Respiratory Diseases Practice Questions

Q: What is the commonest sign of an intrabronchial foreign body in children?

Cough. **Explanation:** Foreign body aspiration (FBA) is a common pediatric emergency, most frequently occurring in children aged 1–3 years. **Why Cough is the Correct Answer:** **Cough** is the most common clinical sign and symptom of an intrabronchial foreign body, present in approximately **80–95% of cases**. When a foreign object enters the tracheobronchial tree, it triggers the cough reflex via the sensory receptors of the vagus nerve located in the larynx, trachea, and carina. While the initial "penetration syndrome" (choking and gasping) is classic, a persistent, unexplained cough remains the most consistent finding during the clinical presentation. **Analysis of Incorrect Options:** * **B. Wheeze:** While common, it is often localized or monophonic. It occurs due to partial airway obstruction but is less frequent than a cough. It is often misdiagnosed as asthma. * **C. Dyspnoea:** Shortness of breath occurs if the foreign body is large or causes significant lung collapse/obstructive emphysema, but it is not as universally present as a cough. * **D. Stridor:** This is a sign of **upper airway** (laryngeal or tracheal) obstruction. Since the question specifies an **intrabronchial** (lower airway) location, stridor is less likely than wheezing or coughing. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Cough, wheezing, and diminished breath sounds (found in only ~40% of patients). * **Most Common Site:** The **Right Main Bronchus** (due to it being wider, shorter, and more vertical than the left). * **Radiology:** Most foreign bodies are **radiolucent** (e.g., peanuts). Look for indirect signs like obstructive emphysema (hyperinflation) or atelectasis. * **Gold Standard Diagnosis/Management:** Rigid Bronchoscopy.

Q: All of the following criteria classify a child aged 11 months as having severe pneumonia, except:

Breathing rate > 40 per minute. This question tests your knowledge of the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for classifying respiratory infections in children aged 2 months to 5 years. ### **Why Option C is the Correct Answer** In a child aged 11 months, a breathing rate of **>40 per minute** is considered normal or "fast breathing" depending on the age bracket, but it does not define "Severe Pneumonia." According to IMNCI: * **Fast breathing** for an 11-month-old is defined as **≥50 breaths per minute**. * A rate of >40 per minute is only considered "fast breathing" for children aged **1 to 5 years**. * More importantly, tachypnea alone classifies a child as having **Pneumonia**, not **Severe Pneumonia**. ### **Analysis of Incorrect Options (Signs of Severe Pneumonia)** Options A, B, and D are all "General Danger Signs" or signs of severe respiratory distress that upgrade the classification to **Severe Pneumonia/Very Severe Disease**: * **Inability to drink or breastfeed (A):** A general danger sign indicating the child is too weak or distressed to maintain hydration/nutrition. * **Nasal flaring (B) and Grunting (D):** These are signs of significant respiratory distress. Grunting, specifically, is an expiratory sound produced against a partially closed glottis to maintain Functional Residual Capacity (FRC). * **Other signs include:** Chest indrawing (subcostal/intercostal), central cyanosis, lethargy, or convulsions. ### **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 * **Classification Shift:** Under the revised WHO criteria, "Chest Indrawing" now classifies a child as **Pneumonia** (treated with oral Amoxicillin), whereas "Severe Pneumonia" requires IV antibiotics and hospitalization due to the presence of general danger signs or severe distress (grunting/cyanosis).

Q: What is the most frequent pulmonary pathogen in cystic fibrosis?

Pseudomonas. **Explanation:** In Cystic Fibrosis (CF), the defect in the CFTR protein leads to thick, dehydrated secretions that impair mucociliary clearance, creating a niche for chronic bacterial colonization. **Why Pseudomonas is the correct answer:** While the initial colonizer in early childhood is often *Staphylococcus aureus*, **Pseudomonas aeruginosa** is the most frequent and significant pulmonary pathogen overall, especially as patients age. By late adolescence and adulthood, up to 80% of CF patients are colonized with *Pseudomonas*. Its ability to form **biofilms** (mucoid strains) makes it incredibly difficult to eradicate, leading to progressive bronchiectasis and respiratory failure, which is the leading cause of mortality in CF. **Why the other options are incorrect:** * **A. Klebsiella:** While it can cause pneumonia in debilitated or alcoholic patients, it is not a characteristic or frequent pathogen in the CF airway. * **B. Enterococci:** These are typically commensals of the GI tract and are rarely implicated in CF pulmonary exacerbations. * **C. Staphylococci:** *S. aureus* is the most common pathogen in **infants and young children** with CF. However, it is eventually surpassed by *Pseudomonas* in prevalence and clinical impact as the child grows older. **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall/Adults:** *Pseudomonas aeruginosa*. * **Most common in Children (<5-10 years):** *Staphylococcus aureus*. * **Burkholderia cepacia complex:** Associated with "Cepacia syndrome" (rapid clinical decline) and is often a contraindication for lung transplantation. * **Drug of Choice for Pseudomonas:** Antipseudonal penicillins (Piperacillin-Tazobactam), Ceftazidime, or Aminoglycosides (Tobramycin).

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: A two-year-old child is classified as having pneumonia if the respiratory rate is more than:

40 breaths/min. The classification of pneumonia in children, according to the **WHO Integrated Management of Childhood Illness (IMCI)** guidelines, relies primarily on the assessment of the respiratory rate to identify "fast breathing." ### **Why Option B is Correct** The threshold for fast breathing is age-dependent because the baseline respiratory rate decreases as a child matures. For a child aged **12 months to 5 years (which includes a two-year-old)**, the cutoff for fast breathing is **≥ 40 breaths per minute**. If a child in this age group presents with a cough or difficulty breathing and a respiratory rate of 40 or more, they are classified as having **Pneumonia**. ### **Analysis of Incorrect Options** * **Option A (30 breaths/min):** This is within the normal range for a two-year-old and does not meet the criteria for tachypnea. * **Option C (50 breaths/min):** This is the cutoff for infants aged **2 months to 12 months**. While a rate of 50 is technically "fast" for a two-year-old, the diagnostic threshold begins at 40. * **Option D (60 breaths/min):** This is the cutoff for neonates and young infants **less than 2 months of age**. ### **High-Yield Clinical Pearls for NEET-PG** * **WHO Classification Summary:** * **< 2 months:** ≥ 60 bpm (Fast breathing) * **2–12 months:** ≥ 50 bpm (Fast breathing) * **12 months–5 years:** ≥ 40 bpm (Fast breathing) * **Pneumonia vs. Severe Pneumonia:** Under revised WHO guidelines, "Pneumonia" is defined by fast breathing, while **"Severe Pneumonia"** is characterized by the presence of at least one danger sign (e.g., chest indrawing, cyanosis, inability to drink, lethargy, or convulsions). * **Measurement Tip:** The respiratory rate must be counted for a full **60 seconds** when the child is calm and not crying to be accurate.

Q: A 16-year-old asthmatic uses a salbutamol inhaler twice a week on average and frequently wakes up coughing. She is compliant with her treatment regimen and has good inhaler technique. Which of the following would be the most appropriate next step in managing her asthma?

Budesonide 200mg BD. **Explanation:** The patient’s clinical presentation—using a SABA (Salbutamol) twice weekly and experiencing **nocturnal symptoms** (frequent coughing at night)—indicates that her asthma is **not well-controlled**. According to GINA (Global Initiative for Asthma) guidelines, the presence of nocturnal symptoms even once a week classifies the asthma as "Persistent," necessitating the initiation of **maintenance controller therapy**. **1. Why Budesonide is Correct:** Inhaled Corticosteroids (ICS), such as **Budesonide**, are the first-line maintenance therapy for persistent asthma. They address the underlying airway inflammation, reduce bronchial hyper-responsiveness, and are the most effective agents for preventing exacerbations and nocturnal symptoms. **2. Why the other options are incorrect:** * **Theophylline (B):** This is a methylxanthine with a narrow therapeutic index and significant side effects. It is considered an add-on therapy and is never the first-line choice for maintenance. * **Montelukast (C):** While Leukotriene Receptor Antagonists (LTRAs) can be used, they are generally considered less effective than ICS as monotherapy. ICS remains the "Gold Standard" for initial controller treatment. * **Salmeterol (D):** Long-Acting Beta-Agonists (LABA) should **never** be used as monotherapy in asthma due to the risk of life-threatening exacerbations. They must always be combined with an ICS. **Clinical Pearls for NEET-PG:** * **Step-up Criteria:** If a patient uses a SABA >2 times/week or has nocturnal awakenings >1-2 times/month, start Step 2 therapy (Low-dose ICS). * **Drug of Choice:** ICS is the most effective long-term medication for controlling asthma across all age groups. * **Side Effects:** Local side effects of ICS include oropharyngeal candidiasis and dysphonia (minimized by using a spacer and rinsing the mouth).

Question 1

What is the commonest sign of an intrabronchial foreign body in children?

Accepted Answer

Cough

Answer

Wheeze

Answer

Dyspnoea

Answer

Stridor

Question 2

Pneumatoceles are seen in which of the following conditions?

Accepted Answer

Klebsiella pneumonia

Answer

Pneumococcal pneumonia

Answer

Mycoplasma pneumonia

Answer

Streptococcal pneumonia

Question 3

All of the following criteria classify a child aged 11 months as having severe pneumonia, except:

Accepted Answer

Breathing rate > 40 per minute

Answer

Inability to drink or breastfeed

Answer

Nasal flaring

Answer

Grunting

Question 4

What is the most frequent pulmonary pathogen in cystic fibrosis?

Accepted Answer

Pseudomonas

Answer

Klebsiella

Answer

Enterococci

Answer

Staphylococci

Question 5

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 6

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 7

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 8

A two-year-old child is classified as having pneumonia if the respiratory rate is more than:

Accepted Answer

40 breaths/min

Answer

30 breaths/min

Answer

50 breaths/min

Answer

60 breaths/min

Question 9

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 10

A 16-year-old asthmatic uses a salbutamol inhaler twice a week on average and frequently wakes up coughing. She is compliant with her treatment regimen and has good inhaler technique. Which of the following would be the most appropriate next step in managing her asthma?

Accepted Answer

Budesonide 200mg BD

Answer

Theophylline 300mg sustained release

Answer

Montelukast 10mg

Answer

Salmeterol 50mg BD

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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