Respiratory Diseases Practice Questions

Q: For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program? I. Fast breathing (Greater than or equal to 40 breaths per minute) II. Child vomits everything III. Stridor in a calm child IV. Chest indrawing: Select the correct answer using the code given below :

III and IV. ***III and IV*** - **Stridor in a calm child** is a critical sign indicating severe upper airway obstruction, classified as "very severe disease" in IMNCI. This is a general danger sign requiring urgent referral. - **Chest indrawing** (severe lower chest wall indrawing) signifies increased work of breathing and severe respiratory distress, categorizing it under "severe pneumonia" in IMNCI and requiring urgent referral. - These two signs represent the most specific respiratory indicators of severe pneumonia or very severe disease. *I and II* - **Fast breathing** for a 4-year-old (age 12 months to 5 years) is correctly defined as ≥40 breaths per minute per IMNCI. However, fast breathing alone indicates **pneumonia** (not severe pneumonia), which can be managed as outpatient with oral antibiotics. - **Child vomits everything** is indeed a general danger sign indicating "very severe disease" in IMNCI, but when combined with fast breathing (which indicates only simple pneumonia), this combination is less specific than III and IV. *II and III* - **Child vomits everything** is a general danger sign for "very severe disease" requiring urgent referral. - **Stridor in a calm child** is also a sign of "very severe disease." - While both are valid signs, this combination misses **chest indrawing**, which is the primary respiratory-specific sign of severe pneumonia and more directly answers the question about severe pneumonia classification. *II and IV* - **Child vomits everything** is a general danger sign for "very severe disease." - **Chest indrawing** is the key sign of "severe pneumonia." - While both are valid signs of severe pneumonia or very severe disease, the combination of **stridor and chest indrawing (III and IV)** represents the two most specific respiratory signs and is the preferred answer for this classification.

Q: A child of 2 years having a respiratory rate of 46 per minute shall be classified by a health worker as

pneumonia. ***Correct: Pneumonia*** - A respiratory rate of **46 breaths per minute** in a 2-year-old child falls within the criteria for **fast breathing**. According to World Health Organization (WHO) IMCI guidelines, fast breathing is defined as a respiratory rate ≥ 50 breaths/minute for children aged 2 months to 12 months, and **≥ 40 breaths/minute for children aged 12 months to 5 years**. - Fast breathing alone (without chest indrawing or danger signs) is the **key clinical sign** for classifying a child with cough or difficulty breathing as having **pneumonia**. - This is based on the **WHO IMCI classification** used by health workers for management of childhood illness. *Incorrect: No pneumonia, cough or cold* - This classification would be made if the child's respiratory rate was **within the normal range** for their age (< 40 breaths per minute for age 1-5 years) and if there were no other signs of pneumonia or severe disease. - A respiratory rate of 46 breaths per minute in a 2-year-old is **above the normal limit** and meets the criteria for fast breathing. *Incorrect: Severe pneumonia* - Severe pneumonia is classified by the presence of **chest indrawing** in addition to cough or difficult breathing, without danger signs. - While the child has fast breathing, the question does not mention **chest indrawing**, which is required for this classification. *Incorrect: Very severe disease* - Very severe disease is classified when there are **danger signs** present: inability to drink or breastfeed, persistent vomiting, convulsions, lethargy or unconsciousness, or stridor in a calm child. - The question only mentions elevated respiratory rate without any **danger signs**, so this classification does not apply.

Q: Which sign is most important in deciding severe pneumonia in a child?

Chest indrawing. ***Chest indrawing*** - **Chest indrawing** (or retractions) indicates increased work of breathing due to reduced lung compliance or airway obstruction, a key sign of severe pneumonia in children. - It signifies that accessory muscles are engaged to pull the chest wall inward with each breath, demonstrating significant respiratory distress. *Fast breathing* - **Fast breathing** (tachypnea) is a general sign of respiratory distress and a criterion for diagnosing pneumonia, but it alone does not differentiate severe from non-severe pneumonia. - While present in pneumonia, it doesn't indicate the same level of respiratory effort or severity as chest indrawing. *Nasal flaring* - **Nasal flaring** is an effort to decrease airway resistance by widening the nostrils during inspiration, indicating increased work of breathing. - It's a sign of respiratory distress that can occur in both moderate and severe pneumonia, but it is not as specific to severe disease as chest indrawing. *Grunting* - **Grunting** is an expiratory sound produced by partial closure of the glottis to maintain positive end-expiratory pressure, preventing alveolar collapse. - While a sign of moderate to severe respiratory distress, especially in neonates, it does not carry the same weight as chest indrawing for classifying severe pneumonia in older children by WHO guidelines.

Q: The recommended dose of cotrimoxazole for treatment of pneumonia in a child weighing 16 kg is

Three paediatric tablets twice a day. ***Three paediatric tablets twice a day*** - A paediatric cotrimoxazole tablet contains **20 mg trimethoprim + 100 mg sulfamethoxazole**. - The recommended dose for pneumonia is **4 mg/kg trimethoprim + 20 mg/kg sulfamethoxazole** twice daily. - For a 16 kg child: Required dose = **64 mg trimethoprim + 320 mg sulfamethoxazole** per dose. - Three tablets provide **60 mg trimethoprim + 300 mg sulfamethoxazole**, which is the closest appropriate dose to the calculated requirement. *One paediatric tablet twice a day* - This provides only **20 mg trimethoprim + 100 mg sulfamethoxazole** per dose. - This is **grossly inadequate** for a 16 kg child, providing less than one-third of the required dose. - Such underdosing risks treatment failure and antibiotic resistance. *Two paediatric tablets twice a day* - This provides **40 mg trimethoprim + 200 mg sulfamethoxazole** per dose. - While better than one tablet, this is still **subtherapeutic** for a 16 kg child with pneumonia. - This represents only about 60% of the recommended dose. *Four paediatric tablets twice a day* - This provides **80 mg trimethoprim + 400 mg sulfamethoxazole** per dose. - This is **slightly higher** than required but would risk unnecessary adverse effects. - Three tablets is the more appropriate choice for this weight range.

Q: A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Pneumonia. ***Pneumonia*** - A respiratory rate of 60 breaths per minute in a 3-month-old infant meets the **WHO criteria for fast breathing**, which is the primary indicator for diagnosing **pneumonia** in this age group. - The absence of chest indrawing, stridor, or convulsions means this falls under **pneumonia**, not **severe** or **very severe pneumonia**. *Very severe pneumonia* - This would be diagnosed if there were **danger signs** such as inability to feed, lethargy, or convulsions, which are explicitly stated as absent. - Presence of **stridor** in a calm child or **severe malnutrition** would also suggest very severe pneumonia, none of which are mentioned. *Severe pneumonia* - This classification requires the presence of **chest indrawing** or **stridor** in a child, which are noted as absent in the clinical presentation. - While the child has fast breathing, the lack of additional severe signs distinguishes it from severe pneumonia. *No Pneumonia* - The presence of **fast breathing** (respiratory rate of 60 in a 3-month-old) is a clear sign of respiratory distress indicating **pneumonia**, according to WHO guidelines. - If the child had a normal respiratory rate and no other signs of respiratory illness, this option might be considered.

Q: A 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. Physical examination shows rhinitis, mild cyanosis, and fever. Which of the following is the most likely etiology of this child's pulmonary infection?

Respiratory syncytial virus. ***Respiratory syncytial virus*** - **Respiratory syncytial virus (RSV)** is the most common cause of **bronchiolitis** in infants and young children, characterized by cough, wheezing, and respiratory distress. - The age of the patient (6-month-old infant) and the clinical presentation, including rhinitis, cyanosis, and fever, are highly consistent with an RSV infection. *Cytomegalovirus* - **Cytomegalovirus (CMV)** infection primarily affects immunocompromised individuals or can cause congenital infections. - While CMV can cause respiratory symptoms, it typically manifests as **pneumonitis** in infants, often without the prominent wheezing seen in this case. *Parainfluenza virus* - **Parainfluenza virus (PIV)** is a common cause of **croup** (laryngotracheobronchitis) in infants and young children, characterized by a barking cough and stridor. - While PIV can rarely cause bronchiolitis, the typical presentation described, especially with prominent wheezing, is less characteristic of PIV compared to RSV. *Adenovirus* - **Adenovirus** can cause a variety of respiratory illnesses, including pneumonia, bronchitis, and pharyngitis. - While adenovirus can cause severe respiratory infections in infants, RSV is more frequently associated with the specific constellation of severe cough, wheezing, and respiratory distress in this age group.

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

Foreign body aspiration. ***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.

Q: A 3 year old non-vaccinated child presented with fever and fast breathing. His mother reported that he has recently developed measles rash. CXR shown below is indicative of which infection?

Staphylococcus aureus. ***Staphylococcus aureus*** - **Post-measles pneumonia** is a serious complication, and **Staphylococcus aureus** is a common and aggressive secondary bacterial pathogen. - The CXR findings of a **necrotizing pneumonia** with a single or multiple **pneumatoceles** (air-filled cysts within the lung parenchyma) are highly suggestive of S. aureus infection, especially in a non-vaccinated child post-measles. *Streptococcal viridans* - **Streptococcus viridans** species are more typically associated with **subacute bacterial endocarditis** or dental infections, not acute necrotizing pneumonia in this context. - While they are part of the normal oral flora, they are rarely primary causes of severe community-acquired pneumonia in children. *Streptococcal pneumoniae* - **Streptococcus pneumoniae** is a very common cause of **community-acquired pneumonia** in children, often presenting as lobar pneumonia. - However, its typical presentation on CXR is **lobar consolidation or broncho-pneumonia**, and it is less frequently associated with the rapid development of **pneumatoceles** or **necrotizing pneumonia** as seen in post-measles complications, compared to *S. aureus*. *Staphylococcus Albus* - **Staphylococcus albus** is an older name for **Staphylococcus epidermidis**, which is a **coagulase-negative Staphylococcus**. - While *S. epidermidis* can cause infections, it is primarily associated with **device-related infections** (e.g., catheters, prosthetics) and is an uncommon cause of severe pneumonia, particularly necrotizing pneumonia in healthy children.

Q: The commonest cause of Bacterial Pneumonia in children is -

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** * **Streptococcus pneumoniae**, also known as pneumococcus, is globally the **most common bacterial cause of pneumonia in children**, particularly in unvaccinated populations. * It is a **gram-positive bacterium** that can cause a range of invasive and non-invasive diseases, with pneumonia being the most significant. * *Staphylococcus aureus* * While **Staphylococcus aureus** can cause pneumonia in children, especially in cases following a viral illness or in hospitalized patients, it is **less common overall** than *S. pneumoniae*. * *S. aureus* pneumonia often presents with more severe features, such as **abscess formation** and **empyema**. * *Hemophilus influenzae* * **Haemophilus influenzae type b (Hib)** used to be a major cause of bacterial pneumonia in children, but its incidence has **significantly decreased** due to widespread vaccination. * Non-typeable Haemophilus influenzae (NTHi) can still cause pneumonia, particularly in infants and children with underlying conditions, but it is not the leading cause. * *Streptococcus pyogenes* * **Streptococcus pyogenes** (Group A Strep) is primarily known for causing **pharyngitis** (strep throat), **scarlet fever**, and **skin infections**. * While it can cause pneumonia, this is a **relatively rare** presentation compared to *S. pneumoniae*.

Question 1

For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program?
I. Fast breathing (Greater than or equal to 40 breaths per minute)
II. Child vomits everything
III. Stridor in a calm child
IV. Chest indrawing:

Select the correct answer using the code given below :

Accepted Answer

III and IV

Answer

I and II

Answer

II and III

Answer

II and IV

Question 2

A 15-month-old child presents with fever and cough since the last two days, the respiratory rate is 55/min and there is no drawing of the chest. According to the National Programme for Acute Respiratory Infections, the line of management should be

Accepted Answer

Administration of antibiotic at home along with treatment for fever, advising the mother to return for reassessment after two days

Answer

Immediate referral of the child to hospital for urgent admission

Answer

Administration of treatment for fever at home, advising the mother to return after two days for assessment of the need for an antibiotic

Answer

Referral of the child to hospital for admission, after administration of first dose of antibiotic

Question 3

A child of 2 years having a respiratory rate of 46 per minute shall be classified by a health worker as

Accepted Answer

pneumonia

Answer

no pneumonia, cough or cold

Answer

severe pneumonia

Answer

very severe disease

Question 4

Which sign is most important in deciding severe pneumonia in a child?

Accepted Answer

Chest indrawing

Answer

Fast breathing

Answer

Nasal flaring

Answer

Grunting

Question 5

The recommended dose of cotrimoxazole for treatment of pneumonia in a child weighing 16 kg is

Accepted Answer

Three paediatric tablets twice a day

Answer

Four paediatric tablets twice a day

Answer

Two paediatric tablets twice a day

Answer

One paediatric tablet twice a day

Question 6

A 3-month-old baby presents with fever and respiratory rate of 60/min. The baby is irritable but feeding well. There is no stridor, no chest indrawing, and no convulsions. What is the diagnosis?

Accepted Answer

Pneumonia

Answer

Very severe pneumonia

Answer

Severe pneumonia

Answer

No Pneumonia

Question 7

A 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. Physical examination shows rhinitis, mild cyanosis, and fever. Which of the following is the most likely etiology of this child's pulmonary infection?

Accepted Answer

Respiratory syncytial virus

Answer

Cytomegalovirus

Answer

Parainfluenza virus

Answer

Adenovirus

Question 8

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

Accepted Answer

Foreign body aspiration

Answer

Staphylococcal bronchopneumonia

Answer

Congenital lobar emphysema

Answer

Aspiration pneumonia

Question 9

A 3 year old non-vaccinated child presented with fever and fast breathing. His mother reported that he has recently developed measles rash. CXR shown below is indicative of which infection?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcal viridans

Answer

Streptococcus pneumoniae

Answer

Staphylococcus Albus

Question 10

The commonest cause of Bacterial Pneumonia in children is -

Accepted Answer

Streptococcus pneumoniae

Answer

Staphylococcus aureus

Answer

Haemophilus influenzae

Answer

Streptococcus pyogenes

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

On this page

Practice by Chapter

Want unlimited practice?