Pulmonology Flashcards
A newborn term baby girl had respiratory distress shortly after birth for which she was intubated. PE reveals a coloboma of the right eye and abnormally formed and low-set ears. An NGT cannot be passed although there was no cleft or other mass lesions. The most appropriate next diagnostic step is:
Flexible bronchoscopy
Respiratory problems rank high among Filipino children. The nature of this problem is frequently:
Infectious
The principal agent that causes the common colds is the:
Rhinovirus
A 4 vear old male child is brought to the emergency room dueto difficulty breathing. He has high fever of 39C 12 hours ago. he started having sore throat and a mild fever which progressed and prompted consult. Patient is seen drooling and the neck is slightly held hyperextended. What is the most likely diagnosis in this case?
Which among the ff. is the best next step in the management et this patient?
If xray was done, what is the expected finding?
Acute epiglottitis
Secure airway with intubation
Thumb sign
Age group for viral croup/LTB
3 mos to 3 years
Pathogen for viral croup
Parainfluenza virus
Fever severity of viral croup, low or high grade?
Low grade
Associated symptoms of viral croup
Barking cough
Hoarseness
True or False: Stridor improves in viral croup after administration of racemic epinephrine.
True
Steeple sign
Viral croup/LTB
Xray finding for epiglottitis
Thumb/Leaf sign
Associated symptoms of epiglottitis
Muffled voice
Drooling
Age group for epiglottitis
3 years to 7 years
Pathogen responsible for epiglottitis
H. Influenza type B
A 3 year old male is brought to ER due to acute onset of noisy breathing. Patient is coughing from time to time, no cyanosis noted, and he points to the neck when asked about pain. Mother says the patient was apparently well and playing with his toys before the onset of the symptoms. What is the most likely diagnosis?
Foreign body aspiration
Which foreing body is most commonly obtained from respiratory tracts of children?
Nuts
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
Associated with prominent itching and sneezing, nasal eosinophilia
Allergic rhinitis
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
Unilateral foul smelling discharge, bloody nasal secretion
Foreign body
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
Headache, facial pain, periorbital edema, rhinorrhea for >2 weeks
Sinusitis
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
Persistent rhinorrhea w/ onset in the first 3 months of life
Congenital syphilis
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
History of prolonged use of topical or oral decongestant
Rhinitis medicamentosa
Patient presents with sore scratchy throat, nasal obstruction, and rhinorrhea.
+
Paroxysms of cough leaving the baby breathless & subconjunctival hemorrhage
Pertussis
CHARGE Syndrome
Coloboma of the eye Heart defect Atresia choanae Retarded growth and development Genital anomalies or hypogonadism Ear anomalies
Sinusitis pathogens
S. Pneumoniae (30%)
H. Influenza (20%)
M. Catarrhalis (20%)
What are the sinuses present at birth?
Maxillary ethmoid
What sinuses are pneumatized at 4 years old?
Sphenoid
What sinuses begin to develop at 7-8 years old?
Frontal
A 3 year old male child was brought to the clinic due to intermittent episodes of continuous coughing until the child turns purple followed by a deep loud inspiration. 1 week ago, the mother recalled that he had episodes of sneezing, rhinorrhea, what is the most likely diagnosis?
What is the best treatment for above condition?
Pertussis
Macrolides (Azithromycin)
3 stages of Pertussis lasting 2 weeks each.
What is the infectious stage?
Catarrhal, Paroxysmal, Convalescent
Catarrhal- infectious
Period of communicability of Pertussis
From 7 days after exposure to 4 weeks after onset of typical paroxysms
Incubation period of Pertussis
3-12 days
The most common complication of acute nasopharyngitis is: A. Otitis media B. Pneumonia C. Meningitis D. Tracheitis
A. Otitis media
To prevent occurence of glomerulonephritis or rheumatic fever in children, cases of acute tonsillopharyngitis is best treated with: A. Bacitracin B. Penicillin C. Chloramphenicol D. Tetracycline
B. Penicillin
URTI
+
CXR: patchy infiltrates & ragged tracheal column
Bacterial tracheits
URTI
+
CXR: Thumb sign
Epiglottits
URTI
+
CXR: Subglottic narrowing
Croup/ Laryngotracheobronchitis
URTI
+
CXR: air trapping of the right lung with mediastinal shift towards the right lung
Treatment:
Foreign body
Rigid bronchoscopy
URTI
+
CXR: steeple sign
Croup/LTB
A 4 year-old male was brought to the clinic due to coughing and wheezing usually worse at night, with difficulty of breathing. PE revealed HR 105, RR 46, T 37C, chest PE presence wheezing on bilateral lung fields, occasional rhonchi, and prolonged expiratory phase. What is the most likely diagnosis?
Bronchial asthma
Respiratory difficulty in bronchial asthma is due to: A. Bronchial muscle spams B. Bronchial mucosal edema C. Mucus hypersecretion D. All of the above
D. All of the above
In the case of asthmatic children, one should be cautious with the prolonged use of this drug: A. Prednisone B. Epinephrine C. Salbutamol D. Terbutaline
A. Prednisone- increase mucus production
Study GINA ^_^
Management of Asthma
Topnotch p. 55-56 :)
An 8-month old boy was brought to the ER by his mother due to fast breathing and wheezing. Mother is known to be a smoker and has a history of bronchial asthma. The mother says that her baby has been well until 2 days ago, when he started having runny nose and mild undocumented fever. PE of the infant reveals wheezing on both lung fields. What is the most likely diagnosis in this case?
What is the best step in the management?
Bronchiolitis
Nebulize albuterol and oxygen
If chest xray is requested in a patient with bronchiolitis, what will be the expected finding?
A. Hyperinflated lungs with patchy atelectasis
B. Steeple sign
C. lobar consolidation
D. Diffuse interstitial infiltrates
A. Hyperinflated lungs with patchy atelectasis
Wheezing
+
History of viral infection among the family members. Patient is 2 years old
Bronchiolitis
Wheezing
+
History of atopy in the family. Recurrent wheezing especially after mild viral infection after exercise
Asthma
Wheezes are heard loudest over the trachea. Persistent wheezing never seems to go away
Chondromalacia
Absent breath sounds on right lung. Patient is 3 yo
Foreign body
Management of infectious croup in a hospitalized 15 month old child: A. Immediate intubation B. Ampicillin and chloramphenicol C. Erythromycin D. Aerosolized racemic epinephrine
D. Aerosolized racemic epinephrine
Characteristic findings in the CXR of a patient with staphylococcal pneumonia include the following, except: A. Hemothorax B. Pneumatocele C. Pleural effusion D. Pneumothorax
A. Hemothorax
Fever, cough, tachypnea
+
Poorly nourished, unvaccinated w/ onset of rashes all over the body
Measles pneumonia
Fever, cough, tachypnea
+
Cystic Fibrosis, chronic granulomatous disease, burn patient, neutropenic
Pseudomonas
Fever, cough, tachypnea
+
Teen/young adult, lives in a dormitory, initial cough is non productive
“Walking pneumonia”
Mycoplasma
Fever, cough, tachypnea
+
Has aviarium at home
Psittacosis
Fever, cough, tachypnea
+
Eye discharge during the first 5-14 days of neonatal period
Chlamydia
- Attaches to respiratory epithelium
- Inhibits cellular destruction
- Sloughed cellular debris and inflammatory cells and mucus cause airway obstruction
A. GABHS
B. Pneumococcus
C. Mycoplasma
D. Staphylococcus
C. Mycoplasma
- extensive areas of hemorrhagic stroke
- irregular areas of cavitation
- pneumatoceles, empyema and bronchopulmonary fistulas
A. GABHS
B. Pneumococcus
C. Mycoplasma
D. Staphylococcus
D. Staphylococcus
- diffuse infection with interstitial pneumonia
- necrosis of tracheobronchial mucosa, formation of large amounts of exudates, edema, local hemorrhage
- involvement of lymphatic vessels and pleural
A. GABHS
B. Pneumococcus
C. Mycoplasma
D. Staphylococcus
A. GABHS
- local edema that aids in the proliferation of organisms and spread into adjacent areas resulting in focal lobar involvement A. GABHS B. Pneumococcus C. Mycoplasma D. Staphylococcus
B. Pneumococcus
Child with cough, colds, fever, wheezing, stridor
+
CXR: Lobar consolidation
A. Staphylococcus
B. Pneumococcus
C. RSV
D. TB
B. Pneumococcus
Child with cough, colds, fever, wheezing, stridor
+
CXR: Hyperinflation with bilateral interstitial infiltrates & periobronchial cuffing
A. Staphylococcus
B. Pneumococcus
C. RSV
D. TB
C. RSV
Child with cough, colds, fever, wheezing, stridor
+
CXR: Prominant areas of cavitations & multiple pneumatocoeles
A. Staphylococcus
B. Pneumococcus
C. RSV
D. TB
A. Staphylococcus
Child with cough, colds, fever, wheezing, stridor
+
CXR: right sided hilar adenopathy
A. Staphylococcus
B. Pneumococcus
C. RSV
D. TB
D. TB
A 3 y/o male comes in with a 2-day history of runny nose and mild dry cough with a fever of 38C. His elder brother was noted to have cough and colds 5 days prior. He was brought in for consult today because the mother noted worsening of cough with a barking character. The child's voice was also hoarse. PE showed HR 102, RR 43, T 38C, seen sitting upright, looks anxious whenever examined, slightly erythematous posterior pharynx, and stridor. What is the most likely diagnosis? A. atypical pneumonia B. bronchiolitis C. bacterial tracheitis D. epiglottitis E. laryngotracheobronchitis
E. Laryngotracheobronchitis
A 5 y/o male patient comes in with a 2-day history of runny nose and mild dry cough with a fever of 39C. He was brought in for consult today because the mother noted worsening of brassy cough, with hoarseness, and with production of copious purulent sputum. PE revealed HR 102, RR 58, T 39C. The child is seen on semi-recumbent position with his mother on the examination bed, looks anxious, with slightly erythematous posterior pharynx, (+) rhonchi on auscultation. What is the most likely diagnosis? A. atypical pneumonia B. bronchiolitis C bacterial tracheitis D. epiglottitis E. laryngotracheobronchitis
C. Bacterial tracheitis
CXR finding in patients with bacterial tracheitis
Ragged air column sign
Type of cough: STACCATO
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
C. Chlamydia
Type of cough: BRASSY
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. Tracheitis F. Bordatella G. Habit cough
E. Tracheitis
Most common: S. Aureus
Type of cough: BARKING “SEAL”
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
D. Parainfluenza
- croup
Type of cough: Whooping; posttusive vomiting
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
F. Bordatella
Type of cough: most severe in the morning
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
A. Cystic fibrosis
Type of cough: with vigorous exercise
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
B. Asthma
Type of cough: Disappears with sleep
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
G. Habit cough
Type of cough: tight sounding with wheezing
A. Cystic fibrosis B. Asthma C. Chlamydia D. Parainfluenza E. S. Aureus F. Bordatella G. Habit cough
B. Asthma
In most children, the only evidence of primary tuberculosis is: A. Cough B. Afternoon fever C. Erythema nodosum D. Recent conversion of PPD to positive
D. Recent conversion of PPD to positive
Tuberculin sensitivity develops \_\_\_\_\_ after its administration in the forearm A. 5 B. 72 hours C. 3 months D. 7 months
B. 72 hours
The most common extrapulmonary form of tuberculosis in children is: A. Meningitis B. Scrofula C. Ileitis D. TB verrucosa cutis
B. Scrofula
A 3 year old boy has a positive tuberculin test. Which of the ff is suggestive of miliary TB A. Infection of the hilar lymph node B. Weight loss C. Hepatosplenomegaly D. Chronic cough
C. Hepatosplenomegaly
An 8 year-old male comes in to the clinic for check up but he feels well and has no symptoms. He has come in contact with his sick grandfather who was recently diagnosed to have tuberculosis. A skin test was done which revealed a 10mm induration and 5mm erythema and chest X ray is negative. What is the next best step in
the management of this patient?
A. supportive, watchful waiting
B.none, negative skin test
C.INH for 9 months
D.INH, Rifampicin, Pyrazinamide and Ethambutol for 4 months then 2months RI
C.INH for 9 months
1. A 9 month-old male was brought to the clinic due to cough and difficulty breathing. The mother noted that he initially had runny nose with clear nasal discharge and dry cough 3 days prior. At present, the infant has a fever of 38.5 C, fast breathing, and cough which prompted consult PE revealed HR of 158, RR 68, T 38.8C; he is irritable, coughing, (+) nasal flaring, (+) subcostal retractions, (+) crackles over bilateral lung fields, and decreased breath sounds over the right lung field. What is the most likely diagnosis? A. pneumonia B. bronchial asthma C. bronchiolitis D. bronchitis E. Pertussis
2. In relation to the above case, where should the patient be sent? A. home B.OPD C. regular ward D. ICU
3. If a chest X ray was done in the above case which revealed bilateral interstitial infiltrates, and the assessment made was pneumonia, what would be the classification of the above patient? A. minimal risk B. PCAP B C. PCAP C D. high risk E. low risk
- A. Pneumonia
- C. Regular
- C. PCAP C
Which of the ff. is considered the most consistent clinical manifestation of pneumonia in children? A. fever B. tachypnea C. cough D. crackles on auscultation
B. Tachypnea
Positive PPD test (mm)
>10 mm, or >5 mm in the presence of any: History of close contact with known TB Clinical findings suggestive of TB CXR findings suggestive of TB Immunocompromised
Treatment of TB:
INH 10mg/k/day Rif 15 mg/k/day PZA 25mg/k/day Ethambutol 15mg/k/day Streptomycin IM 20-40 mg IM OD
Indicators of pneumonia in:
A. 3 months to 5 years
B. 5 years to 12 months
C. Beyond 12 years
A. Tachypnea and retractions
B. Fevery, tachypnea, and crackles
C. Fever, tachypnea, tachycardia + one abnormal chest findings of decreased BS, rhonchi, crackles or wheezes
Pneumonia most common etiology
A. 0-28 days
B. 3 weeks- 3 months
C. Overall
A. GBS
B. RSV, then chlamydia
C. virus
Study CAP guidelines ^_^
Topnotch p. 59
A 3 y/o male patient presents with a 2-day history of gradual decreased oral intake, irritability, and fever of 38.5C. The child points to the neck area that seems to bother him and his voice was a little muffled. PE revealed HR 108, RR 33, T 38.7 C with minimal movement and refusal to move the neck ) neck stiffness. On oral l examination there is mild erythematous posterior pharynx and bulging of the posterior pharyngeal wally chest PE revealed no crackles, occasional rhonchi. What is the most likely diagnosis? A. retropharyngeal abscess B. peritonsillar abscess C. bacterial tracheitis D. epiglottitis E. laryngotracheobronchitis
A. Retropharyngeal abscess
A 3 y/o male patient presents with a 2-day history of gradual decreased oral intake, irritability, and fever of 38.5C. The child points to the neck area that seems to bother him and his voice was a little muffled. PE revealed HR 108, RR 33, T 38.7 C with minimal movement and refusal to move the neck ) neck stiffness. On oral l examination there is mild erythematous posterior pharynx and bulging of the posterior pharyngeal wally chest PE revealed no crackles, occasional rhonchi. What is the most likely diagnosis? A. retropharyngeal abscess B. peritonsillar abscess C. bacterial tracheitis D. epiglottitis E. laryngotracheobronchitis
A. Retropharyngeal abscess
1. A 16 year-old female patient presents with a 3-day history of cough and sore throat. She sought consult because of worsening sore throat and cough, fever, and trismus. There was also some dysphagia. PE revealed an asymmetrical right tonsillar bulge with displacement of the uvula and erythematous posterior pharyngeal wall, BP 100/60, HR 98, RR 22. T 38.8 C. What is the most likely diagnosis? A. retropharyngeal abscess B. peritonsillar abcess C. bacterial tracheitis D. epiglottitis E. laryngotracheobronchitis
2. What is your management of choice for this patient? A. Antibiotics only B. Surgical management only C. Antibiotics and Surgery D. Antibiotics +/- surgical drainage
- B. peritonsillar abcess
2. D. Antibiotics +/- surgical drainage
A 4 year old male child was brought to the clinic due to worsening cough now with purulent sputum. Symptoms started 3 days ago with runny nose with clear nasal discharge, after which a frequent intermittent dry hacking cough followed. Examination revealed HR 90, RR 33, T 37.2C, PE revealed: erythematous congested nasal mucosa, slightly erythematous posterior pharynx, with some occasional coarse crackles and scattered high pitched wheezing, no nasal flaring, no retractions. What is the most likely diagnosis? A. pneumonia B. bronchial asthma C. bronchiolitis D. bronchitis E. Pertussis
D. Bronchitis
