Pulmonology Flashcards
A 6-year-old child presents with recurrent episodes of wheezing, coughing, and breathlessness especially at night. His symptoms seem to worsen when playing outside. What is the most likely diagnosis?
Asthma
What are the first-line maintenance treatments for a child with mild persistent asthma?
What defines mild persistent asthma?
First-line maintenance treatments for mild persistent asthma include low-dose inhaled corticosteroids.
ICS are effective in reducing inflammation and hyper-responsiveness in the airways, thus decreasing the frequency and severity of asthma symptoms and exacerbations.
Sx more than 2 times per week or 3-4 night symptoms per month
A 4-year-old girl is brought to the clinic due to persistent cough and frequent respiratory infections. Her growth charts show failure to thrive. What diagnostic test would be most indicative of cystic fibrosis?
A sweat chloride test
A high level of chloride in sweat is a hallmark of cystic fibrosis, resulting from mutations in the CFTR gene affecting chloride transport.
Discuss the role of chest physiotherapy in the management of a patient with cystic fibrosis.
What medication is now the mainstay treatment for cystic fibrosis?
It helps clear mucus from the lungs, thereby reducing the risk of infection and improving lung function. This is essential due to the excessive, thick mucus production seen in cystic fibrosis.
CFTR modifiers (Trikafta)
A 2-month-old infant is brought to the emergency room with a 3-day history of nasal congestion, cough, and increasing difficulty breathing. On examination, the infant has wheezing and crackles. What is the most likely causative agent?
Respiratory Syncytial Virus
RSV is the most common cause of bronchiolitis and pneumonia in infants and young children.
Describe the typical presentation of a toddler suspected of having aspirated a small object. What are the initial steps in the management of this case?
What is both diagnostic and therapeutic in diagnosing an airway FB?
Typical presentation includes sudden onset of coughing, choking, and wheezing or stridor, depending on the location of the object.
Initial steps include back blows for infants and abdominal thrusts for older children if the child is in distress and cannot breathe, speak, or cry.
Rigid bronchoscopy
A 10-year-old child, who recently immigrated from a country with a high incidence of tuberculosis, presents with a persistent cough, night sweats, and weight loss. What screening tests are indicated?
Screening tests indicated include the Mantoux tuberculin skin test or an IGRA (Interferon-Gamma Release Assay).
These tests identify immune responses to the bacterium causing tuberculosis and are recommended for individuals at high risk.
A 7-year-old boy with known moderate persistent asthma presents with an acute exacerbation. He is currently on low-dose inhaled corticosteroids. Which of the following would be the most appropriate next step in managing this exacerbation?
A. Increase the dose of inhaled corticosteroids
B. Administer a systemic corticosteroid
C. Start an antibiotic
D. Discontinue inhaled corticosteroids
Administer a systemic corticosteroid
A 3-year-old child diagnosed with cystic fibrosis is being evaluated for a management plan. Which of the following therapies is essential to include in her daily regimen to manage her pulmonary symptoms?
A. High-dose ibuprofen
B. Chest physiotherapy
C. Oral glucocorticoids
D. Long-acting beta-agonists
Chest physiotherapy
During a routine visit, the parent of a 5-month-old infant with RSV bronchiolitis asks about the use of albuterol. What is the most appropriate response regarding the use of albuterol in this case?
A. “Albuterol is effective in reducing symptoms in all cases of bronchiolitis.”
B. “Albuterol is typically not recommended as it has not shown consistent benefit in infants with RSV bronchiolitis.”
C. “Albuterol is mandatory for treating RSV bronchiolitis.”
D. “Albuterol should be used only in severe cases of RSV bronchiolitis.”
“Albuterol is typically not recommended as it has not shown consistent benefit in infants with RSV bronchiolitis.”
Bronchiolitis, particularly due to Respiratory Syncytial Virus (RSV), is a common lower respiratory tract infection in infants and young children, characterized primarily by bronchiolar inflammation and obstruction. The treatment for bronchiolitis is largely supportive, including hydration and sometimes oxygen supplementation, depending on the severity of the symptoms. Clinical trials and the AAP have not found consistent benefit of using albuterol during RSV bronchiolits.
A pediatric patient suspected of foreign body aspiration shows no signs of respiratory distress, but there is concern about a possible aspiration of a small plastic bead. What is the most appropriate diagnostic test to confirm the presence of a foreign body in this scenario?
A. Chest X-ray
B. Bronchoscopy
C. Pulmonary function test
D. Laryngoscopy
Bronchoscopy
Which of the following is a common finding on a pulmonary function test in a child with chronic obstructive lung disease due to cystic fibrosis?
A. Increased forced expiratory volume in one second (FEV1)
B. Decreased total lung capacity
C. Decreased FEV1/FVC ratio
D. Increased peak expiratory flow rate
Decreased FEV1/FVC ratio
A 9-year-old girl recently immigrated from a high TB prevalence country presents with a cough lasting more than three weeks. She has a positive IGRA test but no other symptoms of tuberculosis. What is the most appropriate next step?
A. Start treatment for active TB
B. Order a chest X-ray
C. Prescribe antibiotics for a suspected bacterial infection
D. Ignore the IGRA test as a false positive
Order a chest x-ray
A premature newborn presents with grunting, nasal flaring, and cyanosis shortly after birth. Chest X-ray shows a ground-glass appearance with air bronchograms. Which of the following is the most effective treatment to improve this newborn’s respiratory status?
A. Immediate intubation and mechanical ventilation
B. Administration of intravenous antibiotics
C. Surfactant replacement therapy via endotracheal tube
D. High flow nasal cannula oxygen therapy
Surfactant replacement therapy via endotracheal tube
Which of the following infants qualifies for RSV prophylaxis with palivizumab according to current guidelines?
A. A 2-month-old infant born at 28 weeks gestation entering their first RSV season
B. A 15-month-old with a history of mild bronchiolitis in the previous RSV season
C. A 10-month-old with bronchopulmonary dysplasia not requiring medical therapy within the last 6 months
D. An 18-month-old born with congenital heart disease who has been surgically corrected and is not receiving medication
A 2-month-old infant born at 28 weeks gestation entering their first RSV season
