NBME 12 tricky pulm. question

[LuckiestOne]

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A 6 year old boy is brought to the emergency dept because of coughing, wheezing and rapid breathing for the last 6 hours,. He was diagnosed with an upper respiratory tract infection 2 days ago. His temp is 37.2, pulse is 120/min, resp rate 44/min, BP 90/60 mm HG. Inspiratory and expiratory wheezes are heard throughout the lung fields. There is decreased tactile fremitus Which of the following is the most likely diagnosis?

A) Asthma
B) Atelectasis
C) Bronchitis
D) left sided heart failure
E) Pneumococcocal pneumonia

What are the reasons why each answer is right/wrong? General consensus says Asthma but I am not sure how asthma causes low BP and high HR. Is this because the pt gets hypoxic -> vasodilation in the periphery and SANS fire up to cause tachy?

Bronchitis/pneumonia is out because cough isn't productive.. right?

Why can't this be Atelectasis? Thanks guys

 

[ijn]

A 6 year old boy is brought to the emergency dept because of coughing, wheezing and rapid breathing for the last 6 hours,. He was diagnosed with an upper respiratory tract infection 2 days ago. His temp is 37.2, pulse is 120/min, resp rate 44/min, BP 90/60 mm HG. Inspiratory and expiratory wheezes are heard throughout the lung fields. There is decreased tactile fremitus Which of the following is the most likely diagnosis?

A) Asthma
B) Atelectasis
C) Bronchitis
D) left sided heart failure
E) Pneumococcocal pneumonia

What are the reasons why each answer is right/wrong? General consensus says Asthma but I am not sure how asthma causes low BP and high HR. Is this because the pt gets hypoxic -> vasodilation in the periphery and SANS fire up to cause tachy?

Bronchitis/pneumonia is out because cough isn't productive.. right?

Why can't this be Atelectasis? Thanks guys

The child is six years old. You shouldn't apply adult cutoff values for BP and HR to pediatric patients. Most likely he doesn't have hypotension or tachycardia as his values are within limits for a child less than 10 years of age. He does have tachypnea.

Atelectasis would show up as a localized change in lung sounds. The question prompt describes wheezing throughout the lung fields. That is more consistent with asthma.

Pneumococcal pneumonia is out because of the lack of fever. Breath sounds would be altered locally, not throughout all fields. Pneumonia clasically presents with increased tactile fremitus.

With bronchitis you'd expect to hear sounds such as rales/crackles or ronchi. He doesn't have a fever so it's less he has acute bronchitis from infection. Bronchitis clasically presents with increased tactile fremitus.

 

[LuckiestOne]

The child is six years old. You shouldn't apply adult cutoff values for BP and HR to pediatric patients. Most likely he doesn't have hypotension or tachycardia as his values are within limits for a child less than 10 years of age. He does have tachypnea.

Atelectasis would show up as a localized change in lung sounds. The question prompt describes wheezing throughout the lung fields. That is more consistent with asthma.

Pneumococcal pneumonia is out because of the lack of fever. Breath sounds would be altered locally, not throughout all fields. Pneumonia clasically presents with increased tactile fremitus.

With bronchitis you'd expect to hear sounds such as rales/crackles or ronchi. He doesn't have a fever so it's less he has acute bronchitis from infection. Bronchitis clasically presents with increased tactile fremitus.

Thanks for the great explanation!