Respiratory Diseases — MCQs

Respiratory Diseases Indian Medical PG Practice Questions and MCQs

Question 271: A 9 month old child with respiratory rate 53/min and presence of cough is classified as :

A. Tachypnoea (Correct Answer)
B. Systemic Inflammatory Response Syndrome (SIRS)
C. Respiratory Distress Syndrome
D. Acute Respiratory Distress Syndrome (ARDS)

Explanation: ***Tachypnoea*** - A respiratory rate of **53 breaths/min** in a 9-month-old child meets the criteria for **tachypnoea**, as the normal respiratory rate for this age group is typically 20-40 breaths/min. - The presence of **cough** alongside tachypnoea suggests a respiratory infection or process causing increased work of breathing. - **WHO IMNCI Context**: According to WHO Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, a child aged 2-12 months with fast breathing (≥50 breaths/min) and cough would be **classified as "Pneumonia"**. However, from the given options, **tachypnoea** is the most appropriate clinical descriptor. - Among the provided options, tachypnoea is the correct answer as it accurately describes the elevated respiratory rate. *Systemic Inflammatory Response Syndrome (SIRS)* - SIRS is a **clinical syndrome** characterized by dysregulated inflammatory response with specific criteria: **fever/hypothermia**, tachycardia, tachypnoea, and abnormal WBC count. - Requires **at least 2 of 4 criteria** for diagnosis, including temperature abnormality or WBC abnormality. - Tachypnoea alone with cough, without other systemic signs, is insufficient for SIRS diagnosis. *Respiratory Distress Syndrome* - **Respiratory Distress Syndrome (RDS)** is a condition of **premature newborns** (typically <34 weeks gestation) due to surfactant deficiency. - Presents within **hours after birth** with tachypnoea, grunting, retractions, and cyanosis. - **Not applicable** to a 9-month-old child, as surfactant production is mature by this age. *Acute Respiratory Distress Syndrome (ARDS)* - **ARDS** is severe acute lung injury with specific diagnostic criteria: bilateral pulmonary infiltrates, severe hypoxemia (PaO2/FiO2 ratio <300), and absence of cardiac failure. - Requires **chest imaging evidence** and arterial blood gas analysis for diagnosis. - While tachypnoea can occur in ARDS, the diagnosis requires much more than elevated respiratory rate and cough alone.

Question 272: Which of the following statements about croup is false?

A. Disease includes laryngitis and laryngotracheobronchitis.
B. Brassy cough is a common presenting feature.
C. Causes upper airway obstruction
D. Croup is caused by bacterial infections. (Correct Answer)

Explanation: ***Croup is caused by bacterial infections.*** - Croup, or **laryngotracheobronchitis**, is predominantly caused by **viral infections**, most commonly **parainfluenza virus**. - While bacterial superinfection can occur, the primary etiology of croup is viral, affecting the upper airway. *Disease includes laryngitis and laryngotracheobronchitis.* - **Laryngitis** and **laryngotracheobronchitis** are indeed different forms or classifications of croup, reflecting the inflammation of the larynx, trachea, and bronchi. - Croup is a broad term that encompasses these inflammatory conditions of the upper airway, commonly seen in young children. *Brassy cough is a common presenting feature.* - A **brassy (barking) cough** is a hallmark symptom of croup, resulting from inflammation and narrowing of the subglottic region. - This distinctive cough is often accompanied by **stridor** due to upper airway obstruction. *Causes upper airway obstruction* - The inflammation and swelling of the **larynx** and **trachea** in croup lead to narrowing of the airway lumen, causing **upper airway obstruction**. - This obstruction is responsible for characteristic symptoms like **inspiratory stridor** and difficulty breathing.

Question 273: In the IMNCI guidelines, what is the respiratory rate threshold that defines fast breathing for a 6-month-old infant?

A. 60 breaths per minute
B. 50 breaths per minute (Correct Answer)
C. 40 breaths per minute
D. 30 breaths per minute

Explanation: ***50 breaths per minute*** - According to the **Integrated Management of Childhood Illness (IMNCI)** guidelines, a respiratory rate of **50 breaths per minute or more** defines **fast breathing** in infants aged **2 months to 12 months**. - This threshold is crucial for identifying potential **pneumonia** or other severe respiratory infections in this age group, requiring prompt medical attention. *60 breaths per minute* - A respiratory rate of **60 breaths per minute or more** is considered fast breathing for **infants less than 2 months old**. - This threshold is specific to neonates and very young infants, as their normal resting respiratory rates are higher. *40 breaths per minute* - A respiratory rate of **40 breaths per minute** is considered the threshold for fast breathing in **children aged 12 months (1 year) to 5 years**. - This threshold applies to older infants and young children, where the normal respiratory rate is lower than in younger infants. *30 breaths per minute* - A respiratory rate of **30 breaths per minute** is generally considered within the **normal range for older children and adults**. - It does not represent fast breathing for an infant or young child according to IMNCI guidelines.

Question 274: What is the appropriate management for a 3-year-old child presenting to the primary health center with fever and cough for 5 days, exhibiting chest indrawing?

A. Prescribe antibiotics and schedule a follow-up.
B. Make an urgent referral to tertiary care.
C. Administer antibiotics and refer to tertiary care. (Correct Answer)
D. Administer antipyretics only.

Explanation: **Administer antibiotics and refer to tertiary care.** * **Chest indrawing** in a child with fever and cough indicates **severe pneumonia**, which requires prompt medical intervention. * Administering the first dose of **appropriate antibiotics** (e.g., amoxicillin) at the primary health center is crucial to stabilize the child before **urgent referral** to a tertiary care facility for advanced management. * *Prescribe antibiotics and schedule a follow-up.* * Simply prescribing antibiotics and scheduling a follow-up is inadequate for a child with **severe pneumonia** and **chest indrawing**, as their condition can rapidly deteriorate. * This approach delays access to specialized care, increasing the risk of complications and mortality in a severe case. * *Make an urgent referral to tertiary care.* * While **urgent referral** is necessary, it is important to initiate immediate treatment at the primary level by administering the first dose of antibiotics. * Delaying antibiotic administration until arrival at the tertiary center could worsen the child's condition. * *Administer antipyretics only.* * **Antipyretics** only address the fever symptom and do not treat the underlying **bacterial infection** causing pneumonia. * This option neglects the critical need for **antibiotic therapy** and specialized medical attention, making it an inappropriate and dangerous management strategy.

Question 275: In Respiratory Distress Syndrome (RDS) in a child, which type of cells are found to be defective?

A. Macrophages
B. Type 1 pneumocytes
C. Bronchial epithelium
D. Type II pneumocytes (Correct Answer)

Explanation: ***Type II pneumocytes*** - **Type II pneumocytes** are specialized cells responsible for producing and secreting **surfactant**, a lipoprotein complex that reduces surface tension in the alveoli and prevents alveolar collapse. - In **Respiratory Distress Syndrome (RDS)**, particularly in premature infants, these cells are **immature or insufficient**, leading to inadequate surfactant production, increased alveolar surface tension, and subsequent alveolar collapse with impaired gas exchange. - This is the primary cellular defect in RDS, making Type II pneumocytes the correct answer. *Type 1 pneumocytes* - **Type I pneumocytes** are thin, flattened squamous cells that cover approximately 95% of the alveolar surface area and are primarily responsible for **gas exchange**. - While essential for respiratory function, they do not produce surfactant and are not the defective cell type in RDS. *Bronchial epithelium* - The **bronchial epithelium** lines the conducting airways and consists of ciliated columnar cells involved in **mucociliary clearance** and airway protection. - Defects in bronchial epithelium are associated with conditions like asthma, chronic bronchitis, or cystic fibrosis, not with RDS. *Macrophages* - **Alveolar macrophages** are immune cells residing in the alveolar spaces, responsible for phagocytosis of pathogens and debris. - While they play important roles in pulmonary defense and can be affected in various lung diseases, they are not the primary defective cell type in RDS, which is fundamentally a surfactant deficiency disorder.

Question 276: What is a key diagnostic criterion for acute respiratory distress syndrome (ARDS) in a child?

A. Within 7 days of known clinical insult (Correct Answer)
B. Respiratory failure not fully explained
C. Left ventricular dysfunction
D. All of the options

Explanation: ***Within 7 days of known clinical insult*** - A key diagnostic criterion for **Acute Respiratory Distress Syndrome (ARDS)** in children is the onset of respiratory symptoms within **7 days of a known clinical insult**. - This temporal relationship helps distinguish ARDS from other causes of respiratory failure that may have a more chronic or delayed onset. *Respiratory failure not fully explained* - **Respiratory failure not fully explained** by other conditions is a general characteristic but not a specific diagnostic criterion on its own. - ARDS requires the exclusion of cardiac failure as the primary cause of pulmonary edema, indicated by an absence of left atrial hypertension. *Left ventricular dysfunction* - **Left ventricular dysfunction** would suggest **cardiogenic pulmonary edema**, which needs to be excluded for a diagnosis of ARDS. - ARDS is characterized by **non-cardiogenic pulmonary edema**, meaning the fluid in the lungs is not due to heart failure. *All of the options* - This option is incorrect because **left ventricular dysfunction** is an *exclusion criterion* for ARDS, not a diagnostic criterion, as ARDS is defined by **non-cardiogenic pulmonary edema**. - While the other options relate to aspects of ARDS, only one is a key diagnostic criterion as formulated.

Question 277: A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:

A. SIRS
B. Respiratory distress (Correct Answer)
C. Tachypnoea
D. ARDS

Explanation: ***Respiratory distress*** - **Indrawing of the chest** is a classic sign of increased work of breathing, indicating the child is struggling to oxygenate. - A respiratory rate of **52 breaths per minute in a 3-month-old** is significantly elevated and, combined with indrawing, points to respiratory distress. - According to **WHO IMCI guidelines**, chest indrawing in a child with fast breathing is classified as **pneumonia/respiratory distress** requiring immediate treatment. *SIRS* - **Systemic Inflammatory Response Syndrome (SIRS)** criteria are typically more comprehensive and include fever or hypothermia, tachycardia, tachypnea, and abnormal white blood cell count. - While tachypnea is present, the other defining features of SIRS are not fully met by the information provided, nor does indrawing directly classify as SIRS. *Tachypnoea* - **Tachypnoea** refers specifically to an elevated respiratory rate, which is present (52 breaths per minute). - However, the presence of **chest indrawing** indicates more than just rapid breathing; it signifies significant respiratory effort and compromise. - The classification must capture both the elevated rate and the increased work of breathing. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe form of lung injury characterized by widespread inflammation, hypoxemia, and bilateral infiltrates on chest imaging. - While respiratory distress is a feature of ARDS, the given information is insufficient to diagnose ARDS, which requires specific criteria relating to oxygenation and radiological findings.

Question 278: What is the most appropriate method for administering asthma treatment to an infant under one year of age?

A. MDI with Mask (no spacer)
B. Nebulizer therapy
C. MDI with Spacer (no mask)
D. MDI with Spacer and Mask (Correct Answer)

Explanation: ***MDI with Spacer and Mask*** - For infants and young children, a **metered-dose inhaler (MDI)** used with a **spacer** and a **well-fitting mask** is the **most appropriate** method for delivering asthma medication. - The spacer helps to reduce the velocity of the aerosol and allows the infant to inhale the medication over several breaths, while the mask ensures the medication is delivered to the airways without significant loss. - This method is **portable**, **convenient**, and **cost-effective** for routine outpatient management. *MDI with Spacer (no mask)* - While a spacer is crucial for optimizing drug delivery from an MDI, an infant cannot effectively seal their lips around a spacer mouthpiece for proper inhalation. - This method would result in significant **medication loss** and insufficient dose delivery to the lungs. *MDI with Mask (no spacer)* - An MDI used directly with a mask without a spacer leads to inefficient drug delivery due to the **high velocity** of the aerosol spray. - The medication impinges on the back of the throat and face, reducing the amount that reaches the small airways. *Nebulizer therapy* - Nebulizers are also an **acceptable and effective option** for infants, particularly in acute settings or when families find them easier to use. - However, they are **time-consuming** (typically 10-15 minutes per treatment), require a power source or batteries, and are less portable than MDI systems. - For **routine outpatient management**, an MDI with spacer and mask is generally **preferred** due to its convenience, portability, and comparable efficacy when used correctly.

Question 279: Which of the following is not a recommended treatment for bronchiolitis?

A. Bronchodilator
B. Humid oxygen
C. Macrolides (Correct Answer)
D. All of the options

Explanation: ***Macrolides*** - **Macrolide antibiotics** are *not* recommended for treatment of **bronchiolitis**, as the condition is primarily caused by **viral infections** (mainly RSV), rendering antibiotics completely ineffective. - Bronchiolitis is a **viral illness**, and use of antibiotics like macrolides provides *no benefit*, increases risk of **antibiotic resistance**, and may cause unnecessary side effects. - This is the **most clearly not recommended** option among the choices. *Humid oxygen* - While **supplemental oxygen** is indicated for infants with **hypoxemia** (oxygen saturation <90%), **routine humidification** of oxygen is *not specifically recommended* by current guidelines. - Evidence does *not support* routine use of humidified oxygen therapy in bronchiolitis. - However, supplemental oxygen itself (when needed for low oxygen levels) is appropriate supportive care. *Bronchodilator* - **Bronchodilators** (like albuterol or salbutamol) are *not routinely recommended* for bronchiolitis, as most infants do not have significant **bronchospasm** and show *no sustained benefit*. - Guidelines suggest a **trial dose** may be considered, but should be *discontinued* if there is no clear clinical improvement. - The primary pathology is **bronchiolar inflammation and mucus plugging**, not reversible bronchospasm. *All of the options* - This option is incorrect because the question asks for what is "*not* recommended." - **Macrolides** are the most definitively not recommended, as they are completely ineffective against viral infections. - While bronchodilators and routine humidification also lack strong evidence, **macrolides** represent inappropriate therapy with no mechanism of benefit.

Question 280: A 3-month-old infant with no chest indrawing and a respiratory rate of 52/minute. The diagnosis is:

A. Severe pneumonia
B. Pneumonia (Correct Answer)
C. No pneumonia
D. Very severe disease

Explanation: ***Pneumonia*** - A respiratory rate of 52/minute in a 3-month-old infant **meets the age-specific threshold for tachypnea** (respiratory rate ≥ 50 breaths/minute for infants 2-12 months according to IMCI guidelines). - In the **absence of chest indrawing**, the presence of fast breathing (tachypnea) alone classifies this as **pneumonia** per IMCI classification. - This requires **outpatient management with oral antibiotics** and close follow-up. *No pneumonia* - This diagnosis would apply if the respiratory rate was **< 50 breaths/minute** for this age group with no chest indrawing. - Since the respiratory rate is 52/minute (≥ 50/minute), this rules out "no pneumonia." *Severe pneumonia* - This diagnosis requires the presence of **chest indrawing** in addition to fast breathing. - The question explicitly states **"no chest indrawing,"** which excludes severe pneumonia. - Severe pneumonia would require **hospitalization and parenteral antibiotics**. *Very severe disease* - This diagnosis involves **danger signs** such as inability to drink or breastfeed, persistent vomiting, convulsions, lethargy, unconsciousness, or severe malnutrition. - None of these critical signs are mentioned in the clinical scenario. - Very severe disease requires **urgent hospitalization and injectable antibiotics**.

Practice by Chapter

Upper Respiratory Tract Infections

Practice Questions

Lower Respiratory Tract Infections

Practice Questions

Asthma Management

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Cystic Fibrosis

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Bronchiolitis

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Foreign Body Aspiration

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Sleep-Disordered Breathing

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Congenital Lung Malformations

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Pleural Diseases

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Tuberculosis in Children

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Chronic Lung Disease in Premature Infants

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Pulmonary Function Testing

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