspicion for cystic fibrosis. Sweat chloride levels have been measured between 40-60 mmol/l on two separate occasions. Which of the following tests should be performed next to support the diagnosis of cystic fibrosis?

Accepted Answer

Measure nasal potential difference

Answer

Repeat sweat chloride levels on a different day

Answer

Perform a 72-hour fecal fat collection

Answer

Perform DNA analysis for the F508 mutation

Question 5

"Steeple sign" on X-ray in children is most likely indicative of which condition?

Accepted Answer

Croup

Answer

Vocal cord paralysis

Answer

Streptococcal pharyngitis

Answer

Asthma

Question 6

What is true regarding bronchiolitis obliterans without cyanosis?

Accepted Answer

Continuous oxygen therapy is the mainstay of treatment

Answer

Most commonly caused by parainfluenza virus

Answer

Ribavirin for 16 hours/day for 4-5 days is useful

Answer

Ipratropium bromide is contraindicated

Question 7

A 2-year-old boy presented with cough, fever, and difficulty in breathing. His respiratory rate is 50/min. There is no chest indrawing. Auscultation of the chest reveals bilateral crepitations. What is the most probable diagnosis?

Accepted Answer

Pneumonia

Answer

Very severe pneumonia

Answer

Severe pneumonia

Answer

No pneumonia

Question 8

All of the following are useful for treating acute bronchial asthma in children except?

Accepted Answer

Sodium Cromoglycate inhalation

Answer

100% Oxygen

Answer

Hydrocortisone

Answer

Salbutamol

Question 9

An infant presented to OPD with features of respiratory distress. The X-ray is shown below. The most probable organism is?

Accepted Answer

S. aureus

Answer

S. pyogenes

Answer

Klebsiella

Answer

E.coli

Question 10

What is the drug of choice for the prophylaxis of Bronchiolitis in a child with heart disease?

Accepted Answer

Palivizumab

Answer

Ribavirin

Answer

Doxycycline

Answer

Penicillin V

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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