Pulmonology Lect 7- Croup ETC

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Pulmonology Lect 7- Croup ETC - Quiz

Croup, influenza, acute bronchitis, bronchiolitis, pertussis, ARDS, SARS


Questions and Answers
  • 1. 

    Which disorder is charaacterized by a distincively brassy cough combined with  hoarseness, inspiratory stridor, and signs of respiratory distress?

    • A.

      Influenza

    • B.

      Croup

    • C.

      Acute Bronchitis

    • D.

      Bronchiolitis

    • E.

      Pertussis

    Correct Answer
    B. Croup
    Explanation
    Croup is characterized by a distinctively brassy cough combined with hoarseness, inspiratory stridor, and signs of respiratory distress. Influenza, acute bronchitis, bronchiolitis, and pertussis do not typically present with these specific symptoms.

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  • 2. 

    T/F Viral croup has a gradual onset and course

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Viral croup is a respiratory infection that primarily affects young children. It is characterized by inflammation of the upper airway, causing symptoms such as a barking cough, hoarseness, and difficulty breathing. The onset and course of viral croup are typically gradual, with symptoms starting off mild and worsening over a period of a few days. This is why the statement "Viral croup has a gradual onset and course" is true.

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  • 3. 

    What are the signs and symptoms of croup?

    • A.

      Respiratory distress

    • B.

      Inspiratory stridor

    • C.

      Barking cough

    • D.

      Low or high grade fever (more often high)

    • E.

      Low or high grade fever (more often low)

    Correct Answer(s)
    A. Respiratory distress
    B. Inspiratory stridor
    C. Barking cough
    E. Low or high grade fever (more often low)
    Explanation
    The signs and symptoms of croup include respiratory distress, which refers to difficulty in breathing; inspiratory stridor, which is a high-pitched sound heard during inhalation; barking cough, which is a distinctive cough sound resembling a seal or a dog; and low or high grade fever, with the fever more commonly being low rather than high.

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  • 4. 

    How do you diagnose croup?

    • A.

      Chest X ray showing bilateral infiltrates

    • B.

      CT scan showing calcifications in the lungs and spleen

    • C.

      Soft tissue neck x ray showing the classic narrowing of the trachea in the AP view showing steeple sign or wine bottle sign

    • D.

      Soft tissue neck CT showing narrowing of the epiglottis

    Correct Answer
    C. Soft tissue neck x ray showing the classic narrowing of the trachea in the AP view showing steeple sign or wine bottle sign
    Explanation
    The correct answer is "soft tissue neck x ray showing the classic narrowing of the trachea in the AP view showing steeple sign or wine bottle sign." This is because croup is a viral infection that causes inflammation and swelling of the upper airway, including the trachea. The narrowing of the trachea can be seen on a soft tissue neck x-ray, specifically in the AP view, and it appears as a characteristic "steeple sign" or "wine bottle sign." This imaging finding is helpful in diagnosing croup and distinguishing it from other conditions that may cause similar symptoms.

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  • 5. 

    T/F Croup in children is more serious than croup in an adult

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Croup is a respiratory condition that primarily affects children, particularly those under the age of 5. It is caused by inflammation and swelling of the airways, leading to symptoms such as a barking cough and difficulty breathing. While croup can occur in adults, it is generally milder compared to children. This is because children have narrower airways, making them more susceptible to airway obstruction. Additionally, children have less developed immune systems, which can result in a more severe response to respiratory infections. Therefore, croup in children is generally considered more serious than in adults.

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  • 6. 

    What is the non drug treatment for croup?

    • A.

      Analgesics and a cough preparation

    • B.

      Rest in bed

    • C.

      Humidified air from a hot shower or bath or hot or cold steam from a vaporizer or nebulizer- continue until the cough subsides

    • D.

      Cough supressants, fluids to prevent drying of secretions, smoking cessation, and antihistamines

    • E.

      Hydration, humidification, and oxygen supplementation

    Correct Answer
    C. Humidified air from a hot shower or bath or hot or cold steam from a vaporizer or nebulizer- continue until the cough subsides
    Explanation
    The non drug treatment for croup is humidified air from a hot shower or bath or hot or cold steam from a vaporizer or nebulizer. This treatment should be continued until the cough subsides. This helps to soothe the airways and reduce inflammation, making it easier for the child to breathe and reducing coughing symptoms.

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  • 7. 

    What are the signs a croup patient exhibits when they are in need of hospitalization?

    • A.

      Cyanosis, decreased LOC, progressive stridor, or toxic appearing

    • B.

      Necrosis of epithelium

    • C.

      Acute sinusitis, otitis media, and purulent bronchitis, and pneumonia

    • D.

      Rhabdomyolysis

    • E.

      Reye's syndrome

    Correct Answer
    A. Cyanosis, decreased LOC, progressive stridor, or toxic appearing
    Explanation
    The signs listed in the correct answer indicate that a croup patient may need hospitalization. Cyanosis refers to a bluish discoloration of the skin and mucous membranes, which can be a sign of inadequate oxygenation. Decreased LOC (level of consciousness) suggests that the patient's mental status is deteriorating. Progressive stridor refers to a high-pitched, noisy breathing sound that worsens over time and may indicate airway obstruction. A toxic appearance implies that the patient appears very ill and may have systemic involvement. These signs collectively indicate a severe and potentially life-threatening condition, necessitating hospitalization for further evaluation and management.

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  • 8. 

    T/F Inspiratory stridor at rest in a child is very worry-some

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Inspiratory stridor at rest in a child is very worrisome because it can indicate a potentially serious obstruction in the upper airway. This could be caused by conditions such as croup, epiglottitis, or a foreign body obstruction. Inspiratory stridor refers to a high-pitched sound heard during inhalation, and if it occurs at rest, it suggests that the airway is significantly narrowed or blocked. Prompt medical attention is necessary in such cases to ensure proper evaluation and management of the underlying cause.

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  • 9. 

    What medication should be used for hospitalized croup patients or moderately ill patients to try to eliminate the need for intubation during the first 24-48 hours when the illness is most severe?Keep the child in the ER for at least 4 hours to avoid a rebound with worse symptoms

    • A.

      Albuterol

    • B.

      Racemic epinephrine (Vaponefrin)

    • C.

      Oseltamivir (Tamiflu)

    • D.

      Aznamivir (Relenza)

    Correct Answer
    B. Racemic epinephrine (Vaponefrin)
    Explanation
    Racemic epinephrine (Vaponefrin) should be used for hospitalized croup patients or moderately ill patients to try to eliminate the need for intubation during the first 24-48 hours when the illness is most severe. This medication helps to reduce airway inflammation and can improve breathing in these patients. It is commonly used in the treatment of croup to relieve symptoms and prevent the need for more invasive interventions like intubation.

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  • 10. 

    George recommends giving a steroid to treat croup. What is the recommended steroid?

    • A.

      Budesonide

    • B.

      Glucocorticoids

    • C.

      Prednisone

    • D.

      Dexamethasone

    Correct Answer
    D. Dexamethasone
    Explanation
    The recommended steroid for treating croup is dexamethasone.

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  • 11. 

    A child presents with a fever of 38.9, a runny nose, cough, and noisy breathing on inspiration. After further evaluation, the child's mother describes the symptoms as getting worse at night. What is the most likely diagnosis?

    • A.

      Influenza

    • B.

      Acute bronchitis

    • C.

      Acute laryngotracheitis (viral croup)

    • D.

      Pertussis

    Correct Answer
    C. Acute laryngotracheitis (viral croup)
    Explanation
    Based on the symptoms described, including fever, runny nose, cough, and noisy breathing on inspiration, along with worsening symptoms at night, the most likely diagnosis is acute laryngotracheitis (viral croup). Croup is a viral infection that causes inflammation in the upper airway, specifically the larynx and trachea. The hallmark symptom of croup is a barking cough, which can be more severe at night due to increased inflammation and narrowing of the airway. Other symptoms can include a hoarse voice, difficulty breathing, and a low-grade fever.

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  • 12. 

    T/F Croup involves the larynx, trachea, and bronchi

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Croup is a respiratory condition that primarily affects the larynx, trachea, and bronchi. It is characterized by inflammation and swelling of these airways, leading to symptoms such as a barking cough, hoarseness, and difficulty breathing. Therefore, it is correct to say that croup involves the larynx, trachea, and bronchi.

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  • 13. 

    T/F People who die from the flu usually die from secondary bacteria pneumonia

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    People who die from the flu usually die from secondary bacterial pneumonia. This is because the flu weakens the immune system, making it easier for bacteria to infect the lungs and cause pneumonia. This secondary infection can be more severe and life-threatening than the flu itself. Therefore, it is true that people who die from the flu usually die from secondary bacterial pneumonia.

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  • 14. 

    T/F Influenza is transmitted by the respiratory route?

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Influenza is transmitted by the respiratory route. This means that the virus spreads through droplets that are produced when an infected person coughs, sneezes, or talks. These droplets can then be inhaled by others, allowing the virus to enter their respiratory system and cause infection. This mode of transmission is why it is important to practice good respiratory hygiene, such as covering the mouth and nose when coughing or sneezing, to prevent the spread of influenza.

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  • 15. 

    T/F You as a clinician can distinguish influenza A and B from each other based on the patients presentation

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    As a clinician, it is not possible to distinguish between influenza A and B based solely on the patient's presentation. Both types of influenza cause similar symptoms such as fever, cough, sore throat, and body aches. Laboratory testing is required to accurately identify the specific strain of influenza virus.

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  • 16. 

    When is flu season? (Click all that apply)

    • A.

      Winter

    • B.

      Summer

    • C.

      Spring

    • D.

      Fall

    Correct Answer(s)
    A. Winter
    D. Fall
    Explanation
    Flu season typically occurs during the winter and fall. This is because the influenza virus thrives in colder temperatures and lower humidity, making it easier for the virus to spread. Additionally, people tend to spend more time indoors during these seasons, increasing the likelihood of close contact and transmission of the virus. Spring and summer, on the other hand, have warmer weather and higher humidity, which create less favorable conditions for the virus to survive and spread.

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  • 17. 

    T/F Pandemics are associated with type A influenza infections

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Pandemics are indeed associated with type A influenza infections. Type A influenza viruses are known to cause pandemics because they have the ability to undergo significant genetic changes, leading to the emergence of new strains that can spread rapidly and cause severe illness in humans. These pandemics can have a global impact and result in high mortality rates. Type A influenza viruses have caused several pandemics throughout history, including the 1918 Spanish flu pandemic and the more recent H1N1 pandemic in 2009.

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  • 18. 

    A patient presents with a fever for the last 6 days, chills, malaise, myalgias, substernal soreness, headache, nasal congestion, and nausea. The patient denies a productive cough, but does have symptoms of a head cold (coryza) and a sore throat. What is the probable diagnosis based on this description?

    • A.

      Croup

    • B.

      Avian Flu

    • C.

      Influenza

    • D.

      Bronchiolitis

    Correct Answer
    C. Influenza
    Explanation
    Based on the symptoms described, the most probable diagnosis is influenza. The patient presents with fever, chills, malaise, myalgias, headache, nasal congestion, and nausea, which are all common symptoms of influenza. Additionally, the patient has symptoms of a head cold (coryza) and a sore throat, which can also be seen in influenza cases. Croup, avian flu, and bronchiolitis do not typically present with all of these symptoms, making influenza the most likely diagnosis.

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  • 19. 

    How do you diagnose influenza?

    • A.

      Rapid lab testing from bronchial or throat swabs (usually available during the epidemic season)

    • B.

      Rapid lab testing from nasal or throat swabs (usually available during the epidemic season)

    • C.

      Over-night lab testing from bronchial or throat swabs

    • D.

      Over-night lab testing from nasal or throat swabs

    Correct Answer
    B. Rapid lab testing from nasal or throat swabs (usually available during the epidemic season)
    Explanation
    Rapid lab testing from nasal or throat swabs is the preferred method for diagnosing influenza. This method allows for quick and accurate detection of the virus, especially during the epidemic season when influenza cases are more common. By analyzing samples taken from the nose or throat, the lab can identify the presence of the influenza virus and provide a timely diagnosis. This approach is more efficient compared to over-night lab testing, which may lead to delays in diagnosis and treatment.

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  • 20. 

    What is the treatment window for influenza?

    • A.

      24 hours

    • B.

      24-48 hours

    • C.

      48-72 hours

    • D.

      72 hours

    Correct Answer
    B. 24-48 hours
    Explanation
    The treatment window for influenza is typically within 24-48 hours. This means that it is most effective to start antiviral medication within this time frame after experiencing symptoms. Starting treatment early can help reduce the severity and duration of the illness. After 48 hours, the effectiveness of antiviral medication may decrease, so it is important to seek medical attention as soon as possible if you suspect you have influenza.

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  • 21. 

    What predisposes a patient with influenza to secondary bacterial infections?

    • A.

      Necrosis of the nasal mucosa only

    • B.

      Necrosis of the oral mucosa only

    • C.

      Necrosis of the primary bronchioles only

    • D.

      Necrosis of the respiratory epithelium

    Correct Answer
    D. Necrosis of the respiratory epithelium
    Explanation
    Influenza can cause necrosis of the respiratory epithelium, which is the lining of the respiratory tract. This damage weakens the immune defenses of the respiratory system, making it easier for bacteria to invade and cause secondary infections. The respiratory epithelium normally acts as a barrier against bacteria, so when it is damaged, bacteria can more easily enter the body and cause infections. This is why necrosis of the respiratory epithelium predisposes a patient with influenza to secondary bacterial infections.

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  • 22. 

    What are the complications of influenza? (click all that apply)

    • A.

      Coccidiomycosis pneumonia

    • B.

      Pneumococcal pneumonia

    • C.

      Streptococcal pneumonia

    • D.

      Staphylococcal pneumonia

    Correct Answer
    B. Pneumococcal pneumonia
    Explanation
    Pneumococcal pneumonia is a complication of influenza. Influenza weakens the immune system, making individuals more susceptible to secondary bacterial infections such as pneumococcal pneumonia. This type of pneumonia is caused by the bacteria Streptococcus pneumoniae and can lead to severe respiratory symptoms and even death in some cases.

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  • 23. 

    What groups of people are at high risk for influenza complicaitons?

    • A.

      Young and old

    • B.

      Middle aged men

    • C.

      Middle aged women

    • D.

      Elderly and chronically ill

    • E.

      Chronically ill patients only

    Correct Answer
    D. Elderly and chronically ill
    Explanation
    Elderly individuals and those who are chronically ill are at a higher risk for complications from influenza. This is because their immune systems may be weaker, making it harder for them to fight off the virus and its effects on the body. Additionally, chronic illnesses can weaken the body's overall health and ability to recover from illness, further increasing the risk of complications. It is important for these high-risk groups to take extra precautions, such as getting vaccinated and practicing good hygiene, to prevent influenza and its potential complications.

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  • 24. 

    What is also known as fatty liver with encephalopathy that is associated with aspirin in children during a viral infection? Hint: it is characterized by progressive hepatic failure and encephalopathy

    • A.

      ARDS

    • B.

      SARS

    • C.

      Crutzfield-jacob syndrome

    • D.

      Reye's syndrome

    Correct Answer
    D. Reye's syndrome
    Explanation
    Reye's syndrome is a condition characterized by fatty liver and encephalopathy that occurs in children during or after a viral infection, often associated with the use of aspirin. It is known for its progressive hepatic failure and encephalopathy. ARDS and SARS are respiratory conditions, while Crutzfield-Jacob syndrome is a neurodegenerative disorder. Therefore, Reye's syndrome is the correct answer.

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  • 25. 

    How do you treat Reye's syndrome?

    • A.

      Cephalosporins

    • B.

      Bronchodilators

    • C.

      Intubate patient and wait 24 hours

    • D.

      Supportive treatment and directed toward the management of cerebral edema

    Correct Answer
    D. Supportive treatment and directed toward the management of cerebral edema
    Explanation
    Reye's syndrome is a rare but serious condition that primarily affects children and teenagers recovering from a viral infection, such as the flu or chickenpox. It is characterized by swelling in the brain and liver dysfunction. The most appropriate treatment for Reye's syndrome is supportive care, which focuses on managing cerebral edema (swelling in the brain). This may involve measures such as providing fluids, electrolyte balance, and medications to reduce brain swelling. Other options like cephalosporins, bronchodilators, or intubation are not indicated for the treatment of Reye's syndrome.

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  • 26. 

    What is the name of the influenza vaccine?

    • A.

      Sanofi influenza virus vaccine

    • B.

      Trivalent influenza virus vaccine

    • C.

      Tetravalent influenza virus vaccine

    • D.

      Infanrix influenza virus vaccine

    Correct Answer
    B. Trivalent influenza virus vaccine
    Explanation
    The correct answer is Trivalent influenza virus vaccine. This vaccine is named trivalent because it protects against three different strains of the influenza virus. The strains included in the vaccine are chosen based on predictions of which strains are most likely to circulate in a given flu season. The trivalent influenza vaccine is commonly used and recommended for annual flu vaccination.

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  • 27. 

    How long does the influenza vaccine provide immunity for?

    • A.

      It provides full immunity for the rest of the patient's life

    • B.

      It provides full immunity for a few months to one year

    • C.

      It provides partial immunity for a few months to one year

    • D.

      It provieds partial immunity for the rest of the patient's life

    Correct Answer
    C. It provides partial immunity for a few months to one year
    Explanation
    The correct answer is that the influenza vaccine provides partial immunity for a few months to one year. This means that after receiving the vaccine, the patient may still be at risk of contracting the flu, but the severity and duration of the illness may be reduced. The level of immunity can vary from person to person and may decrease over time, which is why it is recommended to get vaccinated annually.

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  • 28. 

    How long does it take the body to acquire immunity after the vaccination?

    • A.

      1 week

    • B.

      2 weeks

    • C.

      3 weeks

    • D.

      4 weeks

    Correct Answer
    B. 2 weeks
    Explanation
    After receiving a vaccination, it takes the body approximately two weeks to develop immunity. During this time, the immune system is activated and begins to produce specific antibodies to fight against the pathogen introduced by the vaccine. These antibodies help to recognize and neutralize the virus or bacteria if the individual is exposed to it in the future. Therefore, it is important to wait for at least two weeks after vaccination to ensure that the body has acquired sufficient immunity.

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  • 29. 

    What months should you recommend your patients to get vaccinated?

    • A.

      August of September

    • B.

      September or October

    • C.

      October or November

    • D.

      November or December

    Correct Answer
    C. October or November
    Explanation
    It is recommended to recommend patients to get vaccinated in October or November. This timing is ideal because it allows for the vaccine to take effect before the peak of flu season, which typically occurs in the winter months. Getting vaccinated during this period ensures that patients are protected against the flu when it is most prevalent.

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  • 30. 

    What is/are the treatment(s) for influenza that must be administered within 48 hours of onset of symptoms and is effective against influenza type A and type B?

    • A.

      Zanamivir (Relenza)

    • B.

      Oseltamivir (Tamiflu)

    • C.

      Amantadine (Symmeterel)

    • D.

      Rimantadine (Flumadine)

    Correct Answer(s)
    A. Zanamivir (Relenza)
    B. Oseltamivir (Tamiflu)
    Explanation
    Zanamivir (Relenza) and Oseltamivir (Tamiflu) are the recommended treatments for influenza that should be administered within 48 hours of symptom onset. These medications are effective against both influenza type A and type B. Amantadine (Symmeterel) and Rimantadine (Flumadine) are antiviral medications that were previously used to treat influenza, but they are no longer recommended due to high resistance rates among circulating influenza strains. Therefore, Zanamivir and Oseltamivir are the appropriate treatments for early intervention against influenza.

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  • 31. 

    Which two drugs are rarely used because they have limited viral coverage? (they only cover influenza A) Hint: both agents are most effective when given withing 48 hours after symptoms onset and are effective primarily in patients over the age of 12.

    • A.

      Amantadine (Symmetrel)

    • B.

      Zanamivir (Relenza)

    • C.

      Rimantadine (Flumadine)

    Correct Answer(s)
    A. Amantadine (Symmetrel)
    C. Rimantadine (Flumadine)
    Explanation
    Amantadine (Symmetrel) and Rimantadine (Flumadine) are rarely used drugs because they have limited viral coverage, specifically only covering influenza A. These drugs are most effective when given within 48 hours after symptom onset and are primarily effective in patients over the age of 12. Zanamivir (Relenza) is not included in the answer as it is a different drug that is commonly used for the treatment of influenza, but it is not limited to influenza A and has a broader viral coverage.

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  • 32. 

    Prognosis of the influenza virus that is uncomplicated is good and the illness should last between 1-7 days. When a patient has a persistent fever, white cell count over 10,000 what should be suspected?

    • A.

      Respiratory distress caused by increased airway resistance

    • B.

      Respiratory distress casued by decreased airway resistance

    • C.

      Bacterial pneumonia- most often pneumococcal pneumonia, but staphylococcal pneumonia is the most serious

    • D.

      Bacterial pneumonia- most often staphylococcal pneumonia, but pneumococcal pneumonia is the most serious

    Correct Answer
    C. Bacterial pneumonia- most often pneumococcal pneumonia, but staphylococcal pneumonia is the most serious
    Explanation
    When a patient with influenza has a persistent fever and a white cell count over 10,000, it suggests the possibility of bacterial pneumonia. Bacterial pneumonia, particularly pneumococcal pneumonia, is a common complication of influenza. Staphylococcal pneumonia is also a serious form of bacterial pneumonia that can occur. Therefore, the correct answer is that bacterial pneumonia, most often pneumococcal pneumonia, but staphylococcal pneumonia is the most serious, should be suspected in such cases.

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  • 33. 

    What is considered an acute inflammatory condition of the tracheobronchial tree associated with generalized respiratory symptoms?

    • A.

      Croup

    • B.

      Influenza

    • C.

      Bronchiolitis

    • D.

      Acute bronchitis

    Correct Answer
    D. Acute bronchitis
    Explanation
    Acute bronchitis is considered an acute inflammatory condition of the tracheobronchial tree associated with generalized respiratory symptoms. It is characterized by inflammation of the bronchial tubes, usually caused by a viral infection. Symptoms include cough, chest discomfort, and difficulty breathing. Croup, influenza, and bronchiolitis are also respiratory conditions, but they have different causes and symptoms compared to acute bronchitis.

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  • 34. 

    What are the infectious agents that lead to acute bronchitis? (Remember that infectious causes are primarily viral)Click all that apply

    • A.

      Influenza A and B

    • B.

      Influenza A only (not B)

    • C.

      Parainfluenza

    • D.

      Rhinovirus

    • E.

      Coronavirus and respiratory syncytial virus (RSV)

    Correct Answer(s)
    A. Influenza A and B
    C. Parainfluenza
    D. Rhinovirus
    E. Coronavirus and respiratory syncytial virus (RSV)
    Explanation
    Acute bronchitis is primarily caused by viral infections. Influenza A and B viruses, parainfluenza virus, rhinovirus, coronavirus, and respiratory syncytial virus (RSV) are all infectious agents that can lead to acute bronchitis.

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  • 35. 

    What time of year is acute bronchitis most common?

    • A.

      Summer months

    • B.

      Fall months

    • C.

      Winter months

    • D.

      Spring months

    Correct Answer
    C. Winter months
    Explanation
    Acute bronchitis is most common during the winter months. This is because during winter, the air tends to be colder and drier, which can irritate the airways and make them more susceptible to infections. Additionally, people tend to spend more time indoors during winter, increasing the likelihood of close contact and transmission of respiratory viruses that can cause bronchitis.

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  • 36. 

    T/F Cough is a predominant symptom of acute bronchitis and can persist for up to 2-3 weeks

    • A.

      True

    • B.

      Fasle

    Correct Answer
    A. True
    Explanation
    Cough is a predominant symptom of acute bronchitis and can persist for up to 2-3 weeks. This means that when someone has acute bronchitis, they are likely to experience a persistent cough that can last for a period of 2-3 weeks. This symptom is a characteristic feature of acute bronchitis and helps in its diagnosis.

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  • 37. 

    If you want to treat a viral illness in a pushy patient who wants antibiotics with? (Canitini jokes that this is no longer effective due to overuse)

    • A.

      Doxycycline

    • B.

      Zithromax

    • C.

      Cipro

    • D.

      Metronidazole

    Correct Answer
    B. Zithromax
    Explanation
    Zithromax is a commonly prescribed antibiotic that is effective against certain types of bacterial infections. However, it is not effective against viral infections. The question mentions that the patient has a viral illness, so prescribing Zithromax would not be appropriate in this case. The mention of Canitini jokes that this antibiotic is no longer effective due to overuse, further emphasizing that it should not be prescribed for a viral illness.

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  • 38. 

    What illness is characterized by the nonspecific inflammation of the terminal and respiratory bronchioles?

    • A.

      Croup

    • B.

      Influenza

    • C.

      Acute bronchitis

    • D.

      Bronchiolitis

    Correct Answer
    D. Bronchiolitis
    Explanation
    Bronchiolitis is an illness characterized by the nonspecific inflammation of the terminal and respiratory bronchioles. This inflammation leads to the narrowing of the airways, causing symptoms such as coughing, wheezing, and difficulty breathing. It is most commonly caused by a viral infection, particularly the respiratory syncytial virus (RSV). Bronchiolitis is more common in infants and young children, and it can be a serious condition, especially in those with weakened immune systems or pre-existing respiratory conditions. Treatment typically involves supportive care, such as adequate hydration and monitoring of symptoms.

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  • 39. 

    T/F Bronchiolitis is often a severe respiratory illness and is usually caused by RSV (respiratory syncytial virus) and sometimes caused by parainfluenza, adenovirus, and rhinovirus

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Bronchiolitis is a respiratory illness that is commonly severe and is primarily caused by the respiratory syncytial virus (RSV). However, it can also be caused by other viruses such as parainfluenza, adenovirus, and rhinovirus. Therefore, the statement that bronchiolitis is often a severe respiratory illness and can be caused by RSV as well as other viruses is true.

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  • 40. 

    What type of bronchiolitis is characterized by chronic inflammation, concentric scarring, and smooth muscle hypertrophy causing luminal obstruction? Hint: these patients have airflow obstruction spirometry, minimal radiographic abnormalities, and progressive clinical course that is unresponsive to corticosteroids.

    • A.

      Restrictive bronchiolitis

    • B.

      Proliferative bronchiolitis

    • C.

      Constrictive Bronchiolitis

    Correct Answer
    C. Constrictive Bronchiolitis
    Explanation
    Constrictive bronchiolitis is the correct answer because it is characterized by chronic inflammation, concentric scarring, and smooth muscle hypertrophy causing luminal obstruction. Patients with this condition have airflow obstruction spirometry, minimal radiographic abnormalities, and a progressive clinical course that is unresponsive to corticosteroids. Restrictive bronchiolitis refers to a different type of bronchiolitis characterized by reduced lung volume and Proliferative bronchiolitis is not a recognized term in the context of bronchiolitis.

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  • 41. 

    Which type of bronchiolitis occurs when intraluminal polyps consisting of fibroblasts, foamy macrophages, and lymphocytes partially or completely obstruct the bronchioles. Hint: these patients may have obstruction or restriction on spirometry. Radiologic infiltrates are common, and the disease is frequently responsive to corticosteroids.

    • A.

      Restrictive bronchiolitis

    • B.

      Proliferative bronchiolitis

    • C.

      Constrictive bronchiolitis

    • D.

      Obstructive bronchiolitis

    Correct Answer
    B. Proliferative bronchiolitis
    Explanation
    Proliferative bronchiolitis occurs when intraluminal polyps consisting of fibroblasts, foamy macrophages, and lymphocytes partially or completely obstruct the bronchioles. This can lead to obstruction or restriction on spirometry. Radiologic infiltrates are common in this condition, and it is often responsive to corticosteroids.

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  • 42. 

    What months are most common for an RSV outbreak?

    • A.

      Summer and fall

    • B.

      Winter and spring

    • C.

      Spring and summer

    Correct Answer
    B. Winter and spring
    Explanation
    RSV (Respiratory Syncytial Virus) is a common respiratory virus that causes infections in the lungs and respiratory tract. It is highly contagious and spreads easily during close contact with infected individuals. RSV outbreaks are most common during the winter and spring months. This is because the virus thrives in colder temperatures and drier air, which are typical during these seasons. Additionally, people tend to spend more time indoors and in close proximity to others during winter and spring, increasing the chances of transmission.

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  • 43. 

    T/F Inoculation of bronchiolitis (which is most common in children) occurs through the nose and eyes

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Bronchiolitis is a common respiratory infection in children, typically caused by a viral infection. It primarily affects the bronchioles, which are the small airways in the lungs. Inoculation refers to the introduction of a pathogen into the body to stimulate an immune response. In the case of bronchiolitis, the virus can enter the body through the nose and eyes, as these are common entry points for respiratory infections. Therefore, it is true that inoculation of bronchiolitis can occur through the nose and eyes.

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  • 44. 

    A child presents with a low-grade fever, tachyonea, wheezes,and hyperinflated lungs. His TMs are bulging and you suspect a concurrent streptococcus pneumonia infection. What illness is associatied with a concurrent streptococcus pneumonia infection?

    • A.

      Croup

    • B.

      Influenza

    • C.

      Acute Bronchitis

    • D.

      Bronchiolitis

    Correct Answer
    D. Bronchiolitis
    Explanation
    Bronchiolitis is associated with a concurrent Streptococcus pneumoniae infection. Bronchiolitis is a viral infection that causes inflammation and congestion in the small airways of the lungs, primarily affecting infants and young children. It is commonly caused by respiratory syncytial virus (RSV), but bacterial infections, such as Streptococcus pneumoniae, can also occur concurrently. The symptoms of bronchiolitis include low-grade fever, rapid breathing (tachypnea), wheezing, and hyperinflated lungs, which align with the symptoms described in the question.

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  • 45. 

    T/F Cultures of naspoharyngeal secretions remains the gold standard of the diagnosis of bronchiolitis. Rapid diagnosis may be made by viral antigen identification of nasal washings for RSV using ELISA or immunofluorescent assay

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement suggests that cultures of nasopharyngeal secretions are still considered the most reliable method for diagnosing bronchiolitis. However, it also mentions that rapid diagnosis can be made by identifying viral antigens in nasal washings using ELISA or immunofluorescent assay. Therefore, the statement is true as it implies that while cultures are the gold standard, there are alternative methods available for a quicker diagnosis.

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  • 46. 

    You are presented with an x ray that shows air trapping and peribonchial thickening. You recall that this patient has a normal CBC, but has a low grade fever, tachypnea, wheezes, rhinorrhea, sneezing, and increased work of breathing. What is the likely diagnosis based on the x ray and presentation of the patient/

    • A.

      Croup

    • B.

      Influenza

    • C.

      Acute Bronchitis

    • D.

      Bronchiolitis

    • E.

      Pertussis

    Correct Answer
    D. Bronchiolitis
    Explanation
    Based on the symptoms described (low grade fever, tachypnea, wheezes, rhinorrhea, sneezing, increased work of breathing) and the findings on the x-ray (air trapping and peribronchial thickening), the likely diagnosis is bronchiolitis. Bronchiolitis is a viral infection that affects the smallest airways in the lungs, causing inflammation and narrowing. It commonly occurs in infants and young children, and is typically caused by respiratory syncytial virus (RSV). The symptoms and x-ray findings are consistent with bronchiolitis, making it the likely diagnosis in this case.

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  • 47. 

    What is the treatment for bronchiolitis?

    • A.

      Hydration, humidification of inspired air, ventilatory support prn, albuterol, ribavirin, and corticosteroids

    • B.

      albuterol, ribavirin, and corticosteroids and not non medical treatment

    • C.

      Hydration, humidification of inspired air, albuterol, ribavirin, and

    Correct Answer
    A. Hydration, humidification of inspired air, ventilatory support prn, albuterol, ribavirin, and corticosteroids
    Explanation
    The treatment for bronchiolitis includes hydration, humidification of inspired air, ventilatory support as needed, albuterol, ribavirin, and corticosteroids. These interventions help to alleviate symptoms, improve breathing, and reduce inflammation in the airways. Albuterol is a bronchodilator that helps to open up the airways, while ribavirin is an antiviral medication that may be used in severe cases. Corticosteroids are anti-inflammatory medications that can help reduce swelling and inflammation in the airways. Hydration and humidification of inspired air can help to keep the airways moist and prevent further irritation. Ventilatory support may be necessary in severe cases where the child is having difficulty breathing.

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  • 48. 

    What is another name for pertussis?

    • A.

      Croup

    • B.

      Influenza

    • C.

      Whooping cough

    • D.

      ARDS

    • E.

      SARS

    Correct Answer
    C. Whooping cough
    Explanation
    Pertussis is commonly known as whooping cough. It is a highly contagious respiratory infection caused by the bacteria Bordetella pertussis. The name "whooping cough" comes from the characteristic sound that occurs when the infected person tries to breathe in after a coughing fit. The coughing fits can be severe and prolonged, causing difficulty in breathing and sometimes leading to complications, especially in infants and young children. Therefore, the correct answer for another name for pertussis is whooping cough.

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  • 49. 

    How is pertussis transmitted?

    • A.

      Feces

    • B.

      Airborne

    • C.

      Respiratory droplets

    • D.

      Contact

    Correct Answer
    C. Respiratory droplets
    Explanation
    Pertussis, also known as whooping cough, is transmitted through respiratory droplets. When an infected person coughs or sneezes, the bacteria that cause pertussis are released into the air in tiny droplets. These droplets can then be inhaled by others who are in close proximity to the infected person, leading to the spread of the disease. It is important to take precautions such as covering the mouth and nose when coughing or sneezing, and practicing good hand hygiene to prevent the transmission of pertussis.

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  • 50. 

    Does immunization or disease confer lasting immunity to pertussis?

    • A.

      No

    • B.

      Yes

    Correct Answer
    A. No
    Explanation
    Immunization or disease does not confer lasting immunity to pertussis. Pertussis, also known as whooping cough, is a bacterial infection that can be prevented by vaccination. However, the immunity provided by the vaccine or by previous infection tends to wane over time. This is why booster doses of the pertussis vaccine are recommended to maintain protection against the disease. Therefore, neither immunization nor previous infection with pertussis provides lifelong immunity.

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