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emq 1.
|
Match each clinical vignette to the most appropriate diagnosis.
Bacterial tracheitis Croup Peritonsillar abscess Aspirated foreign body Retropharyngeal abscess Scombroid toxicity |
Acute anaphylaxis Acute epiglottitis Diptheria Hereditary angioedema |
EMQ 1.
A 4 year old child presents with a fit of coughing and choking. The symptoms have now resolved but the parents have noted a mid pitched whistling noise on both inspiration and expiration.
Answer: Foreign body aspiration.
Comment: this is a typical history for an aspirated foreign body, and the biphasic nature of the stridor is highly suggestive.
EMQ 2.
A 6 year old boy presents with a high fever and difficulty breathing. He has notable tracheal tug and intercostal recession, and when he coughs his parents say it sounds like a seal barking.
Answer: Croup
Comment: this is a typical presentation of acute laryngotrachealbronchitis (croup) which should be evident to anyone sitting the fellowship exam.
EMQ 3.
A 16 year old boy presents with acute neck pain and fever. The symptoms have occurred rapidly over the preceding twelve hours, and he has a hoarse muffled voice. He describes severe odynophagia and cannot regularly swallow his own secretions.
Answer: acute epiglottitis
Comment: the rapidity of onset, odynophagia and muffled voice (a “hot potato voice”) are suggestive of epiglottic inflammation.
EMQ 4.
A 25 year old diabetic presents with a sore throat and high fever. He has had a sore throat for several days. He has severe torticollis and complains of pain when swallowing his secretions. He has no voice changes.
On examination his vital signs are:
HR 125 /min
BP 90/60 mmHg
RR 24 /min
Temp 38.9 oC
Answer: retropharyngeal abscess
Comment: the severe torticollis and impending sepsis favours a diagnosis of retropharyngeal abscess over simple tonsillitis or peritonsillar abscess.
EMQ 5.
A 14 year old boy presents with severe dyspnoea and distress. He had eaten a plate of prawns at a birthday party 30 minutes previously. He has severe inspiratory stridor on arrival to the ED.
Answer: acute anaphylaxis
Comment: this is a classic history for anaphylaxis.
A 4 year old child presents with a fit of coughing and choking. The symptoms have now resolved but the parents have noted a mid pitched whistling noise on both inspiration and expiration.
Answer: Foreign body aspiration.
Comment: this is a typical history for an aspirated foreign body, and the biphasic nature of the stridor is highly suggestive.
EMQ 2.
A 6 year old boy presents with a high fever and difficulty breathing. He has notable tracheal tug and intercostal recession, and when he coughs his parents say it sounds like a seal barking.
Answer: Croup
Comment: this is a typical presentation of acute laryngotrachealbronchitis (croup) which should be evident to anyone sitting the fellowship exam.
EMQ 3.
A 16 year old boy presents with acute neck pain and fever. The symptoms have occurred rapidly over the preceding twelve hours, and he has a hoarse muffled voice. He describes severe odynophagia and cannot regularly swallow his own secretions.
Answer: acute epiglottitis
Comment: the rapidity of onset, odynophagia and muffled voice (a “hot potato voice”) are suggestive of epiglottic inflammation.
EMQ 4.
A 25 year old diabetic presents with a sore throat and high fever. He has had a sore throat for several days. He has severe torticollis and complains of pain when swallowing his secretions. He has no voice changes.
On examination his vital signs are:
HR 125 /min
BP 90/60 mmHg
RR 24 /min
Temp 38.9 oC
Answer: retropharyngeal abscess
Comment: the severe torticollis and impending sepsis favours a diagnosis of retropharyngeal abscess over simple tonsillitis or peritonsillar abscess.
EMQ 5.
A 14 year old boy presents with severe dyspnoea and distress. He had eaten a plate of prawns at a birthday party 30 minutes previously. He has severe inspiratory stridor on arrival to the ED.
Answer: acute anaphylaxis
Comment: this is a classic history for anaphylaxis.