Recurrent wheezing 4th MD studentt

A 2-year-old boy presents with his 4th episode of wheezing in the past year.

He was born at term, has normal growth, and attends day care.
Each episode was triggered by upper respiratory infections.

He has no family history of asthma. Between episodes, he is well with no respiratory symptoms. His immunization is up-to-date.

Physical exam today is normal.
What is the most likely diagnosis at this stage?

• Asthma

• Episodic viral wheeze

• Bronchiolitis

• Primary ciliary dyskinesia

What is the next best step?

• Start daily inhaled corticosteroids

• Order sweat chloride test

• Observation and trial of bronchodilator during illness

• Refer to pulmonologist/ allergist

Which of the following is a red flag suggesting that this child may actually have early asthma?

• Symptoms only during viral infections

• Symptoms between infections and a history of atopy

• No response to bronchodilators

• Onset under 6 year of age

What would make you consider stepping up this child's treatment from episodic SABA to controller?

• Frequent exacerbations with history of severe hospitalization

• Wheezing occurs between viral infections

• The child has eczema and a parent with asthma

• All of the above

A 6-year-old girl presents with recurrent wheezing and coughing for the past 2 years. Symptoms are worse with exercise, cold air, and nighttime. There is a strong family history of atopy (mother has asthma, brother has eczema). She has mild persistent symptoms between illnesses. Physical exam: mild wheeze on auscultation.
What is the most likely diagnosis?

• Vocal cord dysfunction

• Asthma

• Tracheomalacia

• GERD

Which of the following would support the diagnosis?

• Normal growth

• Response to Salbutamol

• Exposure to daycare

• Lack of fever during episodes

What is the most appropriate treatment step now?

• Inhaled corticosteroids daily + SABA as needed

• Montelukast only

• Antibiotics for 10 days

• Reassurance and no treatment

Which of the following is a good tool for monitoring asthma control?

• Serum IgE

• Peak flow meter

• ESR/CRP

• Chest X-ray

A 9-month-old infant presents with persistent noisy breathing since birth. The parents describe a "honking" or "barking" cough, and episodes of wheezing not improving with bronchodilators. Feeding and growth are normal. Symptoms worsen when the child is crying or lying flat. Exam: expiratory wheeze, loud central airway sounds.
What is the most likely diagnosis?

• Asthma

• Tracheomalacia

• Foreign body aspiration

• Bronchiolitis

Which of the following supports this diagnosis?

• Wheezing triggered by virus

• Response to bronchodilator

• Biphasic stridor

• Worsening with crying and feeding