Quiz 12: Cough

Front 1

A 12-year-old male presents to the ED with complaints of anorexia, weight loss, and persistent cough, with nocturnal coughing fits that have been waking him from sleep for the past three weeks. He denies fever, chills, myalgia, sore throat, or rhinorrhea. The patient presented to his primary care physician one week prior with the same complaint, and was treated with amoxicillin and bronchodilator therapy. His chest x-ray was negative for infiltrates at that visit. The patient's symptoms did not improve with this regimen. The cough became more frequent, sometimes causing emesis. Which of the following is the most likely diagnosis?

Back 1

Infection with Bordetella pertussis in the paroxysmal stage

Front 2

Paroxysmal stage of pertussis?

Back 2

• lasts 4-6 weeks
• repetitive, forceful coughing episodes followed by massive inspiratory effort
• whoop sounding cough
• conjuctival hemorrhages
• pneumothoraces
• increased intrathoracic and ICP

Front 3

Treatment of pertussis?

Back 3

• Azithromycin
  
• Clarithromycin
  
• Erythromycin
  

Front 4

T/F: reactive airway disease does not improve with bronchodilator therapy?

Back 4

False

Front 5

Catarrhal stage of pertussis?

Back 5

1-2 weeks

indistinguishable from URI

Front 6

Mycoplasma pneumonia associated with..?

Back 6

fevers

findings on CXR and lung exam

Front 7

Croup?

Back 7

Seal bark

week or less

fever

Front 8

A 12-month-old previously healthy girl presents with cough and mild subcostal retractions. She is afebrile, and physical exam reveals asymmetric wheezing. Chest x-ray demonstrates unilateral air trapping. What is the most likely diagnosis?

Back 8

Foreign body aspiration

Front 9

Croup?

Back 9

bark cough

subglottic inflammation

inspiratory stridor

Front 10

Pneumonia findings?

Back 10

increased WOB

cough

febrile

crackles

decreased breath sounds/area of consolidation

CXR -> lobar diffuse infiltrates

Front 11

Acute bronchiolitis findings?

Back 11

wheezing

febrile

CxR atelectasis

diffuse opacities from bronchiole obstruction

Front 12

Asthma

Back 12

• bilateral wheeze
  
• CXR -> global air trapping
  
• hyperinflated lungs
  

Front 13

A 10-month-old infant is brought to the Peds ED by her parents, who say she has been coughing persistently for the last three hours. The parents were watching a movie at home when they first noticed their daughter coughing. Patient is a vaccinated, well-nourished infant in moderate distress with retractions, nasal flaring, and grunting. On auscultation, you immediately notice diminished breath sounds in the right lung with normal breath sounds on the left. What other associated physical exam finding do you expect to hear?

Back 13

Asymmetric breath sounds and wheezing

Front 14

Stridor

Back 14

URI e.g. epiglottitis

Front 15

Asymmetric breath sounds and wheezing

Back 15

foreign body aspiration

Front 16

Rhonchi

Back 16

bronchitis

pneumonia

Front 17

Crackles

Back 17

pneumonia

CHF

Front 18

Bronchial breath sounds

Back 18

Pneumonia

Front 19

Susie is a 3-year-old girl brought into the clinic by her mother because she has a gradually worsening cough and she has been having trouble breathing. Her mother says Susie sounds like she is barking when she coughs. Susie is up to date with her vaccinations. Susie’s mom always watches her when she’s playing. On physical exam, you note that Susie has inspiratory stridor. She does not have wheezing, there are no retractions, and she has symmetrical breath sounds. No pseudomembranes are appreciated on physical exam. What is Susie’s most likely diagnosis?

Back 19

Croup (laryngotracheobronchitis)

Front 20

Pertussis sound

Back 20

whoop

Front 21

Joe, a previously healthy 11-month-old male with 5-day history of a “cold,” is brought to the ED by mom for one day of acute worsening cough and intermittent wheezing. Per mom, the cough was initially dry but has become more “phlegmy,” making it difficult for Joe to breathe, particularly when he is feeding or more active. His immunizations are up to date, and he has no known allergies. His family history is significant for a 6-year old sister who was diagnosed with asthma four years ago. On exam, Joe is afebrile, mildly tachypneic with normal O2 saturation. He has prominent nasal flaring and mild subcostal retractions. He has clear rhinorrhea but no evidence of oropharyngeal erythema. Lung exam reveals decreased breath sounds and wheezes on the right. What is the most likely diagnosis?

Back 21

Foreign body aspiration

Front 22

Foreign body aspiration

Back 22

• acute onset of wheeze
  
• asymmetric breath sounds
  
• CXR -> decreased deflation on affected side
  
• atelactasis (whiting out)
  
• mediastinal shift towards affected side