Respiratory Diseases — MCQs

Respiratory Diseases Indian Medical PG Practice Questions and MCQs

Question 251: 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:

A. Give antibiotics and re-assess in 3 days
B. Refer to tertiary care
C. Give antibiotics and refer to tertiary centre (Correct Answer)
D. Only antipyretics are given

Explanation: ***Give antibiotics and refer to tertiary centre*** - The child presents with **cough**, **fever**, and **chest in-drawing** with a respiratory rate of **38/minute**. According to **IMNCI guidelines**, the presence of **chest in-drawing** in a child aged 2 months to 5 years classifies the condition as **SEVERE PNEUMONIA**. - For severe pneumonia, IMNCI protocol mandates **urgent referral to a hospital** where the child can receive injectable antibiotics (e.g., IV/IM ampicillin or ceftriaxone) and appropriate monitoring. - The child should be given the **first dose of appropriate antibiotic** at the PHC level before referral to prevent deterioration during transport. - This is the correct management approach combining immediate antibiotic therapy with necessary referral for severe disease. *Give antibiotics and re-assess in 3 days* - This management is appropriate for **simple pneumonia** (fast breathing without chest in-drawing), where oral antibiotics can be given at home with reassessment in 2-3 days. - However, in the presence of **chest in-drawing**, the classification escalates to **severe pneumonia**, which requires hospital-level care with injectable antibiotics and monitoring, not outpatient management. - Managing severe pneumonia at PHC without referral risks complications like respiratory failure, sepsis, or death. *Only antipyretics are given* - This is completely inadequate for a child with **severe pneumonia** (chest in-drawing). - Fever management alone does not address the underlying **bacterial infection** requiring antibiotic therapy. - This approach would lead to disease progression and potentially fatal complications. *Refer to tertiary care* - While referral is correct, giving the **first dose of antibiotic before referral** is a critical component of IMNCI protocol. - Pre-referral antibiotic administration helps prevent deterioration during transport and initiates early treatment. - Therefore, "give antibiotics AND refer" is more complete than referral alone.

Question 252: Fast breathing in a 6-month-old infant is taken as:

A. >30 breaths/min
B. >50 breaths/min (Correct Answer)
C. >60 breaths/min
D. >40 breaths/min

Explanation: ***>50 breaths/min*** - For infants aged 2 to 12 months, a respiratory rate of **greater than 50 breaths per minute** is considered consistent with **tachypnea** or fast breathing. - This is an important indicator of respiratory distress, often used in clinical assessment frameworks like the **Integrated Management of Childhood Illness (IMCI)**. *>30 breaths/min* - A respiratory rate of **>30 breaths/min** would be considered fast breathing for an older child or adult, but it is within the normal range for an infant. - Normal respiratory rates are **higher in infants** and gradually decrease with age. *>60 breaths/min* - While a respiratory rate of **>60 breaths/min** is indeed fast and indicates severe respiratory distress, it is not the initial threshold for defining fast breathing in a 6-month-old infant. - This rate would suggest a more **severe clinical presentation** than simply "fast breathing." *>40 breaths/min* - A respiratory rate **>40 breaths/min** is typically considered fast breathing for children aged 1 to 5 years, but not for infants under 12 months. - For a 6-month-old, this rate is still within the **normal or upper-normal range**, depending on activity and state.

Question 253: Which of the following conditions is most associated with digital clubbing in children?

A. Croup
B. Bronchiolitis
C. Asthma
D. Cystic fibrosis (Correct Answer)

Explanation: ***Cystic fibrosis*** - **Cystic fibrosis** is a common cause of **digital clubbing** in children due to chronic hypoxemia and lung disease, leading to abnormal growth of connective tissue at the nail beds. - The chronic lung infections, bronchiectasis, and airway obstruction characteristic of cystic fibrosis contribute to persistent **tissue hypoxia**, which is a primary driver of clubbing. *Croup* - Croup is an acute viral infection of the upper airway, primarily characterized by a **barking cough** and **stridor**, and generally resolves within a week without chronic complications like clubbing. - It does not cause chronic hypoxemia necessary for the development of digital clubbing. *Bronchiolitis* - **Bronchiolitis** is an acute viral infection of the lower respiratory tract, most common in infants, causing wheezing and respiratory distress, but it is typically a **short-lived illness** without chronic sequelae leading to clubbing. - This condition does not cause prolonged enough or severe enough **hypoxia** to result in clubbing. *Asthma* - While severe, uncontrolled **asthma** can cause intermittent hypoxia, it is typically not associated with chronic digital clubbing, especially in children, unless there are other coincident chronic lung conditions. - Digital clubbing is rare in asthma and often suggests an alternate or co-existing pathology, such as **bronchiectasis** or **cystic fibrosis**.

Question 254: A 3-year-old is diagnosed with severe acute asthma exacerbation. Which medication is given first?

A. Inhaled ipratropium
B. IV corticosteroids
C. Nebulized salbutamol (Correct Answer)
D. IV magnesium sulfate

Explanation: ***Nebulized salbutamol*** - **Salbutamol** (albuterol) is a **short-acting beta-2 agonist (SABA)** which provides rapid bronchodilation by relaxing smooth muscles in the airways. - It is the **first-line treatment** for acute asthma exacerbations due to its quick onset of action and effectiveness in relieving bronchospasm. *Inhaled ipratropium* - **Ipratropium**, an anticholinergic, is often added to bronchodilators like salbutamol in **severe exacerbations** but is not the primary initial bronchodilator. - It works by blocking muscarinic receptors, causing **bronchodilation**, but its onset of action is slower than salbutamol. *IV corticosteroids* - **Corticosteroids** reduce airway inflammation and are crucial for preventing relapse and shortening recovery in severe asthma, but their **onset of action is delayed** (several hours). - They are typically administered after initial bronchodilation with SABAs and are not the first medication given for immediate symptom relief. *IV magnesium sulfate* - **Magnesium sulfate** is a smooth muscle relaxant that can be used in **severe, life-threatening asthma exacerbations** that are refractory to standard therapy. - It is considered a **second or third-line treatment** rather than an initial intervention for immediate bronchodilation.

Question 255: An 8-year-old with cystic fibrosis on chronic macrolide therapy presents with a worsening productive cough, fever, and weight loss. Sputum culture shows Pseudomonas aeruginosa, which is multidrug-resistant. Evaluate the risks and benefits of the available treatment options.

A. Inhaled colistin + IV meropenem (Correct Answer)
B. IV ceftazidime + aminoglycoside
C. Long-term inhaled tobramycin
D. Bronchial artery embolization

Explanation: ***Inhaled colistin + IV meropenem*** - This combination targets **multidrug-resistant (MDR) *Pseudomonas aeruginosa***, which is a common and challenging pathogen in cystic fibrosis (CF) patients. - **Inhaled colistin** delivers high concentrations of the antibiotic directly to the lungs, minimizing systemic toxicity, while **IV meropenem** provides systemic coverage for severe infections. *IV ceftazidime + aminoglycoside* - While typically used for *Pseudomonas* infections, this combination might be ineffective against **multi-drug resistant strains**, given the patient's history and the severity of the infection. - Aminoglycosides have significant **nephrotoxicity** and **ototoxicity** risks, especially with prolonged use, which may be contraindicated in a patient with chronic illness. *Long-term inhaled tobramycin* - **Long-term inhaled tobramycin** is a maintenance therapy to prevent exacerbations, not typically used for acute, severe, and MDR infections. - The *Pseudomonas* strain is already **multidrug-resistant**, suggesting tobramycin monotherapy would be insufficient. *Bronchial artery embolization* - This procedure is indicated for managing **massive hemoptysis** in CF patients, which is not described as the primary problem here. - It does not address the underlying **bacterial infection** or the patient's worsening cough, fever, and weight loss.

Question 256: A 12-year-old boy presents with recurrent episodes of wheezing, coughing, and shortness of breath, particularly at night. What is the most likely diagnosis?

A. Asthma (Correct Answer)
B. Chronic Bronchitis
C. Bronchiolitis
D. Pneumonia

Explanation: ***Asthma*** - This presentation of **recurrent wheezing, coughing**, and **shortness of breath**, especially at night in a 12-year-old boy, is highly characteristic of **asthma**. - **Nocturnal symptoms** are a classic feature of asthma, often due to circadian rhythms influencing airway inflammation and bronchoconstriction. *Chronic Bronchitis* - **Chronic bronchitis** is defined by a productive cough for at least 3 months in 2 consecutive years and is primarily seen in **adult smokers**. - It is highly unlikely in a 12-year-old boy without a significant smoking history. *Bronchiolitis* - **Bronchiolitis** primarily affects **infants and young children** (usually under 2 years old) and is typically caused by viral infections like **RSV**. - While it presents with wheezing and respiratory distress, it's rare in a 12-year-old and usually an acute rather than recurrent condition. *Pneumonia* - **Pneumonia** is an infection of the lungs, typically presenting with fever, cough with sputum, chest pain, and fatigue. - While it can cause shortness of breath and cough, the **recurrent nature** and improvement with treatment (implied by recurrence) are less typical of pneumonia and more indicative of a chronic reactive airway disease.

Question 257: An 8-year-old girl with asthma presents with wheezing and difficulty breathing despite using her inhaler. What is the next best step in management?

A. Administer a higher dose of inhaled corticosteroids
B. Hospitalize and start intravenous corticosteroids
C. Administer a short-acting beta-agonist via nebulizer (Correct Answer)
D. Schedule for allergy testing

Explanation: ***Administer a short-acting beta-agonist via nebulizer*** - The immediate treatment for acute asthma exacerbations, characterized by wheezing and difficulty breathing despite regular inhaler use, is the administration of a **short-acting beta-agonist (SABA)** to quickly open the airways. - Using a **nebulizer** allows for the efficient delivery of a higher dose of medication directly to the lungs, which is crucial when symptoms are not relieved by a standard inhaler. *Administer a higher dose of inhaled corticosteroids* - While inhaled corticosteroids are important for **long-term asthma control** and reducing inflammation, they do not provide immediate relief during an acute asthma attack. - Increasing the dose will not address the rapid bronchodilation needed to alleviate severe wheezing and difficulty breathing. *Hospitalize and start intravenous corticosteroids* - **Hospitalization and intravenous corticosteroids** are reserved for severe asthma exacerbations that do not respond to initial outpatient management with bronchodilators, or if the patient shows signs of impending respiratory failure. - This step is premature without first attempting more immediate and less invasive treatments for acute symptom relief. *Schedule for allergy testing* - **Allergy testing** is part of identifying asthma triggers and developing a long-term management plan, but it has no role in the acute management of an asthma exacerbation. - Focusing on allergy testing during an acute attack would delay critical treatment for the patient's immediate breathing difficulties.

Question 258: What is the first-line treatment for croup in children?

A. Antibiotics
B. Corticosteroids (Correct Answer)
C. Antihistamines
D. Cough suppressants

Explanation: **Corticosteroids** - **Corticosteroids** (e.g., **dexamethasone**) are the first-line treatment for croup, as they reduce **airway inflammation** and **edema**, improving symptoms. - Their anti-inflammatory effects help alleviate the characteristic **barking cough** and **stridor** associated with croup. *Antibiotics* - Croup is primarily caused by **viral infections**, typically **parainfluenza virus**, making antibiotics ineffective. - **Antibiotics** are only indicated if a **secondary bacterial infection** is suspected, which is rare. *Antihistamines* - **Antihistamines** are not effective in treating croup as they do not address the underlying **viral inflammation** and **airway swelling**. - They may cause **sedation**, which could mask signs of respiratory distress. *Cough suppressants* - **Cough suppressants** are generally not recommended for croup because the cough is a protective mechanism to clear the airways. - Suppressing the cough could potentially worsen **airway obstruction** in children with croup.

Question 259: In managing bronchiolitis in an infant, which treatment is most commonly tried but not recommended due to its ineffectiveness in improving clinical outcomes?

A. High-flow oxygen
B. Antibiotics
C. Systemic corticosteroids
D. Nebulized albuterol (Correct Answer)

Explanation: ***Nebulized albuterol*** - Bronchiolitis is primarily caused by **viral infections** (most commonly RSV), leading to inflammation and mucus production, not bronchoconstriction that responds to bronchodilators. - Despite being commonly attempted in clinical practice, studies have consistently shown that **albuterol** (a bronchodilator) does not improve clinical outcomes, reduce hospital stays, or decrease the need for respiratory support in infants with bronchiolitis. - **Key point**: Unlike asthma (where bronchodilators are effective), bronchiolitis involves small airway obstruction from mucus and inflammation, not reversible bronchospasm. *High-flow oxygen* - **High-flow nasal cannula (HFNC) oxygen therapy** is recommended for infants with bronchiolitis experiencing respiratory distress and hypoxemia. - It provides humidified oxygen at a high flow rate, which reduces work of breathing and improves oxygenation, making it an **effective supportive treatment**. *Systemic corticosteroids* - While systemic corticosteroids are also not routinely recommended for bronchiolitis, they are less commonly tried compared to bronchodilators. - The inflammatory response in viral bronchiolitis is less responsive to steroids, and their use has not shown consistent benefit. *Antibiotics* - Bronchiolitis is predominantly a **viral illness**, making antibiotics unnecessary. - Antibiotics are indicated only when there is strong evidence of a **secondary bacterial infection**, not for routine bronchiolitis management.

Question 260: A 3-year-old child presents with a barking cough, hoarseness, and stridor, with symptoms worsening at night. Which virus is most commonly responsible for these symptoms?

A. Parainfluenza virus (Correct Answer)
B. Respiratory syncytial virus
C. Influenza virus
D. Adenovirus

Explanation: ***Parainfluenza virus*** - This virus is the **most common cause of croup**, characterized by a **barking cough**, hoarseness, and inspiratory stridor, especially in young children. - Croup symptoms often **worsen at night** due to various physiological factors like changes in cortisol levels and upper airway congestion when lying flat. *Respiratory syncytial virus* - **RSV** is a primary cause of **bronchiolitis** and **pneumonia** in infants and young children, leading to wheezing and respiratory distress. - While it can cause some upper respiratory symptoms, it does not typically present with the classic **barking cough and stridor** characteristic of croup. *Influenza virus* - **Influenza** typically causes a sudden onset of symptoms like high fever, body aches, chills, and a **non-barking cough**. - While it can lead to severe respiratory illness, croup is not its characteristic presentation; instead, it often causes **tracheobronchitis** or pneumonia. *Adenovirus* - **Adenovirus** can cause a wide range of illnesses, including conjunctivitis, gastroenteritis, and respiratory infections, but it is **not the most common cause of croup**. - Respiratory adenovirus infections typically manifest as pharyngitis, **pneumonia**, or laryngotracheitis, but without the distinctive barking cough of parainfluenza.

Practice by Chapter

Upper Respiratory Tract Infections

Practice Questions

Lower Respiratory Tract Infections

Practice Questions

Asthma Management

Practice Questions

Cystic Fibrosis

Practice Questions

Bronchiolitis

Practice Questions

Foreign Body Aspiration

Practice Questions

Sleep-Disordered Breathing

Practice Questions

Congenital Lung Malformations

Practice Questions

Pleural Diseases

Practice Questions

Tuberculosis in Children

Practice Questions

Chronic Lung Disease in Premature Infants

Practice Questions

Pulmonary Function Testing

Practice Questions

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