Acute Respiratory

Question 1

A 3-year old girl presents with fever, right upper quadrant abdominal pain and vomiting. There is no diarrhoea.

On examination, she has the following signs:

Vital signs: T=39°C, RR = 65/min, HR = 130/min.
She is alert but irritable.
Her abdomen is soft and not distended.
There is some right upper quadrant tenderness on palpation for the liver edge, but no other tenderness, no hepatosplenomegaly, or masses.
Chest is clear to auscultation and percussion. There is mild lower costal indrawing. ENT exam is normal.
There is no rash. There is no neck stiffness. Urine dipstick shows ketones but otherwise normal.
Given this presentation, what is the most likely diagnosis?

Question 1Select one:

a.
Pyelonephritis

b.
Appendicitis

c.
Cholecystitis

d.
Pneumonia

Answer 1

Pneumonia

key is rapid breathing - bacterial pneumonia

Question 2

A 5-month-old boy presents in winter with a 3-day history of coryza, cough, mild fever and breathlessness with poor oral intake. He has previously been well and was born at 39 weeks gestation. He has 3 older siblings at school and preschool. On examination he has a cough, has a temperature of 38.5oC and has oxygen saturations of 93% in room air. His respiratory rate is 50 breaths per minute and there is inter and subcostal recession. On auscultation of his chest there are widespread wheeze and fine inspiratory crackles.

WHICH ONE of the organisms listed below is the MOST LIKELY cause of this clinical presentation?

Question 2Select one:

a.
Respiratory syncytial virus

b.
Parainfluenza type 4 virus

c.
Human metapneumovirus

d.
Mycoplasma pneumoniae

Answer 2

RSV

Question 3

You are asked to see a 9 month old boy, Tane, who has a temperature of 39.8°C. He has not fed well since yesterday and vomited once today. On examination, he looks tired and lethargic, and doe not make eye contact. He is breathing at 70 breaths/minute and has mild lower costal indrawing. Chest auscultation shows no added sounds.

What is the MOST LIKELY diagnosis?

Question 3Select one:

a.
Acute RSV bronchiolitis

b.
Inhaled foreign body

c.
Aspiration pneumonia

d.
Bacterial pneumonia

Answer 3

Bacterial pneumonia

Question 4

A 3 year old-boy, Rua, who is unimmunised, has presented with high fever, rapid breathing, vomiting and lethargy. He has just been diagnosed with acute right upper lobar pneumonia.

What is the most likely bacterial cause of his pneumonia?

Question 5Select one:

a.
Streptococcus pneumoniae

b.
Haemophilus influenzae

c.
Streptococcus viridans

d.
Staphylococcus aureus

Answer 4

Streptococcus pneumoniae

viruses cause bilateral

Question 5

A 3 year old girl, Renaria, who has been fully vaccinated, has a positive PCR test for Bordetella pertussis, after having had a week of coughing paroxysms.

WHICH ONE of the following would be INCORRECT to advise her parents about the course of the illness?

Question 6Select one:

a.
Cough suppressants don’t shorten the duration

b.
The coughing may persist for several months

c.
Erythromycin by mouth will shorten the duration

d.
New viral infections may prolong the coughing

Answer 5

Erythromycin by mouth will shorten the duration

treat infectivity but not symptoms