Pneumonia/Croup/Epiglottitis/Pneumothorax/Pleural Effusion/Retropharyngeal Abscess/Respiratory Distress & Failure

Question 1

Differentiating bacterial sinusitis from a cold may be difficult. Pattern of illness suggesting sinusitis include

Answer 1

• Persistent nasal congestion, rhinorrhea and daytime cough ≥ 10 days without improvement
• Severe symptoms with Temp. ≥ 39C and purulent nasal discharge ≥ 3 days
• Worsening symptoms either by recurrence of symptoms after an initial improvement or new symptoms of fever, nasal discharge and daytime cough

Question 2

True about pharyngoconjunctival fever

Answer 2

Outbreaks are associated with exposure in swimming pools

Question 3

The management of common cold frequently entails supportive treatment. Which of the following management is appropriate

Answer 3

A. The 1st generation antihistamines may reduce rhinorrhea by 25-30% (effect related to anticholinergic rather than antihistamine properties, thus 2nd gen have no effect on cold symptoms
B. Vitamin C and warm humidified air are no more effective than placebo in the tx of common cold symptoms.
C. Honey has a modest effect in relieving nocturnal symptom but should be avoided in children younger than 1 yr of age bec of the risk of botulism.
D. Rhinorrhea may be treated with ipatropium bromide or 1st generation antihistamines

Question 4

Differentiating bacterial sinusitis from a cold may be difficult. Pattern of illness suggesting sinusitis include:

Answer 4

• Persistent nasal congestion, rhinorrhea and daytime cough ≥ 10 days without improvement
• Severe symptoms with Temp. ≥ 39C and purulent nasal discharge ≥ 3 days
• Worsening symptoms either by recurrence of symptoms after an initial improvement or new symptoms of fever, nasal discharge and daytime cough

Question 5

The following statements about retropharyngeal abscess is/are TRUE

Answer 5

• it occurs most commonly in children younger than 3-4 yrs of age and less common in older children
• The etiology is most often polymicrobial.

Question 6

CT scan of a retropharyngeal mass revealing scalloping of the lymph node wall predicts:

Answer 6

abscess formation

Question 7

The following statement/s on chronic tonsillar infection is/are correct

Answer 7

• children present with history of foreign body sensation.

- Tonsils may be enlarged with tonsillar crypts containing copious debris.

Question 8

According to the Paradise Criteria, Tonsillectomy is indicated for recurrent tonsillitis if:

Answer 8

• the child has 7 episodes of tonsillitis within 1 year.
• the child has 5 episodes of tonsillitis per year for the past 2 years.
• The child has 3 episodes of tonsillitis per year for the past 3 years.
• The child has unilateral tonsillar enlargement and biopsy is needed to rule out a neoplasm

Question 9

Indications for adenoidectomy

Answer 9

• Chronic nasal and sinus infection not responding to medical management
• Recurrent acute otitis media
• nasal obstruction causing craniofacial and occlusive developmental abnormalities

Question 10

most common cause of peritonsillar abscess:

Answer 10

Group A streptococci

Question 11

Clinical Guidelines for Tonsillectomy include a recommendation for

Answer 11

single dose of IV dexamethasone intraoperatively to reduce swelling

Question 12

A 3 year old child was brought to the ER due to 4 days history of high grade fever and poor oral intake, sometimes accompanied by drooling. The mother claimed he was brought to a nearby pediatric clinic 2 weeks ago due to a bout of pharyngitis. On PE, the child is irritable, with muffled voice and mild signs of dehydration, (+) cervical lymphadenopathy, with medial displacement of the tonsil. Chest auscultation did not reveal adventitious breath sounds. What could be the diagnosis?

Answer 12

Lateral pharyngeal abscess

Question 13

Sudden onset of wheezing in a healthy child should warrant examination for:

Answer 13

Foreign body aspiration

Question 14

steeple sign is a finding seen on neck radiograph and it is

Answer 14

A. viewed on the PA view
B. may be seen in croup and normal patients without croup, rarely in epiglottitis.
C. sign of subglottic narrowing
D. not a good indication of disease severity

Question 15

Croup is characterized by:

Answer 15

Coryza, stridor and hoarseness of voice

Question 16

Exudative effusion is characterized by

Answer 16

PF protein > 3g/dl

Question 17

Rapid drainage of ≥1 liter pleural fluid on thoracentesis may result in the development of:

Answer 17

Reexpansion pulmonary edema

Question 18

Indication/s for chest tube insertion in a patient with pleural effusion include:

Answer 18

Pleural fluid <50mg/dL

Purulent pleural fluid

Question 19

Formation of pyopneumothorax or bronchopleural fistula occurs in what stage of pleural effusion?

Answer 19

Fibrinopurulent stage

Question 20

management of pleural effusion may involve the following

Answer 20

• Chest tube insertion if the glucose level is <50mg/dl
• Antibiotic coverage for 3-4 weeks for staphylococcal infection
• Chest tube insertion and antibiotic coverage if PF GS shows Gram (+) organism

Question 21

A 3 year old male was brought to the ER due to difficulty of breathing. On history, the mother claimed that he started having coryza and barking cough 5 days ago, accompanied by low grade fever. The symptoms were mild and he was home medicated with paracetamol. However, the patient developed stridor and now has high grade fever and productive cough with purulent sputum. On PE, the child is toxic looking, inspiratory stridor is heard but auscultation showed occl rhonchi only. What is the diagnosis?

Answer 21

Bacterial tracheitis

Question 22

possible etiologic organism responsible for Bacterial tracheitis

Answer 22

Strep pyogenes

Question 23

conditions resulting to pneumothorax

Answer 23

Staphylococcal pneumonia
Bronchial asthma
PTB
Collagen synthesis defect

Question 24

following statement about pneumothorax is correct

Answer 24

Catamenial pneumothorax is associated with the presence of pleural blebs and diaphragmatic defects.

Question 25

most common bronchial foreign body aspiration culprit in toddlers:

Answer 25

nuts

Question 26

mediastinal crunch or Hamman sign suggest the presence of

Answer 26

pneumomediastinum

Question 27

Hemothorax may be present in the following conditions

Answer 27

Blunt chest trauma
Intrathoracic malignancies
Pulmonary Sequestration

Question 28

most common site where aspirated foreign body lodge is in the

Answer 28

right middle bronchus

Question 29

True regarding tracheomalacia

Answer 29

A. Frequently seen as a sequalae of tracheoesophageal fistula correction
B. Flexible bronchoscopy provides definitive diagnosis of tracheomalacia
C. Characterized by a low-pitched monophonic wheezing heard predominantly during expiration

Question 30

Which of the following is most diagnostic of the presence of pneumomediastinum?

Answer 30

subcutaneous emphysema

Question 31

Fulminant course (croup vs epiglottitis)

Answer 31

B. epiglottitis

Question 32

Severe airway obstruction

Answer 32

B. epiglottitis

Question 33

Steeple sign on neck x-ray

Answer 33

croup

Question 34

Child in tripod position

Answer 34

B. epiglottitis

Question 35

Barking cough

Answer 35

croup

Question 36

Pulmonary abscess

Answer 36

pulmonary effusion

Question 37

Foreign body aspiration

Answer 37

Atelectasis

Question 38

Bronchial asthma with air trapping

Answer 38

pneumothorax

Question 39

Ehlers Danlos Syndrome

Answer 39

pneumothorax

Question 40

Osteosarcoma

Answer 40

Pleural Effusion