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* nbme 4 - 1
  besho013 - 04/28/12 12:14
  For each patient with respiratory problems. select the most likely pathophysiology.
A) Allergen-induced bronchospasm
B) Barotrauma-relateci alveolar disease
C) Cardiac-induced pulmonary edema
D) Chemical imtant pneumonitis
E) Community-acquired viral disease
F) Conguousl spread bacterial infection
G) Osmotically generated fluid shift
H) Toxin-mediated capillary leak
33. A 7-year-old boy is brought to the emergency department because of facial edema and respiratory distress since eating dinner 2 hours
ago He has had coryza and cough dunng the past 2 days His temperature is 37 5C (99 5F). pulse is 100min. respirations are
40mm. and blood pressure is 10070 mm Hg. Breath sounds are unequal with decreased aeration and a prolonged expiratory phase.

i picked A but i feel its not consistent with the last line from the vignette
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* Re:nbme 4 - 1
  usmlepak - 04/28/12 12:42
  yes its A  
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* Re:nbme 4 - 1
  besho013 - 04/28/12 12:44
  what about unequal with decreased aeration and a prolonged expiratory phase
is that a combination of foreign body aspiration and allergy reaction
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* Re:nbme 4 - 1
  gigi74 - 04/29/12 19:25
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* Re:nbme 4 - 1
  zerios2 - 03/04/15 16:38
  Why wouldn't it be F) A contiguously spread bacterial infection? It sounds like HIB to me. 2 day on set with an acute epiglottitis. Just saying.

Found this in Uptodate:

Angioedema (anaphylaxis or hereditary) Allergic reaction or acute angioneurotic edema has rapid onset without antecedent cold symptoms or fever. The primary manifestations are swelling of the lips and tongue, urticarial rash, dysphagia without hoarseness, and sometimes inspiratory stridor [82,83]. There may be a history of allergy or a previous attack.

In a case series of 134 children with epiglottitis from a single state (1975 to 1992), the following findings were documented in the history or physical examination [14]:


◾Difficulty breathing (80 percent)
◾Stridor (80 percent)
◾Muffled or hoarse voice (79 percent)
◾Pharyngitis (73 percent)
◾Fever (57 percent)
◾Sore throat (50 percent)
◾Tenderness of anterior neck (38 percent)
◾Cough (30 percent)
◾Difficulty swallowing (26 percent)
◾Change in voice (20 percent)
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* Re:nbme 4 - 1
  fsparks - 03/04/15 16:55
  The point you are missing is that this happened JUST AFTER 2 hours of eating dinner. He is reacting to something he ate.  
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* Re:nbme 4 - 1
  aiaown - 03/04/15 17:02
  it looks A :  
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* Re:nbme 4 - 1
  zerios2 - 03/04/15 17:36
  Ok, I think your'e right. It's AAAAA.

Acute epiglottitis Epiglottitis, which is rare in the era of vaccination against Haemophilus influenzae type b, is distinguished from croup by the absence of barking cough and the presence of anxiety that is out of proportion to the degree of respiratory distress. Onset of symptoms is rapid, and because of the associated bacteremia, the child is highly febrile, pale, toxic, and ill-appearing. Because of the swollen epiglottis, the child will have difficulty swallowing and is often drooling. The children usually prefer to sit up and seldom have observed cough [41]. Epiglottitis occurs infrequently, and there is no predominant etiologic pathogen.

It isn't spasmodic croup either:

Spasmodic croup Spasmodic croup also occurs in children three months to three years of age [2]. In contrast to laryngotracheitis, spasmodic croup always occurs at night; the duration of symptoms is short, often with symptoms subsiding by the time of presentation for medical attention; and the onset and cessation of symptoms are abrupt. Fever is typically absent, but mild upper respiratory tract symptoms (eg, coryza) may be present. Episodes can recur within the same night and for two to four successive evenings [30]. A striking feature of spasmodic croup is its recurrent nature, hence the alternate descriptive term, "frequently recurrent croup". There may be a familial predisposition to spasmodic croup, and it may be more common in children with a family history of allergies [24].
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