Respiratory Block

Question 1

expiratory wheezing

Answer 1

Intrathoracic airway obstruction

Question 2

A 5 y.o., presents with status asthmaticus, able to speak 2 words, with scant wheezing, respiration of 40 bpm, and an O2 saturation of 95%. You provided 3 nebulized albuterol treatments and the patient can now speak in sentences, has musical wheezing throughout, and an O2 saturation of 85%. The decrease in the O2 saturation is due to this phenomenon.

Answer 2

V/Q mismatch with “dead space ventilation”

Question 3

A 3 y.o boy is undergoing mechanical ventilation 12 hr after repair of an atrial septal defect. Opioids and benzodiazepines are being used for analgesia and sedation. The mandatory ventilatory rate has been decreased from 20 to 10 bpm in preparation for removal of the endotracheal tube. The PaO2 is 120 mmHg and the PaCO2 is 75 mmHg. The arterial pH is 7.13. The child has no spontaneous respirations. Auscultation of the chest demonstrates that the breath sounds are slightly reduced on the left side. Occasional crackles can be heard over both bases. The most likely cause of acidosis is

Answer 3

respiratory depression

Question 4

A 1 month old infant is breathing supplemental oxygen from a hood at a measured concentration of 45% after developing respiratory distress. A PO2 of 60 mmHg, a PCO2 of 50 mmHg, and a pH of 7.30 are measured in a blood sample obtained from the left radial artery.

Answer 4

Blood gas anomalies are caused by ventilation-perfusion inequality

Question 5

A premature infant is undergoing mechanical ventilation for respiratory distress syndrome. Peak inspiratory pressure is 32 cm H2O, positive end-expiratory pressure (PEEP) is 5 cm H2O ad ventilatory rate is 30 bpm. The infant has decreased peripheral perfusion, manifested as a prolonged capillary refill time and weak arterial pulses. The central venous pressure measured at the right atrium with an umbilical venous catheter is 2 mmHg (or approximately 3 cm H2O. PaO2 is 80 mmHg, and PCO2 is 38 mmHg. Cause of improvement in infant’s perfusion.

Answer 5

Administer 10mL/kg of normal saline

Question 6

Clubbing

Answer 6

Cystic fibrosis
Chronic congestive heart failure
Thalassemia
Cirrhosis

Question 7

A 2 y.o new to your practice has a history of multiple respiratory illness. You note the presence of mild stridor on exam. Test to be indicated

Answer 7

Barium swallow

Question 8

A 4 month old African-American infant was found unresponsive in his crib by his mother in the early morning and could not be resuscitated. He had been placed for sleep on his back but was found on his stomach. At a well-child examination the previous day, he had been found to be in a good health and receive his routine immunizations. He was born at 36 wks of gestation and weighed 2,420 g. His medical history was otherwise unremarkable. After a thorough scene investigation, autopsy, and review of the medical history, the cause of death was determined to be sudden infant death syndrome (SIDS). Factors to be of risk for SIDS in this patient.

Answer 8

Prematurity
Movement to a prone position after having been supine to sleep
Exposure to tobacco smoke
Low birth weight

Question 9

Strongest risk factor associated with SIDS

Answer 9

Smoking by the mother in the prenatal period

Question 10

Most common congenital abnormality of the nose

Answer 10

Choanal atresia

Question 11

Nasal foreign bodies may caused

Answer 11

Aspiration
Local tissue necrosis
Infection
Toxic shock syndrom

Question 12

Most important consideration when a disk battery is seen as a nasal foreign body

Answer 12

It may leak and cause local tissue damage

Question 13

Nosebleeds are commonly associated with

Answer 13

Digital trauma
Family history of epistaxis
Sinus infection
Dry winter air

Question 14

Nosebleeds in children most commonly arise from

Answer 14

Kiesselbach plexus (anterior septum)

Question 15

Nasal polyps in children

Answer 15

Associated with allergic rhinitis

Question 16

A parent of a 9 month old complains that her child is always sick with a cold. She wonders if her child needs antibiotics to clear infection. You have review the child’s chart and note normal growth and development and several phone calls for cold management. Most appropriate response

Answer 16

Otherwise healthy young children may have as many as 12 colds per year
Withdrawing the child from daycare may decrease number of colds
Antibiotics are not effective in the treatment of cold viruses
Over the counter cold remedies are not effective in decreasing symptoms in infants

Question 17

Frontal sinuses in children

Answer 17

Begin development around age 7-8 years

Question 18

Predisposing factors for bacterial sinusitis

Answer 18

Viral upper respiratory tract infections
Cigarette smoke exposure
Allergic rhinitis
Cleft palate

Question 19

Common pathogen in acute sinusitis

Answer 19

Streptococcus pneumoniae
Staphylococcus aureus
Moraxella catarrhalis
Nontypable haemophilus influenzae

Question 20

Important bacterial causes of pharyngitis

Answer 20

Group A streptococcus
Fusobacterium necrophorum
Mycoplasma pneumoniae
Neisseria gonorrhea
Group C streptococcus
Corynebacterium diphtheria

Question 21

Viral cause of pharyngitis

Answer 21

Adenovirus
Rhinovirus
Epstein-Barr virus
human immunodeficiency virus
Herpes simplex virus
Enterovirus

Question 22

A 17 y.o boy presents to the emergency department with difficulty breathing. He has had a sore throat and fever all week. Chest radiograph show multiple nodules. Blood culture will show

Answer 22

Fusobacterium necrophorum

Question 23

Typical development of retropharyngeal abscess

Answer 23

Neck cellulitis to boil to deep abscess

Pharyngitis to infected lymph node to node cellulitis to phlegmon to abscess

Question 24

Rapid enlargement of one tonsil is highly suggestive of

Answer 24

Tonsillar malignancy

Question 25

In children, diagnosis of airway obstruction is made by

Answer 25

History and physical examination

Question 26

Performed for recurrent or chronic pharyngotonsillitis

Answer 26

Tonsillectomy alone

Question 27

Frequent clinical presentation of cryptic tonsillitis

Answer 27

Halitosis
Chronic sore throat
History of expelling foul-tasting and foul-smelling cheesy lumps

Question 28

Most episodes of acute pharyngotonsillitits

Answer 28

Viral

Question 29

Indications for adenoidectomy alone

Answer 29

Chronic nasal infection (chronic adenoiditis)
Chronic sinus infections that have failed medical management
Recurrent bouts of acute otitis media
Recurrent otorrhea in children with tympanostomy tubes