Respiratory Diseases Practice Questions

Q: Fever persisting even after treatment of pneumonia. What is the likely diagnosis?

Empyema. **Explanation:** The persistence of fever despite appropriate antibiotic therapy for pneumonia (typically after 48–72 hours) is a classic clinical indicator of a **parapneumonic complication**, most commonly **Empyema**. **1. Why Empyema is the Correct Answer:** Empyema refers to the accumulation of pus in the pleural space. When a patient with pneumonia does not show clinical improvement (defervescence), it suggests that the infection has localized in a space where systemic antibiotics have poor penetration or that a "focal collection" has formed. In pediatrics, *Staphylococcus aureus* and *Streptococcus pneumoniae* are common culprits. The presence of pus creates a persistent inflammatory state, necessitating drainage (thoracocentesis or chest tube) in addition to antibiotics. **2. Why Other Options are Incorrect:** * **Fungal Lesion:** While fungal pneumonia can cause persistent fever, it is rare in immunocompetent children. It usually presents in severely immunocompromised patients or as a chronic indolent course, rather than an acute failure of standard pneumonia treatment. * **Hydrothorax:** This refers to a non-inflammatory serous fluid collection (transudate), often due to heart failure or nephrotic syndrome. It does not typically cause a persistent high-grade fever. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Ultrasound of the chest is highly sensitive for detecting pleural fluid and septations (loculated empyema). * **Light’s Criteria:** Used to differentiate exudate (pneumonia/empyema) from transudate. * **Management:** If fever persists, the first step is a repeat physical exam (look for dullness on percussion/decreased breath sounds) followed by a Chest X-ray or Ultrasound. * **Other causes of persistent fever:** Lung abscess, antibiotic resistance, or a non-infectious cause like a foreign body.

Q: A 10-year-old child presents with a 3-day history of cough and coryza, increasing respiratory distress for the last 1 day, and a whistling sound from the chest since morning. The child has had multiple similar episodes in the past, especially during seasonal changes. What is the most probable diagnosis?

Bronchial Asthma. ### Explanation **Correct Answer: A. Bronchial Asthma** The diagnosis of Bronchial Asthma is based on the clinical triad of **recurrent episodes** of airway obstruction, **reversibility**, and **hyper-responsiveness** to triggers. In this case, the "whistling sound" (wheezing) and respiratory distress triggered by a viral prodrome (cough/coryza) are classic. The most significant clue for NEET-PG is the **history of multiple similar episodes** and **seasonal variation**, which strongly points toward a chronic inflammatory airway disease rather than an acute infection or a one-time event. **Why other options are incorrect:** * **B. Bronchiolitis:** While it presents with wheezing and distress, it typically affects children **<2 years of age** (peak at 6 months). A 10-year-old is outside the typical age range for a first episode of bronchiolitis. * **C. Bronchopneumonia:** This usually presents with high-grade fever, productive cough, and toxic appearance. On auscultation, you would expect **crepitations (crackles)** rather than a continuous whistling wheeze. It does not typically present with a recurrent, seasonal pattern. * **D. Foreign Body Aspiration:** This presents with a **sudden onset** of choking and respiratory distress, usually without a preceding viral prodrome (coryza). The wheeze is often monophonic and localized to one side, rather than the diffuse polyphonic wheeze seen in asthma. **Clinical Pearls for NEET-PG:** * **Diagnosis:** In children >5 years, **Spirometry** is the gold standard (shows obstructive pattern with >12% improvement in FEV1 post-bronchodilator). * **Triggers:** Viral infections (especially Rhinovirus) are the most common triggers for asthma exacerbations in children. * **Rule of Thumb:** "All that wheezes is not asthma, but recurrent wheeze in a school-aged child is asthma until proven otherwise."

Q: A 6-month-old baby presents with a respiratory rate of 54/min and retractions. How should the doctor at a Primary Health Centre manage this case?

Classify as pneumonia, start oral antibiotics.. This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for managing Acute Respiratory Infections (ARI). ### **1. Why Option D is Correct** According to IMNCI guidelines, the classification of respiratory distress in a child aged 2 months to 5 years is based on specific clinical signs: * **Fast Breathing:** In a 6-month-old, a respiratory rate (RR) of **≥50 breaths/min** is defined as fast breathing. This patient has a RR of 54/min. * **Chest Indrawing (Retractions):** The presence of lower chest indrawing without "danger signs" classifies the case as **Pneumonia**. * **Management:** For "Pneumonia," the protocol is to provide **oral Amoxicillin** (80 mg/kg/day for 5 days) and home care advice. Referral is not required unless danger signs are present. ### **2. Why Other Options are Incorrect** * **Option A & B:** These classifications are reserved for **"Severe Pneumonia."** This requires the presence of at least one **General Danger Sign** (inability to drink/breastfeed, persistent vomiting, lethargy/unconsciousness, or convulsions) or **Stridor** in a calm child. Since none are mentioned, injectable antibiotics and urgent referral are not indicated. * **Option C:** Oxygen therapy is indicated for Severe Pneumonia (SpO2 <90-92%). For non-severe pneumonia, oral antibiotics are the primary intervention. ### **3. Clinical Pearls for NEET-PG** * **RR Cut-offs for Fast Breathing:** * <2 months: ≥60/min * 2–12 months: **≥50/min** * 12 months–5 years: ≥40/min * **Drug of Choice:** Oral **Amoxicillin** is now the first-line treatment for pneumonia in the community (replacing Cotrimoxazole). * **Key Sign:** Lower chest indrawing must be persistent to be clinically significant. If only intercostal retractions are present, it is still classified as pneumonia.

Q: A 9-year-old boy with moderately persistent, well-controlled asthma is currently using short-acting beta-agonists, daily inhaled steroids, and a leukotriene inhibitor. He presents with white patches on his buccal mucosa. What is the next best step?

Rinse his mouth after using inhaled medications. **Explanation:** The clinical presentation of white patches on the buccal mucosa in a patient using inhaled corticosteroids (ICS) is classic for **Oropharyngeal Candidiasis (Oral Thrush)**. **1. Why Option B is Correct:** Inhaled corticosteroids, while effective for asthma, can cause local immunosuppression in the oral cavity. This allows for the overgrowth of *Candida albicans*. The most effective preventive measure and the immediate next step in management is to advise the patient to **rinse their mouth and gargle with water** after each use of the ICS inhaler. Using a **spacer device** also helps by reducing the amount of drug deposited in the oropharynx and increasing delivery to the lower airways. **2. Why Other Options are Incorrect:** * **Option A & C:** While oral thrush can be a sign of systemic immunosuppression (like HIV or primary immunodeficiency), it is a known and common local side effect of ICS. In a patient with well-controlled asthma on steroids, the medication is the most likely culprit; invasive testing is not indicated unless the infection is refractory or recurrent despite proper technique. * **Option D:** Discontinuing asthma medications is dangerous and could lead to a life-threatening exacerbation. The asthma is "well-controlled," meaning the current regimen is effective and should be maintained with better administration technique. **Clinical Pearls for NEET-PG:** * **Local side effects of ICS:** Oral candidiasis, dysphonia (due to vocal cord myopathy), and reflex cough. * **Prevention:** "Rinse and Spit" technique and use of a Valved Holding Chamber (Spacer). * **Treatment:** If symptomatic, topical antifungal agents like **Nystatin** suspension or **Clotrimazole** troches are used. * **Systemic effects of ICS:** Though rare at standard doses, high doses in children can lead to transient growth deceleration and adrenal suppression.

Q: A 2-year-old male child presents with cough, high-grade fever, and rapid breathing for the past 7 days. On examination, the respiratory rate is 50/min, and visible chest indrawing is present. What is the next appropriate line of management?

Home management with Amoxicillin.. ### Explanation This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for the classification and management of pneumonia. #### Why Option B is Correct: According to IMNCI guidelines, a child aged 2 months to 5 years with a cough/difficulty breathing is classified based on clinical signs: 1. **Pneumonia:** Presence of **fast breathing** (RR ≥ 40/min for ages 1–5 years) OR **chest indrawing**. 2. **Severe Pneumonia:** Presence of any **danger signs** (inability to drink, persistent vomiting, convulsions, lethargy, or stridor in a calm child). In this case, the child has fast breathing (50/min) and chest indrawing but **no danger signs**. Under the revised WHO/IMNCI criteria, "Chest Indrawing" is now classified as **Pneumonia** (not severe pneumonia) and can be managed at **home with oral Amoxicillin** (40 mg/kg/dose twice daily for 5 days). #### Why Other Options are Wrong: * **Option A & D:** These are inappropriate because the child meets the criteria for pneumonia. Ignoring the need for antibiotics increases the risk of progression to respiratory failure. * **Option C:** Hospitalization (IV antibiotics) is reserved for **Severe Pneumonia** (presence of danger signs) or if the child fails to respond to oral antibiotics. #### 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 * **First-line antibiotic:** Oral Amoxicillin is the gold standard for community-acquired pneumonia in children. * **Key Change:** Previously, chest indrawing signified "Severe Pneumonia" requiring hospitalization. Current guidelines classify it as "Pneumonia" manageable at home to reduce the hospital burden.

Q: Which of the following is NOT a cause of stridor in infants?

Bronchiolitis. **Explanation:** The fundamental concept to distinguish these conditions is the **anatomical location** of the airway obstruction. **Stridor** is a high-pitched, predominantly inspiratory sound caused by turbulent airflow through a partially obstructed **upper airway** (above the thoracic inlet, i.e., larynx, pharynx, or trachea). * **Why Bronchiolitis is the correct answer:** Bronchiolitis is a **lower respiratory tract infection** affecting the small airways (bronchioles). Obstruction in the lower airways results in **wheezing** (a high-pitched polyphonic expiratory sound) rather than stridor. Since it does not involve the upper airway, it is not a cause of stridor. **Analysis of Incorrect Options:** * **Laryngomalacia:** The most common cause of congenital stridor. It involves collapse of supraglottic structures during inspiration. * **Croup (Laryngotracheobronchitis):** The most common cause of acute stridor in children (6 months to 3 years), characterized by subglottic edema and a "barking" cough. * **Retropharyngeal Abscess:** An upper airway emergency where pus accumulation in the prevertebral space narrows the pharyngeal lumen, leading to inspiratory stridor, drooling, and neck stiffness. **High-Yield Clinical Pearls for NEET-PG:** * **Inspiratory Stridor:** Indicates obstruction at or above the vocal cords (e.g., Laryngomalacia, Epiglottitis). * **Biphasic Stridor:** Indicates subglottic or glottic obstruction (e.g., Croup, Subglottic stenosis). * **Expiratory Stridor (or Wheeze):** Indicates tracheobronchial obstruction (e.g., Foreign body in bronchus, Bronchiolitis). * **Steeple Sign:** Classic X-ray finding in Croup (subglottic narrowing). * **Thumb Sign:** Classic X-ray finding in Epiglottitis (swollen epiglottis).

Q: A 7-week-old preterm infant, who was intubated for 2 weeks and weaned off oxygen at 3 weeks of age, presents with recent onset of hypoxia, respiratory distress, wheezes, and runny nose. A chest radiograph reveals patchy infiltrates and hyper-expansion in both lung fields. Her 2-year-old sibling has an upper respiratory infection. What is the most likely diagnosis for this clinical scenario?

Bronchiolitis. **Explanation:** The clinical presentation is a classic case of **Acute Bronchiolitis**, likely caused by Respiratory Syncytial Virus (RSV). The key diagnostic clues are the **acute onset** of respiratory distress (wheezing, hypoxia) following a viral prodrome (runny nose) and exposure to an ill contact (the sibling). While the infant has a history of prematurity and mechanical ventilation, the fact that she was successfully weaned off oxygen at 3 weeks of age and remained asymptomatic until now makes a chronic condition less likely than an acute infection. The chest X-ray findings of **hyper-expansion and patchy infiltrates** are characteristic of air trapping seen in bronchiolitis. **Why other options are incorrect:** * **Bronchopulmonary Dysplasia (BPD):** Defined as the need for supplemental oxygen at 36 weeks post-menstrual age. This infant was off oxygen by 3 weeks of age, ruling out BPD. * **Respiratory Distress Syndrome (RDS):** This occurs immediately after birth in preterm infants due to surfactant deficiency. It does not present for the first time at 7 weeks of age. * **Pulmonary Interstitial Emphysema (PIE):** This is a complication of mechanical ventilation where air leaks into the interstitium; it occurs while the patient is on a ventilator, not weeks after extubation. **Clinical Pearls for NEET-PG:** * **Most common cause:** RSV (Respiratory Syncytial Virus). * **Risk Factors for severe disease:** Prematurity, congenital heart disease, and chronic lung disease. * **Radiology:** Hyperinflation, flattened diaphragm, and peribronchial cuffing. * **Management:** Primarily supportive (hydration and oxygen). Bronchodilators and steroids are generally not recommended. * **Prophylaxis:** Palivizumab (monoclonal antibody) is indicated for high-risk preterm infants.

Question 1

A 6-year-old girl presents with a 2-day history of cough and fever. On examination, she has a temperature of 39.4°C (103°F), a respiratory rate of 45 breaths per minute, and decreased breath sounds on the left side. Her chest x-ray shows findings consistent with pneumonia. Which of the following is the most appropriate initial treatment?

Accepted Answer

Vancomycin

Answer

N-acetylcysteine and chest physiotherapy

Answer

Partial lobectomy

Answer

Postural drainage

Question 2

Fever persisting even after treatment of pneumonia. What is the likely diagnosis?

Accepted Answer

Empyema

Answer

Fungal lesion

Answer

Hydrothorax

Answer

All of the above

Question 3

A 10-year-old child presents with a 3-day history of cough and coryza, increasing respiratory distress for the last 1 day, and a whistling sound from the chest since morning. The child has had multiple similar episodes in the past, especially during seasonal changes. What is the most probable diagnosis?

Accepted Answer

Bronchial Asthma

Answer

Bronchiolitis

Answer

Bronchopneumonia

Answer

Foreign body aspiration

Question 4

A 6-month-old baby presents with a respiratory rate of 54/min and retractions. How should the doctor at a Primary Health Centre manage this case?

Accepted Answer

Classify as pneumonia, start oral antibiotics.

Answer

Classify as very severe pneumonia and refer immediately.

Answer

Classify as severe pneumonia, start injectable antibiotic and then refer.

Answer

Classify as pneumonia and start oxygen therapy.

Question 5

A 9-year-old boy with moderately persistent, well-controlled asthma is currently using short-acting beta-agonists, daily inhaled steroids, and a leukotriene inhibitor. He presents with white patches on his buccal mucosa. What is the next best step?

Accepted Answer

Rinse his mouth after using inhaled medications

Answer

HIV testing

Answer

Measurement of serum immunoglobulins

Answer

Discontinuation of all asthma medications

Question 6

An 8-year-old girl is brought into the physician's office in mild respiratory distress. She has a history of allergies to cats and wool, and her parents state that she has recurrent episodes of upper respiratory tract infections. Physical examination shows expiratory wheezes, use of accessory respiratory muscles, and a hyperresonant chest to percussion. Analysis of arterial blood gases discloses respiratory alkalosis, and the peripheral eosinophil count is increased. What is the appropriate diagnosis?

Accepted Answer

Asthma

Answer

Acute bronchiolitis

Answer

Cystic fibrosis

Answer

Kartagener syndrome

Question 7

A 2-year-old male child presents with cough, high-grade fever, and rapid breathing for the past 7 days. On examination, the respiratory rate is 50/min, and visible chest indrawing is present. What is the next appropriate line of management?

Accepted Answer

Home management with Amoxicillin.

Answer

Home management with Paracetamol.

Answer

Hospital management with antibiotics.

Answer

Reassurance.

Question 8

A 12-year-old child presents with bilateral nasal polyps. His mother complains of a salty taste on the child's skin while kissing. What condition should be investigated?

Accepted Answer

Cystic fibrosis

Answer

Rhinosporidiosis

Answer

Angiofibroma

Answer

Antrochoanal polyp

Question 9

Which of the following is NOT a cause of stridor in infants?

Accepted Answer

Bronchiolitis

Answer

Croup

Answer

Laryngomalacia

Answer

Retropharyngeal abscess

Question 10

A 7-week-old preterm infant, who was intubated for 2 weeks and weaned off oxygen at 3 weeks of age, presents with recent onset of hypoxia, respiratory distress, wheezes, and runny nose. A chest radiograph reveals patchy infiltrates and hyper-expansion in both lung fields. Her 2-year-old sibling has an upper respiratory infection. What is the most likely diagnosis for this clinical scenario?

Accepted Answer

Bronchiolitis

Answer

Bronchopulmonary dysplasia

Answer

Respiratory distress syndrome (hyaline membrane disease)

Answer

Pulmonary interstitial emphysema

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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