Respiratory Diseases Practice Questions

Q: Most common bacterial cause of pneumonia in children is?

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - **_Streptococcus pneumoniae_** is the most frequent **bacterial** cause of pneumonia across all pediatric age groups, leading to **lobar pneumonia** - It accounts for the majority of bacterial pneumonia cases requiring hospitalization in children - **Vaccination** (PCV13/PCV15) has significantly reduced its incidence but it remains the leading bacterial pathogen *Staphylococcus aureus* - **_Staphylococcus aureus_** is a less common bacterial cause in children unless there are predisposing factors like **recent influenza infection**, **cystic fibrosis**, or **immunocompromised states** - When it occurs, it often presents with more severe features including **necrotizing pneumonia**, **empyema**, and **abscess formation** *RSV* - **Respiratory Syncytial Virus (RSV)** is the most common **viral** cause of lower respiratory tract infections in infants and young children, particularly **bronchiolitis** and viral pneumonia - While RSV causes more overall pneumonia cases in young children, the question asks specifically for **bacterial** causes *Klebsiella* - **_Klebsiella pneumoniae_** is an **uncommon cause** of pneumonia in otherwise healthy children - It typically affects individuals with **compromised immune systems**, **chronic lung disease**, or occurs as a **nosocomial infection**

Q: A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

Heimlich maneuver. ***Heimlich maneuver*** - The sudden onset of **aphonia** and **respiratory distress** during dinner indicates **foreign body airway obstruction** (FBAO). - The **Heimlich maneuver** is the immediate, life-saving intervention for conscious individuals with complete airway obstruction. *Emergency tracheostomy* - This is an invasive surgical procedure performed when other methods to clear the airway have failed or are not possible due to severe obstruction or trauma. - It is not the **first-line intervention** for a conscious child with FBAO. *Humidified oxygen* - While supportive of respiratory function, humidified oxygen alone will not resolve an **acute foreign body obstruction** causing aphonia and severe distress. - It does not address the underlying mechanical blockage of the airway. *Cricothyroidotomy* - This is an emergency procedure to establish an airway, typically used in adults when other methods of intubation or airway clearance have failed. - It is generally **contraindicated in children under 12** due to the risk of damaging the cricoid cartilage, which is a major part of the child's airway.

Q: A child is brought to the paediatric OPD with fever of 24 hours duration. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is-

Cystic Fibrosis. ***Cystic Fibrosis*** - Recurrent **chest infections** and **foul-smelling stools** (due to pancreatic insufficiency leading to malabsorption) are classic hallmarks of cystic fibrosis. - This genetic disorder primarily affects the **lungs** and **digestive system**, leading to thick, sticky mucus. *Crigler-Najjar Syndrome* - This syndrome is a rare genetic disorder characterized by severe **unconjugated hyperbilirubinemia**, leading to **jaundice** and potential neurological damage. - It does not typically present with recurrent chest infections or foul-smelling stools. *Maple Syrup urine Disease* - This is an **amino acid metabolism disorder** leading to the accumulation of branched-chain amino acids, characterized by a distinctive "maple syrup" odor in the urine. - It presents with neurological symptoms, feeding difficulties, and developmental delay, not primarily chest infections and foul-smelling stools. *Bilirubin Conjugation Defect* - This refers to conditions like Gilbert's syndrome or Crigler-Najjar syndrome, which cause varying degrees of **unconjugated hyperbilirubinemia** and **jaundice**. - It does not explain the recurrent respiratory infections or malabsorption symptoms like foul-smelling stools.

Q: A month old HIV positive child following an upper respiratory infection developed sudden onset of breathlessness. The chest x-ray shows hyperinflation. The O2 saturation was greater than 90%. What is the most appropriate antiviral therapy among the given options?

Ribavirin. **Ribavirin** - The clinical presentation of a 1-month-old HIV-positive infant with sudden breathlessness, hyperinflation on chest X-ray, and oxygen saturation >90%, following an URI, is highly suggestive of **Respiratory Syncytial Virus (RSV) bronchiolitis**. - **Ribavirin** is an antiviral drug that was historically used for severe RSV infection, especially in high-risk infants like those who are immunocompromised. - **Note:** Current guidelines emphasize supportive care as primary treatment; ribavirin use is now controversial due to limited efficacy and toxicity concerns. *IV Ganciclovir* - **Ganciclovir** is primarily used for the treatment of **Cytomegalovirus (CMV)** infections, which typically present differently than the acute bronchiolitis described. - CMV pneumonitis often manifests with diffuse interstitial infiltrates and may be accompanied by other systemic CMV manifestations. *Cotrimoxazole* - **Cotrimoxazole (trimethoprim-sulfamethoxazole)** is the drug of choice for prophylaxis and treatment of **Pneumocystis jirovecii pneumonia (PJP)**. - While PJP is common in HIV-positive infants, the acute onset, hyperinflation, and O2 saturation >90% are less typical for severe PJP, and cotrimoxazole is an antibiotic, not an antiviral. *Nebulized Acyclovir* - **Acyclovir** is an antiviral agent used to treat **herpes simplex virus (HSV)** and **varicella-zoster virus (VZV)** infections. - Respiratory involvement with HSV or VZV in an infant would present with different clinical features and radiological findings than those described.

Q: A 3 month old infant presents with a 3 day history of fever, cough, and poor feeding. On examination, the baby appears ill and has a temperature of 102 F and a respiratory rate of 32. A chest x-ray film showed bilateral patchy infiltrates in the lungs. Which of the following is the most likely etiologic agent?

Respiratory syncytial virus. ***Respiratory syncytial virus*** - **Respiratory syncytial virus (RSV)** is the most common cause of **bronchiolitis** and **pneumonia** in infants, particularly those under 6 months. - The presentation of fever, cough, poor feeding, respiratory distress (high respiratory rate), and bilateral patchy infiltrates on chest X-ray are highly characteristic of severe RSV infection in a **3-month-old infant**. *Parainfluenza type 1* - **Parainfluenza type 1 (PIV-1)** is primarily associated with **croup** (laryngotracheobronchitis) in infants and young children, characterized by a **barking cough** and stridor. - While it can cause lower respiratory tract infections, severe pneumonia with bilateral patchy infiltrates and prominent respiratory distress is less typical than with RSV. *Influenza type A* - **Influenza type A** can cause severe respiratory illness in infants, but it is typically more common in older children and adults. - While it can present with fever, cough, and pneumonia, RSV is a more frequent cause of severe lower respiratory tract disease in this specific age group (**3-month-old infant**). *Coronavirus* - While some coronaviruses (e.g., **SARS-CoV-2**) can cause severe respiratory illness in infants, they are generally less common causes of typical infant bronchiolitis or pneumonia compared to RSV. - The pattern of a 3-month-old with fever, cough, respiratory distress, and patchy infiltrates is most strongly associated with RSV in the absence of specific epidemiological factors pointing to another coronavirus.

Q: A 14-year-old boy presents with headache, fever, and cough for 2 days. Sputum is scant and non-purulent and gram stain reveals many white cells but no organisms. The treatment should be initiated with :

Azithromycin. ***Azithromycin*** - The clinical picture of **headache, fever, cough, scant non-purulent sputum**, and Gram stain showing white cells but no organisms is highly suggestive of **atypical pneumonia**, likely caused by *Mycoplasma pneumoniae* in this age group. - **Macrolides** like azithromycin are the **first-line treatment** for atypical pneumonia as they are effective against organisms like *Mycoplasma* and *Chlamydia* which lack cell walls and are therefore resistant to beta-lactam antibiotics. *Levofloxacin* - **Levofloxacin** is a **fluoroquinolone**, which is effective against atypical pathogens but is generally reserved for **older patients** or those with **allergies** to macrolides due to concerns about potential side effects like cartilage damage in children. - Using fluoroquinolones as a first-line treatment in adolescents for suspected atypical pneumonia is **not recommended** due to these potential side effects and the availability of safer alternatives. *Amikacin* - **Amikacin** is an **aminoglycoside antibiotic** primarily used for severe infections caused by **Gram-negative bacteria**. - It is **ineffective against atypical bacteria** like *Mycoplasma* or *Chlamydia* which are the likely causative agents in this scenario. *Cefazolin* - **Cefazolin** is a **first-generation cephalosporin**, which is a **beta-lactam antibiotic** effective mostly against Gram-positive cocci and some Gram-negative bacteria. - It is **ineffective against atypical pathogens** because these organisms **lack a cell wall** (like *Mycoplasma*) or have cell walls that are not targeted by beta-lactam antibiotics.

Q: A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Acute laryngotracheobronchitis. ***Acute laryngotracheobronchitis*** - The x-ray finding of a **steeple sign** (subglottic narrowing) is a classic radiographic feature of **croup**, also known as acute laryngotracheobronchitis. - Croup is characterized by a **barking cough**, hoarseness, and inspiratory stridor, primarily affecting the **larynx** and **trachea**. *Acute pharyngitis* - Acute pharyngitis is an **inflammation of the pharynx** and does not typically involve the subglottic region or cause the characteristic steeple sign on radiographs. - It presents with symptoms like **sore throat**, fever, and difficulty swallowing, without the prominent stridor or barking cough of croup. *Acute epiglottitis* - Acute epiglottitis, though a serious airway emergency, typically shows a **thumb sign** on a lateral neck x-ray due to a swollen epiglottis, not a steeple sign. - It presents with rapid onset of **high fever**, **dysphagia**, drooling, and muffled voice, often without a cough. *Parapharyngeal abscess* - A parapharyngeal abscess is a deep neck infection that would likely present with a **mass effect**, **displacement of airway structures**, and **soft tissue swelling** on imaging, not subglottic narrowing. - Symptoms include severe **sore throat**, **fever**, **trismus**, and neck swelling, with potential airway compromise from external compression.

Q: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Give antibiotics. ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.

Q: A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Acute Laryngotracheobronchitis. ***Acute Laryngotracheobronchitis*** - The combination of **low-grade fever** and **stridor** in a 2-year-old child strongly suggests **croup**, which is medically known as acute laryngotracheobronchitis. - Croup is characterized by **inflammation** of the larynx, trachea, and bronchi, often presenting with a **barking cough** and inspiratory stridor. The X-ray image would show the characteristic **steeple sign**. *Acute Bacterial Tracheitis* - This is a more severe bacterial infection that can present with stridor but typically shows **higher fever**, **toxic appearance**, and rapid clinical deterioration. - Unlike croup, bacterial tracheitis patients appear **more ill** and may have **purulent secretions** requiring more aggressive management. *Acute Epiglottitis* - A serious condition characterized by **rapid onset of high fever**, **dysphagia**, drooling, and a **"tripod" position**, which are not indicated by the given symptoms. - The stridor in epiglottitis is typically quieter and may indicate more severe airway obstruction compared to the characteristic stridor of croup. *Foreign Body aspiration* - While foreign body aspiration can cause stridor, it is typically an **acute event** with a sudden onset of choking, coughing, and respiratory distress. - There is no mention of a choking episode or sudden onset, and a low-grade fever is less typical for an uncomplicated foreign body aspiration.

Question 1

Most common bacterial cause of pneumonia in children is?

Accepted Answer

Streptococcus pneumoniae

Answer

Staphylococcus aureus

Answer

RSV

Answer

Klebsiella

Question 2

A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

Accepted Answer

Heimlich maneuver

Answer

Emergency tracheostomy

Answer

Humidified oxygen

Answer

Cricothyroidotomy

Question 3

A child is brought to the paediatric OPD with fever of 24 hours duration. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is-

Accepted Answer

Cystic Fibrosis

Answer

Crigler-Najjar Syndrome

Answer

Maple Syrup urine Disease

Answer

Bilirubin Conjugation Defect

Question 4

A month old HIV positive child following an upper respiratory infection developed sudden onset of breathlessness. The chest x-ray shows hyperinflation. The O2 saturation was greater than 90%. What is the most appropriate antiviral therapy among the given options?

Accepted Answer

Ribavirin

Answer

IV Ganciclovir

Answer

Cotrimoxazole

Answer

Nebulized Acyclovir

Question 5

A 3 month old infant presents with a 3 day history of fever, cough, and poor feeding. On examination, the baby appears ill and has a temperature of 102 F and a respiratory rate of 32. A chest x-ray film showed bilateral patchy infiltrates in the lungs. Which of the following is the most likely etiologic agent?

Accepted Answer

Respiratory syncytial virus

Answer

Parainfluenza type 1

Answer

Influenza type A

Answer

Coronavirus

Question 6

A 14-year-old boy presents with headache, fever, and cough for 2 days. Sputum is scant and non-purulent and gram stain reveals many white cells but no organisms. The treatment should be initiated with :

Accepted Answer

Azithromycin

Answer

Levofloxacin

Answer

Amikacin

Answer

Cefazolin

Question 7

A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Accepted Answer

Acute laryngotracheobronchitis

Answer

Acute pharyngitis

Answer

Acute epiglottitis

Answer

Parapharyngeal abscess

Question 8

A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Accepted Answer

Give antibiotics

Answer

Refer to a higher-level health facility for further management.

Answer

Monitor at home without medical treatment.

Answer

Provide symptomatic treatment with antipyretics only.

Question 9

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Accepted Answer

Acute Laryngotracheobronchitis

Answer

Acute Bacterial Tracheitis

Answer

Acute Epiglottitis

Answer

Foreign Body aspiration

Question 10

A 2 years old child presents to PHC with fever and cough. He has chest in-drawing and respiratory rate of 38 per minute, weight 11 kg. The next step in management according to IMNCI is:

Accepted Answer

Give antibiotics and refer to tertiary centre

Answer

Give antibiotics and re-assess in 3 days

Answer

Refer to tertiary care

Answer

Only antipyretics are given

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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