Respiratory Diseases Practice Questions

Q: A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Swyer-James-MacLeod syndrome. ***Swyer-James-MacLeod syndrome*** - This syndrome presents with **unilateral hyperlucent lung**, reduced vascularity, and bronchiectasis, often following a severe childhood respiratory infection, leading to air trapping and recurrent infections. - The imaging findings of **unilateral loss of lung volume**, hyperlucency, and reduced vascularity are classic for Swyer-James-MacLeod syndrome, which is also known as unilateral emphysema. *Immotile cilia syndrome* - This is a broader term that encompasses conditions like Kartagener syndrome, characterized by ciliary dysfunction leading to **recurrent sinopulmonary infections**; however, it does not typically present with unilateral hyperlucent lung or reduced vascularity. - While it causes bronchiectasis, the specific imaging findings described (unilateral hyperlucency) are not characteristic of isolated immotile cilia syndrome. *Kartagener syndrome* - This is a subgroup of primary ciliary dyskinesia that includes the classic triad of **situs inversus**, bronchiectasis, and sinusitis. The patient in the prompt has normally placed abdominal organs, ruling out situs inversus. - Although it involves recurrent pulmonary infections and bronchiectasis, the presence of **normally placed abdominal organs** and unilateral hyperlucency on imaging makes Kartagener syndrome less likely. *Mendelson syndrome* - This refers to **chemical pneumonitis** caused by the aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - It presents acutely with respiratory distress, hypoxemia, and diffuse infiltrates on imaging, which is inconsistent with the chronic presentation of recurrent infections and unilateral hyperlucency described.

Q: Which one of the following conditions does not typically present with inspiratory stridor in children?

Bronchiolitis. ***Bronchiolitis*** - This condition primarily affects the **small airways** (bronchioles) and is caused by inflammation and swelling, leading to **expiratory wheezing** and difficulty breathing, rather than inspiratory stridor. - While it can cause respiratory distress, the narrowing of the lower airways typically manifests as **wheezing and crackles**, not the harsh, high-pitched sound of inspiratory stridor associated with upper airway obstruction. *Laryngomalacia* - This is a common congenital condition characterized by the collapse of **supraglottic structures** during inspiration, leading to intermittent **inspiratory stridor** that is often worse when the infant is feeding, agitated, or supine. - The stridor is typically **soft and musical**, and usually improves spontaneously as the child grows. *Acute epiglottitis* - This is a severe and rapidly progressive bacterial infection of the **epiglottis**, which can cause significant **upper airway obstruction** and life-threatening inspiratory stridor. - Children with epiglottitis often present with a **sudden onset of high fever**, sore throat, **drooling**, and a **"tripod" position** (leaning forward with neck extended). *Croup* - This condition, typically caused by a viral infection, leads to **subglottic inflammation** and swelling, resulting in the characteristic **"barking" cough** and **inspiratory stridor**. - The stridor is due to the narrowing of the trachea below the vocal cords.

Q: A 10-year-old male child presenting with complaints of poor growth, poor appetite, short stature, clubbing, and recurrent chest infections, along with steatorrhea, is most likely diagnosed with what?

Cystic fibrosis. ***Cystic fibrosis*** - The constellation of **poor growth**, **short stature**, **recurrent chest infections**, **clubbing**, and **steatorrhea** is highly indicative of cystic fibrosis. - **Cystic fibrosis** is a genetic disorder affecting exocrine glands, leading to thick, sticky mucus that clogs the lungs and pancreas, causing malabsorption. *Celiac Disease* - **Celiac disease** primarily affects the small intestine, leading to malabsorption and poor growth. - While it can cause steatorrhea and poor growth, it does not typically present with recurrent chest infections or significant clubbing. *Biliary cirrhosis* - **Biliary cirrhosis** involves liver damage and can cause steatorrhea due to impaired bile flow. - However, it is not typically associated with recurrent chest infections or prominent clubbing unless advanced. *Bronchiectasis* - **Bronchiectasis** is characterized by permanent dilation of the bronchi, leading to chronic cough and recurrent respiratory infections. - While it can cause clubbing and recurrent chest infections, it does not directly cause steatorrhea or poor growth as a primary feature, although malnutrition can occur secondary to chronic illness.

Q: A child with recent onset of upper respiratory tract infection after 2 days presents with acute onset of breathlessness, cough, and fever. Which of the following treatments is contraindicated?

Morphine. ***Morphine (CONTRAINDICATED)*** - Morphine is a **potent respiratory depressant** and is **absolutely contraindicated** in a child with acute breathlessness and respiratory infection. - It suppresses the respiratory drive, worsening hypoxia and potentially leading to **respiratory failure**. - The sedative effects mask crucial clinical signs of deteriorating respiratory status, delaying life-saving interventions. - **Opioids should never be used** in acute respiratory distress in children. *Antipyretics (NOT contraindicated)* - **Paracetamol** or **ibuprofen** are safe and appropriate for fever management in children with respiratory infections. - They improve patient comfort without adversely affecting respiratory function. - Fever reduction helps decrease metabolic demand and oxygen consumption. *Antibiotics (NOT contraindicated)* - Indicated when **bacterial pneumonia** or bacterial superinfection complicates the viral URI. - Choice depends on clinical assessment, chest X-ray findings, and laboratory markers (elevated WBC, CRP). - Common organisms include *Streptococcus pneumoniae* and *Haemophilus influenzae*. *O2 inhalation (NOT contraindicated)* - **Essential treatment** for hypoxia (SpO2 <92-94%) in acute respiratory distress. - Delivered via nasal prongs, face mask, or high-flow nasal cannula depending on severity. - Oxygen therapy is a **life-saving intervention** and should never be withheld.

Q: Which of the following is not associated with primary ciliary dyskinesia?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** is a condition related to the thyroid gland's function and is **not directly associated** with defects in ciliary structure or function. - While other systemic conditions can coexist, there is no known mechanistic link between primary ciliary dyskinesia and thyroid dysfunction. *Sterility in males* - **Sterility in males** is a common manifestation of primary ciliary dyskinesia, as the abnormal cilia impair **sperm motility**, preventing effective fertilization. - The **flagellum of sperm** shares structural similarities with cilia, and its dysfunction leads to **immotile spermatozoa**. *Sinusitis* - **Sinusitis** is a hallmark symptom of primary ciliary dyskinesia due to impaired ciliary clearance in the **paranasal sinuses**. - The inability to effectively clear mucus leads to chronic and recurrent **sinus infections** and inflammation. *Respiratory infection* - **Recurrent respiratory infections**, including bronchitis, pneumonia, and bronchiectasis, are characteristic features of primary ciliary dyskinesia. - Defective ciliary action in the **respiratory tract** prevents proper clearance of mucus and pathogens, leading to chronic infections.

Q: In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?

Hoarseness. ***Correct: Hoarseness*** - **Laryngomalacia** primarily involves the collapse of supraglottic structures during inspiration, leading to inspiratory stridor - Hoarseness is NOT typically observed because laryngomalacia does **not directly affect the vocal cords** - Hoarseness indicates pathology at the level of the **vocal cords** themselves (such as vocal cord paralysis or inflammation), which is a different entity - The supraglottic collapse in laryngomalacia occurs above the vocal cords, leaving vocal cord function intact *Incorrect: Stridor will be inspiratory* - **Inspiratory stridor** is the hallmark feature of laryngomalacia - The collapse of supraglottic structures during inspiration creates a narrow airway, producing the characteristic high-pitched sound on inhalation - This is the most common presenting symptom in affected infants *Incorrect: Prominent arytenoids* - Laryngoscopy in laryngomalacia often reveals **prominent or redundant arytenoid mucosa** - The collapse of redundant tissue over the arytenoids makes them appear more prominent due to inward movement during inspiration - This contributes to the airway obstruction seen in the condition *Incorrect: Floppy aryepiglottic folds* - **Floppy, shortened aryepiglottic folds** are a hallmark anatomical feature of laryngomalacia - These folds collapse inward during inspiration, obstructing the laryngeal inlet - This collapse is the primary mechanism causing the inspiratory stridor in laryngomalacia

Q: All of the following statements about laryngomalacia are true, except for:

Surgical Tracheostomy is the treatment of choice. ***Surgical Tracheostomy is the treatment of choice*** - While laryngomalacia is the most common cause of **stridor** in infants, most cases are **mild and self-limiting**, resolving spontaneously by **12 to 18 months of age**. - **Surgical tracheostomy** is reserved for severe cases with significant **airway obstruction**, **failure to thrive**, or **life-threatening apneic spells** after failed conservative management and supraglottoplasty. *It is the most common congenital anomaly of the larynx* - This statement is **true**; laryngomalacia is indeed the most frequent congenital anomaly of the larynx, affecting approximately **60% of all congenital laryngeal anomalies**. - It is the most common cause of **inspiratory stridor** in infants. *It is associated with an omega shaped epiglottis* - This statement is **true**; the characteristic finding in laryngomalacia is the collapse of the **supraglottic structures** during inspiration. - This often includes a **long, curled, 'omega-shaped' epiglottis**, which contributes to the airway obstruction. *Stridor is increased on crying and relieved on lying prone* - This statement is **true**; the inspiratory stridor in laryngomalacia is typically **worsened by agitation, crying, feeding, or supine positioning**. - Lying **prone** or **side-lying** positions can help relieve the stridor by allowing the supraglottic tissues to fall forward and open the airway.

Q: Most dangerous sign in lower respiratory tract infection (LRTI) in children is:

Grunting. ***Grunting*** - **Grunting** is an expiratory sound produced by partial closure of the glottis to maintain positive end-expiratory pressure (PEEP), indicating **severe respiratory distress** and **impending respiratory failure**. - This compensatory mechanism suggests significant **alveolar collapse** or **pulmonary edema** and is a **critical danger sign** requiring immediate intervention in children with LRTI. - According to WHO and IMNCI guidelines, grunting is classified as a **danger sign** warranting urgent referral and management. *Incorrect: Chest retraction* - **Chest retractions** occur when the intercostal muscles, suprasternal, or subcostal areas pull inward during inspiration due to increased negative intrathoracic pressure. - Although it is a sign of respiratory distress indicating increased work of breathing, it is less dire than grunting, which signifies a more critical phase of respiratory failure. *Incorrect: Tachypnea* - **Tachypnea** (increased respiratory rate) is an early and common sign of LRTI in children, as the body attempts to compensate for hypoxemia or increased metabolic demand. - While concerning, it is often an initial response and, by itself, is not as immediately life-threatening as grunting, which suggests severe impairment of gas exchange. *Incorrect: Abdominal breathing* - **Abdominal breathing** (or diaphragmatic breathing) is a normal compensatory mechanism in infants and young children during respiratory distress. - While it indicates increased work of breathing, it is not as dangerous as grunting, which signifies a more advanced stage of respiratory compromise.

Q: In a child with exercise-induced asthma, which action is recommended?

Prophylaxis with beta-agonist. ***Prophylaxis with beta-agonist*** - **Short-acting beta-agonists (SABAs)** like albuterol are the first-line treatment for preventing **exercise-induced bronchoconstriction** when taken 15-30 minutes before physical activity. - They work by **relaxing the smooth muscles** of the airways, opening them up and making it easier to breathe during exercise. *Prophylaxis with steroids* - **Inhaled corticosteroids** are primarily used for **long-term control** of persistent asthma, reducing airway inflammation. - They are not typically used as a **preventative measure immediately prior to exercise** for exercise-induced bronchoconstriction. *Prophylaxis with theophylline* - **Theophylline** is a bronchodilator with a **narrow therapeutic index** and significant side effects, making it a less preferred option for asthma prophylaxis. - It is generally reserved for patients who are not well-controlled on other standard therapies and requires **therapeutic drug monitoring**. *Breathing exercise* - While **breathing exercises** can be beneficial for overall lung health and managing asthma symptoms, they are not a substitute for pharmacological prophylaxis in preventing **acute exercise-induced bronchoconstriction**. - They may complement medication but do not provide the **immediate bronchodilation** needed before exercise.

Q: A 10-month-old child weighing 5 kg and measuring 65 cm in length presents with cough and cold. He has a respiratory rate of 48 per minute, with no retractions, grunting, or cyanosis. There is no history of convulsions. Which statement is true?

No pneumonia, only cough and cold. **_No pneumonia, only cough and cold_** - The child's respiratory rate of 48 breaths per minute is within the normal range for a 10-month-old child, where a respiratory rate **less than 50 breaths per minute** is considered normal. - The absence of **retractions, grunting, or cyanosis** further indicates no signs of respiratory distress or severe illness. *The child may have pneumonia* - The child does not meet the criteria for pneumonia, as there is **no fast breathing** (respiratory rate below 50/min) and **no signs of chest indrawing**. - Pneumonia would typically involve a significantly **elevated respiratory rate** for the child's age or signs of severe respiratory distress. *The child has severe pneumonia* - Severe pneumonia is characterized by signs such as **chest indrawing**, deep or labored breathing, or symptoms like inability to drink, convulsions, or lethargy none of which are present. - A respiratory rate of 48/min is not considered fast breathing for this age group, ruling out even non-severe pneumonia based on respiratory rate criterion. *The child has very severe disease* - Very severe disease would manifest with critical signs like **cyanosis**, inability to breastfeed or drink, repeated vomiting, or convulsions, none of which are exhibited by the child. - The child's symptoms are limited to a cough and cold without any alarming signs, suggesting a mild, uncomplicated illness.

Question 1

A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?

Accepted Answer

Swyer-James-MacLeod syndrome

Answer

Immotile cilia syndrome

Answer

Kartagener syndrome

Answer

Mendelson syndrome

Question 2

Which one of the following conditions does not typically present with inspiratory stridor in children?

Accepted Answer

Bronchiolitis

Answer

Laryngomalacia

Answer

Acute epiglottitis

Answer

Croup

Question 3

A 10-year-old male child presenting with complaints of poor growth, poor appetite, short stature, clubbing, and recurrent chest infections, along with steatorrhea, is most likely diagnosed with what?

Accepted Answer

Cystic fibrosis

Answer

Celiac Disease

Answer

Biliary cirrhosis

Answer

Bronchiectasis

Question 4

A child with recent onset of upper respiratory tract infection after 2 days presents with acute onset of breathlessness, cough, and fever. Which of the following treatments is contraindicated?

Accepted Answer

Morphine

Answer

Antipyretics

Answer

Antibiotics

Answer

O2 inhalation

Question 5

Which of the following is not associated with primary ciliary dyskinesia?

Accepted Answer

Hypothyroidism

Answer

Sinusitis

Answer

Respiratory infection

Answer

Sterility in males

Question 6

In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?

Accepted Answer

Hoarseness

Answer

Stridor will be inspiratory

Answer

Prominent arytenoids

Answer

Floppy aryepiglottic folds

Question 7

All of the following statements about laryngomalacia are true, except for:

Accepted Answer

Surgical Tracheostomy is the treatment of choice

Answer

It is associated with an omega shaped epiglottis

Answer

It is the most common congenital anomaly of the larynx

Answer

Stridor is increased on crying and relieved on lying prone

Question 8

Most dangerous sign in lower respiratory tract infection (LRTI) in children is:

Accepted Answer

Grunting

Answer

Chest retraction

Answer

Tachypnea

Answer

Abdominal breathing

Question 9

In a child with exercise-induced asthma, which action is recommended?

Accepted Answer

Prophylaxis with beta-agonist

Answer

Prophylaxis with steroids

Answer

Prophylaxis with theophylline

Answer

Breathing exercise

Question 10

A 10-month-old child weighing 5 kg and measuring 65 cm in length presents with cough and cold. He has a respiratory rate of 48 per minute, with no retractions, grunting, or cyanosis. There is no history of convulsions. Which statement is true?

Accepted Answer

No pneumonia, only cough and cold

Answer

The child may have pneumonia

Answer

The child has severe pneumonia

Answer

The child has very severe disease

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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