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WorksheetsRecurrent wheezing 4th MD studentt
Total questions: 16
Worksheet time: 8mins
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
What investigation helps confirm the diagnosis?
Flexible bronchoscopy
Chest X-ray
Spirometry
Sweat chloride test
What is the usual management approach?
Urgent surgery
Long-term antibiotics
Conservative management and monitoring
Inhaled corticosteroids
A 1-year-old previously healthy toddler is brought to the ER with sudden onset of coughing and wheezing during snack time. The caregiver is unable to recall any choking events.
On exam: Vital signs stable, no fever
- Diminished breath sound and localized expiratory wheezing on the right side.
What is the most likely diagnosis?
Viral Bronchiolitis
Asthma exacerbation
Foreign body aspiration
Pneumonia
What is the most appropriate next step in management?
Inhaled bronchodilator
Urgent bronchoscopy
Chest Physiotherapy
Start antibiotic
What is the most likely finding on this Lt lateral decubitus X-ray?
Hyperinflation of the left lung
Bilateral diffuse infiltrates
Pleural effusion on the right side
Right lower lobe consolidation
Which physical exam finding most strongly suggests airway obstruction rather than reactive airway diseases?
Inspiratory stridor
Diffuse bilateral wheezing
Widespread crepitation in both lungs
Unilateral diminished breath sounds with localized wheezing
