Rita's Respiratory questions

Question 1

An 8yo presents with cough and fever. PE shows basilar crackles in the LLL. Chest x-rays show small infiltrate the left lower lung. What is the most likely dx?

a) Tuberculosis
b) Strep pneumonia
c) Mycoplasma
d) Staph

Answer 1

b) Strep pneumonia

–if 18yo, may be mycoplasma…

Question 2

A 6 month old presents with new onset of a low-grade fever, runny nose, and mild wheezing. What is the most likely dx?

a) pneumonia
b) bronchiolitis
c) pneumothorax
d) asthma

Answer 2

b) bronchiolitis

wheezing: indicates lower airway involvement
w/ pneumonia: would not have low-grade fever

Question 3

A 2yo presents to the office with sudden respiratory distress and decreased BS at the right base. What is the most likely dx?

a) Asthma
b) Pneumonia
c) Pneumothorax
d) Pleural effusion

Answer 3

c) Pneumothorax

Question 4

Which of the following is usually not seen in croup?

a) high fever
b) brassy cough
c) running nose

Answer 4

a) high fever

–v. atypical: w/high fever, looking toxic –> worry about bronchiolitis

Question 5

An 8yo with a hx of asthma presents with chest pain and decreased breath sounds on the right without wheezing or crackles. What is the most likely dx?

a) asthma
b) pneumonia
c) atelectasis

Answer 5

c) atelectasis

- -> v. common to see on chest x-ray of someone with asthma

Question 6

What is the main cause of pneumonia in a child

Answer 6

c) RSV

Question 7

What are the x-ray findings in bronchiolitis?

a) Normal x-ray
b) Hyperinflation with a flattened diaphragm
c) Peribronchial cuffing
d) Streaky infiltrate

Answer 7

b) Hyperinflation with a flattened diaphragm

Question 8

What drugs do you treat a 5yo with for mild intermittent asthma?

a) Singular
b) Long acting beta agonist and Flovent
c) Short acting beta agonist

Answer 8

c) Short acting beta agonist

Question 9

A child presents with recurrent right lower lobe pneumonia. Which one of the following is not included in your differential dx?

a) Foreign body
b) Aspiration
c) Cystic fibrosis
d) Recurrent mycoplasma pneumonia

Answer 9

d) Recurrent mycoplasma pneumonia

Question 10

What would you expect to hear on auscultation of the back under the clavicle of an asthmatic during an acute exacerbation?

a) Normal breath sounds
b) Inspiratory sound is longer and louder than expiratory phase
c) Expiratory phase is longer than inspiratory phase
d) Inspiratory and expiratory breath sounds are equal

Answer 10

c) Expiratory phase is longer than inspiratory phase

–prolonged expiratory phase = bronchial breath sounds

Question 11

What is the most common cause of pneumonia in a school-aged child?

a) Strep pneumonia
b) Mycoplasma pneumonia
c) H. influenza

Answer 11

a) Strep pneumonia

Question 12

A 4yo child with a hx of pneumonia presents with dullness to percussion, decreased air entry, decreased tactile and vocal fremitus, and voice egophany. What is the most likely dx?

a) Pneumothorax
b) Viral pneumonia
c) Pleural effusion

Answer 12

c) Pleural effusion

Question 13

What is the most common cause of pleural effusion?

a) viral pneumonia
b) bacterial pneumonia
c) foreign body

Answer 13

b) bacterial pneumonia

Question 14

You are seeing a 5 month old baby with retractions, wheezing, slight rales, hyperinflation and atelectasis on x-ray. What is the most likely dx?

a) bronchiolitis
b) pneumonia
c) URI
d) foreign body

Answer 14

a) bronchiolitis

Question 15

A 16yo teenager presents afebrile with bursts of coughing for 6 weeks. What is the organism?

a) Strep pneumonia
b) Mycoplasma pneumonia
c) Pertussis
d) Tuberculosis

Answer 15

c) Pertussis

**key = “bursts” of coughing

Question 16

What kind of breath sounds would be found in the left lower part of the thoracic cavity?

a) Bronchial BS
b) Bronchovesicular BS
c) Vesicular BS heard over most of the lung
d) Tracheal BS

Answer 16

c) Vesicular BS heard over most of the lung

Question 17

What do normal breath sounds sound like?

a) inspiration greater than expiration
b) expiration is equal to inspiration
c) expiration is greater than inspiration

Answer 17

a) inspiration greater than expiration

Question 18

Which of the following is a contraindication to weight lifting?

a) coughing
b) hypertension
c) allergic rhinitis
d) gastroenteritis

Answer 18

b) hypertension

Question 19

What is the first-line tx of choice for pertussis in a child over 1 month?

a) Bactrim
b) Amoxil
c) Azithromycin
d) Erythromycin

Answer 19

c) Azithromycin

( –> when in doubt, choose this!)

erythromycin really not good for the stomach…

Question 20

Based on the new guidelines, which of the following is recommended in caring for a full term 5 month old with normal O2 sat, wheezing, and a dx of bronchiolitis?

a) Ribavirin should be routinely used in this disease
b) Inhaled corticosteroids are effective in caring for pts with this disease
c) Antibiotics should be used in patients with fever and RSV bronchiolitis
d) Bronchodilators should not be routinely used

Answer 20

d) Bronchodilators should not be routinely used