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Flashcards in Lower Respiratory Disorders Deck (59)
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1

A 4 wo presents in mid-January with a 1 week history of nasal congestion and occasional cough. On the evening prior she had a temp of 102, refused to breastfeed, had paroxysmal coughing, and noisy, labored breathing. You note an ill-appearing infant who is lethargic with tachypnea and intercostal retractions. She does not attend daycare, but has a 3 yo sib who is in daycare and who recently had a cold. Considering the clinical presentation, what is the most likely cause of illness?
a) mycoplasma pneumonia
b) RSV bronchiolitis
c) aspiration pneumonia
d) streptococcal infection of the pharynx

b) RSV bronchiolitis

2

A 4 wo presents in mid-January with a 1 week history of nasal congestion and occasional cough. On the evening prior she had a temp of 102, refused to breastfeed, had paroxysmal coughing, and noisy, labored breathing. You note an ill-appearing infant who is lethargic with tachypnea and intercostal retractions. She does not attend daycare, but has a 3 yo sib who is in daycare and who recently had a cold. Considering the clinical presentation, what would be the treatment of choice?
a) antihistamine, decongestant, and cough suppressant
b) oral antibiotics and follow-up chest radiograph in 2 weeks
c) bronchoscopy with lavage, chest physiotherapy, and respiratory isolation
d) hospitalization, bronchodilators, supplemental oxygen, and nutritional support

d) hospitalization, bronchodilators, supplemental oxygen, and nutritional support

3

Of the following children, which one should not have tuberculin skin testing?
a) a 14 yo whose uncle was recently granted parole after 5 years in prison and is now living with pt's family
b) a 2 yo who was infected with RSV 3 months ago and is currently asymptomatic
c) a 3 mo whose family emigrated to the US from Cambodia 1 month ago
d) an 18 mo whose mother is infected with HIV

b) a 2 yo who was infected with RSV 3 months ago and is currently asymptomatic

4

Which of the following clinical presentations least warrants sweat chloride testing?
a) a 10 yo female sib of a pt newly diagnosed with CF; sib is without pulmonary problems and growth parameters are at 50% for age
b) 2 yo male with recurrent pneumonia and growth parameters at 5% for age
c) 4 yo female with nocturnal cough, which resolves after treatment with bronchodilators and short-term steroids; growth parameters at 10% for age
d) 7 yo female with nasal polyps, mildly hyperexpanded lungs, growth parameters at 25% for age

c) 4 yo female with nocturnal cough, which resolves after treatment with bronchodilators and short-term steroids; growth parameters at 10% for age

5

Of the following diagnostic findings, which one should be referred to a specialist immediately?
a) suspected foreign body aspiration
b) sweat chloride results of 30 mEq/L
c) pulmonary function tests of 85% predicted
d) chest radiograph with hyperexpansion

a) suspected foreign body aspiration

6

What is the most common agent for nonviral pneumonia from older preschool to young adulthood?
a) Mycoplasma/ Chlamydia aureus
b) Staphylococcus aureus
c) Ureaplasma
d) Haemophilus influenza

a) Mycoplasma/ Chlamydia aureus

7

Which one of the following diagnoses would not be part of the differential for recurrent lobar pneumonia in a 2 year old?
a) cystic fibrosis
b) foreign body aspiration
c) atelectasis
d) bronchitis

d) bronchitis

8

The most common clinical presentation of pneumonia includes:
a) cough, fever, tachypnea, and abdominal pain
b) hemoptysis, putrid breath, and weight loss
c) sudden chest pain, cyanosis
d) retractions, stridor

a) cough, fever, tachypnea, and abdominal pain

9

In addition to airway hyper-responsiveness and reversible airway obstruction, asthma is a chronic lung disease characterized by:
a) bronchiectasis
b) inflammation
c) pleural effusion
d) pulmonary edema

b) inflammation

10

The most common trigger for an acute asthma episode in the very young child is:
a) respiratory infections
b) exercise
c) tobacco smoke
d) outdoor allergens

a) respiratory infections

11

Appropriate daily medication for mild persistent asthma should include:
a) an inhaled low-dose corticosteroid
b) short-acting beta2 agonist
c) an oral systemic corticosteroid
d) a cough suppressant

a) an inhaled low-dose corticosteroid

12

Which of the following is not a goal of appropriate asthma management:
a) limited activity and exercise
b) prevent recurrent exacerbations
c) prevent chronic troublesome symptoms
d) maintain near normal pulmonary function

a) limited activity and exercise

13

A 4 yo male with a history of atopic dermatitis and recurrent pneumonias presents with a persistent nighttime cough. His most likely diagnosis is:
a) asthma
b) foreign body aspiration
c) croup
d) cystic fibrosis

a) asthma

14

The most typical chest radiographic finding consistent with the diagnosis of asthma is:
a) normal chest film
b) diffuse airway edema
c) right upper lobe infiltrate
d) hyperinflation

d) hyperinflation

15

When providing asthma education regarding the use of a long acting beta 2 agonist it is important to stress:
a) it should not be used as a quick relief medication
b) may be given every 30 minutes x 3 for rescue therapy
c) may be most beneficial for exercise-induced asthma
d) should never be taken while also using inhaled corticosteroids

a) it should not be used as a quick relief medication

16

An 8 yo with moderate persistent asthma is still having a daily cough. She reports TID use of a short-acting beta 2 agonist and cromolyn sodium at her visit. Your managment plan should be altered to include:
a) broad-spectrum antibiotics and recheck 2 weeks
b) addition of systemic corticosteroids for 5 days
c) replace cromolyn sodium with inhaled corticosteroids
d) addition of an inhaled anticholinergic

c) replace cromolyn sodium with inhaled corticosteroids

17

A 10 yo has recently been diagnosed with mild intermittent asthma. Which of the following is not a routine part of his clinic management?
a) spirometry
b) MDI technique demonstration
c) environmental triggers and control method review
d) school excuse not to participate in PE

d) school excuse not to participate in PE

18

Major contributors to asthma morbidity and mortality are:
a) underdiagnosis and inappropriate treatment
b) an increase in indoor allergies
c) overuse of anti-inflammatory medications
d) an increase in air pollution

a) underdiagnosis and inappropriate treatment

19

The primary treatment of bronchopulmonary dysplasia is:
a) pancreatic enzymes
b) surgical repair
c) adequate oxygenation
d) chest physiotherapy

c) adequate oxygenation

20

The single most predictive factor in the development of bronchopulmonary dysplasia is:
a) birth weight
b) maternal weight
c) maternal education level
d) respiratory infections

a) birth weight

21

The classic radiographic finding in croup is:
a) hyperinflation
b) perihilar lymphadenopathy
c) thumb sign
d) steeple sign

d) steeple sign

22

Unilateral wheezing is a finding suggestive of:
a) croup
b) asthma
c) foreign body aspiration
d) cystic fibrosis

c) foreign body aspiration

23

Which of the following is not characteristic of an apparent life-threatening event (ALTE):
a) change in muscle tone
b) fever
c) change in skin color
d) apnea

b) fever

24

Following an ALTE management and treatment are based on findings from:
a) a thorough history and physical exam
b) an electroencephalogram
c) a chest radiograph
d) a sleep study

a) a thorough history and physical exam

25

The predominant characteristic of a young infant with bronchopulmonary dysplasia is:
a) prolonged fevers
b) hypoxemia on room air
c) recurrent pneumonias
d) chronic hypoinflation

b) hypoxemia on room air

26

The PNP is teaching a group of expectant parents about infant care and illness prevention. It is most important for the PNP to stress:
a) keeping all animals out of the house
b) keeping the infant away from cigarette smoke
c) keeping the infant well covered at night
d) keeping the infant away from crowds

b) keeping the infant away from cigarette smoke

Exposure to cigarette smoke has been associated with increased incidence of illnesses such as asthma, bronchiolitis, and OM in children.

27

Which of the following does not place an infant at increased risk for SIDS?
a) Documented episodes of periodic breathing
b) Prematurity
c) Severe bronchopulmonary dysplasia
d) Apnea of prematurity

a) Documented episodes of periodic breathing

Infantile apnea or periodic breathing (periods of less than 15-20 seconds) without pallor, cyanosis, or limpness is normal and not related to SIDS.

28

In the management of a child with bronchiolitis the early use of which of the following is likely to be the most beneficial?
a) antihistamines
b) broad spectrum antibiotics
c) fluids and nutritional support
d) bronchodilators

c) fluids and nutritional support

Medications are not routinely recommended. Bronchodilators and corticosteroids can be used in select infants.

29

A NICU graduate with bronchopulmonary dysplasia (BPD) has been discharged home. A potential problem area that requires close monitoring is:
a) insufficient caloric intake
b) atrophy of abdominal muscles due to abdominal breathing patterns
c) lack of tactile stimuli due to restrictions on parental handling
d) the predisposition to development of nasal polyps

a) insufficient caloric intake

The pathophysiology of BPD is similar to chronic obstructive lung disease. Diuretic use and limitation of fluids is often part of the management plan. Limitation of fluids may make it difficult to provide adequate caloric intake.

30

A 4 yo child with CF comes to the primary care office with complaints of runny nose, cough, congestion, and fever. You know that children with CF:
a) are more likely to have normal CXR and LFT findings
b) usually are poor eaters with accompanying poor growth
c) routinely take an oral mucolytic agent
d) warrant more liberal use of antibiotics for respiratory infections

d) warrant more liberal use of antibiotics for respiratory infections

Children with CF are more vulnerable to serious respiratory infection, so liberal use of antibiotics is the best course of action.