Respiratory Diseases — MCQs

Respiratory Diseases Indian Medical PG Practice Questions and MCQs

Question 291: A 2-month-old child with a birth weight of 2 kg presents with poor feeding, excessive sleepiness, and wheezing. What is the most likely diagnosis?

A. Viral upper respiratory tract infection
B. Severe pneumonia
C. Bronchiolitis (Correct Answer)
D. Congestive heart failure

Explanation: ***Bronchiolitis*** - This presentation in a 2-month-old, especially with a history of **low birth weight**, points to bronchiolitis, characterized by **poor feeding**, **excessive sleepiness**, and **wheezing**. - **Bronchiolitis** primarily affects infants under 2 years (peak 2-6 months) and presents with signs of **lower respiratory tract involvement** including wheezing, tachypnea, and respiratory distress, which can lead to fatigue and feeding difficulties. - The **wheezing** is the key distinguishing feature indicating **small airway inflammation** typical of bronchiolitis. *Incorrect: Viral upper respiratory tract infection* - While viral URTI can cause nasal congestion and rhinorrhea, it typically affects the **upper airways** (nose, pharynx). - **Wheezing** indicates **lower airway involvement**, making bronchiolitis more likely than simple URTI. - The combination of systemic symptoms (poor feeding, excessive sleepiness) with wheezing suggests more significant lower respiratory disease. *Incorrect: Severe pneumonia* - Though severe pneumonia can cause similar systemic symptoms, **crackles or rales** are more characteristic than **wheezing**. - Pneumonia typically presents with **fever**, **cough**, and **focal consolidation** on examination. - The predominant **wheezing** in this case points more toward bronchiolitis with its diffuse small airway involvement. *Incorrect: Congestive heart failure* - CHF is an important differential in low birth weight infants with poor feeding and respiratory distress. - However, CHF typically presents with **tachycardia**, **hepatomegaly**, **gallop rhythm**, and **bilateral crackles** rather than prominent wheezing. - The **wheezing** without cardiac signs makes bronchiolitis more likely than a primary cardiac cause.

Question 292: What is the recommended position of a child during an asthmatic attack?

A. Supine
B. Semi erect (Correct Answer)
C. Erect
D. Trendelenburg

Explanation: ***Semi erect*** - A **semi-erect or sitting position** (also called the orthopneic position) is the recommended position for children during an asthmatic attack. - This position optimizes **lung expansion**, facilitates use of accessory muscles of respiration, and reduces the work of breathing. - The forward-leaning posture helps to **relieve dyspnea** and is the position most children naturally adopt during respiratory distress. *Supine* - Lying flat on the back **worsens breathing difficulty** by allowing abdominal contents to push against the diaphragm, restricting lung expansion. - This position increases respiratory effort and may worsen **hypoxemia**. - It also increases the risk of **aspiration** if the child coughs or vomits. *Erect* - While a fully upright sitting position is also helpful for breathing, the term **"semi-erect"** or **"sitting"** is more commonly used in clinical guidelines and textbooks when describing the optimal position for acute asthma. - Both positions are acceptable in practice, but "semi-erect" is the preferred terminology as it encompasses the natural forward-leaning posture children adopt during respiratory distress. *Trendelenburg* - In the **Trendelenburg position**, the head is lower than the feet, which **significantly worsens respiratory distress** by increasing pressure on the diaphragm. - This position is contraindicated in asthma and is used for specific conditions such as **hypotensive shock** or during certain surgical procedures, not for respiratory compromise.

Practice by Chapter

Upper Respiratory Tract Infections

Practice Questions

Lower Respiratory Tract Infections

Practice Questions

Asthma Management

Practice Questions

Cystic Fibrosis

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Bronchiolitis

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Foreign Body Aspiration

Practice Questions

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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