Quiz 13: Chronic Cough

Front 1

A 4-year-old boy who recently emigrated from eastern Europe presents with his mother to your general pediatrics clinic. His mother reports that he has a chronic nonproductive cough during the day and night, mild wheezing for one month and failure to gain weight (his weight has dropped from the 50th to the 10th percentile for his age). His mother denies any high fevers, rhinorrhea, or night sweats. Which of the following are the next best diagnostic tests?

Back 1

Chest x-ray and tuberculin skin test

Front 2

Signs/symptoms of primary pulmonary tuberculosis?

Back 2

• toddlers: nonproductive cough, mild dyspnea, wheezing, and/or FTT
• children: systemic complaints (may not have), severe cough, sputum production

Front 3

Diagnostic tests for TB?

Back 3

• tuberculin skin test
• CXR

Front 4

T/F: CXR appropriate in all children with chronic cough?

Back 4

Yes

Front 5

Test for asthma?

Back 5

Methacholine challenge (if spirometry normal)(

Front 6

An 11-year old boy presents to clinic with wheezing. Mom states that in the past he has used inhaled albuterol and it has helped with wheezing and shortness of breath. On further history you find out that the patient experiences shortness of breath three times a week and is awakened at night by these symptoms once a week. What is the most appropriate outpatient therapy?

Back 6

Low dose inhaled corticosteroids

Front 7

When to use rescue inhaler (SABA) only?

Back 7

intermittent asthma

symptoms fewer than two days a week

Front 8

When to use low dose ICS

Back 8

mild persistent asthma

(symptoms 3-6 days/week and 3-4 nights/month)

Front 9

When to use medium dose ICS?

Back 9

moderate persistent asthma (daily symptoms)

Front 10

When to use medium ICS, LABA, and oral corticosteroids?

Back 10

severe persistent asthma

Front 11

A 4-year-old patient presents with several months of cough. Mom also reports a history of red skin patches, which are pruritic, and allergies to peanuts, eggs, and mangoes. Which of the following would be characteristic of the cough that this patient would present with?

Back 11

Worse at night

Front 12

What kind of cough disappears at night?

Back 12

habitual cough

Front 13

What kind of cough is associated with bacterial infections?

Back 13

paroxysmal

Front 14

What kind of coughs are associated with croup or subglottic disease?

Back 14

barking coughs

Front 15

What kind of cough are associated with crackles?

Back 15

alveolar or small airway conditions

Front 16

A 9-year-old male presents to your clinic with discoloration under his eyes, persistent cough, and skin rashes. He is found to have wheezing on physical exam and increased lung volume bilaterally on chest x-ray. He has struggled with these complaints over the past three years but recently his symptoms have gotten worse, affecting him every other day. He is afebrile. He is found to have wheezing on physical exam and increased lung volume bilaterally on chest x-ray. What would be the most appropriate treatment for him?

Back 16

Short-acting beta agonist PRN with low-dose inhaled corticosteroid

Front 17

A 10-year-old male comes to the clinic with a chief complaint of progressive cough for two weeks that began gradually. His cough is described as productive and wet with whitish sputum. His mother denies throat pain, vomiting, and diarrhea in his review of systems. His mother reports that he has been febrile up to 101.5°F daily. She thinks he is fatigued and has not eaten well in the past week. On exam, there is air passage throughout all lung fields, with crackles in the lower right lung field, but no other abnormal sounds. What would you likely find in your workup?

Back 17

Alevolar consolidation in the RLL

Front 18

Alevolar consolidation in the RLL is associated with what diagnosis?

Back 18

Pneumonia