Respiratory Disorders

Question 0

3. A 4 month old child has difficulty of breathing but with good feeding. On PE RR was 60/min. HR 110/min. Febrile. (Can’t remember if retractions were present.) According to WHO, what will you give?
   a. Chloramphenicol
   b. Cotrimoxazole
   c. Amoxicillin

Answer 0

according to IMCI:
if with retractions, IM Chloro then refer to hospital
if without retractions, oral cotrimoxazole

Question 1

In Acute respiratory failure, what is to be prioritized:

a. hypoxemia
b. hypercarbia
c. renal perfusion
d. cerebral edema

Answer 1

a. hypoxemia
* NTP Chapter on Respiratory Distress and Failure: Hypoxemia is more dangerous than hypercarbia. Administration of supplemental oxygen is a safe and wise precaution in all patients who are at risk for acute respiratory failure or an exacerbation of chronic respiratory insufficiency, even if there is no initial evidence of hypoxemia.

Question 2

In dengue without warning signs, who are you going to admit:

a. on the 6th day of illness, 2nd day afebrile
b. on the 1st febrile day, well
c. on the 3rd day of illness, with dengue alert area from a far away barangay
d. on the 1st febrile day with brother admitted for dengue

Answer 2

c. on the 3rd day of illness, with dengue alert area from a far away barangay

NTP:
A relatively mild 1st phase with abrupt onset of fever, malaise, vomiting, headache, anorexia, and cough is followed after 2-5 days by rapid clinical deterioration and collapse. In this 2nd phase, the patient usually has cold, clammy extremities, a warm trunk, flushed face, diaphoresis, restlessness, irritability, mid-epigastric pain, and decreased urinary output.

Close monitoring is essential for at least 48 hr, because shock may occur or recur precipitously early in the disease

Question 3

29. A child with cough, fever, being treated as pneumonia…(mahaba din ang case na to). CXR revealed infiltrates in the left lower lung field. Review of previous plates done in the same year show the same infiltrates. What is the diagnosis?
    a. Recurrent Pneumonia
    b. Pulmonary sequestration
    c. Bronchiectasis
    d. (sorry, di ko na rin to maalala) Chronic recurrent aspiration?

Answer 3

(more case details needed?)

Radiographic lung infiltrates resulting from acute pneumonia usually resolve within 1-3 wk, but a substantial number of children, particularly infants, fail to completely clear infiltrates within a 4-wk period. Persistent or recurring infiltrates present a diagnostic challenge

Question 4

Asthmatic patient 10 years old, presents at the ER, awake, O2 sats 90%, RR 30s, retractions, with tight air entry:

a. Mild asthma exacerbation
b. Moderate asthma exacerbation
c. Severe asthma exacerbation
d. Impending respiratory failure

Answer 4

c. Severe asthma exacerbation

Question 5

Patient with mild persistent asthma (in the PPS question, described as daytime attacks 3 times a week with night time attacks 2 times a month, PEF 80%), given diphenhydramine (not sure kung diphen nga binigay, pero may binibigay). What is the treatment?

a. 50mcg fluticasone
b. 50 mcg fluticasone + antileukotriene
c. 120 mcg fluticasone
d. antileukotriene

Answer 5

c. 120 mcg fluticasone

Consult GINA guidelines

Question 6

Barking cough. What is the management? (A case of CROUP) 
A. Salbutamol 
B. Nebulized epinephrine 
C. Cefuroxime?  
D.

Answer 6

B. (Nelson’s 19 th edition)The mainstay of treatment for children with croup is airway management and treatment of hypoxia. Treatment of the respiratory distress should take priority over any testing. Most children with either acute spasmodic croup or infectious croup can be managed safely at home. Despite the observation that cold night air is beneficial, a Cochrane review has found no evidence supporting the use of cool mist in the emergency department for the treatment of croup. Children with both wheezing and croup can experience worsening of their bronchospasm with cool mist. Nebulized racemic epinephrine is an accepted treatment for moderate or severe croup. The mechanism of action is believed to be constriction of the precapillary arterioles through the β-adrenergic receptors, causing fluid resorption from the interstitial space and a decrease in the laryngeal mucosal edema. Traditionally, racemic epinephrine, a 1:1 mixture of the d- and l-isomers of epinephrine, has been administered. A dose of 0.25-0.5 mL of 2.25% racemic epinephrine in 3 mL of normal saline can be used as often as every 20 min. Racemic epinephrine was initially chosen over the more active and more readily available l-epinephrine to minimize anticipated cardiovascular side effects such as tachycardia and hypertension. There is evidence that l-epinephrine (5 mL of 1:1,000 solution) is equally effective as racemic epinephrine and does not carry the risk of additional adverse effects. This information is both practical and important, because racemic epinephrine is not available outside the USA.

Question 7

60. Single best measure for assessing severity of airflow obstruction –

Answer 7

FEV1

p. 15 Asthma Concensus

Question 8

62. A 6 y.o. px with history of fever, ….drooling
    a. Epiglottitis
    b. Bacterial tracheitis

Answer 8

a. Epiglottitis

No drooling in bacterial tracheitis

Question 9

Most common cause of stridor – Laryngomalacia p.1409

2nd most common is subglottic stenosis

Answer 9

Laryngomalacia p.1409

2nd most common is subglottic stenosis