Free Pediatric Pulmonology Practice Questions

Question 1

After three hours of continuous nebulized albuterol and systemic corticosteroids, a 12-year-old with an asthma exacerbation has good bilateral air entry, minimal wheezing, and no retractions. She remains tachypneic at 36/min and has developed a fine tremor. Oxygen saturation is 97% on room air; blood pressure, capillary refill, and mental status are normal. Lactate has risen from 1.6 to 6.2 mmol/L, potassium is 2.9 mmol/L, and a venous gas shows pH 7.32 with PCO2 30 mmHg. How should these findings change her bronchodilator treatment?

Accepted Answer

Reduce albuterol while monitoring airflow, lactate, and potassium.

Answer

Increase the continuous albuterol dose to treat the persistent tachypnea.

Answer

Continue the current albuterol dose and add intravenous magnesium.

Answer

Intubate for presumed respiratory muscle exhaustion.

Question 2

A surveillance sputum culture from a 9-year-old with cystic fibrosis grows Pseudomonas aeruginosa for the first time. He feels well, has no increase in cough, and has an FEV1 of 96% predicted, unchanged from his usual value. Previous quarterly cultures were negative, and he has never received antipseudomonal eradication therapy. Which approach is favored by the Cystic Fibrosis Foundation for this initial isolation?

Accepted Answer

Give inhaled tobramycin 300 mg twice daily for 28 days.

Answer

Observe until the next quarterly culture unless symptoms develop.

Answer

Admit for a 14-day course of intravenous ceftazidime and tobramycin.

Answer

Begin long-term inhaled tobramycin in alternating 28-day cycles.

Question 3

Pulmonary function testing in a 14-year-old referred for possible restrictive lung disease yields acceptable, repeatable maneuvers: FEV1/FVC 0.66 (lower limit of normal 0.79), FVC z score -2.3, plethysmographic TLC z score +0.2, and RV/TLC z score +3.0. The laboratory defines normal as z scores between -1.645 and +1.645. Which interpretation belongs in the report?

Accepted Answer

Airflow obstruction with air trapping; restriction is not demonstrated.

Answer

Mixed obstructive and restrictive ventilatory impairment.

Answer

Isolated restriction with an increased residual-volume fraction.

Answer

Nonspecific ventilatory impairment without demonstrable airflow obstruction.

Question 4

For seven weeks, a previously healthy 5-year-old has coughed wetly every day, particularly on waking. Growth and activity are normal. There is no choking history, feeding-related cough, recurrent pneumonia, or digital clubbing. Chest radiography and technically satisfactory spirometry are normal. Albuterol has not helped, and no antibiotics have been given. What should be recommended at this visit?

Accepted Answer

Give amoxicillin-clavulanate for two weeks, then reassess.

Answer

Treat with a daily inhaled corticosteroid for six weeks.

Answer

Start an eight-week omeprazole trial for occult reflux.

Answer

Obtain chest CT and bronchoscopy before starting treatment.

Question 5

Minutes after the ventilator rate is increased from 12 to 24/min in a deeply sedated, intubated child with severe asthma, blood pressure falls from 108/64 to 64/32 mmHg. The expiratory flow tracing never reaches zero before the next inspiration. Breath sounds are equally diminished, bilateral lung sliding is present on ultrasound, and a suction catheter passes freely through the endotracheal tube. While the team supports circulation, which immediate maneuver addresses the most likely cause?

Accepted Answer

Briefly disconnect the ventilator to permit complete exhalation.

Answer

Increase the ventilator rate to correct the hypercapnia.

Answer

Raise the set PEEP to recruit collapsed alveoli.

Answer

Perform needle decompression for tension pneumothorax.

Question 6

At 36 weeks postmenstrual age, an infant born at 26 weeks remains on nasal CPAP of 6 cm H2O because trials off pressure produce sustained tachypnea and retractions. The delivered oxygen concentration has been 21% for the past ten days. For documentation using the Jensen 2019 support-based definition, how should bronchopulmonary dysplasia be classified?

Accepted Answer

Grade 2 bronchopulmonary dysplasia

Answer

No bronchopulmonary dysplasia

Answer

Grade 1 bronchopulmonary dysplasia

Answer

Grade 3 bronchopulmonary dysplasia

Question 7

An overnight study obtained for morning headaches in an 8-year-old shows an obstructive apnea-hypopnea index of 0.4/hour and a central apnea index of 0.2/hour. Oxygen saturation stays between 94% and 98%. Technically reliable transcutaneous CO2 is 54-58 mmHg for 38% of total sleep time, with concordant end-tidal measurements. There is no sustained snoring, inspiratory flow limitation, or paradoxical respiratory effort. Awake CO2 before sleep is 40 mmHg. What clinically important finding would be missed by interpreting only the apnea-hypopnea index?

Accepted Answer

Sleep-related hypoventilation

Answer

Moderate obstructive sleep apnea

Answer

Recurrent central sleep apnea

Answer

Isolated sleep-related hypoxemia

Question 8

An adequate nasal ciliary specimen from a 7-year-old has normal ultrastructure on transmission electron microscopy. He was born at term but needed respiratory support for three unexplained days, and daily wet cough and nasal congestion began in early infancy. He now has bronchiectasis and normal organ situs. Cystic fibrosis has been excluded. Standardized velum-closure nasal nitric oxide measurements are 24 and 28 nL/min on separate visits when he is well. Which conclusion is justified?

Accepted Answer

Primary ciliary dyskinesia remains likely and warrants molecular diagnostic evaluation.

Answer

Normal ciliary ultrastructure excludes primary ciliary dyskinesia.

Answer

Normal organ situs makes a ciliary cause of these findings unlikely.

Answer

Two low nasal nitric oxide results alone establish a definitive diagnosis.

Question 9

Following opioid analgesia after orthopedic surgery, an otherwise healthy adolescent becomes somnolent and breathes at 7/min. Before oxygen is started, an arterial sample on room air shows PaCO2 64 mmHg and PaO2 65 mmHg. The chest examination and radiograph are unremarkable. Use barometric pressure 760 mmHg, water-vapor pressure 47 mmHg, and respiratory quotient 0.8. Which alveolar-arterial oxygen gradient and mechanism best account for the hypoxemia?

Accepted Answer

Approximately 5 mmHg; reduced alveolar ventilation from depressed respiratory drive.

Answer

Approximately 21 mmHg; ventilation-perfusion mismatch from postoperative atelectasis.

Answer

Approximately 85 mmHg; a substantial intrapulmonary right-to-left shunt.

Answer

Approximately 5 mmHg; impaired oxygen diffusion across the alveolar-capillary membrane.

Question 10

During a household contact investigation, a 3-year-old is evaluated 12 days after her last exposure to a grandparent with smear-positive, drug-susceptible pulmonary tuberculosis. She has no symptoms, her examination and chest radiograph are normal, and a properly read tuberculin skin test has 2 mm of induration. A repeat skin test is scheduled for 8-10 weeks after the last exposure. What should happen in the interval?

Accepted Answer

Begin window prophylaxis in coordination with the tuberculosis program.

Answer

Observe without medication because the initial skin test is negative.

Answer

Obtain serial gastric aspirates before deciding whether preventive treatment can begin.

Answer

Start a multidrug regimen for active tuberculosis on the basis of exposure alone.

Free Pediatric Pulmonology Practice Questions

Domain 1: Lung Development and Physiology 6% of exam

Question 1

Domain 2: Common Signs and Symptoms 8% of exam

Question 2

Domain 3: Respiratory Disorders of the Neonate and Infant 5% of exam

Question 3

Domain 5: Respiratory Infections 6% of exam

Question 4

Domain 6: Cystic Fibrosis (CF) 6% of exam

Question 5

Domain 7: Non-CF Bronchiectasis 4% of exam

Question 6

Domain 8: Asthma 9% of exam

Question 7

Domain 9: Sleep-Disordered Breathing and Control of Breathing Disorders 4% of exam

Question 8

Domain 11: Respiratory Failure 5% of exam

Question 9

Domain 18: Core Principles of Pulmonary Diagnosis and Monitoring Techniques 8% of exam

Question 10

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