Respirology

Question 1

A 2 year old boy with 2 months of wet cough. He is currently in daycare. There have been no cough free days during this time. 3 months ago he had a witnessed chocking episode on a small toy. Physical examination today is normal. Chest radiograph is normal. The most appropriate step in management:

1. Referral for bronchoscopy
2. Inspiratory/Expiratory chest radiograph
3. Treatment with antibiotics for a persistent bronchitis
4. Re-assurance and watchful waiting

Answer 1

1. Referral for bronchoscopy

Question 2

A 2 year old boy with 1 months of cough. He is currently in daycare. He has coughed most days, however has had a few cough free days. Cough started with starting daycare. Past medical and family history are unremarkable. Physical examination today is normal. The most appropriate step in management:

1. Referral for bronchoscopy
2. Sweat Chloride
3. Trial of inhaled corticosteroids
4. Re-assurance and watchful waiting

Answer 2

4. Re-assurance and watchful waiting

Question 3

3 year old boy with chronic congestion and daily wet cough since infancy, PE tubes for recurrent otitis media and a history of prolonged oxygen need at birth (born at term). On examination bilateral bronchovesicular breath sounds. Chest radiograph reveals bilateral areas of atelectasis. The best test would be:

1. Sweat Test
2. Ciliary Electron Microscopy
3. CT Chest
4. Immunoglobulins

Answer 3

2. Ciliary Electron Microscopy

Question 4

An 10 year old girl with asthma is prescribed fluticasone 50 mcg 1 puff twice daily. She has no night time symptoms, has daytime symptoms of cough/wheezing 4 times/week most often while playing hockey. The most appropriate next step:

1. Taking salbutamol before exercise
2. Increasing dose of fluticasone to 125 mcg 1 puff twice daily
3. Adding montelukast
4. Adding a long acting beta agonist

Answer 4

2. Increasing dose of fluticasone to 125 mcg 1 puff twice daily

Question 5

A 3 year old boy has been diagnosed with 3 pneumonia in the left lower lobe. A repeat chest radiograph at 6 weeks post treatment reveals a persistent unchanged opacity. The most important test would be:

1. Sweat Chloride
2. CT scan without contrast
3. Flexible bronchoscopy
4. CT scan with contrast

Answer 5

4. CT scan with contrast

Question 6

An 8 year old boy is snoring nightly with some pauses. He has no daytime somnolence, but has poor attention and worsening grades at school. He has large adenoids on xray. The most appropriate next step:

1. Referral for tonsillectomy and adenoidectomy
2. Referral for Polysomnography
3. Overnight Oximetry
4. Reassurance

Answer 6

2. Referral for Polysomnography