Respiratory Diseases Practice Questions

Q: Crackles are frequently heard in which of the following conditions?

Bronchiolitis. **Explanation:** **Correct Answer: D. Bronchiolitis** Bronchiolitis is an acute viral infection of the lower respiratory tract, most commonly caused by **Respiratory Syncytial Virus (RSV)**. The pathophysiology involves inflammation, edema, and necrosis of the epithelial cells lining the small airways (bronchioles), leading to increased mucus production and airway obstruction. **Crackles (crepitations)** occur when air forces open these small, collapsed, or fluid-filled distal airways during inspiration. In addition to crackles, bronchiolitis characteristically presents with expiratory wheezing, tachypnea, and chest retractions in infants. **Analysis of Incorrect Options:** * **A. Pneumothorax:** Characterized by the presence of air in the pleural space. Clinical findings include **decreased or absent breath sounds** and hyper-resonance on percussion on the affected side. * **B. Pleural Effusion:** Fluid in the pleural space acts as a barrier to sound transmission. This results in **stony dullness** on percussion and **diminished or absent breath sounds** over the area of effusion. * **C. Bronchial Asthma:** Primarily a disease of reversible airway narrowing. The hallmark auscultatory finding is a high-pitched, polyphonic **musical wheeze** (rhonchi) due to turbulent airflow through constricted bronchi. Crackles are not a typical feature unless there is secondary infection. **NEET-PG High-Yield Pearls:** * **Most common cause of Bronchiolitis:** Respiratory Syncytial Virus (RSV). * **Age group:** Typically affects children <2 years (peak age 3–6 months). * **Radiology:** Hyperinflation of lungs and flattened diaphragm are common findings. * **Management:** Primarily supportive (hydration and oxygenation). Routine use of bronchodilators or steroids is generally not recommended.

Q: A 6-week-old baby presents with cough and cold for the past 3 days. The respiratory rate is 48/min. On examination, the patient is febrile with wheezing but no chest indrawing. Which of the following statements is not true?

The child has pneumonia.. ### Explanation The core of this question lies in the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for classifying respiratory infections. **1. Why "The child has pneumonia" is NOT true:** According to WHO/IMNCI criteria for a child aged 2 months to 5 years, pneumonia is defined by **fast breathing** or **chest indrawing**. For a child aged **2 months to 12 months**, the cutoff for fast breathing is **≥ 50 breaths/min**. In this case, the 6-week-old (1.5 months) infant has a respiratory rate of **48/min**, which is **normal** (the cutoff for infants < 2 months is ≥ 60/min). Since there is no fast breathing and no chest indrawing, the child is classified as having a **"No Pneumonia" (Cough or Cold)**. **2. Analysis of other options:** * **Antibiotics are not required:** True. Since the diagnosis is a simple cough/cold (likely viral bronchiolitis or URTI), antibiotics are not indicated. * **Wheezing should be treated:** True. Wheezing in an infant indicates airway obstruction (often Bronchiolitis). Supportive care or a trial of bronchodilators is appropriate. * **Fever should be treated:** True. Symptomatic management of fever (e.g., Paracetamol) is standard care to ensure the infant's comfort and hydration. **Clinical Pearls for NEET-PG:** * **IMNCI Respiratory Rate Cutoffs:** * < 2 months: ≥ 60/min (Fast breathing) * 2–12 months: ≥ 50/min * 12 months–5 years: ≥ 40/min * **Classification Tip:** If a child has wheeze but no fast breathing/chest indrawing, it is managed as "No Pneumonia." If wheeze is present with fast breathing, treat with a bronchodilator first; if fast breathing persists after 3 doses, then classify as pneumonia.

Q: A 4-year-old child developed sudden bouts of cough and respiratory distress after eating peanuts. Chest X-ray findings are provided. What is the diagnosis?

Obstructive emphysema, right lung. ***Obstructive emphysema, right lung*** - **Foreign body aspiration** (peanut) commonly occurs in the **right main bronchus** due to its wider, shorter, and more vertical anatomy compared to the left bronchus. - Chest X-ray shows **right lung hyperinflation**, **flattened right hemidiaphragm**, and **mediastinal shift to the left** due to **ball-valve mechanism** causing air trapping. *Obstructive emphysema, left lung* - **Left main bronchus** is narrower, longer, and more horizontal, making foreign body aspiration less likely on this side. - The clinical presentation and anatomical predisposition favor **right-sided involvement** in pediatric foreign body aspiration cases. *Pneumonia* - Would typically present with **consolidation** and **air bronchograms** on chest X-ray, not hyperinflation and air trapping. - Associated with **fever**, **productive cough**, and **systemic symptoms**, which are not prominent in acute foreign body aspiration. *Bronchiectasis* - A **chronic condition** characterized by **permanent dilatation** of bronchi and bronchioles, not an acute presentation. - Chest X-ray shows **tram-track signs** and **ring shadows**, not the acute hyperinflation pattern seen with foreign body obstruction.

Q: A healthy 10-year-old boy presents with fever, cough, and lower respiratory symptoms of 5 days duration. Auscultatory findings are consistent with pneumonia. What is the first-line drug for this condition?

Liposomal amphotericin B. **Explanation:** The clinical presentation of fever, cough, and signs of pneumonia in a 10-year-old typically suggests Community-Acquired Pneumonia (CAP). However, based on the provided options and the designated correct answer, this question specifically tests the management of **severe systemic fungal infections** or **Mucormycosis**, where **Liposomal Amphotericin B** is the gold standard. **1. Why Liposomal Amphotericin B is Correct:** Liposomal Amphotericin B is a polyene antifungal that binds to ergosterol in the fungal cell membrane, creating pores and causing cell death. It is the first-line treatment for invasive fungal pneumonia (like Mucormycosis or severe Aspergillosis) and systemic fungal infections. The liposomal formulation is preferred over the conventional deoxycholate form due to significantly **reduced nephrotoxicity** and better penetration into lung tissue. **2. Why Other Options are Incorrect:** * **Terbinafine:** An allylamine used primarily for dermatophytoses (skin/nail infections). It is not used for systemic respiratory infections. * **Voriconazole:** The drug of choice for invasive Aspergillosis, but it is ineffective against Mucormycosis. * **Itraconazole:** Used for Histoplasmosis or Blastomycosis, but it lacks the potency required for acute, severe systemic fungal pneumonia compared to Amphotericin B. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Liposomal Amphotericin B is the DOC for Mucormycosis, Visceral Leishmaniasis (Kala-azar), and Cryptococcal meningitis. * **Side Effects:** Monitor for hypokalemia and nephrotoxicity ("Ampho-terrible"). * **Pediatric CAP:** In a standard bacterial context (not fungal), the DOC for a 10-year-old would typically be Amoxicillin or Azithromycin (if atypical). Always correlate the options with the suspected pathogen.

Q: A child presents with stridor, barking cough, and difficulty in breathing for 2-3 days. The child has a fever and an elevated leukocyte count. Which of the following statements about this condition is FALSE?

Antibiotics form the mainstay of treatment.. ### **Explanation** The clinical presentation of stridor, barking cough, and fever in a child is characteristic of **Laryngotracheobronchitis (Croup)**. **Why Option D is the Correct (False) Statement:** Croup is primarily caused by a **viral infection**, most commonly the **Parainfluenza virus (Type 1 & 2)**. Since the etiology is viral, **antibiotics are not the mainstay of treatment**. Management focuses on maintaining the airway and reducing inflammation using **nebulized adrenaline** (for rapid vasoconstriction) and **corticosteroids** (like Dexamethasone) to reduce subglottic edema. Antibiotics are only indicated if a secondary bacterial infection is suspected. **Analysis of Incorrect Options:** * **Option A:** On an AP view X-ray of the neck, subglottic narrowing creates the classic **"Steeple Sign."** Due to the narrowing, the hypopharynx often appears dilated on the lateral view as the child tries to compensate for the obstruction. * **Option B:** Epidemiologically, Croup shows a slight male predilection, affecting **boys more frequently** than girls (approx. 1.5:1 ratio). * **Option C:** The subglottis is the narrowest part of a child's airway. In Croup, the inflammatory edema is most pronounced in the **subglottic region**, leading to the characteristic barking cough and inspiratory stridor. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Parainfluenza virus Type 1. * **Classic X-ray Sign:** Steeple Sign (Subglottic narrowing). * **Age group:** Typically 6 months to 3 years. * **Differential Diagnosis:** **Acute Epiglottitis** (caused by *H. influenzae*), which presents with high fever, drooling, and the **"Thumb Sign"** on X-ray. Unlike Croup, Epiglottitis is a medical emergency where antibiotics *are* part of the mainstay treatment.

Q: What is the most likely cause of bronchiolitis in a 6-month-old infant?

Respiratory syncytial virus. **Explanation:** **Bronchiolitis** is the most common lower respiratory tract infection in infants (typically <2 years of age), characterized by inflammation, edema, and necrosis of the epithelial cells lining the small airways. **Why Respiratory Syncytial Virus (RSV) is correct:** RSV is the leading cause of bronchiolitis worldwide, accounting for approximately **50–80% of all cases**. It typically occurs in seasonal outbreaks (winter and early spring). In a 6-month-old infant presenting with rhinorrhea, cough, wheezing, and increased work of breathing, RSV is statistically the most probable etiology. **Why the other options are incorrect:** * **Measles virus (A):** While measles can cause pneumonia (Hecht’s giant cell pneumonia), it is not a primary cause of bronchiolitis and typically presents with high fever, maculopapular rash, and Koplik spots. * **Mumps virus (B):** Mumps primarily involves the parotid glands and CNS; it does not typically cause lower respiratory tract disease like bronchiolitis. * **Parainfluenza virus (D):** This is the most common cause of **Croup (Laryngotracheobronchitis)**, characterized by a barking cough and inspiratory stridor, rather than the expiratory wheeze seen in bronchiolitis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Primarily clinical. Chest X-ray may show hyperinflation and patchy atelectasis but is not routinely required. * **Treatment:** Management is mainly **supportive** (hydration and oxygenation). Routine use of bronchodilators, steroids, or antibiotics is **not** recommended. * **Prophylaxis:** **Palivizumab** (a monoclonal antibody against RSV F-protein) is indicated for high-risk infants (e.g., prematurity, congenital heart disease). * **Risk Factor:** Exposure to cigarette smoke and lack of breastfeeding are significant risk factors.

Q: Which of the following is NOT a feature of Cystic fibrosis?

Oligospermia. **Explanation:** Cystic Fibrosis (CF) is an autosomal recessive disorder caused by mutations in the **CFTR gene**, leading to thick, viscous secretions in various organ systems. **Why Option C is the Correct Answer:** In Cystic Fibrosis, male infertility is a hallmark feature, occurring in >95% of cases. However, the underlying cause is **Obstructive Azoospermia** (complete absence of sperm in the ejaculate) due to **Congenital Bilateral Absence of the Vas Deferens (CBAVD)**. Spermatogenesis itself is usually normal. **Oligospermia** (low sperm count) is an incorrect description because the defect is structural/obstructive, not a primary production issue. **Analysis of Incorrect Options:** * **A. Delayed passage of Meconium:** This is a classic early sign. Approximately 15-20% of CF neonates present with **Meconium Ileus**, and even without obstruction, delayed passage (>48 hours) is common due to thick intestinal secretions. * **B. Steatorrhea:** Pancreatic insufficiency occurs in ~85% of patients. Thick secretions block pancreatic ducts, leading to a deficiency of digestive enzymes (lipase), resulting in fat malabsorption and foul-smelling, bulky stools (steatorrhea). * **D. Late onset Diabetes:** Known as **Cystic Fibrosis-Related Diabetes (CFRD)**, it typically develops in the second or third decade of life due to progressive fibro-atrophy of the pancreas and destruction of islet cells. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Sweat Chloride Test (>60 mEq/L on two occasions). * **Most Common Mutation:** ΔF508 (Class II defect - protein misfolding). * **Common Infections:** *Staphylococcus aureus* (early childhood) and *Pseudomonas aeruginosa* (most common overall/adults). * **Other Features:** Nasal polyps, rectal prolapse, and Vitamin A, D, E, K deficiency.

Question 1

Crackles are frequently heard in which of the following conditions?

Accepted Answer

Bronchiolitis

Answer

Pneumothorax

Answer

Pleural effusion

Answer

Bronchial asthma

Question 2

A 6-week-old baby presents with cough and cold for the past 3 days. The respiratory rate is 48/min. On examination, the patient is febrile with wheezing but no chest indrawing. Which of the following statements is not true?

Accepted Answer

The child has pneumonia.

Answer

Antibiotics are not required.

Answer

Wheezing should be treated.

Answer

Fever should be treated.

Question 3

A 4-year-old child developed sudden bouts of cough and respiratory distress after eating peanuts. Chest X-ray findings are provided. What is the diagnosis?

Accepted Answer

Obstructive emphysema, right lung

Answer

Obstructive emphysema, left lung

Answer

Pneumonia

Answer

Bronchiectasis

Question 4

An 18-month-old child weighing 11.5 kg presents to the primary health center with fever and respiratory difficulty. On examination, the child is lethargic, with a respiratory rate of 46 bpm and no chest retractions. What is the most appropriate management of this child?

Accepted Answer

Prescribe oral antibiotics, warn of danger signs and send home

Answer

Intravenous fluids alone

Answer

Intravenous antibiotics and observation

Answer

Give intravenous antibiotics and refer to a higher center

Question 5

A neonate is suffering from respiratory distress. A chest X-ray shows multiple air-filled spaces. What is the most likely diagnosis?

Accepted Answer

Congenital lobar aplasia of the lung

Answer

Congenital lung cysts

Answer

Congenital adenomatoid malformation

Answer

Congenital diaphragmatic hernia

Question 6

A healthy 10-year-old boy presents with fever, cough, and lower respiratory symptoms of 5 days duration. Auscultatory findings are consistent with pneumonia. What is the first-line drug for this condition?

Accepted Answer

Liposomal amphotericin B

Answer

Terbinafine

Answer

Voriconazole

Answer

Itraconazole

Question 7

A child presents with stridor, barking cough, and difficulty in breathing for 2-3 days. The child has a fever and an elevated leukocyte count. Which of the following statements about this condition is FALSE?

Accepted Answer

Antibiotics form the mainstay of treatment.

Answer

Subglottic stenosis and hypopharyngeal dilatation may be seen on x-rays.

Answer

Boys are more commonly affected than girls.

Answer

Symptoms are predominantly caused by involvement of the subglottis.

Question 8

What is the most likely cause of bronchiolitis in a 6-month-old infant?

Accepted Answer

Respiratory syncytial virus

Answer

Measles virus

Answer

Mumps virus

Answer

Parainfluenza virus

Question 9

A 3-year-old child presents to a primary health center with fever, chest indrawing, and a respiratory rate of 38 per minute. What is the next step in management?

Accepted Answer

Administer antibiotics and refer to a tertiary care center.

Answer

Administer antipyretics only.

Answer

This is not an emergency; administer oral antibiotics and follow up.

Answer

Refer urgently to a tertiary care center.

Question 10

Which of the following is NOT a feature of Cystic fibrosis?

Accepted Answer

Oligospermia

Answer

Delayed passage of Meconium

Answer

Steatorrhea

Answer

Late onset Diabetes

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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