Respiratory Diseases Practice Questions

Q: Loeffler's syndrome is characterized by:

Transient, migratory pulmonary infiltrations. **Explanation:** **Loeffler’s Syndrome** (Simple Pulmonary Eosinophilia) is a transient respiratory illness characterized by the accumulation of eosinophils in the lungs. It is most commonly caused by a Type I hypersensitivity reaction to the trans-pulmonary migration of helminthic larvae, such as *Ascaris lumbricoides*, *Ancylostoma duodenale*, or *Necator americanus*. 1. **Why Option A is correct:** The hallmark radiological finding of Loeffler’s syndrome is **transient, migratory (fleeting) pulmonary infiltrates**. These are non-segmental, peripheral opacities that shift in location or disappear completely within 2–4 weeks as the larvae complete their migration through the lungs. 2. **Why Options B and C are incorrect:** Fibrosis (apical or basal) represents chronic, irreversible structural damage (as seen in Tuberculosis or Idiopathic Pulmonary Fibrosis). Loeffler’s syndrome is an acute, benign, and self-limiting condition that does not lead to permanent scarring or fibrosis. 3. **Why Option D is incorrect:** Miliary mottling refers to small (1–2 mm) uniform nodules distributed throughout the lung fields, typically seen in Miliary Tuberculosis or Sarcoidosis. **High-Yield Clinical Pearls for NEET-PG:** * **Triad:** Peripheral blood eosinophilia, migratory pulmonary infiltrates, and a benign clinical course. * **Commonest Cause:** *Ascaris lumbricoides* is the most frequent parasitic trigger. * **Diagnosis:** Often incidental on CXR; stool examination for ova/parasites may be negative during the respiratory phase (as the worms haven't reached the intestine yet). * **Treatment:** Usually self-limiting; requires only symptomatic management or anthelmintics once the larvae reach the gut.

Q: What are the WHO criteria for hospital admission in pneumonia?

All of the above. In pediatric practice, the WHO Integrated Management of Childhood Illness (IMCI) guidelines classify pneumonia based on clinical severity to determine the site of care. The correct answer is **All of the above** because each option represents a clinical sign of respiratory distress or systemic toxicity requiring inpatient management. ### **Explanation of Options:** * **Nasal Flaring & Difficulty in Breathing:** These are hallmark signs of **Severe Pneumonia**. According to WHO, the presence of "chest indrawing" or "danger signs" (nasal flaring, grunting, or use of accessory muscles) indicates that the work of breathing is significantly increased, necessitating oxygen therapy and parenteral antibiotics. * **High Fever:** While not a standalone criterion for "Severe Pneumonia," a very high fever in a child with cough/cold indicates systemic involvement or potential sepsis. In the context of the NEET-PG pattern, systemic signs (inability to drink, lethargy, or persistent high fever) are triggers for admission to monitor for complications like empyema or pleural effusion. ### **Clinical Pearls for NEET-PG:** * **WHO Classification (Revised):** 1. **Pneumonia:** Fast breathing (Age <2m: ≥60; 2–12m: ≥50; 1–5y: ≥40 bpm). *Treatment: Home antibiotics (Amoxicillin).* 2. **Severe Pneumonia:** Fast breathing + Chest indrawing OR any Danger Sign. *Treatment: Hospitalization + IV Ampicillin/Gentamicin.* * **General Danger Signs:** Inability to drink/breastfeed, persistent vomiting, lethargy/unconsciousness, and convulsions. * **Gold Standard for Diagnosis:** While WHO uses clinical signs for resource-limited settings, **Chest X-ray** is the investigation of choice to confirm pneumonia in a hospital setting. * **Most Common Cause:** *Streptococcus pneumoniae* remains the most common bacterial cause across all pediatric age groups (excluding neonates).

Q: All of the following are used in the acute attack of asthma in a 4-year-old child, except:

Sedatives. In the management of acute asthma, the primary goal is to relieve airway obstruction and reduce inflammation. **Why Sedatives are Contraindicated (Correct Answer):** Sedatives (such as benzodiazepines or promethazine) are strictly contraindicated in acute asthma. They cause **respiratory center depression**, which can lead to hypoventilation, hypercapnia, and respiratory failure. In a child struggling to breathe, anxiety is often a physiological sign of hypoxia; suppressing this drive can be fatal. **Explanation of Other Options:** * **Salbutamol (Short-Acting Beta-2 Agonist):** This is the **first-line treatment** (Gold Standard) for acute attacks. It acts rapidly to cause bronchodilation by relaxing airway smooth muscle. * **Corticosteroids:** These are essential in acute management to reduce airway inflammation and edema. They prevent late-phase reactions and reduce the risk of relapse. Systemic steroids (oral or IV) are typically used in acute exacerbations. * **Theophylline:** While no longer first-line due to a narrow therapeutic index and side effects, intravenous Aminophylline/Theophylline can be used as an **add-on therapy** in severe refractory asthma (Status Asthmaticus) that does not respond to initial bronchodilators. **Clinical Pearls for NEET-PG:** * **Drug of Choice (Acute):** Inhaled Salbutamol (via MDI with spacer or nebulization). * **Most sensitive indicator of severity:** Use of accessory muscles and inability to speak in full sentences. * **Silent Chest:** A grave clinical sign indicating minimal air entry; it is a medical emergency. * **Magnesium Sulfate:** Used intravenously in severe cases for its smooth muscle relaxant properties.

Q: A 3-year-old, well-immunized male child presents with sore throat, fever, noisy breathing, and inability to swallow for the past four hours. Examination reveals a toxic, tachypneic child with inspiratory stridor, suprasternal, supraclavicular, and intercostal retractions during inspiration. What is the most likely diagnosis?

Acute Epiglottitis. **Explanation:** The clinical presentation of a **toxic-looking** child with a rapid onset of high fever, sore throat, **drooling (inability to swallow)**, and inspiratory stridor is classic for **Acute Epiglottitis**. This is a life-threatening pediatric emergency involving inflammation of the supraglottic structures. The "4 Ds" (Drooling, Dysphagia, Distress, and Dysphonia) are hallmark signs. Despite being well-immunized (which reduces the risk of *H. influenzae* type b), other pathogens like *Streptococcus pyogenes* or *Staphylococcus aureus* can still cause the condition. **Why other options are incorrect:** * **Acute Laryngotracheobronchitis (Croup):** Typically presents with a "barking" cough, hoarseness, and a slower prodrome of URI symptoms. The child is usually not "toxic" or drooling. * **Diphtheria:** Characterized by a slow onset, low-grade fever, and a thick, grey, adherent **pseudomembrane** on the tonsils/pharynx. It does not typically cause the acute, fulminant respiratory distress seen here. * **Bronchopneumonia:** Presents with cough, rales/crepitations, and expiratory wheezing rather than inspiratory stridor. Stridor indicates an upper airway obstruction. **NEET-PG High-Yield Pearls:** * **X-ray Finding:** Lateral neck X-ray shows the **"Thumb sign"** (swollen epiglottis). * **Management:** The priority is **airway stabilization** (intubation) in a controlled environment (OR). Do not examine the throat with a tongue depressor, as it may trigger fatal laryngospasm. * **Positioning:** Children often assume the **"Tripod position"** (leaning forward on hands) to maximize airway diameter.

Q: Bronchiolitis obliterans is suggested by all findings except:

Diffuse infiltrates seen on chest X-ray. **Explanation:** **Bronchiolitis Obliterans (BO)** is a chronic obstructive lung disease characterized by the fibrotic narrowing or complete occlusion of the small airways (bronchioles). **Why Option D is the Correct Answer:** In BO, the primary pathology is airway obstruction rather than alveolar filling. Therefore, the characteristic radiographic finding is **hyperlucency** (due to air trapping) and **vascular pruning**, rather than diffuse infiltrates. Diffuse infiltrates are more characteristic of acute infectious pneumonia or interstitial lung diseases, not the chronic obstructive remodeling seen in BO. **Analysis of Incorrect Options:** * **Option A (Hyperlucency):** This is a hallmark finding. As bronchioles become obliterated, air becomes trapped distally (check-valve mechanism), leading to hyperinflation and increased radiolucency on X-ray. * **Option B (Obstructive pattern):** Since BO involves the narrowing of small airways, Pulmonary Function Tests (PFTs) characteristically show a **fixed obstructive pattern** (decreased FEV1 and FEV1/FVC ratio) that does not respond to bronchodilators. * **Option C (Sequelae of Adenovirus):** Post-infectious BO is most commonly associated with **Adenovirus (types 3, 7, and 21)**. Other causes include Mycoplasma pneumoniae, measles, and graft-versus-host disease (GVHD) post-transplant. **NEET-PG High-Yield Pearls:** * **Swyer-James (MacLeod) Syndrome:** A classic manifestation of post-infectious BO where one lung or lobe appears hyperlucent and small with a small pulmonary artery. * **HRCT Finding:** The "gold standard" imaging finding is the **Mosaic Perfusion Pattern** (areas of decreased attenuation representing air trapping). * **Diagnosis:** Often clinical, based on a history of severe lower respiratory infection followed by persistent wheezing and obstruction unresponsive to therapy.

Q: What is the most likely etiology in a 10-month-old child with a 7-day history of high-grade fever, exhibiting the following X-ray findings, and not responding to ceftriaxone?

Staphylococcus aureus. ***Staphylococcus aureus*** - Characteristic X-ray findings in infants include **pneumatoceles**, **empyema**, and **pyopneumothorax**, which are pathognomonic for staphylococcal pneumonia. - Failure to respond to **ceftriaxone** suggests **MRSA**, as ceftriaxone does not provide adequate coverage against methicillin-resistant strains. *Streptococcus pneumoniae* - Typically responds well to **ceftriaxone** therapy, making this unlikely given the treatment failure described. - Usually presents with **lobar consolidation** on chest X-ray without the characteristic cavitary lesions or pneumatoceles seen with staph infections. *Mycoplasma* - Predominantly affects **school-age children** and adolescents, not typically seen in 10-month-old infants. - Presents with **atypical pneumonia** symptoms including gradual onset, dry cough, and bilateral interstitial infiltrates rather than high-grade fever and cavitary lesions. *Respiratory Syncytial Virus* - Causes **bronchiolitis** with hyperinflation and peribronchial thickening on chest X-ray, not lobar pneumonia with cavitary changes. - Typically presents with **wheezing**, **rhinorrhea**, and **cough** rather than high-grade fever and pneumonic consolidation.

Q: Palivizumab, a monoclonal antibody, is used for the prophylaxis of:

Respiratory syncytial virus. **Explanation:** **Palivizumab** is a humanized monoclonal antibody directed against the **F (fusion) protein** of the **Respiratory Syncytial Virus (RSV)**. By binding to this protein, it prevents the virus from entering the host cells, thereby inhibiting viral replication. **Why the correct answer is right:** * **Option D (RSV):** RSV is the leading cause of bronchiolitis and pneumonia in infants. Palivizumab is specifically FDA-approved for the **prophylaxis** (not treatment) of serious lower respiratory tract disease caused by RSV in high-risk pediatric populations (e.g., preterm infants, children with chronic lung disease, or hemodynamically significant congenital heart disease). **Why incorrect options are wrong:** * **Option A (hMPV):** While human metapneumovirus causes similar clinical symptoms to RSV, Palivizumab is highly specific to the RSV F-protein and does not cross-react with hMPV. * **Option B (Parainfluenza):** These viruses belong to the same family (*Paramyxoviridae*) but have different surface glycoproteins. There is currently no monoclonal antibody prophylaxis for Parainfluenza. * **Option C (Influenza):** Prevention of Influenza is primarily achieved through annual vaccination (inactivated or live-attenuated) or antiviral drugs like Oseltamivir, not monoclonal antibodies. **High-Yield Clinical Pearls for NEET-PG:** * **Administration:** It is given as a **monthly intramuscular injection** during the RSV season (usually 5 consecutive doses). * **Target:** It targets the **A antigenic site** of the F-protein. * **Newer Alternative:** **Nirsevimab** is a newer, long-acting monoclonal antibody recently approved for RSV prophylaxis that requires only a single dose per season. * **Note:** Palivizumab is **not effective** for the treatment of an active RSV infection; it is strictly for prevention.

Question 1

Loeffler's syndrome is characterized by:

Accepted Answer

Transient, migratory pulmonary infiltrations

Answer

Fibrosis in the pulmonary apices

Answer

Fibrosis in the base of one or both lungs

Answer

Miliary mottling

Question 2

What are the WHO criteria for hospital admission in pneumonia?

Accepted Answer

All of the above

Answer

High fever

Answer

Nasal flaring

Answer

Difficulty in breathing

Question 3

All of the following are used in the acute attack of asthma in a 4-year-old child, except:

Accepted Answer

Sedatives

Answer

Theophylline

Answer

Corticosteroids

Answer

Salbutamol

Question 4

A 4-month-old infant presents with cough and a respiratory rate greater than 60/min, with no chest retractions. What is the appropriate management according to the Integrated Management of Childhood Illness (IMNCI) protocol?

Accepted Answer

Administer oral antibiotics, explain danger signs, and schedule a follow-up.

Answer

Administer intramuscular antibiotics and refer urgently.

Answer

Explain danger signs and schedule a follow-up.

Answer

Administer intramuscular antibiotics and hospitalize.

Question 5

A 3-year-old, well-immunized male child presents with sore throat, fever, noisy breathing, and inability to swallow for the past four hours. Examination reveals a toxic, tachypneic child with inspiratory stridor, suprasternal, supraclavicular, and intercostal retractions during inspiration. What is the most likely diagnosis?

Accepted Answer

Acute Epiglottitis

Answer

Acute Laryngotracheobronchitis

Answer

Diphtheria

Answer

Bronchopneumonia

Question 6

A 14-year-old boy presented with chronic diarrhea and weight loss. History reveals that he has repeated attacks of respiratory tract infections with Pseudomonas aeruginosa. His younger brother died from a severe respiratory infection at the age of 7. Which of the following agents is most likely to improve this patient's condition?

Accepted Answer

Pancreatic lipase

Answer

Octreotide

Answer

Metronidazole

Answer

Loperamide

Question 7

Bronchiolitis obliterans is suggested by all findings except:

Accepted Answer

Diffuse infiltrates seen on chest X-ray

Answer

Hyperlucency on chest X-ray

Answer

Obstructive pattern on pulmonary function test

Answer

Sequelae of Adenovirus infection

Question 8

What is the MOST suitable management for a 2-year-old child presenting with cough for 5 days? On examination, the respiratory rate is 40/minute. The child is well-nourished, active, and feeding well.

Accepted Answer

Advise mother to provide home care.

Answer

Start cotrimoxazole in age-appropriate doses.

Answer

Start with the first dose of intramuscular ampicillin.

Answer

None of the above.

Question 9

What is the most likely etiology in a 10-month-old child with a 7-day history of high-grade fever, exhibiting the following X-ray findings, and not responding to ceftriaxone?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Mycoplasma

Answer

Respiratory Syncytial Virus

Question 10

Palivizumab, a monoclonal antibody, is used for the prophylaxis of:

Accepted Answer

Respiratory syncytial virus

Answer

Human metapneumovirus

Answer

Para-influenza virus types 2 and 4

Answer

Influenza virus

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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