PEDS lower respiratory Questions Flashcards
Shelby, a 4-week-old, presents to your office
in mid-January with a one-week history of nasal congestion and occasional cough. On the evening prior to this visit Shelby developed a temperature of 102°F, refused to breastfeed, had paroxysmal coughing, and noisy, labored breathing. On exam, you note an ill-appearing infant who is lethargic with tachypnea and intercostal retractions. Shelby does not attend daycare but has a 3-year-old sibling who is in daycare and who recently had a “cold.” Considering the clinical presentation, what is the most likely cause of Shelby’s illness?
a. Mycoplasma pneumonia
b. RSV bronchiolitis
c. Aspiration pneumonia
d. Streptococcal infection of the pharynx
b. RSV bronchiolitis
In the above scenario Shelby’s case, which of the following would be the treatment of choice?
a. Antihistamine, decongestant, and cough suppressant
b. Oral antibiotics and follow-up chest radio- graph in two weeks
c. Bronchoscopy with lavage, chest physio- therapy, and respiratory isolation
d. Hospitalization, bronchodilators, supple- mental oxygen, and nutritional support
d. Hospitalization, bronchodilators, supple- mental oxygen, and nutritional support
Of the following children, which one should not have tuberculin skin testing?
a. Richard, a 14-year-old, whose uncle was recently granted parole after five years in prison and is currently living with Richard’s family
b. Theresa, a 2-year-old who was infected with RSV three months ago and is currently asymptomatic
c. Han, a 3-month-old whose family emigrated to the U.S. from Cambodia one month ago
d. Chris, an 18-month-old whose mother is infected with HIV
b. Theresa, a 2-year-old who was infected with RSV three months ago and is currently asymptomatic
- Which of the following clinical presentations least warrants sweat chloride testing?
a. 10-year-old female sibling of a patient newly diagnosed with cystic fibrosis; sibling is without pulmonary problems and growth parameters are at 50% for age
b. 2-year-old male with recurrent pneumonia and growth parameters at 5% for age
c. 4-year-old female with nocturnal cough, which resolves after treatment with bronchodilators and short-term steroids; growth parameters at 10% for age
d. 7-year-old female with nasal polyps, mildly hyperexpanded lungs, growth parameters at 25% for age
c. 4-year-old female with nocturnal cough, which resolves after treatment with bronchodilators and short-term steroids; growth parameters at 10% for age
Of the following diagnostic findings, which one should be referred to a specialist immediately?
a. Suspected foreign body aspiration
b. Sweat chloride results of 30 mEq/L
c. Pulmonary function tests of 85% predicted
d. Chest radiograph with hyperexpansion
a. Suspected foreign body aspiration
- What is the most common agent for nonviral pneumonia from older preschool to young adulthood?
a. Mycoplasma/Chlamydia aureus
b. Staphylococcusaureus
c. Ureaplasma
d. Haemophilus influenza
a. Mycoplasma/Chlamydia aureus
- Which one of the following diagnoses would not be part of the differential for recurrent lobar pneumonia in a 2-year-old?
a. Cystic fibrosis
b. Foreign body aspiration
c. Atelectasis
d. Bronchitis
d. Bronchitis
The most common clinical presentation of
pneumonia includes:
a. Cough, fever, tachypnea, and abdominal pain
b. Hemoptysis, putrid breath, and weight loss
c. Sudden chest pain, cyanosis
d. Retractions, stridor
a. Cough, fever, tachypnea, and abdominal pain
In addition to airway hyper-responsiveness and reversible airway obstruction, asthma is a chronic lung disease characterized by:
a. Bronchiectasis
b. Inflammation
c. Pleural effusion
d. Pulmonary edema
b. Inflammation
The most common trigger for an acute asthma episode in the very young child is:
a. Respiratory infections
b. Exercise
c. Tobaccosmoke
d. Outdoor allergens
a. Respiratory infections
Luke has mild persistent asthma. Appropriate daily medication should include:
a. An inhaled low-dose corticosteroid
b. Short-acting beta 2 agonists
c. An oral systemic corticosteroid
d. A cough suppressant
a. An inhaled low-dose corticosteroid
Which of the following is not a goal of appropriate asthma management?
a. Limited activity and exercise
b. Prevent recurrent exacerbations
c. Prevent chronic troublesome symptoms
d. Maintain near normal pulmonary functions
a. Limited activity and exercise
Deon is a 4-year-old male with a history of atopic dermatitis and recurrent pneumonias, according to his mother. He presents with a persistent nighttime cough. His most likely diagnosis is:
a. Asthma
b. Foreign body aspiration
c. Croup
d. Cystic fibrosis
a. Asthma
The most typical chest radiographic finding con- sistent with the diagnosis of asthma is:
a. Normal chest film
b. Diffuse airway edema
c. Right upper lobe infiltrate
d. Hyperinflation
Hyperinflation
When providing asthma education regarding the use of a long-acting beta2 agonist, it is important to stress:
a. It should not be used as a quick-relief medication
b. May be given every 30 minutes times three for rescue therapy
c. May be most beneficial for exercise-induced asthma
d. Should never be taken while also using inhaled corticosteroids
a. It should not be used as a quick-relief medication
Claire is an 8-year-old with moderate persistent asthma who is still having a daily cough. She reports three times a day use of a short-acting inhaled beta2 agonist and cromolyn sodium at her clinic visit. Your management plan should be altered to include:
a. Broad-spectrum antibiotics and recheck in two weeks
b. Addition of systemic corticosteroids for five days
c. Replace cromolyn sodium with inhaled corticosteroids
d. Addition of an inhaled anticholinergic
c. Replace cromolyn sodium with inhaled corticosteroids
Ben is a 10-year-old who has recently been diagnosed with mild intermittent asthma. Which of the following is not a routine part of his clinic management?
a. Spirometry evaluation
b. Metered dose inhaler technique
demonstration
c. Environmental triggers and control methods review
d. School excuse to not participate in physical
education activities
d. School excuse to not participate in physical
education activities
Major contributors to asthma morbidity and mortality are:
a. Underdiagnosis and inappropriate treatment
b. An increase in indoor allergens
c. Overuse of anti-inflammatory medications
d. An increase in air pollution
a. Underdiagnosis and inappropriate treatment
The primary treatment for bronchopulmonary dysplasia is:
a. Pancreaticenzymes
b. Surgicalrepair
c. Adequate oxygenation
d. Chestphysiotherapy
c. Adequate oxygenation
- The single most predictive factor in the development of bronchopulmonary dysplasia is:
a. Birthweight
b. Maternalage
c. Maternal educational level
d. Respiratory infections
a. Birthweight
The classic radiographic finding in croup is:
a. Hyperinflation
b. Perihilar lymphadenopathy
c. Thumbsign
d. Steeplesign
d. Steeplesign
- Unilateral wheezing is a finding suggestive of:
a. Croup
b. Asthma
c. Foreign body aspiration
d. Cysticfibrosis
c. Foreign body aspiration
- Which of the following is not characteristic of an apparent life-threatening event (ALTE):
a. Change in muscle tone
b. Fever
c. Change in skin color
d. Apnea
b. Fever
- Following an apparent life-threatening event (ALTE), management and treatment are based on findings from:
a. A thorough history and physical exam
b. An electroencephalogram
c. A chest radiograph
d. A sleep study
a. A thorough history and physical exam
- The predominant characteristic of a young infant with bronchopulmonary dysplasia is:
a. Prolongedfevers
b. Hypoxemia on room air
c. Recurrentpneumonias
d. Chronic hypoinflation
b. Hypoxemia on room air
