Pediatrics By Lesson– Respiratory+Allergy

A 16-year-old boy with a history of asthma, presents with acute chest pain after basketball training. Examination reveals a hemodynamically and respiratory stable teenager, with normal oxygen saturation in room air, and decreased breath sounds on the right. Chest x-ray is attached.

Which of the following is the most appropriate next step?

A 4-year-old girl has had 5 episodes of wheezing and shortness of breath over the last year. She has been treated with bronchodilators and inhaled steroids as an outpatient. Her recent chest x-ray is normal.

Which of the following predicts continuous symptoms into adulthood?

A 3-year-old boy is undergoing work up due to failure to thrive. History is positive for several large smelly stools per day, and several episodes of pneumonia and cough necessitating inhalation therapy.

Which of the following tests will contribute the most to diagnosis?

A 17-year-old who is followed up by a cardiologist due aortic root dilatation, presents with sudden respiratory distress and left chest pain. He has no fever or additional complaints. Examination reveals he is 180 cm high and weighs 63 Kg. Blood pressure is 120/75, room air saturation is 91%, 105 beats/min, and respiratory rate of 20/min. Heart sounds are normal, his

chest is symmetrical, with slightly reduced breath sounds on the left. Chest X-ray is below.

Which of the following treatments, in addition to supplementary oxygen, is most appropriate for this patient?

A 5-months-old generally well infant who is fed with milk substitutes, has two smoking parents, and a paternal history of asthma. He presents to the emergency room with two days of fever, cough and rhinorrhea, with difficulty in feeding. His oxygen saturation is 91% in room air, he is dyspneic and breathes 40 breaths per minute, and auscultation reveals

slight rales over both lungs.

Which of the following treatments, in addition to supplementary oxygen, is most appropriate for this patient?

A 3-year-old girl presents to the emergency room with drooling and trouble swallowing, which started after playing with a TV remote. She is hemodynamically and respiratory stable, with no drooling, and drinking freely. Chest X-ray is below.

Which of the following is the next step?

3-days-old newborn has not passed stools and is evaluated due to distended abdomen and vomiting. Below is his abdominal X-ray.

Which of the following is the most likely diagnosis?

A child presents to the emergency room with a barking cough beginning acutely
in the middle of the night. Breath sounds and oxygen saturation are normal.
Upper airway X-ray is attached. His condition is relieved by a budesonide inhalation.

Which of the following is the most likely pathogen causing his condition?

A 3-year-old boy presents with chronic purulent rhinorrhea and recurrent otitis media.
Examination reveals right sided heart sounds.
Which of the following may develop in later stages of his most probable disease?

Which of the following most accurately fits the description of transient tachypnea of newborn?

A baby is referred to the ER after an episode of apnea accompanied by cyanosis. Which of the following conditions is consistent with the definition of a high-risk Brief Resolved Unexplained Event (BRUE)?

A 5-year-old male, unvaccinated, presents with a high fever, sore throat, dysphagia, drooling, and progressive shortness of breath over the past few hours. Lateral examination of the neck was performed (image attached)

Which of the following is the most likely cause of his condition?

Which of the following is a risk factor for Sudden Infant Death Syndrome (SIDS)?

A 7-year-old boy with obesity reports mood changes and excessive irritability. At school, he often falls asleep during class. The parents report snoring and secondary nocturnal enuresis.

Which of the following tests will most likely advance the diagnosis of this child?

A 7-year-old boy arrives for evaluation due to complaints of a persistent cough. His medical history is positive for several cases of pneumonia and repeated episodes of excretory ear infections. As part of the investigation of chronic cough, a chest X-ray demonstrates the observed finding (see X-ray).

What additional finding would most likely support the diagnosis?

A male baby aged one year and two months, healthy and vaccinated, arrives at the emergency department due to a sudden stridor. A few hours before his visit, mild hoarseness appeared with complaints that may indicate mild infection in the upper respiratory tract. No fever, saturation 99% on RA. On auscultation to the heart – regular sounds, no murmurs, symmetrical chest, normal expansion. On auscultation to the lungs – coarse crepitations from an upper source.

What is the treatment of choice in this situation?

 A 2-year-old generally well boy, who has been treated in the past with inhalations, presents with acute stridor.
Examination reveals stridor, as well as good and equal breath sounds.

Which of the following is not an appropriate treatment for his condition?

A 3-year-old boy has recurrent pneumonias, chronic rhinorrhea, and recurrent otitis. Workup included a normal sweat test and nasal potential, normal lymphocyte and complement function test, and a normal blood count. Chest x-ray is below.

Which of the following tests will most likely promote diagnosis?

A 2-week-old newborn presents with respiratory distress and cyanosis appearing after birth. The mother describes respiratory distress and cyanosis at rest, which improve when the baby is crying. In addition, she describes slow nursing due to respiratory distress.

Which of the following tests will promote the diagnosis?

A 5-year-old boy with cystic fibrosis presents with recent respiratory deterioration, including exercise intolerance, and exacerbated cough and sputum. Auscultation reveals wheezing and pulmonary function tests reveal deterioration compared to the previous test. There is no evidence of viral disease. He is treated with steroids, and laboratory results include increased IgE and eosinophils.

Which of the following, in addition to steroids, is the most appropriate treatment at this stage?

A 3-year-old boy was born at term, with a normal birth weight after an uneventful pregnancy and labor. He has passed his first stool at 72 hours of age. He is followed up for failure to gain weight, soft stool, steatorrhea, and has had an episode of pancreatitis.

Which of the following tests will promote the diagnosis?

A 1-year-old infant with failure to thrive and recurrent pneumonias, was diagnosed after birth with meconium ileus.

Which of the following is a diagnostic criterion in his most likely disease?

A 3-year-old boy is in intensive care, ventilated and sedated, deteriorates on the 3rd day.

Chest x-ray is attached. Pleural drainage revealed pH 7.3, protein 2.5 gr/dl, WBC 5000/m2, LDH 150 IU/L, glucose 72 mg/dl.

Which of the following is the most likely diagnosis?

A 5-year-old generally healthy boy presents with fever, rhinorrhea, cough, and myalgia over the last 2 days. Examination reveals reactive lymphadenopathy without any other abnormalities.

Blood work is presented in the table.

Which of the following is the most appropriate diagnostic step?

A 2-year-old male with a history of 3 incidents of pneumonia in the base of the left lung. Upon examination in every incident – crackles above the left lung. It should be noted that there is a persistent systolic murmur heard on the left side of the back.

Which of the following diagnoses is the most likely in his case?

A 2-month-old male, healthy until now, has been suffering from a cough and breathing difficulties for the past 3 days.

Upon examination: tachypnea and intercostal retractions. Upon auscultation of the lungs – bilateral diffuse crackles.

What is the most recommended reasonable treatment in this case?

Male, 6 years of age, woke up at the night with stridor that worsens with crying. Upon examination – inspiratory stridor. No respiratory distress. Normal vital signs. Upon auscultation of the lungs – no abnormal findings.

What is the next recommended step in the treatment process?

Which of the following conditions is a risk factor for Sudden infant death syndrome?

A two-year-old toddler was referred to the ER due to stridor. Has had rhinitis and fever for the past 3 days. Attached is a neck X-ray with the finding marked (with an arrow).

Which of the following pathogens is common for his likely diagnosis?

A 9-year-old boy with persistent cough, chronic rhinitis and recurrent otitis.
A chest X-ray is attached.

What is the likely diagnosis?

Attached is the chest X-ray of a 5-year old boy. Pleurocentesis was performed as part of the investigation.

What finding from the fluid will support a diagnosis of an infectious process?

A two-month-old female baby arrives for evaluation due to complaints that have persisted since she was a week old, including, among other things, noisy breathing and stridor mainly when lying on her back, feeding difficulties and slow weight gain. On her examination – the baby is alert and vital, saturation 98% in RA, equal and good air intake, inspiratory stridor is heard, on auscultation to the heart – regular sounds without murmurs, the rest of the examination without findings.

What is the most recommended treatment in this case?

A premature baby was born to a diabetic mother via a Caesarian section in week 27. Following delivery, the baby developed significant respiratory distress and was treated with surfactant.

Which of the following findings can most likely explain his medical condition?

A 3-year-old girl presents with high fever and cough over the last 3 days. Examination reveals decreased breath sounds on the right, and rales over the right lung. Below is her X-ray. High dose amoxicillin was recommended.
On the third day the fever and cough persist, and there is back pain.

Which of the following is the next therapeutic step?

A 16-year-old, generally healthy boy presents with fever, headaches, dyspnea, hemoptysis, malaise, and hematuria. Examination reveals he is pale, with respiratory rate of 24/min, bilateral lung rales with reduced breath sounds on the right, and sensitivity upon sinus percussion. No other abnormal findings.

Which of the following diagnostic tests will facilitate decisions regarding the most likely diagnosis?

A 2-year-old generally well boy, who has been treated in the past with inhalations, presents with acute stridor. Examination reveals stridor, as well as good and equal breath sounds.

Which of the following is not an appropriate treatment for his condition?

A 2-month-old infant, with normal prenatal history, presents with fever, productive cough, and rhinorrhea. Examination reveals dyspnea, chest retractions and diffuse rales on auscultation.

Chest X-ray is negative for a pulmonary infiltrate.

Which of the following is the most appropriate treatment?

A 17-year-old boy presents with shortness of breath and nausea starting a few minutes after being stung by a bee. His examination includes blood pressure of 65/40, and a heart rate of 140 per minute. He improved after been treated with an adrenaline injection. He has been stung by bees twice before without a systemic reaction.
His blood test is significant for increased anti bee venom IgE levels.

Which of the following is the best approach?

A 13-year-old boy presents to the emergency room due to ankle and calf pain, dizziness and pharyngeal pain, that started 20 minutes before, while walking in the forest.
Examination reveals flushing, blood pressure 70/40, heart rate of 130/min, respiratory rate of 30/min, saturation 95% in room air, and the finding in the picture attached.

Which of the following is the mandatory immediate treatment in this case?

A 16-year-old girl presents with facial swelling and shortness of breath which appeared the same morning, and had become worse over the last hours. Her history is positive for a few events of facial swelling that resolved spontaneously. Examination reveals findings in the attached pictures, heart rate of 125/min, respiratory rate of 25 breaths/min, blood pressure 110/75, saturation of 96% in room air, and non-pitting edema of the face, tongue, oral mucosa, and larynx.

Which of the following is the most likely finding in her blood work?

A child is diagnosed with atopic dermatitis. He is referred for examination due to the rash in the photos.

Which of the following is the most appropriate treatment?

A 2-month-old solely breastfed male is evaluated for mucus and occasional small amount of blood in the stool. The infant appears well, afebrile, and gaining weight appropriately. The mother rules out vomiting, rashes, shortness of breath, or restlessness. No allergy is known in the family.

What is the most appropriate initial step in managing the case?

A 6-year-old boy, who suffers from a recurrent itching rash in body folds areas since his first year of life (photo below). In addition, he experiences multiple episodes of nocturnal itching. In the past he had cow milk protein allergy.

Which of the following is the most appropriate treatment? 

A 10-months-old baby was diagnosed with cow milk protein allergy at 3 months of age due to bloody stools. Skin test and milk protein IgE in the serum were negative at the time of diagnosis.

Which of the following will best determine if the infant is still allergic to cow milk protein?

6-month-old female, breastfed; introduction to solids has begun. The mother says that after exposure to citrus fruits, redness and fine sores appear around the mouth. The redness and sores resolve after a few days, and upon repeated exposure, the rash returns. The baby’s sister has an allergy to sesame.

What should be recommended to the mother in this case, and why?

5 years of age, ate peanuts for the first time in his life. Arrived for examination due to generalized redness on the skin, itching and general weakness. Upon admission, pulse 190, BP 60/40 mmHg, 40 breaths per minute, saturation 90%, capillary refill time – 1 second.

What will be the next stage in his treatment?

A 7-week-old boy, has been having watery diarrhea with blood drops, several vomiting episodes and agitation episodes for about a week. Background of breastfeeding and in the past week baby formula has been added to his diet. Examination: no fever, aIert and vital. In relation to his condition, what is the best way to confirm his diagnosis?

A 4-month-old girl, until now has been exclusively breastfed, is brought for examination due to bloody stools. On examination – gaining weight well, vital, soft abdomen, no signs of anal fissure. Stool PCR negative for enteropathogens. The mother indicates that for the past few weeks, she has been fed infant formula.

What is the most recommended treatment in this case?

A 3-year-old female, normally healthy, was discharged about 10 days ago from hospitalization due to pneumonia, treated with intravenous penicillin, referred due to edema and erythema of the hand in the infusion area, accompanied by fever up to 38.7°C, evidence of enlarged lymph nodes and joint pain. What is the best treatment in this case?

A 9-year-old boy was stung by a bee and arrives at the emergency department with widespread redness on the surface of the skin, itching, and general weakness. On admission: pulse 190, blood pressure 60/40 mmHg, 40 breaths per minute, saturation 90%, capillary refill of 1 second.

What will be the immediate next step in the treatment?

A 9-months-old baby with atopic dermatitis develops the extensive rash demonstrated in the picture.

Which of the following is the most recommended treatment?