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Pediatric SMLE # > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Which of the following will you find in a croup patient?

A. Nasal flaring

B. Expiratory wheezing

C. Tachypnea

D. Lip cyanosed

A

Answer: all??

Most children have just a “croupy” cough and hoarse cry. Some may have stridor only upon activity or agitation, whereas others may have audible stridor at rest and clinical evidence of respiratory distress. Overall however, a child with croup typically does not appear toxic. Paradoxically, a child with a severe case of croup may have “quiet” stridor due to a significant degree of airway obstruction. In mild cases, respiratory sounds at rest are normal; however, mild expiratory wheezing may be heard. Children with more severe cases have inspiratory and expiratory stridor at rest with visible suprasternal, intercostal, and subcostal retractions. Air entry may be poor. Lethargy and agitation occur and are due to marked respiratory difficulty and, hence, causing hypoxemia and increasing hypercarbia. Respiratory arrest may occur suddenly during an episode of severe coughing. Additional warning signs of severe respiratory disease include tachypnea, tachycardia (out of proportion to fever), and hypotonia. Children unable to maintain adequate oral intake will become dehydrated. Cyanosis is a late, ominous sign.

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2
Q

Child with croup. What will you find in chest auscultation?

A. Wheezing

B. Crepitation

C. Gasp

D. Silent chest ( not sure about this option)

A

Answer: A

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3
Q

Mother brought her 2 years old child to the er with history of upper respiratory tract infection for the last 3 days with mild respiratory distress. This evening the child started to have hard barking cough with respiratory distress. On examination: rr 40/min, associated with nasal flaring, suprasternal & intercostal recessions. What is the most likely diagnosis?

A. Viral pneumonia

B. Bacterial pneumonia

C. Bronchiolitis

D. Acute epiglottitis

E. Laryngotracheobronchitis (croup)

A

Answer: e

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4
Q

What is the most common cause of acute bronchiolitis?

A. Respiratory syncytial virus (rsv)

B. Adenovirus

C. Parainfluenza

D. Mycoplasma pneumonia.

To which part of body it can go ?

A.Spleen

B.Bladder

C. Kidney

D. Liver

A

Answer: a

RSV

Answer: d

Rsv may be recovered from extrapulmonary tissues, such as liver, cerebrospinal fluid, or pericardial fluid

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5
Q

Baby came with barking coughing ( croup case ) what you will hear on pulmonary auscultation?

A. Bronchial breathing

B. Decreased breath sounds

C. Prominent increase inspiratory sound

D. Increase exploratory wheezing

A

Answer: c

inspiratory stridor “uptodate”

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6
Q

Child presented with croup presentation (barking cough … etc.), what is the management in ER ?

A. Inhaled steroid

B. Inhaled epinephrine and oral steroid

C. Oral steroid with antibiotics

D. Empirical antibiotics

A

Answer : b epinephrine

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7
Q

During otoscopy examination of a child, pulling the ear at which direction is going to help to see tympanic membrane?

A. Anterior and inferior

B. Posterior and inferior

C. Anterior and superior

D. Posterior and superior

A

Answer: b

3 years of age & older >> Straighten the patient’s ear canal by pulling the pinna up and back

younger than 3 years of age >> down and back

In general: in children, the auricle should be pulled downward and backward.

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8
Q

Child present to er with fever and sore throat for one week. Now he has paroxysms` cough and cyanosis at end of cough ?

A. Epiglotitis

B. Sinusitis

C. Croup

D. Bronchitis

A

Answer : c

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9
Q

16 months post-partum present with progressive loss of hearing in rt ear , and now in lt , conductive h , dehiscent semilunar canal :

A. Glue ear,

B. Otosclerosis

C. Tympanosclerosis

D. Meniere disease

A

Answer: b

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10
Q

Child came with wheezing and cough, diagnosed to have asthma and his dr. prescribed beclomethasone space inhaler or nebulizer?? twice daily. you will be worried about:

a. Growth retardation
b. Extraocular problem

A

Answer: A

NB. Corticosteroids inhalers can lead to oral thrush (yeast infection of the mouth).

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11
Q

Child football player on short acting β-agonist 5 time a week use + on zafirlukast A. Long β agonist

B. Inhaled steroid

C. Theophylline

D. It’s okay no thing is needed

A

Answer: b

Explanation: the child has uncontrolled asthma for which we should add steroids to his management

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12
Q

Child presented with Asthma exacerbation. The patient did not respond to Beta agonist. What is your next step?

a. Aminophylline
b. Systemic steroid

A

Answer: B

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13
Q

case of pertussis ,, How to diagnose of pertussis?

A

Nasopharyngeal swab

Whooping cough (pertussis)

•Caused by Bordetella pertussis

• Paroxysmal cough followed by inspiratory whoop and vomiting; in infants, apnoea rather than whoop, which is potentially dangerous

• Diagnosis: culture of organism on pernasal swab, marked lymphocytosis on blood film.

•Although erythromycin eradicates the organism, it decreases symptoms only if started during the catarrhal phase. close contacts should receive erythromycin prophylaxis, and unvaccinated infant contacts should be vaccinated.

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14
Q

Boy presented with unilateral nasal obstruction and foul smelling. What is the diagnosis?

A

answer : Foreign body

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15
Q

Child with thumb sign on lateral Xray. What is the diagnosis?

A

Answer: Epiglottitis

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16
Q

Child presented with recurrent nasal congestion, rhinorrhea, sneezing, tearing eyes,..What is the diagnosis?

A

Answer: Allergic rhinitis

is characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, postnasal drainage, and itching of the eyes, nose, and palate with a pattern of allergic triggers.

More insidious effects of the disorder include fatigue, irritability, reduced performance at school and work, and depression

Definitive diagnosis would require specific IgE reactivity during skin-prick or in vitro testing, but a therapeutic trial may be ordered on the basis of a presumptive clinical diagnosis.

Treatment consists of allergen avoidance where possible and pharmacotherapy (antihistamines, corticosteroids, cromoglicate, decongestants, leukotriene receptor antagonists).

Intranasal corticosteroids remain the single most effective class of medications for treating allergic rhinitis.

17
Q

What is the causative organism of croup or typical symptoms of croup (laryngotracheobronchitis)?

A

Answer: Parainfluenza virus

Croup is usually caused by viruses. Bacterial infection may occur secondarily. Parainfluenza virus type 1 is the most common cause of croup; other causes include RSV and influenza virus.

●Croup most commonly occurs in children 6 to 36 months of age. Most cases occur in the fall or early winter.

Treatment :Orally administered corticosteroids are the mainstay for all levels of severity, combined with nebulised epinephrine (adrenaline) in moderate to severe croup to provide temporary relief of the symptoms

18
Q

child with croup what is the best initial investigation to diagnosis?

a. CXR

b-pharyngeal swab

A

Answer: x-ray

chest x ray —> show steeple sign in croup patient

19
Q

Case of croup , what is symptoms associated :

A- Cyanosis

B- wheezing

C- dysphonia

A

Answer: A. cyanosis

20
Q

Child presented with bronchiolitis. What is your management?

A

Answer: Give Oxygen

21
Q

Epiglottitis case

A

Answer: intubate

22
Q

Case of drooling of saliva , tripod position

A

Answer: Epiglotitis

Causes of drooling :

  • Developmental
  • Physiological Teething : Nausea , Foods Emotional stimuli
  • Central nervous system and muscular disorders
  • Mental retardation
  • Oropharyngeal lesions
  • Esophageal lesions
  • Gastroesophageal reflux
  • Drugs and chemicals
  • Familial dysautonomia (Riley-Day syndrome)
  • Wilson disease
  • Rett syndrome
23
Q

Pediatric case of bronchiectasis what is the most important ?

A

Answer: Physiotherapy or home oxygen or steroid

24
Q

Baby with tachypnea, cough, hemoptysis and bilateral lung infiltrates. what is the treatment ?

A. Steroid

B. Antibiotic

C. Surgery

A

Answer: B

lower respiratory tract infection and foreign body aspiration are common causes.

Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution CT

The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause.

Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with close monitoring. Massive hemoptysis ( if blood loss is more than 200 mL per day ). may require additional therapeutic options such as therapeutic bronchoscopy, angiography with embolization, and surgical intervention such as resection or revascularization.

Important causes of massive hemoptysis in children are: bronchiectasis, pulmonary tuberculosis, CHD, bronchial AV malformation,foreign body aspiration, cystic fibrosis, bronchial adenomas, DIC and tracheostomy-related.

Reference: Hemoptysis in Children; See: http://medind.nic.in/ibv/t10/i3/ibvt10i3p245.pdf

25
Q

child with bad smell and tooth is good :::: tonsillitis with crept

A

Answer: Tonsilloliths

Tonsils — The tonsils may be involved in the pathogenesis of bad breath in a small percentage of cases (perhaps 3 percent).

Tonsillectomy based solely upon a complaint of bad breath should be avoided.

Some patients complain of small stones on their tongue or tonsils. when they cough that have a foul odor . These stones are “tonsilloliths” that form in crypts of the tonsils.

26
Q

What is the feature of pneumocyte type 1 ?

A

95% of the alveolar surface

27
Q

Child came with rhinorrhea, cough, respiratory distress, which vaccine can prevent this disease?

A

The symptoms and sings are not sufficient to make dx, and to decide which vaccine we choose ,however there are some DD :

*Croup : barking cough, croyza, inspiratory stridor, peripheral cyanosis, CXR shows steeple sing and com-monly caused by parainfluenza ( no vaccine for parainfluenza)

*Pertussis : caused by bordetella pertussis. Pt. presents with : - catarrhal stage: congestion + rhinorrhea (14days) - Paroxysmal stage : whooping cough + inspiratory whooping followed by vomiting (14-30 days) - Convalescent stage : decrease of coughing (14days) DTaP vaccine has decreased incidence

*Bronchiolitis caused by RSV Pr. Present with wheezing + apnea We can prevent such a disease by giving RSV specific monoclonal antibody(palivizumab) + all children older than 6 months should take influenza vaccine to prevent influenza associated diseases

*Pneumonia we give -Hib and s.pneumonia vaccination -influenza vaccine Palivizumab

28
Q

Child with recurrent URTI with pseudomonas, and atypical organism. Whats the cause:

A. CF

B. low CD4

A

Answer:A cystic fibrosis

Pediatric SMLE # (18 decks)

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