Respiratory Diseases Practice Questions

Q: What is the most likely cause of acute onset of cough, stridor, and dyspnea in a child?

Foreign body aspiration. **Explanation:** The clinical triad of **acute onset** cough, stridor, and dyspnea in a child is the classic presentation of **Foreign Body Aspiration (FBA)**. In pediatric patients, the sudden nature of symptoms (the "penetration syndrome") is the most critical diagnostic clue. Stridor indicates an upper airway or tracheal obstruction, while wheezing or decreased breath sounds usually suggest a bronchial location. **Why the other options are incorrect:** * **Acute Asthma:** While it presents with cough and dyspnea, it typically manifests as **expiratory wheezing** rather than inspiratory stridor. It is usually preceded by triggers or a known history of atopy and is rarely as instantaneous as FBA. * **Aspiration Pneumonitis:** This involves the inhalation of gastric contents or liquids. While it causes respiratory distress, it usually presents with fever, rales, and signs of inflammation over hours, rather than the sudden mechanical obstruction seen with a solid foreign body. * **Primary Complex (Tuberculosis):** This is a chronic infection. It presents with a persistent cough, low-grade fever, and weight loss over weeks or months, not with acute stridor and sudden dyspnea. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Right main bronchus (due to it being wider, shorter, and more vertical). * **Most common age group:** 1–3 years (toddlers). * **Gold Standard Diagnosis & Management:** Rigid Bronchoscopy (both diagnostic and therapeutic). * **Radiology:** The most common finding is **obstructive emphysema** (air trapping) on expiratory films; however, a normal X-ray does not rule out FBA if clinical suspicion is high.

Q: Which of the following is the most likely diagnosis in a child presenting with increased cough at night?

Asthma. **Explanation:** **Asthma** is the most likely diagnosis because **nocturnal cough** is a hallmark clinical feature of the disease. The worsening of symptoms at night (and early morning) occurs due to the circadian rhythm of the body, which leads to a natural dip in endogenous cortisol levels, increased vagal tone (causing bronchoconstriction), and decreased airway caliber. In pediatric practice, a chronic, dry, irritating cough that occurs exclusively or predominantly at night is often considered "Cough Variant Asthma" until proven otherwise. **Analysis of Incorrect Options:** * **Pneumonia:** Typically presents with high-grade fever, productive cough, tachypnea, and localized chest signs (crepitations/dullness). The cough is persistent throughout the day rather than specifically nocturnal. * **Bronchiolitis:** Primarily affects infants (<2 years) and presents with acute onset wheezing, respiratory distress, and signs of viral prodrome (rhinorrhea). It is an acute inflammatory process, not a chronic nocturnal pattern. * **Laryngomalacia:** The most common cause of congenital stridor. It presents with **inspiratory stridor** that typically worsens when the infant is supine or crying, but it is characterized by noisy breathing rather than an isolated nocturnal cough. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Asthma is a clinical diagnosis; however, in children >5 years, Spirometry (showing reversibility with bronchodilators >12% improvement in FEV1) is the gold standard. * **Cough Variant Asthma:** A phenotype where cough is the only symptom; it responds well to inhaled corticosteroids (ICS). * **Rule of Thumb:** Any child with recurrent "bronchitis" or nocturnal cough should be evaluated for Asthma.

Q: Which one of the following values is not a feature of acute severe asthma?

PEF of 60 to 70% of expected. **Explanation:** The classification of asthma severity is a high-yield topic for NEET-PG. To identify the correct answer, one must distinguish between **Moderate** and **Acute Severe Asthma** (Status Asthmaticus). **1. Why Option B is the correct answer:** In **Acute Severe Asthma**, the Peak Expiratory Flow (PEF) is significantly reduced, typically **less than 50%** of the predicted or best value. A PEF of 60–70% is characteristic of a **Moderate Exacerbation**. Therefore, this value is "not a feature" of the severe category. **2. Analysis of Incorrect Options (Features of Severe Asthma):** * **Heart rate > 110/min (Option A):** Tachycardia is a physiological response to respiratory distress, hypoxia, and increased work of breathing. In children, the threshold varies by age, but >110 bpm is a standard marker for severity in adults and older children. * **Pulsus Paradoxus (Option C):** This refers to an exaggerated fall in systolic BP (>10 mmHg) during inspiration. In severe asthma, massive negative intrathoracic pressure is required to breathe, which impacts cardiac filling and output. Its presence signifies significant airway obstruction. * **PaO2 < 8 kPa (Option D):** 8 kPa is approximately **60 mmHg**. Hypoxemia (PaO2 < 60 mmHg) without cyanosis is a hallmark of severe asthma. If the PaO2 drops further or PaCO2 begins to rise (normalizing or increasing), it indicates impending respiratory failure. **Clinical Pearls for NEET-PG:** * **Silent Chest:** The most ominous sign in asthma; it indicates such little air movement that wheezing disappears. * **Normal PaCO2:** In an acute attack, a patient should be hyperventilating (low PaCO2). A "normal" PaCO2 (40 mmHg) in a struggling asthmatic is a sign of muscle fatigue and **impending respiratory failure**. * **Life-threatening features:** PEF < 33%, SpO2 < 92%, silent chest, cyanosis, exhaustion, or hypotension.

Q: An 8-year-old child presents with a 7-month history of cough, a 1-month history of hemoptysis, and a 4-day history of fever. An X-ray shows the following findings. What is your diagnosis?

Consolidation. ***Consolidation*** - The presence of **homogeneous opacity with air bronchograms** on chest X-ray in a child with chronic cough, hemoptysis, and fever is characteristic of **pulmonary consolidation**. - **Air bronchograms** (air-filled bronchi visible within the consolidated lung tissue) are pathognomonic for consolidation, distinguishing it from other conditions. *Hydatid cyst* - Typically presents as a **well-defined, round, homogeneous opacity** without air bronchograms on chest X-ray. - May show the classic **water lily sign** when the cyst ruptures, creating a characteristic appearance of floating membranes. *Lung abscess* - Characteristically shows a **thick-walled cavity with an air-fluid level** on chest X-ray, not homogeneous opacity. - Usually presents with **purulent sputum** and systemic toxicity, rather than the gradual onset described. *Thoracic duct malformations* - Extremely **rare condition** in pediatric patients, typically presenting with **chylothorax** (milky pleural effusion). - Would show **pleural fluid collection** rather than parenchymal consolidation with air bronchograms.

Q: A young boy developed respiratory distress. On examination, the chest X-ray showed hyperinflation of one lung. Which of the following is the most possible diagnosis?

Foreign body aspiration. ### Explanation The correct answer is **Foreign body aspiration (FBA)**. **Why it is correct:** In pediatric patients, foreign body aspiration often acts as a **"ball-valve" mechanism**. During inspiration, the airways dilate, allowing air to pass the obstruction. However, during expiration, the airways narrow, causing the foreign body to completely occlude the lumen. This results in air-trapping and subsequent **obstructive hyperinflation** of the affected lung. While Congenital Lobar Emphysema (CLE) also causes hyperinflation, FBA is statistically the most common cause of sudden-onset respiratory distress with unilateral hyperinflation in a previously healthy child. **Why the other options are incorrect:** * **Congenital Lobar Emphysema (CLE):** While it presents with hyperinflation, it is typically diagnosed in the **neonatal period or early infancy** (usually <6 months) due to cartilage deficiency. The question implies a "young boy," suggesting an older age group where FBA is more prevalent. * **Atelectasis:** This involves the collapse of lung tissue, which would show **opacity and volume loss** (mediastinal shift toward the lesion) on X-ray, rather than hyperinflation. * **Bronchiectasis:** This is a chronic condition characterized by permanent dilation of bronchi. X-ray findings typically show "tram-track" opacities or cystic changes, not acute unilateral hyperinflation. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis/Management:** Rigid Bronchoscopy (for both diagnosis and removal). * **Classic Triad:** Sudden onset of coughing, wheezing, and diminished breath sounds (though only present in ~50% of cases). * **Radiology:** If the X-ray is inconclusive, perform **expiratory films** or lateral decubitus films; the affected lung will fail to collapse.

Question 1

A 2-year-old female child was brought to a PHC with a history of cough and fever for 4 days and inability to drink for the last 12 hours. On examination, the child weighed 5 kg and had a respiratory rate of 45/minute with fever. How would this child be classified?

Accepted Answer

Very severe disease

Answer

Severe pneumonia

Answer

Pneumonia

Answer

No pneumonia

Question 2

All of the following statements about cystic fibrosis (CF) are true EXCEPT:

Accepted Answer

A high concentration of sodium or chloride in sweat is diagnostic of CF.

Answer

It can cause diarrhea.

Answer

Staphylococcus aureus, Hemophilus influenzae, and Pseudomonas aeruginosa are common causes of respiratory infections.

Answer

Rhinosinusitis is a common finding in CF.

Question 3

What is the most likely cause of acute onset of cough, stridor, and dyspnea in a child?

Accepted Answer

Foreign body aspiration

Answer

Acute asthma

Answer

Aspiration pneumonitis

Answer

Primary complex

Question 4

Which of the following is the most likely diagnosis in a child presenting with increased cough at night?

Accepted Answer

Asthma

Answer

Pneumonia

Answer

Bronchiolitis

Answer

Laryngomalacia

Question 5

A child presents with fever, stridor, and barking cough. An X-ray is provided below. Which of the following is true about the patient?

Accepted Answer

Symptoms are predominantly caused by involvement of the subglottis.

Answer

Antibiotics should be started immediately.

Answer

The X-ray is showing the thumb sign.

Answer

The condition is caused by H. influenzae b.

Question 6

Which of the following is FALSE regarding cystic fibrosis?

Accepted Answer

It is associated with chromosome 7.

Answer

It is associated with the CFTR gene.

Answer

It follows autosomal recessive inheritance.

Answer

It is characterized by recurrent respiratory tract infections.

Question 7

Which one of the following values is not a feature of acute severe asthma?

Accepted Answer

PEF of 60 to 70% of expected

Answer

Heart rate more than 110/min

Answer

Pulsus paradoxus

Answer

PaO2 of less than 8 kPa

Question 8

Which of the following findings are true about bronchiolitis in children?

Accepted Answer

Caused by respiratory syncytial virus, hyperinflation of the chest, and may lead to bronchial asthma later in life

Answer

Hyperinflation of the chest, pleural effusion, and may lead to bronchial asthma later in life

Answer

Caused by respiratory syncytial virus and hyperinflation of the chest

Question 9

An 8-year-old child presents with a 7-month history of cough, a 1-month history of hemoptysis, and a 4-day history of fever. An X-ray shows the following findings. What is your diagnosis?

Accepted Answer

Consolidation

Answer

Hydatid cyst

Answer

Lung abscess

Answer

Thoracic duct malformations

Question 10

A young boy developed respiratory distress. On examination, the chest X-ray showed hyperinflation of one lung. Which of the following is the most possible diagnosis?

Accepted Answer

Foreign body aspiration

Answer

Congenital lobar emphysema

Answer

Bronchiectasis

Answer

Atelectasis

Respiratory Diseases — MCQs

Respiratory Diseases — MCQs

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