Pulm 3

Question 1

A 6 yo is brought in by her mother who is worried because the child has been experiencing bursts of rapid, consecutive coughs followed by a deep, high-pitched whooping breath after the episode. A couple of times the child has vomited because she has been coughing so hard. What is the most likely cause? What is the most likely diagnosis?

Answer 1

Pertussis caused by Bordetella pertussis

Question 2

What are the 3 phases of pertussis?

Answer 2

Cattaharal phase
Paroxysmal phase
Convalescent phase

Question 3

An 8 yo comes to your office today with his mother. For the past 2 months the boy has had numerous coughing fits followed by a whooping noise. Over the past few days his mother admits that the coughing has been less frequent and less severe than it was previously, but she is still worried. What is the most likely diagnosis? What stage of the disease is the child in? How do you confirm the diagnosis?

Answer 3

Pertussis (Whooping cough) in the convalescent phase

Confirm with a nasopharyngeal culture

Question 4

A mother brings in her 5 yo son who has had a runny nose, tearing, reddened eyes and nose, a hacking night cough, and hasn’t been eating for the past few nights. What stage of which disease do you suspect?

Answer 4

Cattaharal phase of pertussis (whooping cough)

Question 5

What is the best way to prevent pertussis?

Answer 5

DTaP in infants

TDaP in teens, adults, and health care workers

Question 6

A pt presented to you with bursts of rapid, consecutive coughing which were sometimes followed by vomiting. What is the best treatment option for this pt?

Answer 6

Pertussis
Macrolides are 1st line treatment
Azithromycin is the #1 drug of choice

Question 7

A 42 yo female pt presents with an abrupt onset fever, sore throat, and headache. She feels very tired and her eyelids appear to be drooping. What is the most likely cause of her disease? What disease does she most likely have?

Answer 7

Influenza A virus

She has the flu

Question 8

A pt asks you: “Why hasn’t the flu been eradicated yet? What is the flu vaccine made of?” What do you tell her?

Answer 8

It has high mutation rates and is highly susceptible to antigenic drift and antigenic shift. Since the flu virus is constantly changing it is impossible to make a wide-scale effective vaccine to completely eradicate the disease.
The flu vaccine is composed of dead viruses of the few most common flu strains. It is tailored every year to be as effective as possible

Question 9

A pt comes in with a fever of 103 degrees F, a sore thorat, a frontal headache, a runny nose, and severe fatigue. What diagnostic tests would you perform?

Answer 9

Influenza
Viral culture
CBC/electrolyte levels
PCR (90% sensitive)
Serologic testing (65% sensitive)

Question 10

A 6 yo male presents with a fever of 104 degrees F, a sore throat, runny nose, weakness, fatigue, and diarrhea this morning. What treatment do you recommend?

Answer 10

Influenza
Treat with antivirals within 40 hours of symptom onset
Oseltamivir, Zanamivir, Adamantanes, Seltamivir, Probenecid, or Neuraminidase

Question 11

A 18 month old boy presents with fever, runny nose, cough, wheezing, and tachypnea. His mother says that he hasn’t been feeding well. What is the most common etiology? What is the most likely diagnosis?

Answer 11

Bronchiolitis caused by RSV

Question 12

You suspect a pt has bronchiolitis, and although labs aren’t always needed, you think you should perform at least 1 because you’re questioning your diagnosis. What test do you perform and what results would confirm a diagnosis of bronchiolitis?

Answer 12

CXR

Look for hyperinflation, peribronchial cuffing, interstitial markings, and/or subsegmental atelectasis

Question 13

What is the best treatment for a 39 mo girl who was brought in for fever, runny nose, cough, expiratory wheezing, and tachypnea?

Answer 13

Bronchiolitis

It’s self-limiting, so just observation and supportive care. Supplemental O2 if necessary

Question 14

A 4 youfemale presents with fever, cough, wheezing, rales, and a profuse watery/frothy white nasal discharge. Her mother tells you that the child was born 4 weeks early. What disease do you suspect?

Answer 14

Respiratory syncytial virus (RSV)

Group A is most common

Question 15

A child presents with fever, cough, wheezing, cyanosis around his lips, retractions on inspiration, and short (

Answer 15

RSV
Lab tests aren’t always indicated
CBC, serum electrolyte concentrations, urinalysis, O2 saturation, blood gas, culture, PCR, molecular probes, and/or CXR

Question 16

What is the best treatment for a young child with wheezing, tachypnea, rales, and apneic episodes?

Answer 16

RSV
Parenteral fluids
Corticosteroids, bronchodilators, alpha agonists
Ribavirin if severe acute RSV & multiple risk factors
Palviziumab

Question 17

A 4 month old boy is brought in by his mother. Over the past couple days he has had cold-like symptoms and wheezing. On exam you notice expiratory wheezing, prolonged wheezing, coarse & fine crackles, and hyperresonance on percussion. What are the 2 most common causes of this child’s disease? How do you determine which cause is more likely?

Answer 17

Bronchiolitis
RSV or rhinovirus
RSV is more common in the winter
Rhinovirus is more common in the spring & fall

Question 18

A 3 yo boy is brought into the ER at 2am by his mother who is worried because he woke up with a barking cough in the middle of the night. The child has some hoarseness and a bark-like cough that sounds like a seal. On exam you notice inspiratory stridor and chest retractions. What is the most likely etiology? What is the most likely diagnosis?

Answer 18

Croup caused by parainfluenza type 1 virus

The viral infection causes inflammation of the larynx and trachea

Question 19

A 2 yo boy is brought in by his mother who is worried about his loud, barking cough. He has a low-grade fever, nasal congestion, and reddening around his nose. A few days ago he had a cold, but the barking cough has developed within the past few hours. What is the best treatment for this child’s condition?

Answer 19

Croup
Treat symptomatically or with humidified air
Reassure and educate the pt and parents
F/U if symptoms worsen

Question 20

A 36 month of boy comes in because his mother is worried about a barking cough that he has has a few nights in the past two weeks. The cough doesn’t last very long, stops abruptly and the child doesn’t have a fever. What is the most likely diagnosis?

Answer 20

Spasmodic (recurrent) croup