Pulmonology Lect 7- Croup ETC

71 Questions | Total Attempts: 61

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Pulmonology Lect 7- Croup ETC

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


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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

  • 2. 
    T/F Viral croup has a gradual onset and course
    • A. 

      True

    • B. 

      False

  • 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)

  • 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

  • 5. 
    T/F Croup in children is more serious than croup in an adult
    • A. 

      True

    • B. 

      False

  • 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

  • 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

  • 8. 
    T/F Inspiratory stridor at rest in a child is very worry-some
    • A. 

      True

    • B. 

      False

  • 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)

  • 10. 
    George recommends giving a steroid to treat croup. What is the recommended steroid?
    • A. 

      Budesonide

    • B. 

      Glucocorticoids

    • C. 

      Prednisone

    • D. 

      Dexamethasone

  • 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

  • 12. 
    T/F Croup involves the larynx, trachea, and bronchi
    • A. 

      True

    • B. 

      False

  • 13. 
    T/F People who die from the flu usually die from secondary bacteria pneumonia
    • A. 

      True

    • B. 

      False

  • 14. 
    T/F Influenza is transmitted by the respiratory route?
    • A. 

      True

    • B. 

      False

  • 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

  • 16. 
    When is flu season? (Click all that apply)
    • A. 

      Winter

    • B. 

      Summer

    • C. 

      Spring

    • D. 

      Fall

  • 17. 
    T/F Pandemics are associated with type A influenza infections
    • A. 

      True

    • B. 

      False

  • 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

  • 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

  • 20. 
    What is the treatment window for influenza?
    • A. 

      24 hours

    • B. 

      24-48 hours

    • C. 

      48-72 hours

    • D. 

      72 hours

  • 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

  • 22. 
    What are the complications of influenza? (click all that apply)
    • A. 

      Coccidiomycosis pneumonia

    • B. 

      Pneumococcal pneumonia

    • C. 

      Streptococcal pneumonia

    • D. 

      Staphylococcal pneumonia

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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)

  • 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)

  • 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

  • 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

  • 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)

  • 35. 
    What time of year is acute bronchitis most common?
    • A. 

      Summer months

    • B. 

      Fall months

    • C. 

      Winter months

    • D. 

      Spring months

  • 36. 
    T/F Cough is a predominant symptom of acute bronchitis and can persist for up to 2-3 weeks
    • A. 

      True

    • B. 

      Fasle

  • 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

  • 38. 
    What illness is characterized by the nonspecific inflammation of the terminal and respiratory bronchioles?
    • A. 

      Croup

    • B. 

      Influenza

    • C. 

      Acute bronchitis

    • D. 

      Bronchiolitis

  • 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

  • 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

  • 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

  • 42. 
    What months are most common for an RSV outbreak?
    • A. 

      Summer and fall

    • B. 

      Winter and spring

    • C. 

      Spring and summer

  • 43. 
    T/F Inoculation of bronchiolitis (which is most common in children) occurs through the nose and eyes
    • A. 

      True

    • B. 

      False

  • 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

  • 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

  • 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

  • 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

  • 48. 
    What is another name for pertussis?
    • A. 

      Croup

    • B. 

      Influenza

    • C. 

      Whooping cough

    • D. 

      ARDS

    • E. 

      SARS

  • 49. 
    How is pertussis transmitted?
    • A. 

      Feces

    • B. 

      Airborne

    • C. 

      Respiratory droplets

    • D. 

      Contact

  • 50. 
    Does immunization or disease confer lasting immunity to pertussis?
    • A. 

      No

    • B. 

      Yes

  • 51. 
    What are the three stages of pertussis?
    • A. 

      Recurrent, paroxysmal, convalescent stages

    • B. 

      Domant, prominant, and life-threatening

    • C. 

      Obstructive, hyperinflative, restrictive stages

    • D. 

      Catarrhal, paroxysmal, convalescent stages

  • 52. 
    Which stage is characterized by its insidious onset with lacrimation, sneezind, head cold, malaise, and anorexia in addition to a hacking night cough that becomes a daily cough (diurnal)?
    • A. 

      Catarrhal stage

    • B. 

      Paroxysmal stage

    • C. 

      Convalescent stage

  • 53. 
    Which stage of pertussis is characterized by bursts of rapid consecutive coughs followed by a deep, high-pitched inspiration (Whoop)
    • A. 

      Catarrhal stage

    • B. 

      Paroxysmal stage

    • C. 

      Soncalescent stage

  • 54. 
    What stage of pertussis begins 4 weeks after the onset of the illness with a decrease in the frequency and severity of the sudden onset (paroxysms)of cough
    • A. 

      Catarrhal stage

    • B. 

      Paroxysmal stage

    • C. 

      Convalescent stage

  • 55. 
    T/F Symptoms of a cough for more than two weeks in an adult is suggestive of pertusis
    • A. 

      True

    • B. 

      False

  • 56. 
    Laboratory findings of a white blood cell count of __________ to ________ and a nasopharyngeal culture that is positive for _____________ are diagnostic of pertusis
    • A. 

      5,00 to 15,000, nasopharyngeal culture

    • B. 

      15,000 to 20,000, nasopharyngeal culture

    • C. 

      25,000 to 30,000, bronchial culture

    • D. 

      15,000 to 20,000, bronchial culture

  • 57. 
    What agar do you use to grow a culture of  bordetella pertussis to diagnose pertussis?
    • A. 

      Thayer Martin agar

    • B. 

      Chocolate agar

    • C. 

      Bordet-Gengon agar

    • D. 

      Berdet-Gillan agar

  • 58. 
    What is the treatment for pertussis? (3)
    • A. 

      Erythromycin

    • B. 

      Doxycycline

    • C. 

      Azithromycin

    • D. 

      Clarithromycin

    • E. 

      Amoxicillin

  • 59. 
    Wet-lung, white-out, stiff lung, and shock lung are all alternative names of which disease?
    • A. 

      Avian Flu

    • B. 

      Acute Respiratory Distress Syndrome

    • C. 

      RSV

    • D. 

      Pertussis

  • 60. 
    What disease is a hyaline membrane disease of adults resulting form either direct or indirect injury to the alveolar-capillary membrane which ultimately leads to profound hypoxemia with no gas exchange?
    • A. 

      Croup

    • B. 

      Influenza

    • C. 

      Acute Bronchitis

    • D. 

      ARDS

  • 61. 
    T/F ARDS is the most sever form of acute lung injury
    • A. 

      True

    • B. 

      False

  • 62. 
    What pulmonary disorder is characterized by bilateral, widespread radiographic pulmonary infiltrates?
    • A. 

      Avian Flu

    • B. 

      ARDS

    • C. 

      Pertussis

  • 63. 
    What are the risk factors for ARDS?
    • A. 

      Sepsis, severe multiple trauma, and aspiration of gastric contents

    • B. 

      Asthma and emphysema

    • C. 

      TB and AIDS

  • 64. 
    T/F Damage to the endothelial cells of capillaries and epithelial cells increase vascular permeability and decrease production and activity of surfactant
    • A. 

      True

    • B. 

      False

  • 65. 
    T/F Damage to the capillary and alveolar epithelium lead to protein rich pulmonary edema, alveolar collapse, and hypoxemia
    • A. 

      True

    • B. 

      False

  • 66. 
    What strain of influenza is the "bird flu"
    • A. 

      H1N4

    • B. 

      H5N1

    • C. 

      H1N5

  • 67. 
    What is the third step that must happen for the avian flu to become a pandemic?
    • A. 

      It must infect humans whose immune system are naive to the virus

    • B. 

      It must be virulent

    • C. 

      It must be spread easily from person to person

  • 68. 
    Where is the most widespread distribution of H5N1 with human involvement?
    • A. 

      Europe

    • B. 

      South America

    • C. 

      Asia

    • D. 

      Africa

  • 69. 
    What questions should you ask all patients with influenza symptoms to rule out the Avian Flu?
    • A. 

      Have you had a fever and respiratoy symptoms?

    • B. 

      Have you traveled to any of the affected countries in Asia and Europe?

    • C. 

      If so, did you have any contact with poultry or with severely ill people

  • 70. 
    Which of the following is consistent with the presentation of a patient with avian flu?
    • A. 

      Rapid onset of severe illness; fever of 99.9, respiratory sx, distress

    • B. 

      Rapid onset of severe illness and weakness

    • C. 

      Rapid onset of severe illness; fever of 101F, respiratory sx, weakness, and possible vomiting and diarrhea

  • 71. 
    What drug(s) will you use to treat a case of avian flu? Select all that apply
    • A. 

      Amantadine (Symmetrel)

    • B. 

      Ramantadine (Flumadine)

    • C. 

      Oseltamivir (Tamiflu)

    • D. 

      Acyclovir

    • E. 

      Zanamivir (Relenza)