MODULE 22 EMQs
Match the correct diagnosis to each clinical vignette.
Croup
Bronchiolitis
Bronchitis
Asthma
Reactive airways disease
Lower respiratory tract infection
Aspirated foreign body
Pneumothorax
Influenza
Upper respiratory tract infection
EMQ 1.
A 2 year old male presents at 9pm to the emergency department with respiratory distress. His parents describe a three day history of rhinorrhoea and coryza. He has notable inspiratory stridor at rest accompanied by tracheal tug and subcostal recession. When he coughs, the sound has a distinct “barking” note.
ANSWER: CROUP
COMMENT: the age and clinical presentation, especially the barking cough, are typical of croup
EMQ 2.
An 8 month old baby presents with her parents. They are concerned that she has not been feeding well over the past 24 hours, and describe a congested nose and dry cough for the previous 3 days. On examination the child has a temperature of 38.1oC, and diffuse fine crepitations throughout both lung fields.
ANSWER: Bronchilitis
COMMENT: a respiratory illness becoming worse on day 3-4 without focal chest signs is typical of bronchiolitis in this age group.
EMQ 3.
A 10 month old child presents with a decreased level of interactivity. His parents say he has not been feeding particularly well. On examination he has a temperature of 39.6oC and a capillary refill of 3 seconds. He has bronchial breath sounds at the left base.
ANSWER: LRTI.
COMMENT: this child, with signs of sepsis, likely has a pneumonia.
EMQ 4.
A 14 month boy is brought to the emergency department by his mother with a persistent dry cough. He is afebrile and otherwise well. On examination he has a polyphonic wheeze with a deeply pitched note confined to the base of his right lung.
ANSWER: swallowed foreign body.
COMMENT: The localisation of the wheeze to the right lower lobe (the termination point of the right main bronchus) is highly suspicious for an aspirated foreign body.
EMQ 5.
A 4 year old boy with a history of eczema presents to the department complaining of difficulty breathing. He has had a dry cough, rhinorrhoea and red eyes for the previous 24 hours. On examination he has a diffuse polyphonic expiratory wheeze throughout both lung fields.
ANSWER: Reactive airways disease
COMMENT: this child likely has bronchospasm in response to an intercurrent LRTI. Although he may subsequently acquire a formal diagnosis of asthma, this is his first visit and such a diagnosis should not be made at this time.
Croup
Bronchiolitis
Bronchitis
Asthma
Reactive airways disease
Lower respiratory tract infection
Aspirated foreign body
Pneumothorax
Influenza
Upper respiratory tract infection
EMQ 1.
A 2 year old male presents at 9pm to the emergency department with respiratory distress. His parents describe a three day history of rhinorrhoea and coryza. He has notable inspiratory stridor at rest accompanied by tracheal tug and subcostal recession. When he coughs, the sound has a distinct “barking” note.
ANSWER: CROUP
COMMENT: the age and clinical presentation, especially the barking cough, are typical of croup
EMQ 2.
An 8 month old baby presents with her parents. They are concerned that she has not been feeding well over the past 24 hours, and describe a congested nose and dry cough for the previous 3 days. On examination the child has a temperature of 38.1oC, and diffuse fine crepitations throughout both lung fields.
ANSWER: Bronchilitis
COMMENT: a respiratory illness becoming worse on day 3-4 without focal chest signs is typical of bronchiolitis in this age group.
EMQ 3.
A 10 month old child presents with a decreased level of interactivity. His parents say he has not been feeding particularly well. On examination he has a temperature of 39.6oC and a capillary refill of 3 seconds. He has bronchial breath sounds at the left base.
ANSWER: LRTI.
COMMENT: this child, with signs of sepsis, likely has a pneumonia.
EMQ 4.
A 14 month boy is brought to the emergency department by his mother with a persistent dry cough. He is afebrile and otherwise well. On examination he has a polyphonic wheeze with a deeply pitched note confined to the base of his right lung.
ANSWER: swallowed foreign body.
COMMENT: The localisation of the wheeze to the right lower lobe (the termination point of the right main bronchus) is highly suspicious for an aspirated foreign body.
EMQ 5.
A 4 year old boy with a history of eczema presents to the department complaining of difficulty breathing. He has had a dry cough, rhinorrhoea and red eyes for the previous 24 hours. On examination he has a diffuse polyphonic expiratory wheeze throughout both lung fields.
ANSWER: Reactive airways disease
COMMENT: this child likely has bronchospasm in response to an intercurrent LRTI. Although he may subsequently acquire a formal diagnosis of asthma, this is his first visit and such a diagnosis should not be made at this time.