Peds 13 Flashcards
Sunita is a 6-year-old girl with chronic nasal congestion and a history of eczema who presents with two months of cough that is often worse at night, with exercise, and with exposure to cold air. She has no fever, shortness of breath, or history of wheezing, but has a family history of asthma. Her physical exam findings are notable for allergic shiners, clear nasal secretions, and boggy nasal turbinates but a normal oropharynx. Her lung exam is significant for diffuse, mild end-expiratory wheezing but she was not in respiratory distress and was able to speak in full sentences. She was not coughing during the exam.
What is the most likely dx?
Asthma
Which test is used to confirm asthma dx?
B. Spirometry
A 4-year-old boy who recently emigrated from eastern Europe presents with his mother to your general pediatrics clinic. His mother reports that he has a chronic nonproductive cough during the day and night, mild wheezing for one month and failure to gain weight (his weight has dropped from the 50th to the 10th percentile for his age). He does not have high fevers, rhinorrhea, congestion or night sweats. Which of the following are the next best diagnostic tests?
A. Chest x-ray and tuberculin skin test
B. CT of nasal sinuses
C. Spirometry, before and after bronchodilator therapy
D. Chest x-ray and methacholine challenge
E. None needed, patient likely has habit cough
A. Chest x-ray and tuberculin skin test
CXR and tuberculin skin test (TST) is the best choice. Signs and symptoms of primary pulmonary tuberculosis are few to none. Toddlers may present with nonproductive cough, mild dyspnea, wheezing, and/or failure to thrive (defined as weight < 5th percentile or drop in two percentile curves for weight). In children, TB can present without systemic complaints (fever, night sweats, and anorexia), severe cough, and sputum production. Regarding diagnostic tests, the TST is a practical tool for diagnosing TB infections. All children with chronic cough (more than four weeks) should be evaluated with a chest x-ray, as other pathology—such as lung abscess or malignancy—can also be detected on CXR.
An 11-year old boy presents to the clinic with wheezing. Mom states that in the past he has used inhaled albuterol and it has helped with wheezing and shortness of breath. Mother also reports that the patient experiences shortness of breath three times a week and is awakened at night by these symptoms once a week. What is the most appropriate outpatient therapy at this time?
A. Only albuterol rescue inhaler as needed
B. Low dose inhaled corticosteroids daily and albuterol rescue inhaler as needed
C. Medium dose inhaled corticosteroids daily and albuterol rescue inhaler as needed
D. High dose inhaled corticosteroids, LABA (long-acting beta agonist), and oral corticosteroids daily and albuterol rescue inhaler as needed
E. A 5-day course of oral corticosteroids
B. Low dose inhaled corticosteroids daily and albuterol rescue inhaler as needed
A 4-year-old patient presents with several months of cough. Mom also reports a history of red skin patches, which are pruritic, and allergies to peanuts, eggs, and mangoes. Which of the following would most likely be characteristic of the cough that this patient would present with?
A. Does not awaken patient from sleep
B. Paroxysmal
C. Barking cough
D. Worse at night
D. Worse at night
A 9-year-old boy presents to your clinic with discoloration under his eyes, persistent cough, and skin rashes. He has struggled with these complaints over the past three years but recently his symptoms have gotten worse, affecting him every other day. He is afebrile. He is found to have wheezing on physical exam and increased lung volume bilaterally on chest x-ray. What would be the most appropriate treatment for him?
A. Oral antibiotics
B. Short-acting inhaled beta agonist PRN
C. Short-acting inhaled beta agonist PRN with daily low-dose inhaled corticosteroid
D. Short-acting inhaled beta agonist PRN with daily medium-dose inhaled corticosteroid
E. Long-acting inhaled beta agonist alone
C. Short-acting inhaled beta agonist PRN with daily low-dose inhaled corticosteroid
A previously healthy 10-year-old boy comes to the clinic with a chief complaint of progressive cough for three days that began gradually. His cough is described as productive with whitish sputum. His mother reports that he has been febrile up to 101.5 F daily. She thinks he is fatigued and has not eaten well in the past several days. He has no throat pain, vomiting, or diarrhea on review of systems. On exam, there is air passage throughout all lung fields, with crackles in the lower right lung field, but no other abnormal sounds. Which of the following would you likely find in your evaluation?
A. Response to inhaled beta-agonist
B. Hyperinflation in one lung field on chest radiograph
C.Alveolar consolidation in the right lower lobe on chest radiograph
D. Positive PCR for pertussis
E.Fluffy bilateral infiltrates and a large heart on chest radiograph
C.Alveolar consolidation in the right lower lobe on chest radiograph
Alveolar consolidation in the right lower lobe would be suggestive of a pneumonia. The prolonged fever, productive cough, fatigue and focal findings on examination are all suggestive of pneumonia.
What sxs would be in each of the 4 stages of asthma severity?
- stage 1 intermittent
- stage 2 mild persistent
- stage 3 mod persistent
- stage 4 severe persistent
1: sxs < 1x/wk, night <2x/month, FEV1/PEFR >80% predicted
2: sxs > 1x/wk (not daily), night > 2x/month, FEV1/PEFR > 80% predicted w 20-30% variability
3: sxs daily, night > 1x/wk, FEV1/PEFR 60-80% predicted w >30% variability
4: sxs continuous, night frequent, FEV1/PEFR < 60% w >30% variability
What’s the tx for each of the 4 stages of asthma severity?
- stage 1 intermittent
- stage 2 mild persistent
- stage 3 mod persistent
- stage 4 severe persistent
- acute asthma exacerbation
- albuterol PRN
- low dose inhaled corticosteroid daily + albuterol PRN
- medium dose inhaled corticosteroid + albuterol PRN
- high dose inhaled corticosteroid, LABA, oral corticosteroid, albuterol PRN
- brief course oral corticosteroids (5-day?)
What PFT results suggest an asthma dx?
- FVC
- FEV1
- FEF 35-75%
- FEV1/FVC
FVC > 80%
FEV1 < 80% (low)
FEF 25-75% < 55%
FEV1/FVC < 70-80% (low)
-caved in, left shift
What are normal PFT results?
- FVC
- FEV1
- FEF 35-75%
- FEV1/FVC
FVC > 80%
FEV1 > 80%
FEF 25-75% > 55%
FEV1/FVC > 70-80%
