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ABP Pediatric Pulmonology study materials
ABP Pediatric Pulmonology study resources

ABP Pediatric Pulmonology practice questions

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Question 1Pulmonary Physiology and Lung Development

At approximately which gestational age does the lung bud first appear as an outpouching of the foregut?

  1. Week 12
  2. Week 8
  3. Week 4 Correct answer.
  4. Week 16

Explanation

The respiratory diverticulum, or lung bud, arises from the ventral foregut during the fourth week of gestation. This event marks the embryonic stage of lung development, before pseudoglandular branching begins.

Question 2Pulmonary Physiology and Lung Development

Which alveolar cell type synthesizes and secretes pulmonary surfactant?

  1. Type I pneumocyte
  2. Ciliated bronchial epithelial cell
  3. Alveolar macrophage
  4. Type II pneumocyte Correct answer.

Explanation

Type II pneumocytes contain lamellar bodies and secrete surfactant, which lowers alveolar surface tension. Type I pneumocytes form the thin gas-exchange surface but do not produce surfactant.

Question 3Pulmonary Physiology and Lung Development

Which phospholipid is the principal surface-active component of pulmonary surfactant?

  1. Phosphatidylglycerol
  2. Dipalmitoylphosphatidylcholine Correct answer.
  3. Phosphatidylinositol
  4. Sphingomyelin

Explanation

Dipalmitoylphosphatidylcholine (DPPC) is the dominant phospholipid in surfactant and is chiefly responsible for lowering surface tension. Phosphatidylglycerol and phosphatidylinositol are present in smaller amounts.

Question 4Pulmonary Physiology and Lung Development

Fetal lung liquid secretion primarily serves which function during gestation?

  1. Supporting fetal lung growth Correct answer.
  2. Maintaining postnatal alveolar expansion
  3. Stimulating surfactant synthesis
  4. Increasing amniotic fluid volume

Explanation

Fetal lung liquid fills the potential airspaces and provides mechanical stretch that is essential for normal lung growth and airway development. At birth, this fluid is absorbed and replaced by air.

Question 5Pulmonary Physiology and Lung Development

The first breath after delivery requires a large negative intrapleural pressure mainly to overcome which combination?

  1. Diaphragmatic weakness and fatigue
  2. Stiff chest wall and low compliance
  3. Airway resistance and surface tension Correct answer.
  4. Elevated pulmonary vascular resistance

Explanation

The first breath must open fluid-filled airways and overcome the high surface tension at the newly formed air-liquid interface. Surfactant lowers this surface tension and reduces the effort needed for subsequent breaths.

Question 6Pulmonary Physiology and Lung Development

How does fetal hemoglobin facilitate oxygen uptake across the placenta?

  1. It has higher oxygen affinity with a right-shifted curve
  2. It has lower oxygen affinity and releases oxygen readily
  3. It has the same oxygen affinity as adult hemoglobin
  4. It has higher oxygen affinity with a left-shifted curve Correct answer.

Explanation

Fetal hemoglobin binds 2,3-diphosphoglycerate less avidly than adult hemoglobin, which shifts its oxygen dissociation curve to the left. The resulting higher oxygen affinity allows fetal blood to extract oxygen from maternal blood.

Question 7Pulmonary Physiology and Lung Development

Apnea of prematurity is primarily caused by which factor?

  1. Upper airway obstruction
  2. Immature respiratory control Correct answer.
  3. Pulmonary edema
  4. Surfactant deficiency

Explanation

Apnea of prematurity reflects immaturity of brainstem respiratory control and of ventilatory responses to hypoxia and hypercapnia. It is not primarily caused by surfactant deficiency or structural airway obstruction.

Question 8Pulmonary Physiology and Lung Development

Which pair of changes most directly lowers pulmonary vascular resistance at birth?

  1. Decreased cardiac output and acidosis
  2. Increased dead space and hypoxemia
  3. Foramen ovale closure and systemic vasodilation
  4. Lung expansion and increased alveolar oxygen Correct answer.

Explanation

Rhythmic lung expansion and the rise in alveolar oxygen tension are strong pulmonary vasodilators at birth. Together they reduce pulmonary vascular resistance and allow pulmonary blood flow to increase.

Question 9Pulmonary Physiology and Lung Development

Surfactant production by type II pneumocytes first becomes detectable at approximately which gestational age?

  1. 28 weeks
  2. 20 weeks
  3. 24 weeks Correct answer.
  4. 32 weeks

Explanation

Surfactant is first detectable at about 24 weeks of gestation as type II pneumocytes differentiate during the canalicular stage. The amounts needed for reliable term respiration generally accumulate by 34 to 36 weeks.

Question 10Pulmonary Physiology and Lung Development

A term newborn lung contains approximately how many alveoli?

  1. 250 million
  2. 5 million
  3. 50 million Correct answer.
  4. 150 million

Explanation

Term infants have roughly 20 to 50 million alveoli at birth, and the number increases through childhood by alveolar septation. Adults have approximately 300 million alveoli.

Question 11Pulmonary Physiology and Lung Development

Which feature of the infant respiratory system most directly reduces the outward recoil that helps stabilize functional residual capacity?

  1. Large alveolar number
  2. High chest wall compliance Correct answer.
  3. Stiff rib cage
  4. High lung elastic recoil

Explanation

The infant chest wall is highly compliant and contributes little outward recoil, so it opposes the lung's inward recoil less effectively. Infants stabilize functional residual capacity with laryngeal braking and persistent postinspiratory diaphragm activity.

Question 12Pulmonary Physiology and Lung Development

Why is peripheral airway resistance disproportionately high in infants?

  1. Larger alveolar surface area
  2. Increased airway smooth muscle mass
  3. Higher lung elastic recoil
  4. Small airway caliber Correct answer.

Explanation

Airway resistance varies inversely with the fourth power of the radius according to Poiseuille's law. Because infant peripheral airways are very small, even slight narrowing produces a marked rise in resistance.

Question 13Pulmonary Physiology and Lung Development

What is the main physiologic benefit of hypoxic pulmonary vasoconstriction?

  1. Stimulating surfactant release
  2. Blood diversion from hypoxic alveoli Correct answer.
  3. Lowering airway resistance
  4. Perfusion to poorly ventilated alveoli

Explanation

Alveolar hypoxia triggers local pulmonary arteriolar constriction, diverting blood toward better-ventilated lung regions. This improves ventilation-perfusion matching, though widespread hypoxia can cause pulmonary hypertension.

Question 14Pulmonary Physiology and Lung Development

How does a healthy newborn typically respond to sustained hypoxia?

  1. Initial rise then fall Correct answer.
  2. A progressive rise without decline
  3. A sustained increase throughout exposure
  4. No change at any point

Explanation

Newborns often show a biphasic hypoxic ventilatory response, with an early increase followed by a fall that may go below baseline. This pattern reflects immature central respiratory control and inhibitory neuromodulation.

Question 15Pulmonary Physiology and Lung Development

Why does surfactant deficiency in neonatal respiratory distress syndrome cause diffuse atelectasis?

  1. It decreases airway resistance
  2. It promotes alveolar fluid absorption
  3. It increases lung compliance
  4. Rising surface tension promotes collapse Correct answer.

Explanation

Without adequate surfactant, surface tension at the air-liquid interface rises, and small alveoli tend to collapse according to Laplace's law. The resulting atelectasis reduces compliance and impairs gas exchange.

Question 16Pulmonary Physiology and Lung Development

According to Laplace's law, which alveolus has the greatest tendency to collapse if surface tension is equal?

  1. A small alveolus with high surface tension Correct answer.
  2. A large alveolus with high surface tension
  3. A large alveolus with low surface tension
  4. A small alveolus with low surface tension

Explanation

Laplace's law states that collapsing pressure is proportional to surface tension divided by radius. A small radius combined with high surface tension produces the highest collapsing pressure, making surfactant most critical in small alveoli.

Question 17Pulmonary Physiology and Lung Development

At birth, absorption of fetal lung liquid depends mainly on which epithelial switch?

  1. Increased alveolar surface tension
  2. Closure of the ductus arteriosus
  3. Chloride to sodium absorption Correct answer.
  4. Sodium to chloride secretion

Explanation

Before birth the pulmonary epithelium secretes chloride-rich fluid. At delivery, catecholamines and other signals switch it to net sodium absorption through ENaC, and water follows the sodium osmotically.

Question 18Pulmonary Physiology and Lung Development

Oligohydramnios can cause pulmonary hypoplasia mainly by reducing which process?

  1. Pulmonary vascular resistance changes
  2. Fetal breathing and lung fluid retention Correct answer.
  3. Surfactant synthesis by type II cells
  4. Alveolar macrophage migration into airspaces

Explanation

Adequate amniotic fluid permits fetal breathing movements and retention of lung liquid, which mechanically distend the lungs and drive growth. Oligohydramnios removes these stretch stimuli and can result in hypoplasia.

Question 19Pulmonary Physiology and Lung Development

How many generations of dichotomous branching typically separate the trachea from the alveolar sacs?

  1. 40
  2. 23 Correct answer.
  3. 12
  4. 5

Explanation

The human tracheobronchial tree usually branches through about 23 generations. The first 16 generations are conducting airways, and the last generations include respiratory bronchioles and alveolar ducts.

Question 20Pulmonary Physiology and Lung Development

Infants usually raise minute ventilation by increasing respiratory rate rather than tidal volume mainly because of which limitation?

  1. Higher lung elastic recoil with stiffer airways
  2. Lower airway resistance and larger reserves
  3. Small lungs and compliant chest wall Correct answer.
  4. Greater diaphragmatic strength and reserve

Explanation

Infant tidal volume is constrained by small lung volumes and a highly compliant chest wall, so increasing respiratory rate is the main way to raise minute ventilation. This strategy also increases dead space ventilation and the work of breathing.

Question 21Pulmonary Physiology and Lung Development

Which surfactant protein is most essential for organizing the phospholipid film that lowers surface tension?

  1. Surfactant protein A
  2. Surfactant protein C
  3. Surfactant protein D
  4. Surfactant protein B Correct answer.

Explanation

SP-B is required to form and stabilize the surface-active phospholipid film, and hereditary SP-B deficiency causes severe neonatal respiratory failure. SP-A and SP-D are collectins involved in innate immunity, while SP-C contributes to film stability.

Question 22Pulmonary Physiology and Lung Development

How does closure of the ductus arteriosus help establish the normal postnatal pulmonary circulation?

  1. It increases right-to-left shunting
  2. It lowers alveolar oxygen tension
  3. It removes a right-to-left shunt Correct answer.
  4. It raises pulmonary vascular resistance

Explanation

Functional closure of the ductus arteriosus removes the fetal right-to-left shunt from the pulmonary artery to the aorta. The full right ventricular output then passes through the lungs, supporting gas exchange.

Question 23Pulmonary Physiology and Lung Development

Which pattern describes periodic breathing in a healthy newborn?

  1. Waxing and waning respiration with long apneic phases
  2. Continuous deep breaths without pauses
  3. Brief breathing pauses without bradycardia or cyanosis Correct answer.
  4. Prolonged apnea requiring stimulation

Explanation

Periodic breathing consists of short respiratory pauses, usually under 10 seconds, without bradycardia or desaturation. It is common in preterm and some term infants and reflects immature respiratory control.

Question 24Pulmonary Physiology and Lung Development

Which statement about alveolar development after birth is most accurate?

  1. New alveoli form only during the first week
  2. All alveoli are present at birth and only enlarge
  3. Alveolar number rises mainly by branching of conducting airways
  4. Alveolar septation continues for years and increases surface area Correct answer.

Explanation

After birth, the lung adds alveolar septa and increases alveolar number for at least the first few years of life. This septation greatly expands the gas-exchange surface area.

Question 25Pulmonary Physiology and Lung Development

Which mechanical feature of the infant chest wall predisposes to paradoxical inward rib cage motion during inspiration?

  1. Compliant infant rib cage Correct answer.
  2. High lung elastic recoil
  3. Strong intercostal tone
  4. Ossified costal cartilages

Explanation

The infant rib cage is highly compliant and the ribs are more horizontal, so negative intrathoracic pressure can draw the lower ribs inward during inspiration. This paradoxical motion is especially prominent during REM sleep.

Question 26Airway Disorders and Asthma

A 7-year-old child with recurrent wheeze undergoes spirometry. Which finding best supports a diagnosis of asthma?

  1. An FEV1 increase of at least 12% after salbutamol Correct answer.
  2. A history of eczema and allergic rhinitis
  3. A reduced FEV1/FVC ratio that is unchanged after salbutamol
  4. A normal chest radiograph during an acute episode

Explanation

Asthma is characterized by variable airflow obstruction. In children, an increase in FEV1 of at least 12% after a short-acting beta-2 agonist supports the diagnosis. A fixed reduction in FEV1/FVC or a normal chest radiograph does not demonstrate reversibility.

Question 27Airway Disorders and Asthma

A 2-year-old presents with a barking cough, hoarse voice, and inspiratory stridor that began 2 days after a cold and is worse at night. What is the most likely diagnosis?

  1. Epiglottitis
  2. Croup Correct answer.
  3. Inhaled foreign body
  4. Bronchiolitis

Explanation

Croup is a viral laryngotracheitis that typically follows a cold and causes a barking cough, hoarseness, and inspiratory stridor. Symptoms worsen at night and are usually accompanied by a low-grade fever.

Question 28Airway Disorders and Asthma

Which finding most strongly suggests epiglottitis rather than viral croup in a febrile child with stridor?

  1. A low-pitched inspiratory stridor
  2. A barking, seal-like cough
  3. Drooling and a tripod sitting posture Correct answer.
  4. A gradual onset over several days

Explanation

Epiglottitis is an acute bacterial infection that causes high fever, drooling, muffled voice, and the tripod position as the child tries to keep the airway open. Croup instead produces a barking cough and hoarseness with a more gradual viral prodrome.

Question 29Airway Disorders and Asthma

A 3-month-old has had inspiratory stridor since birth. It is worse when supine and while crying, improves in the prone position, and the infant is gaining weight normally. What is the most likely diagnosis?

  1. Laryngomalacia Correct answer.
  2. Vocal cord paralysis
  3. Tracheomalacia
  4. Subglottic stenosis

Explanation

Laryngomalacia is the most common cause of congenital stridor and results from floppy supraglottic structures that collapse during inspiration. Stridor is typically worse when supine and while crying, and improves in the prone position; most infants thrive.

Question 30Airway Disorders and Asthma

Which virus is the most common cause of bronchiolitis in infants?

  1. Respiratory syncytial virus Correct answer.
  2. Parainfluenza virus types 1 and 3
  3. Rhinovirus types A and C
  4. Adenovirus types 3 and 7

Explanation

Respiratory syncytial virus accounts for the majority of bronchiolitis cases in infants, typically in winter epidemics. It infects the small airways and causes wheeze, crackles, and increased work of breathing.

Question 31Airway Disorders and Asthma

A 2-year-old suddenly develops coughing and a unilateral wheeze after playing with small toys. The chest radiograph is normal. Where is an aspirated object most likely to lodge?

  1. Trachea
  2. Larynx
  3. Right main bronchus Correct answer.
  4. Left main bronchus

Explanation

The right main bronchus is wider, shorter, and more vertical than the left, so aspirated objects lodge there more often. A normal chest radiograph does not exclude aspiration because many objects are radiolucent.

Question 32Airway Disorders and Asthma

Which medication is first-line maintenance therapy for a child with persistent asthma?

  1. Montelukast daily
  2. Inhaled corticosteroid Correct answer.
  3. Salbutamol as needed
  4. Oral prednisolone daily

Explanation

Inhaled corticosteroids are the preferred long-term controller because they reduce airway inflammation and the risk of exacerbations. Salbutamol treats acute symptoms but does not control inflammation.

Question 33Airway Disorders and Asthma

How does salbutamol relieve acute asthma symptoms?

  1. Blockade of muscarinic acetylcholine receptors throughout the airways
  2. Relaxation of airway smooth muscle via beta-2 receptors Correct answer.
  3. Stabilization of mast cells before allergen exposure
  4. Reduction of airway inflammation over several weeks of daily use

Explanation

Salbutamol is a short-acting beta-2 agonist that relaxes airway smooth muscle within minutes, producing bronchodilation. It does not treat the underlying airway inflammation.

Question 34Airway Disorders and Asthma

A 6-year-old with asthma has severe dyspnea, speaks in short phrases, and has an SpO2 of 92% on room air. Besides oxygen, which initial treatment is most appropriate?

  1. Nebulized salbutamol plus ipratropium and steroids Correct answer.
  2. Oral montelukast together with a long-acting beta-2 agonist
  3. Nebulized adrenaline and a broad-spectrum antibiotic
  4. Intravenous magnesium sulfate as first-line therapy

Explanation

Severe acute asthma is treated with repeated inhaled short-acting beta-2 agonists, nebulized ipratropium, and systemic corticosteroids. Oxygen is added to maintain saturation.

Question 35Airway Disorders and Asthma

A 3-year-old has croup with stridor at rest but no hypoxia or fatigue. What is the most appropriate initial treatment?

  1. Urgent intubation
  2. Oral dexamethasone Correct answer.
  3. Intravenous antibiotics
  4. Nebulized racemic adrenaline only

Explanation

Oral dexamethasone is recommended for croup with stridor at rest because it reduces airway edema and the need for further intervention. A single dose is usually effective, and the child should be observed.

Question 36Airway Disorders and Asthma

A child with croup has worsening stridor, hypoxia, and fatigue despite oral dexamethasone. What is the next most appropriate intervention?

  1. A second dose of oral dexamethasone
  2. Oral antibiotics
  3. Nebulized adrenaline Correct answer.
  4. Heliox inhalation

Explanation

Nebulized adrenaline rapidly reduces subglottic edema in severe croup and is indicated when there is hypoxia, fatigue, or worsening obstruction. Children receiving it need observation for at least 3 to 4 hours because symptoms can rebound.

Question 37Airway Disorders and Asthma

An 8-year-old has daytime asthma symptoms 3 times per week, nighttime symptoms 3 times per month, and an FEV1 of 85% predicted. How is the asthma classified?

  1. Severe persistent asthma
  2. Moderate persistent asthma
  3. Mild persistent asthma Correct answer.
  4. Intermittent asthma

Explanation

Mild persistent asthma has daytime symptoms more than twice per week but not daily, nighttime symptoms 3 to 4 times per month, and FEV1 at least 80% predicted. Intermittent asthma has symptoms twice per week or less.

Question 38Airway Disorders and Asthma

A 5-year-old uses a pressurized metered-dose inhaler. Which technique best improves lung deposition?

  1. Hold the inhaler 20 cm from the open mouth
  2. Use a valved spacer and inhale one puff at a time Correct answer.
  3. Activate two puffs simultaneously into the mouth
  4. Inhale slowly after activating the inhaler inside the mouth

Explanation

A valved spacer improves delivery to the lower airways by removing the need to coordinate actuation with inhalation. One puff should be actuated into the spacer and inhaled slowly, with a delay between puffs.

Question 39Airway Disorders and Asthma

What is the appropriate role of montelukast in a child with asthma?

  1. A rescue medication for acute exacerbations
  2. A long-acting bronchodilator used with inhaled corticosteroids
  3. An add-on controller rather than an ICS substitute Correct answer.
  4. A first-line controller preferred over inhaled corticosteroids

Explanation

Montelukast is a leukotriene receptor antagonist used as an add-on controller, especially for exercise-induced or allergic asthma. It is less effective than inhaled corticosteroids and is not a rescue drug.

Question 40Airway Disorders and Asthma

A 12-year-old has wheeze and cough only during running. Symptoms occur twice weekly. What is the most appropriate pre-exercise treatment?

  1. Oral prednisolone taken 1 hour before exercise
  2. Inhaled salmeterol taken twice every day
  3. Montelukast taken immediately before exercise
  4. Inhaled salbutamol before exercise Correct answer.

Explanation

Exercise-induced bronchoconstriction is prevented by inhaling a short-acting beta-2 agonist about 10 to 15 minutes before exercise. Frequent symptoms should also prompt evaluation for daily inhaled corticosteroid therapy.

Question 41Airway Disorders and Asthma

A 4-year-old with a croup-like illness develops high fever, toxicity, and thick purulent tracheal secretions. Stridor persists despite nebulized adrenaline. What is the most likely diagnosis?

  1. Congenital laryngomalacia
  2. Viral croup caused by parainfluenza
  3. Bacterial tracheitis Correct answer.
  4. Acute epiglottitis due to Haemophilus influenzae

Explanation

Bacterial tracheitis presents with croup-like symptoms that become toxic, with high fever and thick purulent tracheal secretions. Stridor often persists after nebulized adrenaline, unlike simple viral croup.

Question 42Airway Disorders and Asthma

A 14-year-old presents with recurrent inspiratory stridor during stressful situations. Oxygen saturation is normal, spirometry shows inspiratory truncation of the flow-volume loop, and bronchodilators do not help. What is the most likely diagnosis?

  1. Subglottic stenosis
  2. Vocal cord dysfunction Correct answer.
  3. Tracheomalacia
  4. Exercise-induced asthma

Explanation

Vocal cord dysfunction causes paradoxical adduction of the vocal cords during inspiration, producing stridor and inspiratory truncation on the flow-volume loop. Symptoms are often triggered by stress and do not respond to asthma medications.

Question 43Airway Disorders and Asthma

A 6-week-old with RSV bronchiolitis is feeding at 75% of usual intake, has mild retractions, and has an SpO2 of 95% on room air. What is the most appropriate management?

  1. Supportive care with hydration and monitoring Correct answer.
  2. Immediate intubation
  3. Routine nebulized salbutamol and systemic steroids
  4. Prophylactic antibiotics

Explanation

Most bronchiolitis is self-limited and managed with supportive care: hydration, nasal suctioning, and oxygen if saturation falls. Bronchodilators, steroids, and antibiotics are not routinely indicated.

Question 44Airway Disorders and Asthma

A newborn has respiratory distress, chronic wet cough, and situs inversus. What is the most likely diagnosis?

  1. Cystic fibrosis
  2. Primary ciliary dyskinesia Correct answer.
  3. Severe combined immunodeficiency
  4. Congenital diaphragmatic hernia

Explanation

Primary ciliary dyskinesia causes impaired mucociliary clearance, leading to neonatal respiratory distress, chronic wet cough, and recurrent infections. Situs inversus occurs in about half of cases and completes Kartagener syndrome.

Question 45Airway Disorders and Asthma

A 5-year-old has loud snoring, witnessed apneas, daytime sleepiness, and enlarged tonsils. What is the first-line treatment for suspected obstructive sleep apnea?

  1. Continuous positive airway pressure
  2. Watchful waiting
  3. Adenotonsillectomy Correct answer.
  4. Intranasal corticosteroids

Explanation

Adenotonsillar hypertrophy is the most common cause of obstructive sleep apnea in young children. Adenotonsillectomy is first-line when apnea is documented or severe; CPAP is reserved for selected cases.

Question 46Airway Disorders and Asthma

Why should a long-acting beta-2 agonist not be used as monotherapy in a child with asthma?

  1. It has no measurable bronchodilator effect in children younger than 12 years
  2. It causes progressive irreversible airway fibrosis with long-term use
  3. It can increase severe exacerbations unless paired with an ICS Correct answer.
  4. It is inactivated when delivered through a valved spacer device

Explanation

Long-acting beta-2 agonists can increase the risk of severe asthma exacerbations and asthma-related death when used without an inhaled corticosteroid. They should only be used in combination with an ICS.

Question 47Airway Disorders and Asthma

A 3-year-old has recurrent croup and persistent biphasic stridor. He was intubated for 3 weeks as a neonate. What is the most likely diagnosis?

  1. Laryngomalacia
  2. Vocal cord dysfunction
  3. Tracheoesophageal fistula
  4. Acquired subglottic stenosis Correct answer.

Explanation

Prolonged neonatal intubation can injure the subglottic mucosa and produce acquired subglottic stenosis. The result is persistent biphasic stridor and recurrent croup-like illnesses.

Question 48Airway Disorders and Asthma

A newborn has choking and cyanosis with the first feed. A chest radiograph shows a coiled tube in the proximal esophagus and gas in the stomach. Which anomaly is most likely?

  1. Isolated esophageal atresia without a fistula
  2. Esophageal atresia with a distal fistula Correct answer.
  3. H-type tracheoesophageal fistula
  4. Congenital diaphragmatic hernia

Explanation

Esophageal atresia with a distal tracheoesophageal fistula is the most common type. The coiled nasogastric tube reflects the proximal atresia, while gas in the stomach indicates a connection to the airway.

Question 49Airway Disorders and Asthma

A 2-year-old has chronic stridor, recurrent respiratory infections, and difficulty swallowing solid food. Imaging shows a double aortic arch. What is the diagnosis?

  1. Tracheomalacia
  2. Vascular ring Correct answer.
  3. Subglottic hemangioma
  4. Laryngomalacia

Explanation

A double aortic arch forms a vascular ring that encircles the trachea and esophagus, causing stridor, recurrent infections, and dysphagia. Cross-sectional imaging confirms the diagnosis.

Question 50Airway Disorders and Asthma

A 9-year-old with asthma remains symptomatic despite high-dose inhaled corticosteroid and a long-acting beta-2 agonist. Which step should come first before further escalation?

  1. Add daily oral prednisolone
  2. Start a second long-acting beta-2 agonist
  3. Review adherence and inhaler technique Correct answer.
  4. Refer for lung transplantation

Explanation

Before escalating therapy, the clinician should confirm adherence, inhaler technique, and alternative diagnoses or comorbidities. These factors commonly explain uncontrolled symptoms better than true treatment resistance.