Pediatrics - Pulmonology Flashcards
PED - 5.1
An infant with frequent pulmonal infections may have the following disease:
A) mucoviscidosis
B) hypogammaglobulinaemia
C) chronic granulomatous disease
D) all the above mentioned
ANSWER
D) all the above mentioned
EXPLANATION
In mucoviscidosis, the disturbance of secretion transport, hypogammaglobulinaemia, and the deficiencies of humoral immunity, in chronic granulomatous disease the insufficiency of granulocyte function can both cause frequent pulmonary infections, thus all the above mentioned statements are true.
PED - 5.2
The following statements about newborn’s pneumothorax are true, except one. Which one is the exception?
A) neonatal hypoxic conditions and their respiratory treatment are the main causes
B) in the case of ventilation pneumothorax, the ipsilateral lobe is compressed, which can lead to a shock
C) transillumination is a good supplementation to physical examination
D) if the newborn was on a respirator, it must be taken off from the machine
E) a tensional or high-grade pneumothorax should be detensionated and a long-term suction should be introduced
ANSWER
D) if the newborn was on a respirator, it must be taken off from the machine
EXPLANATION
In neonatal hypoxic states pneumothorax may develop as a complication of respiratory therapy. In this case the ipsilateral lung is compressed by pneumothorax, this diagnosis can be complemented by transillumination, the treatment is aspiration. But a newborn in a severe respiratory failure, worsened by the pneumothorax, should be continually respirated.
PED - 5.3
The following statements are characteristic for pulmonary sequestration, except one. Which one is the exception?
A) the sequestered segment is not connected to the bronchial system
B) is mainly located in the upper lobe
C) may lead to repeated pneumonias
D) the sequestrated part must be removed by surgery
E) its blood flow is not from the pulmonary artery
ANSWER
B) is mainly located in the upper lobe
EXPLANATION
The statements contain facts about pulmonary sequestration, but pulmonary sequestration is much more frequent in the lower lobes, thus B is the exception.
PED - 5.4
The following statements are characteristic for congenital bronchial stenosis, except one. Which one?
A) the cause is the immaturity and softness of the cartilage
B) the secretion can accumulate after the stenosis
C) the hardening of the cartilage can be facilitated with the administration of vitamin D
D) the use of cough suppressors is prohibited
E) it can be diagnosed by bronchoscopy
ANSWER
C) the hardening of the cartilage can be facilitated with the administration of vitamin D
EXPLANATION
With the exception of point C, the other statements are correct considering the conatal bronchial stenosis, therefore the cause is the immaturity and softness of the cartilage, which results in a functional stenosis, behind secretion can accumulate, in these cases coughing should not be suppressed, but on the contrary, expectorants should be considered. The stenosis can be visualized by bronchoscopy. The administration of vitamin D does not facilitate the hardening of the cartilage, so the usual dose can be applied, but overdosing could be harmful.
PED - 5.5
The following statements are true about the neonatal pneumonia, except one. Which one?
A) can develop intrauterine, intrapartum, or postnatally
B) predispositions are the preterm rupture of the membrane, and maternal infections
C) a common pathogen is group B Streptococcus
D) symptoms are similar to RDS
E) elevated serum IgG level is an evidence of a conatal pneumonia
ANSWER
E) elevated serum IgG level is an evidence of a conatal pneumonia
EXPLANATION
Newborn’s pneumonia can develop intrauterine, intrapartum, or postnatally, predispositions are the preterm rupture of the membrane, and maternal pathogens, especially the group B Streptococci. The clinical symptoms resemble to RDS (respiratory distress syndrome). In neonatal pneumonia, the white blood cells count can be elevated or decreased, and usually, like in other neonatal infections, thrombocytopenia develops. At the same time, serum IgG levels do not increase, as the newborn has the mother’s IgG, but a limited ability of producing its own IgG.
PED - 5.6
The following statements are true for an acute tonsillitis, except one. Which one?
A) can be caused by bacteria, viruses and fungal infections
B) a complication can be a rheumatic fever
C) the most common pathogen is Streptococcus pneumoniae
D) often accompanied with cervical lymphadenitis
E) a few days of fever
F) fluid intake is often difficult due to the swollen tonsils
ANSWER
C) the most common pathogen is Streptococcus pneumoniae
EXPLANATION
Streptococcus pneumoniae causes pneumonia and purulent meningitis, rather than acute tonsillitis, but other bacteria, viruses and fungi can cause acute tonsillitis. This is usually accompanied with a few days of fever. Fluid intake is often difficult due to the swollen tonsils, cervical lymphadenitis is common, and in two to three weeks later, a rheumatic fever may occur.
PED - 5.7
Tonsillectomy is required, except one. Which one?
A) frequently repeated follicular tonsillitis with fever
B) tonsillitis with peritonsillar abscess
C) tonsillitis with retropharyngeal abscess
D) repetitive upper respiratory tract infections
E) suspect of an intratonsillar tumor
ANSWER
D) repetitive upper respiratory tract infections
EXPLANATION
In recurrent otitis media, adenoidectomy should be performed to reduce infections, ascending from the pharynx. Thus, frequently repeated tonsillar infections are an indication for tonsillectomy. Peritonsillar and retropharyngeal abscesses are both indications for a tonsillectomy, just as a suspected tumor.
PED - 5.8
Which diagnostic test result is a proof of mucoviscidosis?
A) decreased xylose absorption
B) reduced vitalcapacity
C) reduced bile acid levels in duodenal excretion
D) steatorrhoea
E) a sweat Cl- concentration above 60 mmol/l
F) cor pulmonale
ANSWER
E) a sweat Cl- concentration above 60 mmol/l
EXPLANATION
In mucoviscidosis, the increased chlorine concentration in sweat is a diagnostic proof, a concentration above 60 mmol / l is a typical value. Decreased xylose absorption may occur in other types malabsorption, vitalcapacity can be reduced, but just as in other obstructive and restrictive pulmonary diseases. Steatorrhoea can be caused by any other illnesses associated with maldigestion. Cor pulmonale develops only in very severe, advanced pulmonary diseases in childhood. This can be a symptom in mucoviscidosis, but may also occur in pulmonary fibrosis, extremely severe bronchial asthma, etc. Reduced bile acid levels in duodenal excretion can only be exceptionally present in mucoviscidosis with progressive liver manifestation.
PED - 5.10
Characteristics of pseudocroup, except one:
A) usually occurs at night
B) coughing, stridor can be detected
C) is common in infants and toddlers
D) is mostly caused by bacterial infection
E) cool air, sitting position helps
ANSWER
D) is mostly caused by bacterial infection
EXPLANATION
The causes of pseudocroup can be habitual and allergic-type mechanisms and it is mostly caused by viral infections: acute purulent laryngitis and acute epiglottitis are usually bacterial infections. General characteristics are night-time appearance, coughing, stridor, it is more common in infants and toddlers, and cool air, sitting position helps.
PED - 5.11
The following diseases can be the complications of acute tonsillitis, except one. Which one?
A) lymphadenitis colli
B) acute febris rheumatica
C) sepsis
D) chronic rheumatoid arthritis
E) glomerulonephritis acuta
ANSWER
D) chronic rheumatoid arthritis
EXPLANATION
Chronic rheumatoid arthritis is an autoimmune disease which does not occur as a result of tonsillitis. At the same time, lymphadenitis colli is often associated with the acute phase of tonsillitis, exceptionally, even a sepsis can develop; consequently, as a complication, febris rheumatica and acute glomerulonephritis may develop.
PED - 5.12
The following statements are true for retropharyngeal abscess, except one. Which one is the exception?
A) complication of a purulent pharyngitis
B) disturbs swallowing
C) causes a laryngeal edema
D) head positioning resembles to meningism
E) spontaneous opening of the abscess should be preferred instead of surgery
F) laryngoscopy is required for the diagnosis
G) submandibular lymphadenitis is always present
ANSWER
E) spontaneous opening of the abscess should be preferred instead of surgery
EXPLANATION
Retropharyngeal abscess is an acute severe condition. When the diagnosis is certain, it is advisable to open and empty the abscess and not to wait for the spontaneous opening. The disease is usually a complication of an upper respiratory tract infection, mostly pharyngitis, swelling may disturb swallowing, can cause a laryngeal edema, just as headaches that may resemble to meningitis. The diagnosis can be confirmed with direct inspection, ie laryngoscopy; usually accompanied with the painful swelling of the lymph glands.
PED - 5.13
The following statements are true for acute epiglottitis, except one. Which one is the exception?
A) slow progression
B) high fever, restlessness
C) dyspnea, cyanosis, backward head position
D) can lead to suffocation
ANSWER
A) slow progression
EXPLANATION
Acute epiglottitis is an extremely acute condition characterized by high fever, restlessness, dyspnea, cyanosis, etc., backward head position and suffocation. The hyper acute disease may lead to death in a few hours, slow progression is not an option.
PED - 5.14
What kind of antimicrobial therapy would you apply in epiglottitis and why?
A) I would not use any antimicrobial treatment, as epiglottitis is caused by viruses
B) I would administer acyclovir, as the most common pathogens are Herpes viruses
C) III. generation cephalosporin, as the most common pathogen is Haemophilus influenzae
D) Vancomycin treatment, as epiglottitis is a result of a staphylococcal infection
ANSWER
C) III. generation cephalosporin, as the most common pathogen is Haemophilus influenzae
EXPLANATION
The most common pathogen of epiglottitis is Haemophilus influenzae, and therefore, III. generation cephalosporin, in an intravenous form, is the adequate treatment. Since it is not a viral disease, antimicrobial therapy should be applied; it is not caused herpesvirus, acyclovir is unnecessary. Staphylococci can rarely cause epiglottitis; thus, Vancomycin is not a first-line treatment.
PED - 5.15
The most common pathogen in bronchiolitis?
A) Haemophilus influenzae
B) Pneumococcus
C) coxsackie virus
D) Streptococcus haemolyticus
E) respiratory syncytial virus
ANSWER
E) respiratory syncytial virus
EXPLANATION
Bronchiolitis most commonly occurs in young infants, during the first 6 months of life and is most commonly caused by respiratory syncytial virus. The other listed pathogens can only exceptionally be the cause of this illness.
PED - 5.16
Most common causes of chronic bronchitis, except one. Which one?
A) community acquired repetitive infections
B) allergy
C) sinusitis
D) mucoviscidosis
E) IgE deficiency
ANSWER
E) IgE deficiency
EXPLANATION
The IgE deficiency is virtually not existing, any of its pathological significance can be disputed. Thus, it cannot be the cause of chronic bronchitis; however, repeated infections, including sinusitis, allergic processes, and mucoviscidosis-caused excretion transport disturbances are possible pathologies to bronchitis.
PED - 5.17
A wheezy bronchitis (so called bronchitis obstructiva) can be called infant’s or toddler’s asthma. One statement is false. Which one?
A) more common in infants and toddlers, than in later ages
B) malnutrition is a predisposition
C) physical finding is expiratory dyspnea
D) high fever is not common
ANSWER
B) malnutrition is a predisposition
EXPLANATION
Wheezy bronchitis (so called bronchitis or infant’s or toddler’s asthma) is not related to malnutrition, and even the old clinical experience is that it is more common in well-fed infants. Otherwise, the other listed statements are true to obstructive bronchitis; this is an infant and toddler illness; as in any obstructive process, exspiration is more difficult; high fever can rarely join; and the swelling of the airways’ mucous membrane plays an important role as a cause of dyspnea in this age group.
PED - 5.18
The following factors are present in the pathogenesis of asthma bronchiale, with one exception. Which one?
A) hyperreactivity of the bronchial system
B) IgE mediated antigen antibody response
C) smoking, humid air inhalation
D) physical stress
E) adrenergic drugs
F) psychological effects
ANSWER
E) adrenergic drugs
EXPLANATION
Adrenergic drugs dilate the bronchi; thus, they do not play a role in the pathogenesis of bronchial asthma, they rather improve this condition. In addition, the childhood asthma is based on the hyperreactivity of the bronchial system, most of the cases are allergic, atopic, IgE-mediated reactions. Physical stress can cause bronchospasm, just as psychological factors, other triggering factors are the inhalation of tobacco smoke or humid air.
PED - 5.20
Which of the following treatments are prohibited in severe asthma?
A) increased fluid intake
B) β -receptor agonists
C) β-receptor antagonists
D) theophylline and its derivatives
E) corticosteroid
ANSWER
C) β-receptor antagonists
EXPLANATION
As the asthmatic state is enhanced by adrenergic agents, therefore β-receptor-agonist, β-receptor antagonists, acting as bronchoconstrictors, deteriorate asthma and therefore their use is prohibited. β -receptor agonists and theophylline improve asthmatic state and corticosteroids reduce the eosinophilic inflammation. A person with a high respiratory rate loses more fluid, so additional fluid intake is recommended.
PED - 5.21
The assessment of an asthmatic child’s clinical condition is based on the following, except one:
A) frequency of night complaints
B) frequency of beta-2-agonist demand
C) total serum IgE level
D) assessment of the everyday limitations
E) frequency of daytime complaints
ANSWER
C) total serum IgE level
PED - 5.23
Can show the clinical symptoms of wheezy bronchitis or asthma bronchial, except one. Which one?
A) abnormal aortic arch (vascular ring)
B) cystic fibrosis
C) main bronchi stenosis
D) untreated celiac disease
E) vitium with pulmonary overflow
F) a chronic foreign body in the airways
ANSWER
D) untreated celiac disease
EXPLANATION
Celiac disease (gluten intolerance) usually does not have respiratory manifestation, nor wheezy bronchitis. The other above listed diseases may imitate the clinical symptoms of wheezy bronchitis, e.g. respiratory stenosis caused by a vascular ring, excretion congestion in cystic fibrosis, respiratory disturbances caused by main bronchi stenosis, vitium with pulmonary overflow, or a chronic foreign body in the airways.
PED - 5.28
These pathogens are most likely to cause a pneumonia among school-age children (only one answer is correct):
A) Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae
B) Klebsiella pneumoniae, Escherichia coli
C) Haemophilus influenzae, Staphylococcus aureus
D) group B Streptococcus
ANSWER
A) Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae
EXPLANATION
In school-age children and adolescents, Mycoplasma pneumoniae, Chlamydia pneumoniae and Streptococcus pneumoniae are relatively common pathogens in pneumonia. Klebsiella pneumoniae and Escherichia coli usually cause pneumonia in neonates and premature babies, Haemophilus influenzae in babies and toddlers, and children under the age of 6; group B Streptococci is predominantly causing a newborn infection, Staphylococcus aureus causes pneumonia in babies and toddlers.
PED - 5.30
The complications of pneumonia complications do not include one of the following. Which one?
A) pulmonary fibrosis
B) empyema
C) bronchiectasia
D) sepsis
E) abscess formation
ANSWER
A) pulmonary fibrosis
EXPLANATION
Pulmonary fibrosis does not develop as a complication of pneumonia. Causes can be idiopathic (pulmonary fibrosis, pulmonary haemosiderosis), can be caused by pulmonary sarcoidosis, histiocytosis X, etc., but as a complication of pneumonia purulent pleuritis (empyema), sepsis and pulmonary abscess formation can develop. In chronic recurrent, possibly immunodeficient pneumonias may also have bronchiectasia.
PED - 5.31
To differentiate between bacterial and viral pneumonia these statements are true, except one. Which one is incorrect?
A) in viral pneumonia the white blood cell count is lower than in bacterial pneumonia
B) viral pneumonia in infants are always mild
C) the progression of viral pneumonia is slower
D) lobar infiltrate refers to bacterial etiology
ANSWER
B) viral pneumonia in infants are always mild
EXPLANATION
Virus pneumonia of the infants can often cause a fulminant, life-threatening condition. The other statements although are true: lobar pneumonia usually has bacterial origin, in bacterial infection the white blood cell count is higher, than in virus pneumonia. Virus pneumonia usually has a slower progression compared to acute bacterial pneumonia.
PED - 5.33
Cytomegalovirus pneumonia does not occur in one case. Which one?
A) after renal transplantation
B) in AIDS
C) in respiratory distress syndrome
D) in case of immunosuppressive therapy
E) in other opportunistic infection
ANSWER
C) in respiratory distress syndrome
EXPLANATION
The newborn’s respiration distress syndrome is related mostly to prematurity and immaturity, and the lack of surfactant synthesis is the main factor. Usually CMV infection does not consort to it. In the other listed condition, like for example after renal transplantation due to the cystostatic therapy, in AIDS due to the essence of the disease, or in patient who gets immunosuppressive therapy due to any other reason, there is an immune system dysfunction. And CMV-pneumonia can connected to opportunist infection also.
PED - 5.34
What is typical for Mycoplasma pneumoniae infection? There is only answer correct. Which one is that?
A) typical for infants
B) fulminant process
C) mild cough
D) Incubation period is couple if weeks
E) Mainly alveolar
ANSWER
D) Incubation period is couple if weeks
EXPLANATION
The disease caused by Mycoplasma pneumoniae infection comes out several weeks incubation period, it is mostly a childhood disease with long-lasting progression, because it is an insterstitial process coughing is typical. Due to the previous statements it is basically not an alveolar course.
PED - 5.35
One of the following helmints does not cause eosinophil pneumonia. Which one is that?
A) Oxyuris vermicularis
B) Ascaris lumbricoides
C) Toxocara canis
D) Toxocara catis
ANSWER
A) Oxyuris vermicularis
EXPLANATION
Oxyuris vermicularis does not cause eosinophil pneumonia. The clinical course does not go beyond to intestines and the perianal location. All of the other helmintiasis are generalized, can cause diseases outside of the intestines and eosinophil pnuemonia is characteristic to them.
PED - 5.36
One of the followings cases we have to think to foreign body aspiration. Which one is that?
A) swallowing is regularly and permanently painful
B) swallowing liquids is easily possible, but the solid food gets stucked
C) coughing attack and vomiturition during eating
D) coughing only appears in lying position
E) unusual amount of hiccups/singultus and burps appear
ANSWER
C) coughing attack and vomiturition during eating
EXPLANATION
The suspicion of foreign body aspiration is raised, when coughing attack and retch appear during eating, because that is the time to food aspirating. The other listed process are not specific to foreign body aspiration. Swallowing is not painful and the solid food does not get stucked. Coughing appers in all posture due to the aspirate, hickups and burps are specific in diseases connected to the stomach.
PED - 5.37
A 3-year-old child, who goes to nursery, has serial mild, spontaneously healing airway infections. What do you think first?
A) immunglobulin deficiency
B) cellular immunodefeciency
C) the various possible infections originated from the environment
D) feeding deficiency
E) vitamin C deficiency
F) rachitis
ANSWER
C) the various possible infections originated from the environment
EXPLANATION
When infants or little children get to the nursery, it is common that the airway and mostly virus caused infections they catch from each other appear often, maybe multiply: this is an every day possibility. From the other conditions vitamin C deficiency has no connection to these airway infections. Only very severe, advanced rachitis – which in these days only exceptionally occurs – can lead to general extenuation, frequent infections. Immunglobulin and cellular immunnodeficiency can lead to cumulative infection usually before the nursery period and they are especially rare conditions. Feeding deficiency only in very severe cases leads to cachexy that comes with cumulative infections, and if the child goes the nursery, it is hardly imagnable.
