A 14-year-old female with cystic fibrosis presents for a routine clinic visit with complaints of worsening wheezing, increased cough, and a decrease in exercise tolerance. Her baseline serum total IgE is typically around 200 IU/mL, but today it is 1,200 IU/mL. A chest radiograph shows new, non-clearing infiltrates. What is the most likely complication?
A 1-year-old child with developmental delay has recurrent episodes of pneumonitis. A swallow study is ordered to evaluate for chronic aspiration of liquids from above. Which of the following diagnostic modalities is considered the “gold standard” for the detection and evaluation of aspiration during the act of swallowing?
A 3-month-old infant, born at 38 weeks gestation, is evaluated in the emergency department. The mother reports that while sleeping, the infant suddenly became pale and had irregular breathing for approximately 30 seconds before returning to baseline. The infant is currently asymptomatic with a normal exam. Which historical feature would immediately classify this event as a higher-risk Brief Resolved Unexplained Event (BRUE)?
A 9-year-old boy with non-cystic fibrosis bronchiectasis, confirmed by HRCT, experiences four pulmonary exacerbations over the past year requiring oral or intravenous antibiotics. His baseline pulmonary function is stable between exacerbations. In addition to airway clearance and as-needed antibiotics for exacerbations, which prophylactic therapy has been shown to be effective in reducing the frequency of future exacerbations?
A 2-year-old child is brought to the emergency department with a barking cough and noisy breathing. On examination, you note an audible, monophonic noise that is predominantly heard on inspiration, consistent with stridor from an extrathoracic obstruction. Which compensatory change in the breathing pattern is most characteristic of this condition?
An 11-year-old girl presents with a 6-week history of a persistent non-productive cough, low-grade fevers, malaise, and a 3-kg weight loss. Her blood work is notable for a peripheral eosinophil count of 3,500/mm³. A chest x-ray reveals bilateral, fluffy, patchy infiltrates located in the periphery of the lung fields, with clear central areas. What is the most likely diagnosis?
An infant presents with persistent, low-pitched, monophonic wheezing that is heard predominantly during expiration over the central airways. The symptoms do not improve with bronchodilator therapy. The physician suspects tracheomalacia. Which of the following best describes the characteristic cough associated with this condition?
A term infant born to a mother who smoked heavily throughout pregnancy dies of Sudden Infant Death Syndrome (SIDS) at 3 months of age. What is the most likely pathophysiologic mechanism by which prenatal cigarette smoke exposure increases SIDS risk?
A 12-year-old female with a known diagnosis of systemic lupus erythematosus presents with acute-onset hemoptysis, dyspnea, and new diffuse alveolar infiltrates on her chest radiograph. A lung biopsy is performed to guide aggressive immunomodulatory therapy. Which histopathologic finding is most frequently encountered in diffuse alveolar hemorrhage (DAH) associated with this underlying condition and is associated with a negative prognosis?
A 6-year-old child presents with a sudden onset of sore throat, fever of 38.5°C (101.3°F), tonsillar exudates, and tender anterior cervical adenopathy. A rapid antigen detection test for Group A Streptococcus (GAS) is positive. What is the most appropriate first-line treatment for this child, who has no known drug allergies?
