Pediatric Respiratory Disorders (Asthma, Bronchiolitis, Pneumonia) MCQs

Pediatrics · 30 free questions with answers & explanations.

1. A 6-month-old infant presents in winter with 3 days of fever, cough, and progressive respiratory distress. Examination shows subcostal retractions, nasal flaring, diffuse wheeze, and prolonged expiration. SpO2 is 90% on room air. Chest X-ray shows hyperinflation. What is the MOST likely causative organism?
2. A 10-month-old infant presents in December with wheeze, subcostal retractions, and respiratory rate of 66/min. CXR shows hyperinflation with peribronchial thickening. SpO2 is 91%. RSV antigen test is positive. Current EVIDENCE-BASED guidance for the management of this first episode of bronchiolitis recommends:
3. A 6-month-old infant presents in December with wheezing, tachypnea, subcostal retractions, and SpO2 of 90%. This is the first episode of wheeze. There is no fever. CXR shows hyperinflation and peribronchial cuffing. Nasopharyngeal aspirate NPA-PCR confirms RSV infection. Which of the following has been shown to reduce RSV-related severe bronchiolitis hospitalizations as prophylaxis in high-risk infants?
4. A 2-month-old infant presents with first episode of viral bronchiolitis (RSV-positive). SpO2 is 91% on air, moderate subcostal recessions, poor feeding (only 30% of usual intake). The most evidence-based intervention is:
5. A 5-year-old child with poorly controlled moderate persistent asthma is already on medium-dose inhaled corticosteroid (ICS). The next add-on medication according to GINA 2023 step-up strategy in children 6 years and above (applicable as age approximation) is:
6. A 6-week-old infant presents with 3 days of rhinorrhoea followed by increasing respiratory distress, wheeze, and feeding difficulty. O2 saturation is 90%. Chest X-ray shows hyperinflation with scattered atelectasis. Nasopharyngeal aspirate PCR is positive for RSV. What is the EVIDENCE-BASED first-line treatment?
7. A 3-year-old child is diagnosed with community-acquired pneumonia and is admitted. He has tachycardia, tachypnoea (RR 60/min), subcostal retractions, and temperature of 39.5°C. SpO2 is 88% on room air. Chest X-ray shows a dense lobar consolidation of the right lower lobe. What is the FIRST-LINE antibiotic according to WHO guidelines?
8. A 9-month-old infant presents in winter with 3 days of rhinorrhea followed by progressive wheeze, tachypnea (70/min), severe subcostal retractions, and oxygen saturation of 88% on room air. He requires 40% FiO2 via high-flow nasal cannula. Nasopharyngeal swab is positive for RSV. Based on evidence from MIST and SIGN trials, which pharmacological intervention has shown benefit in RSV bronchiolitis?
9. A 7-year-old child with moderate persistent asthma is on inhaled budesonide 200 mcg/day. Despite this, he continues to have symptoms 4–5 days per week and nighttime wakening twice weekly. Spirometry shows FEV1 72% predicted with significant bronchodilator reversibility. According to GINA 2023 step-up strategy, what is the preferred add-on therapy?
10. A 6-week-old infant presents in winter with 3 days of rhinorrhoea, cough, respiratory rate 68/min, subcostal retractions, oxygen saturation 91% on room air, and diffuse bilateral expiratory wheeze and crepitations. Temperature is 37.6°C. RSV antigen test is positive. The MOST appropriate initial management is:
11. A 4-year-old with a 2-year history of recurrent wheezing is prescribed an inhaled corticosteroid (ICS). Which device is MOST appropriate for delivering ICS in this age group?
12. A 6-week-old infant presents in winter with 3 days of rhinorrhea followed by wheeze, subcostal recessions, and an O2 saturation of 91%. Chest X-ray shows hyperinflation. Nasopharyngeal swab RSV antigen is positive. What is the role of inhaled salbutamol in this infant?
13. A 4-year-old child with moderate persistent asthma (daily symptoms, nighttime awakening 3–4 times/week, FEV1 65% predicted) is on low-dose inhaled corticosteroid (ICS) + short-acting β2-agonist (SABA) as needed. What is the recommended step-up in therapy according to GINA 2024 guidelines for this age group?
14. A 6-week-old infant presents with 3 days of coryza followed by paroxysmal cough with post-tussive vomiting and cyanosis during coughing episodes. No 'whoop' is heard due to the infant's age. Lymphocyte count is 24,000/μL. Nasopharyngeal PCR is positive for Bordetella pertussis. The pathogenic toxin responsible for the characteristic lymphocytosis is:
15. A 9-month-old infant presents in winter with 3 days of wheeze, tachypnea (RR 65/min), subcostal retractions, and SpO2 88% on room air. This is the first episode of wheeze. There is no family history of atopy. The most likely causative virus and the only specific antiviral therapy with any evidence is:
16. A 2-month-old infant presents in January with 3 days of rhinorrhea followed by tachypnea, subcostal retractions, fine crackles, and wheeze bilaterally. Temperature is 37.9°C. SpO2 is 91% on room air. Nasal aspirate tests positive for RSV by rapid antigen test. Which intervention has the STRONGEST evidence of benefit in this infant?
17. A 5-year-old child with a known diagnosis of asthma presents to the emergency department with severe acute asthma (SpO2 88%, unable to complete sentences, use of all accessory muscles). Initial nebulized salbutamol and ipratropium have been given twice. What is the MOST APPROPRIATE next pharmacological addition?
18. A 3-month-old infant in December presents with 2 days of coryzal symptoms followed by tachypnoea (70 breaths/min), subcostal and intercostal retractions, wheeze, and bilateral crepitations. SpO2 is 90% on room air. Which is the treatment backed by strongest evidence?
19. A 7-year-old with known asthma has nocturnal cough, wheezing on most days of the week, and limitation of activities. Peak expiratory flow (PEF) is 55% predicted. His symptoms persist despite low-dose ICS alone. What GINA step of therapy should be started?
20. A 3-month-old infant presents in winter with her first episode of wheeze, intercostal recession, and nasal flaring. SpO2 87% on room air. Nasopharyngeal swab is RSV-positive. She weighs 4.5 kg and was born at 32 weeks gestation. The most evidence-based pharmacological treatment that has demonstrated benefit in severe RSV bronchiolitis in a high-risk premature infant is:
21. A 2-year-old presents in winter with the first episode of wheeze, preceded by 2 days of rhinorrhea and low-grade fever. Auscultation reveals widespread fine crackles and wheeze. SpO2 is 93% on room air. The most likely pathogen is:
22. A 3-month-old infant presents in winter with a 2-day history of rhinorrhoea followed by progressively worsening wheeze, subcostal and intercostal retractions, respiratory rate 72/min, and SpO2 88% on room air. The most common causative organism is:
23. A 9-month-old presents with 3-day history of rhinorrhea, cough, and increasing respiratory distress. On examination: RR 62/min, SpO2 91% on room air, marked subcostal and intercostal retractions, hyperinflated chest, diffuse bilateral wheeze, and fine crackles. What is the RECOMMENDED treatment for SEVERE bronchiolitis in an infant requiring hospitalization according to current evidence-based guidelines?
24. A 3-month-old infant presents with a 3-day history of rhinorrhea, increasing wheeze, tachypnea (respiratory rate 72/min), subcostal retractions, and oxygen saturation 88% on room air. Chest X-ray shows hyperinflation with bilateral perihilar streaking. He is too tired to feed. What is the most appropriate immediate management?
25. A 10-year-old asthmatic presents with severe exacerbation: speaks in phrases only, HR 130/min, RR 34/min, SpO2 91%, marked accessory muscle use, and silent chest on auscultation. Despite 3 doses of nebulized salbutamol and ipratropium, systemic corticosteroids, and IV magnesium sulfate, he is deteriorating. Which is the MOST appropriate next step?
26. A 6-week-old infant presents in winter with wheezing, subcostal retractions, nasal flaring, and SpO2 89% on room air. Nasopharyngeal aspirate PCR is positive for RSV. Which statement about bronchiolitis management is CORRECT?
27. A 7-year-old with moderate persistent asthma has poor control on low-dose inhaled corticosteroid (ICS) alone. The preferred step-up therapy according to GINA guidelines is:
28. A 6-week-old infant presents with 3 days of progressive tachypnea, subcostal retractions, nasal flaring, and diffuse expiratory wheeze. He is afebrile. CXR shows hyperinflation and perihilar haziness. HR is 150/min, SpO₂ 88% on room air. Nasopharyngeal swab PCR is positive for RSV. Which of the following therapies has PROVEN benefit in this condition?
29. A 4-year-old child with moderate persistent asthma has been on low-dose inhaled corticosteroid (ICS) for 3 months but continues to have nighttime symptoms twice weekly and activity limitation. According to GINA 2024 pediatric stepwise therapy, what is the preferred step-up?
30. A 6-week-old infant has a 5-day history of worsening cough and wheeze, low-grade fever (37.8°C), and oxygen saturation of 91% on room air. CXR shows hyperinflation with bilateral patchy infiltrates. The most likely causative virus and whether antibiotics are indicated is: