Upper Respiratory Tract Infections — MCQs
4 year old male, recurrent URTI, has difficulty breathing, High arched palate, Failure to grow and impaired hearing, management is
A child presents with recurrent ear infections and conductive hearing loss. What is the most likely diagnosis?
A 4-year-old boy presents with low-grade fever, inspiratory stridor, and barking cough for the past 5 days. Examination reveals a hoarse voice, a moderately inflamed pharynx, and a slightly increased respiratory rate. His chest x-ray showed subglottic narrowing appearing like a steeple. Which among the following is not indicated in the treatment of this condition?
A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
Most dangerous sign in lower respiratory tract infection (LRTI) in children is:
Which of the following is not associated with primary ciliary dyskinesia?
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?
Which of the following conditions is most associated with digital clubbing in children?
A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?
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?
Upper Respiratory Tract Infections Indian Medical PG Practice Questions and MCQs
Question 1: 4 year old male, recurrent URTI, has difficulty breathing, High arched palate, Failure to grow and impaired hearing, management is
- A. Airway management and feeding support
- B. Genetic testing for syndromes
- C. Speech and language therapy
- D. Referral to ENT and geneticist (Correct Answer)
- E. Prophylactic antibiotics and immunization
Explanation: ***Referral to ENT and geneticist*** - The constellation of **recurrent URTI**, **high-arched palate**, **failure to grow**, and **impaired hearing** in a 4-year-old child suggests a potential underlying craniofacial anomaly or genetic syndrome. - A **geneticist** can help diagnose underlying genetic conditions, while an **ENT specialist** can address the recurrent upper respiratory tract infections and impaired hearing, which could be related to conditions like **cleft palate** or **CHARGE syndrome**. - This is the **most appropriate initial step** for comprehensive evaluation and diagnosis. *Airway management and feeding support* - While important for immediate stabilization in some cases, these are *supportive measures* that might be necessary *after* a diagnosis is established or to manage acute crises. - They do not address the primary investigation and diagnosis of the complex symptoms presented. *Genetic testing for syndromes* - This is an integral part of the diagnostic process for many syndromes. - However, it's typically performed *after* an initial evaluation by a geneticist and often requires specific indications or panel choices based on clinical findings, rather than being the first and sole management step. *Speech and language therapy* - This is a crucial intervention if speech and language development is affected, which is likely given the impaired hearing and potential palate issues. - However, it addresses a symptom rather than the underlying cause and isn't the initial step for diagnosis or comprehensive management. *Prophylactic antibiotics and immunization* - While recurrent URTIs may warrant consideration of prophylactic measures, this approach treats symptoms without addressing the underlying cause. - Appropriate immunization should already be part of routine care, and prophylactic antibiotics don't address the structural and genetic issues causing the clinical presentation.
Question 2: A child presents with recurrent ear infections and conductive hearing loss. What is the most likely diagnosis?
- A. Glue ear (Correct Answer)
- B. Acute otitis media
- C. Otitis externa
- D. Chronic otitis media
Explanation: ***Correct: Glue ear*** - **Glue ear** (otitis media with effusion - OME) is the **most common cause of conductive hearing loss in children** - Frequently develops after **recurrent episodes of acute otitis media**, with persistent middle ear effusion - The thick, glue-like fluid behind the tympanic membrane impairs ossicular movement, causing **conductive hearing loss** - Classic presentation: child with history of recurrent ear infections who develops persistent hearing impairment between acute episodes - Diagnosis confirmed by **tympanometry** showing flat type B curve and **otoscopy** revealing retracted tympanic membrane with fluid level or air bubbles *Incorrect: Chronic otitis media* - Implies **persistent tympanic membrane perforation** with chronic discharge (>6-12 weeks) - More severe, established pathology with potential complications like cholesteatoma - While it causes conductive hearing loss, it's **less common** than OME in typical pediatric presentations - Would expect to see persistent otorrhea and visible perforation on examination *Incorrect: Acute otitis media* - Characterized by **sudden onset** with acute symptoms: otalgia, fever, irritability, bulging red tympanic membrane - While recurrent episodes are common in children, the question describes ongoing conductive hearing loss, suggesting **persistent effusion** rather than isolated acute episodes - Each acute episode resolves, but may be followed by OME *Incorrect: Otitis externa* - **External ear canal** infection ("swimmer's ear"), not a middle ear problem - Presents with ear pain worsened by **tragal pressure** or pinna manipulation, canal edema, and discharge - Does **not cause conductive hearing loss** unless severe canal occlusion occurs - Not associated with recurrent middle ear infections
Question 3: A 4-year-old boy presents with low-grade fever, inspiratory stridor, and barking cough for the past 5 days. Examination reveals a hoarse voice, a moderately inflamed pharynx, and a slightly increased respiratory rate. His chest x-ray showed subglottic narrowing appearing like a steeple. Which among the following is not indicated in the treatment of this condition?
- A. Nebulized racemic epinephrine
- B. Intramuscular dexamethasone
- C. Helium oxygen mixture
- D. Parenteral cefotaxime (Correct Answer)
- E. Nebulized budesonide
Explanation: ***Parenteral cefotaxime*** - The clinical presentation (low-grade fever, inspiratory stridor, barking cough, hoarse voice) and the **steeple sign** on chest X-ray are classic for **croup (laryngotracheobronchitis)**, which is predominantly caused by **viral infections**, not bacterial. Therefore, antibiotics like parenteral cefotaxime are generally **not indicated**. - **Cefotaxime** is a broad-spectrum antibiotic used for serious bacterial infections; its use in viral croup would be inappropriate and could contribute to antibiotic resistance. *Nebulized racemic epinephrine* - **Nebulized racemic epinephrine** is a common and effective treatment for moderate to severe croup, as it helps to **vasoconstrict** the subglottic mucosa, reducing edema and improving airflow. - It provides temporary relief from symptoms, especially stridor, by reducing swelling in the airway. *Intramuscular dexamethasone* - **Dexamethasone**, a corticosteroid, is a cornerstone of croup treatment as it reduces inflammation and edema in the airway, improving respiratory symptoms. - It can be administered orally, intravenously, or intramuscularly, and provides sustained relief, typically for 24-48 hours. *Nebulized budesonide* - **Nebulized budesonide** is an alternative corticosteroid treatment for croup that delivers anti-inflammatory medication directly to the airway. - Studies show it is equally effective to dexamethasone for mild to moderate croup, though dexamethasone is often preferred due to ease of administration and longer duration of action. *Helium oxygen mixture* - A **helium-oxygen mixture (heliox)** is a therapeutic gas that is less dense than air, which can reduce the work of breathing in patients with severe airway obstruction, such as refractory croup. - By decreasing airway turbulence, heliox can temporarily improve air movement past the narrowed subglottic area.
Question 4: A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
- A. Diphtheria (Correct Answer)
- B. Follicular tonsillitis
- C. Aphthous ulcer
- D. Membranous tonsillitis
Explanation: ***Diphtheria*** - The image shows a **thick, grayish-white pseudomembrane** covering the tonsils and likely extending to other parts of the pharynx, which is a classic sign of diphtheria. - **Hoarseness** indicates laryngeal involvement, a severe complication of diphtheria due to pseudomembrane formation extending to the larynx, potentially causing airway obstruction. *Follicular tonsillitis* - This condition presents with **pus-filled follicles** or spots on the tonsils, which are typically yellow or white, rather than a confluent membrane. - While it causes throat pain and fever, it generally does not lead to the formation of a **firm, adherent pseudomembrane** or significant hoarseness from laryngeal obstruction as seen in diphtheria. *Aphthous ulcer* - An aphthous ulcer is a **small, painful, shallow sore** with a white or yellowish center and a red border, typically found on the non-keratinized oral mucosa. - It does not present as a widespread, thick membranous lesion covering the tonsils and causing hoarseness. *Membranous tonsillitis* - While "membranous tonsillitis" describes the presence of a membrane on the tonsils, this term is often used generally. However, the specific characteristics in the image (thick, grayish, adherent membrane with severe symptoms like hoarseness) are pathognomonic for **diphtheria**. - Other causes of membranous tonsillitis, such as infectious mononucleosis, typically present with a less adherent membrane and often lack the severe systemic toxicity and potential for rapid airway compromise seen in diphtheria.
Question 5: Most dangerous sign in lower respiratory tract infection (LRTI) in children is:
- A. Chest retraction
- B. Grunting (Correct Answer)
- C. Tachypnea
- D. Abdominal breathing
Explanation: ***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.
Question 6: Which of the following is not associated with primary ciliary dyskinesia?
- A. Sinusitis
- B. Respiratory infection
- C. Sterility in males
- D. Hypothyroidism (Correct Answer)
Explanation: ***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.
Question 7: 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 8: Which of the following conditions is most associated with digital clubbing in children?
- A. Croup
- B. Bronchiolitis
- C. Asthma
- D. Cystic fibrosis (Correct Answer)
Explanation: ***Cystic fibrosis*** - **Cystic fibrosis** is a common cause of **digital clubbing** in children due to chronic hypoxemia and lung disease, leading to abnormal growth of connective tissue at the nail beds. - The chronic lung infections, bronchiectasis, and airway obstruction characteristic of cystic fibrosis contribute to persistent **tissue hypoxia**, which is a primary driver of clubbing. *Croup* - Croup is an acute viral infection of the upper airway, primarily characterized by a **barking cough** and **stridor**, and generally resolves within a week without chronic complications like clubbing. - It does not cause chronic hypoxemia necessary for the development of digital clubbing. *Bronchiolitis* - **Bronchiolitis** is an acute viral infection of the lower respiratory tract, most common in infants, causing wheezing and respiratory distress, but it is typically a **short-lived illness** without chronic sequelae leading to clubbing. - This condition does not cause prolonged enough or severe enough **hypoxia** to result in clubbing. *Asthma* - While severe, uncontrolled **asthma** can cause intermittent hypoxia, it is typically not associated with chronic digital clubbing, especially in children, unless there are other coincident chronic lung conditions. - Digital clubbing is rare in asthma and often suggests an alternate or co-existing pathology, such as **bronchiectasis** or **cystic fibrosis**.
Question 9: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?
- A. Refer to a higher-level health facility for further management.
- B. Monitor at home without medical treatment.
- C. Give antibiotics (Correct Answer)
- D. Provide symptomatic treatment with antipyretics only.
Explanation: ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.
Question 10: 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?
- A. Celiac Disease
- B. Cystic fibrosis (Correct Answer)
- C. Biliary cirrhosis
- D. Bronchiectasis
Explanation: ***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.
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