USMLE Forum Archives - USMLE Step 2 CK - IM 14
IM 14
TheOne - 11-26-06 18:43
A mother brings her 14-month-old son to the emergency department 30 minutes after the child had an episode of choking and gasping while eating potato chips. The mother doesn't think the child went blue during the episode, and the child returned to playing with her toys shortly after the episode. On examination, the child has an intermittent cough but is otherwise playful and in no apparent acute distress. Physical examination is normal, except for an expiratory wheeze noted in the right lung fields. His respiratory rate is 29/min, pulse rate is
110/min, blood pressure is 90/58 mm Hg, and O2 saturation is 96%. A chest radiograph is obtained and looks normal, but expiratory films are unable to be performed. What is the next step in management?
A. Blind finger sweeps
B. Bronchodilator administration
C. Endotracheal intubation
D. Expectant management
E. Flexible bronchoscopy
F. Rigid bronchoscopy
TheOne - 11-26-06 18:43
A mother brings her 14-month-old son to the emergency department 30 minutes after the child had an episode of choking and gasping while eating potato chips. The mother doesn't think the child went blue during the episode, and the child returned to playing with her toys shortly after the episode. On examination, the child has an intermittent cough but is otherwise playful and in no apparent acute distress. Physical examination is normal, except for an expiratory wheeze noted in the right lung fields. His respiratory rate is 29/min, pulse rate is
110/min, blood pressure is 90/58 mm Hg, and O2 saturation is 96%. A chest radiograph is obtained and looks normal, but expiratory films are unable to be performed. What is the next step in management?
A. Blind finger sweeps
B. Bronchodilator administration
C. Endotracheal intubation
D. Expectant management
E. Flexible bronchoscopy
F. Rigid bronchoscopy
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#1
Re: IM 14
TheOne - 12-01-06 15:59 Come on Guys, are the questions hard or easy???
I see no posts here, what's the problem???
#5
Re: IM 14 TheOne - 02-07-07 20:46 The correct answer is F. Children, especially 1 to 3 years old, are at greatest risk for aspirating foreign objects. The most common objects aspirated that result in airway obstruction include coins, buttons, beads, pins, candy, nuts, hot dogs, chewing gum, grapes, and sausages. Plain radiographic results cannot exclude foreign body aspiration, and when there is an index of suspicion, endoscopy should be performed for definitive diagnosis and treatment. Rigid endoscopy under general anesthesia is the procedure of choice in managing foreign body aspirations in children because it provides greater access to the subglottic airways and ensures oxygenation and easy passage of the telescope and grasping forceps during extraction.
Blind finger sweeps (choice A) should never be performed in infants or children who may have aspirated foreign objects because they may push the objects further downward into the airway.
The use of bronchodilators (choice B) does not treat the underlying cause of the wheezing, i.e., the presence of the aspirated foreign body. Appropriate management is visualization and removal of the object.
Endotracheal intubation (choice C) is inappropriate when the foreign body is still in place. Furthermore, the patient is not experiencing respiratory failure. The next best step in management is to definitively diagnose the foreign body aspiration and remove it endoscopically.
#6
Re: IM 14 ammulufy - 07-06-10 21:48 The features are suggestive of asthma wid a known sensitivity for d food stuff......derfore bronchodilator administration is reqd.,I wud go wid B.
#7
Re: IM 14 babbu5508 - 07-06-10 22:54 E. Flexible bronchoscopy....children are the most susceptible for foreign body obstruction....hence bronchoscopy to see the cause are necessary
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