USMLE Forum Archives - USMLE Step 2 CK - Peds 5
Peds 5
TheOne - 11-26-06 18:46
A mother brings her previously healthy 6-year-old girl to her general practitioner following a 3-week history of upper respiratory tract symptoms. The patient experienced a runny nose, sneezing, a mild fever, and a slight cough that began 3 weeks ago. The child's mother is a smoker, and she recently recovered from a bout with the flu. She took her child to a local naturopath, who administered herbal drops that did not seem to help the condition. In the past week, the child's cough has progressively worsened, with severe bouts of coughing that are
followed by vomiting. The mother notes that the child is gasping noisily after each bout of coughing and appears exhausted, and she is concerned that the child is not getting enough air. The child's past medical history is uneventful, with normal growth and development and no major illnesses. The child has not had her complete set of immunizations because the mother was told by the herbalist about a possible risk for autism from them. On examination, the child has equal bronchial breath sounds bilaterally and adequate inspiratory and expiratory effort
without subcostal or intercostal retractions. There is mild conjunctival erythema a normal oropharynx without exudates or erythema and no cervical lymphadenopathy. Her temperature is 38.2 C (100 F), pulse is 136/min, and respirations are 30/min. Which of the following would most likely have prevented this condition?
A. Antiviral drugs
B. Immunization
C. Reduction of smoking in the home
D. Regular use of bronchodilators
E. Vitamin supplementation
TheOne - 11-26-06 18:46
A mother brings her previously healthy 6-year-old girl to her general practitioner following a 3-week history of upper respiratory tract symptoms. The patient experienced a runny nose, sneezing, a mild fever, and a slight cough that began 3 weeks ago. The child's mother is a smoker, and she recently recovered from a bout with the flu. She took her child to a local naturopath, who administered herbal drops that did not seem to help the condition. In the past week, the child's cough has progressively worsened, with severe bouts of coughing that are
followed by vomiting. The mother notes that the child is gasping noisily after each bout of coughing and appears exhausted, and she is concerned that the child is not getting enough air. The child's past medical history is uneventful, with normal growth and development and no major illnesses. The child has not had her complete set of immunizations because the mother was told by the herbalist about a possible risk for autism from them. On examination, the child has equal bronchial breath sounds bilaterally and adequate inspiratory and expiratory effort
without subcostal or intercostal retractions. There is mild conjunctival erythema a normal oropharynx without exudates or erythema and no cervical lymphadenopathy. Her temperature is 38.2 C (100 F), pulse is 136/min, and respirations are 30/min. Which of the following would most likely have prevented this condition?
A. Antiviral drugs
B. Immunization
C. Reduction of smoking in the home
D. Regular use of bronchodilators
E. Vitamin supplementation
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#4
Re: Peds 5 Brainlab - 12-03-06 10:28 I think the correct answer is B. The cause of disease is B.pertussis.
#5
Re: Peds 5
TheOne - 12-03-06 16:23 The correct answer is B. The child presented to her general practitioner with the characteristic signs and symptoms of whooping cough: upper respiratory tract symptoms with the development of paroxysmal coughing, marked by episodes of coughing with an inspiratory and noisy "whoop" sound. Whooping cough is the most common
vaccine-preventable disease among children younger than 5 years old in the United States. Despite the widespread use of vaccines, the disease has made a comeback in recent years. This child is at risk for whooping cough because she did not receive the DTP/DTaP vaccination and was exposed to a symptomatic adult. (Adults with a mild respiratory illness that is unrecognized as pertussis infections are frequently the source of infection.) Immunization with DTP/DTaP would most likely have prevented the child's infection with Bordetella pertussis (the causative agent of whooping cough). The immunization schedule for full immunity against pertussis (according to the American Academy of Pediatrics) involves the administration of DTP/DTaP at 15-18 months old
and at 2, 4, and 6 years old.
Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting from 1-2 weeks. The 3 stages of disease progression are as follows:
Stage 1: The initial (catarrhal) phase is indistinguishable from common upper respiratory infections with nasal congestion, rhinorrhea, and sneezing, variably accompanied by low-grade fever, tearing, and conjunctival suffusion. Pertussis is most infectious when patients are in the catarrhal phase, but pertussis may remain communicable for 3 or more weeks after the onset of cough.
Stage 2: Patients in the second (paroxysmal) phase present with paroxysms of intense coughing lasting up to several minutes. In older infants and toddlers, the paroxysms of coughing occasionally are followed by a loud whoop as inspired air goes through a still partially closed airway. Infants younger than 6 months do not have the characteristic whoop but may have apneic episodes and are at risk for exhaustion. Posttussive vomiting and turning red with coughing are common in affected children.
Stage 3: Patients in the third (convalescent) stage have a chronic cough, which may last for weeks.
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