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Question 1
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A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?
Your Answer: Transient tachypnoea of the new-born
Explanation:Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:- Aspiration pneumonia shows infiltrates in the lower lobes of the lungs- Congenitally acquired pneumonia shows patchy, asymmetrical densities- Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease- Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins.
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This question is part of the following fields:
- Respiratory
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Question 2
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A young girl is brought to the ED by her parents because of increased body temperature, rhinorrhoea and an unusual bark-like cough. The girl is also drooling because of excessive salivation. What would be the most appropriate management?
Your Answer: Corticosteroids
Explanation:The symptoms and signs described are typical for epiglottitis which represents a paediatric emergency and the child should be put immediately on corticosteroids.
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This question is part of the following fields:
- Respiratory
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Question 3
Incorrect
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A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?
Your Answer: Boerhaave’s syndrome
Correct Answer: Bleeding oesophageal varices
Explanation:Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.
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This question is part of the following fields:
- Respiratory
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Question 4
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A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the following is the most common adverse effect he might complain about?
Your Answer: Dysphonia
Explanation:Usage of inhaled corticosteroids are less associated with systemic adverse effects. However they are associated with local complications including dental caries and most commonly dysphonia.
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This question is part of the following fields:
- Respiratory
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Question 5
Correct
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A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain. Which of the following is the pain most likely linked to?
Your Answer: Meconium ileus equivalent syndrome
Explanation:Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%. The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.
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This question is part of the following fields:
- Respiratory
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Question 6
Correct
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A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?
Your Answer: Cystic fibrosis
Explanation:Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.
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This question is part of the following fields:
- Respiratory
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Question 7
Correct
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A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?
Your Answer: Macrophage
Explanation:The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
Mast cells are only few in number and fibroblasts lay down collagen.
Basophils are not present.
The giant cell made up of macrophages are the most abundant cells in this inflammatory process. -
This question is part of the following fields:
- Respiratory
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Question 8
Correct
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A chloride sweat test was performed on a 13-year-old boy. Results indicated a high likelihood of cystic fibrosis. This diagnosis is associated with a higher risk of developing which of the following?
Your Answer: Bronchiectasis
Explanation:Cystic fibrosis is a life-threatening disorder that causes the build up of thick mucus in the lungs, digestive tract, and other areas of the body. It is a hereditary autosomal-recessive disease caused by mutations of the CFTR gene. Cystic fibrosis eventually results in bronchiectasis which is defined as a permanent dilatation and obstruction of bronchi or bronchioles.
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This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?
Your Answer: Chest X Ray
Correct Answer: Blood for culture and sensitivity
Explanation:Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.
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This question is part of the following fields:
- Respiratory
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Question 10
Correct
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Surfactant reduces the surface tension at the air/liquid interface in the lung. Which of the following cells produce surfactant in the lung parenchyma?
Your Answer: Type II pneumocyte
Explanation:Pulmonary surfactant is a mixture of lipids and proteins which is secreted by the epithelial type II cells into the alveolar space.
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This question is part of the following fields:
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
