Pulmonary

Question 1

What is the recommendation for confirming cystic fibrosis in an infant with a positive IRFT/DNA screen on newborn screening?

Answer 1

Sweat chloride testing after 10 days of age if more than 36 weeks gestation and more than 2 kg

(sweat chloride then CFTR analysis then CFTR physiologic testing/ nasal potential difference

Question 2

What is the most likely clinical manifestation in children with alpha-1 antitrypsin deficiency?

Answer 2

liver disease

pulmonary disease in form of emphysema occurs during 4th or 5th decade of life

Question 3

What is the most common cause of community acquired pneumonia in an otherwise healthy adolescent?

Answer 3

Mycoplasma pneumoniae

serum mycoplasma penumoniae IgM

Question 4

What is the mechanism of action of Montelukast (Singulair)?

Answer 4

Leukotriene receptor antagonist

Question 5

What is the likely radiographic finding associated with Croup (high pitched, barky cough and mild respiratory distress)?

Answer 5

steeple sign (loss of normal shoulders of the subglottic airway or subglottic narrowing)

Question 6

What is the most likely diagnosis for a pt presenting with productive cough, fever and pleuritic chest pain after camping in central/ southeastern/ mid-Atlantic states and found to have mass like infiltrates/ consolidations on CXR and broad based budding yeast on microscopy?

Answer 6

Blastomycosis

Question 7

What is the most likely diagnosis of pt presenting with rhinorrhea, hoarse voice, cough for few days followed by high fever, toxic appearance, tachypnea, and inspiratory stridor with thick, pruulent tracheal secretions, ulcerations and pseudomembranes on scoping or intubating?

Answer 7

bacterial tracheitis (bacterial complication of croup usually due to S. aureus)

Question 8

what chronic disease screened for on the newborn screen has a high prevalence of rectal prolapse?

Answer 8

Cystic fibrosis

Question 9

What is a side effect of Bleomycin used for the treatment of Hodgkin disease?

Answer 9

Pulmonary Fibrosis

see decreased DLCO on PFTs

Question 10

What is the best treatment for a pt presenting with mild persistent asthma symptoms?

Answer 10

start with controller using low dose inhaled corticosteroid inhaler

Question 11

What is the most likely diagnosis for an HIV pt presenting with tachypnea, mild retractions, crackles and ground glass opacities on CXR?

Answer 11

Lymphocytic interstitial pneumonitis

Question 12

What is the treatment for bronchiolitis?

Answer 12

Supportive care

supplemental oxygen for hypoxemia, nasal suctioning for congestion

Question 13

What is the most likely diagnosis of pt presenting with fever, cough, nonpleuritic chest pain, and CXR showing hilar adenopathy with focal alveolar infiltrates after exploring caves in Ohio/ Mississippi valleys?

Answer 13

Histoplasmosis

Question 14

What is associated with an increased risk of vocal cord paralysis?

Answer 14

Difficult breech delivery

can cause injury of recurrent laryngeal nerve from stretching of the neck

Question 15

What is the likely diagnosis for pt presenting with recurrent night-time epistaxis and multiple telangiectasias around mouth/ oral cavity?

Answer 15

Hereditary Hemorrhagic Telangiectasia (aka Osler-Weber- Rendu syndrome)

increased risk of pulmonary/ liver/ GI hemorrhages

Question 16

What vitamin deficiencies are associated with cystic fibrosis/ (4)

Answer 16

1. A
2. D
3. E
4. K

Question 17

What is the treatment for exercise-induced bronchospasm?

Answer 17

short acting B2 agonist just before exercise

Question 18

What are the most common infectious triggers of Stevens-Johnson Syndrome? (2)

Answer 18

1. Mycoplasma pneumoniae

2. CMV

Question 19

What is the treatment for a pt presenting with expiratory stridor with viral illness, rattling in chest, CXR showing unilateral hyperexpansion of lung, and CT showing narrowing of main stem bronchus?

Answer 19

Surgical removal

most likely bronchogenic cyst

Question 20

What is the most likely diagnosis for toddler presenting with sudden onset cough, unilateral wheezing, asymmetric breath sounds, and CXR showing obstructive hyperinflation?

Answer 20

Foreign body aspiration

dx: rigid bronchoscopy

Question 21

What is the normal respiratory rate for a infant (aged birth to 1 year old)?

Answer 21

30-60 breaths per minute

Question 22

What is the most likely radiographic finding in a cystic fibrosis patient with respiratory symptoms?

Answer 22

Diffuse bronchiectasis

Question 23

What is the most likely diagnosis for pt presenting with acute onset respiratory distress, high fever, progressively severe sore throat, dysphagia, muffled voice and drooling?

Answer 23

Epiglottis

Question 24

What is the radiographic finding associated with Epiglottis?

Answer 24

Thumbprint sign (thickening of the aryepiglottic fold and epiglottis)

Question 25

What is the most likely diagnosis for an infant presenting with bowel obstruction at birth and hyponatremia?

Answer 25

Cystic fibrosis
(bowel obstruction- meconium ileus; hyponatremia due to high sodium in sweat)

Question 26

What is a possible side effect of IV magnesium for status asthmaticus if they have been given terbutaline?

Answer 26

hypotension

tx: pause Mg, give bolus, restart Mg at lower rate

Question 27

What is the first line of positive pressure support in status asthmaticus especially is requiring more than 40% FiO2?

Answer 27

heated high flow nasal cannula

Question 28

What is the most likely diagnosis for a patient presenting with history of recurrent pulmonary infections and sudden onset of pneumothorax (acute chest pain, cough and dyspnea without fever)?

Answer 28

Bronchogenic cyst

Question 29

What is the most common clinic presentation of patients with mild obstructive sleep apnea (OSA)?

Answer 29

behavioral issues, mood swings, ADHD-like behavior

Question 30

What are the two most common side effects of chronic inhaled steroid use?

Answer 30

1. skin thinning

2. bruising

Question 31

True or False. Compared with nebulized treatments, used of MDI inhaler with spacer has been shown to be equally effective for all children.

Answer 31

True