Diagnose me
Asthma
Name that movie by its tagline
Cystic Fibrosis
Miscellaneous
100
In October, a 2 year old boy presents with: high pitched barking cough, inspiratory stridor, and an AP neck X-ray shows subglottic narrowing. What is the diagnosis?
What is Laryngotracheobronchitis (CROUP), commonly occurs between 3 months and 3 years with an average age of 2. Boys are more likely than girls to be affected; most incidents occur in fall and winter; parainfluenza is the most common cause
100
You are seeing one of your 10 year old patients for follow up of asthma, which was intermittent at last visit. She reports well controlled symptoms with short acting beta-agonist inhaler. Although it doesn’t bother her, she admits to waking up about 3 times per month with cough. She uses her SABA inhaler daily. She also has trouble keeping up with her classmates in gym class, but attributes this to not liking sports. What is her current asthma severity classification?
What is Moderate Persistent [see asthma chart]
100
“One dream. Four Jamaicans. Twenty below zero.”
What is Cool Runnings
100
What ENT physical finding should always prompt you to think about CF?
What is Nasal polyps, especially if bilateral. May occur in up to 50% of children with CF. Another cause of nasal polyps is Aspirin exacerbated respiratory disease [nasal polyps, acetylsalicylic acid intolerance, and asthma], which can be seen in up to 40% of patients with nasal polyposis. Pay attention to supporting factors for CF in question stem such as GI manifestations, FTT…
100
Which of the following conditions causes biphasic stridor? [laryngomalacia, croup, vascular ring, subglottic stenosis, tracheomalacia]
What is Subglottic stenosis
200
A 3yr girl presents with abrupt onset of : high fever, sore throat, drooling, and stridor. She is given a treatment for croup but does not respond. She deteriorates rapidly and is intubated in the ER. Her parents don't believe in immunizations. What is the most likely diagnosis?
What is Epiglottitis Likely secondary to H influenza B since child isn't vaccinated. Remember other infections can cause epiglottitis too. Can see a thumbprint sign on xray but don't wait to get xray want to intubate immediately (most experienced person).
200
Name 3 other conditions that wheezing may be seen with?
What is Congestive heart failure, aspiration, pulmonary foreign body, cystic fibrosis, alpha-1 anti-trypsin. All that wheezes is not asthma, though episodic, reversible wheezing in an otherwise well child is most likely due to asthma.
200
“There are 2.7 trillion fish in the ocean. They’re looking for one”
What is Finding Nemo
200
A child presents with a permanent dilation of bronchi resulting from airway obstruction by retained mucus secretions. He has symptoms of chronic cough, purulent sputum, fever, and weight loss with finger clubbing, rales, and decreased air entry. Which of the following is most likely associated with this presentation?
What is Bronchiectasis [a disease state characterized by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is associated with a wide range of disorders, but it usually results from bacterial infections, such as staphylococcus or pertussis.]
200
What is the most common cause of true pediatric hemoptysis in the US?
What is Cystic Fibrosis
300
A 15yo boy presents with abrupt onset of fever, cough with wheeze, joint pain, and rash. What is the most likely bacteria to cause this?
What is Mycoplasma Pneumonia It is associated with extrapulmonary manifestations including maculopapular rash or urticarial, hemolytic anemia, polyarthritis, pancreatitis, hepatitis, pericarditis, myocarditis, and neurologic complications
300
Assessment of lung function indices using this tool in asthmatic patient >5 years of age, on an annual basis, is recommended to obtain objective measures of asthma control.
What is Spirometry. It is objective and can be used in children as young as 5. Helpful values- FEV1 (forced expiratory volume at 1 second) and FEV1/FVC (forced vital capacity). Peak flow is useful to evaluate airway obstruction, but poor data for diagnostic purposes/reference values vary widely. Other asthma assessment tools, such as asthma control test, childhood asthma control test, asthma control questionnaires are recommended to be routinely used in ambulatory management.
300
“She brought a small town to its feet and a huge corporation to its knees”
What is Erin Brockovich
300
What does the test screening for CF on newborn screens measure?
What is Immunoreactive trypsinogen [IRT], implemented in all 50 states. Made by the pancreas, increased in CF [but can also be increased in prematurity or after stressful deliveries.
300
Which of the following is the most sensitive diagnostic test for pleural effusion? -Clinical diagnosis, not requiring studies -upright CXR -lateral decubitus -ultrasound -thoracocentesis
What is Ultrasound
400
A 15 year old girl with asthma presents with recurrent episodes of: Malaise, Coughing up brown-mucus plugs, Occasional Hemoptysis, Eosinophilia, High IgE. She improves with corticosteroid therapy, but 2-3 months later, the signs and symptoms recur. What is likely causing the recurrent episodes?
What is Allergic Bronchopulmonary Apergillosis (ABPA).
400
Name the 2 MAJOR and 3 minor criteria of the asthma predictive index
Major: parent with asthma; patient with eczema minor: patient with allergic rhinitis; wheezing APART from colds; Eosinophilia (>/=% on CBC). Applies to patients 3 years and younger to help determine likelihood of a later diagnosis of asthma. While specificity is good, the score is not a good screening tool — it does not detect many patients who will later be diagnosed with asthma.
400
“An adventure 65 million years in the making”
What is Jurassic Park
400
A 16-year-old adolescent is brought to the emergency department for unsteadiness and stumbling while walking, which was first noticed 4 days ago. She has a history of cystic fibrosis and is non-compliant with follow up and medications. On examination, she appears thin and malnourished. She has an ataxic gait and diminished deep tendon reflexes in the lower extremities, as well as some generalized weakness in the lower extremities. Which vitamin deficiency is responsible for her symptoms?
What is Vitamin E… CF patients have difficulty absorbing the fat-soluble vitamins [ADEK]. Vitamin E deficiency manifests as generalized weakness, decreased deep tendon reflexes, hemolytic anemia, visual changes, and ataxia. Vitamin A deficiency is associated with blindness, defective tooth enamel, decreased growth, and a decreased immune response. Vitamin D deficiency results in a wide array of clinical presentations, including seizures and tetany (due to hypocalcemia), failure to thrive, hypotonia, widened cranial sutures, bony changes, developmental delay, delayed tooth eruption, and bowed legs.
400
A 3 yo boy presents with a history of barking cough at night and mild stridor. The next day the child is perfectly healthy. At night the symptoms reoccur. This goes on for at least 3 nights. What is the most likely diagnosis?
What is Spasmodic croup (non-infectious). May be related to GER.
500
A 17yo boy was visiting his grandparents in Indiana over the summer. Two months after cleaning out his grandfathers chicken coop he presents with: mild respiratory symptoms, low grade fever, and CXR shows few focal infiltrates with hilar adenopathy. What is the most likely etiology?
What is Histoplasmosis; most cases are asymptomatic or with mild symptoms classically it is seen in the Mississippi and Ohio river valleys it is associated with chickens and cave dwelling animals such as bats.
500
A common, but frequently overlooked diagnosis that can mimic asthma. Can be worsened by postnasal drip and GERD. Common in teenagers. Flow volume loop will demonstrate truncated inspiratory loop, normal expiratory loop, indicating dynamic airflow obstruction
What is Vocal Cord Dysfunction; an involuntary closure of the vocal cords that typically occurs during exercise. Patients are typically high achieving/competitive. Will frequently indicate region of larynx when asked to show where air is getting blocked. -Respond well to targeted breathing and relaxation exercises with specialized speech therapist.
500
"Work Sucks"
What is Office Space?
500
What type of dehydration are patients with CF most at risk for?
What is Hypochloremic, hyponatremic, due to excess epithelial sodium losses. Important, especially in Florida’s heat, increased sodium chloride supplementation is needed in settings of excessive sweating, high ambient temperature/humidity, strenuous exercise, but also fever, vomiting, or diarrhea. Infants are also at a higher risk compared to older children due to their larger relative body surface areas. BE careful, increasing a patient’s free water would increase their risk of hypochloremia and hyponatremia.
500
What is the main benefit of using high frequency oscillating ventilation over conventional ventilation?
What is Reduced pulmonary barotrauma. HFOV can achieve acceptable oxygenation at lower pressures, reducing the risk of barotrauma to the lungs and can better synchronize with the infants own respiratory effort. Commonly used in PIE and CDH [causes of pulmonary hypoplasia]
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