A full-term male neonate develops respiratory distress with tachypnea and oxygen requirement within hours of birth. A chest radiograph shows right middle and upper lobe atelectasis and dextrocardia. There is no history of meconium aspiration. Which diagnostic test would be most specific to investigate the likely underlying genetic disorder?
A 2-month-old infant presents with biphasic stridor and dysphagia since birth. A chest X-ray is suspicious for an airway anomaly. A CT angiogram reveals a vascular anomaly that completely encircles and compresses both the trachea and esophagus. Which anomaly is most consistent with these findings?
A 6-year-old child with a history of kyphoscoliosis presents with progressive exercise intolerance. Pulmonary function tests are performed to assess for a restrictive lung process. Which pattern of results would be most characteristic of a restrictive disorder?
An 18-month-old child with spinal muscular atrophy type 1 is managed with long-term invasive ventilation via tracheostomy. Due to significant neuromuscular weakness and an ineffective cough, the pulmonology team recommends a therapy that actively assists both the inspiratory and expiratory phases of a cough. Which airway clearance modality is specifically designed to meet this goal?
A term newborn infant develops respiratory distress shortly after birth, characterized by episodes of cyanosis that are dramatically relieved when the infant cries. Attempts to pass a small, firm catheter through either nostril into the pharynx are unsuccessful. What is the most likely diagnosis?
A 9-year-old boy with acute lymphocytic leukemia is admitted for chemotherapy via his long-term indwelling central venous catheter. During his admission, he develops sudden onset of right-sided pleuritic chest pain and dyspnea. A pulmonary embolism is suspected. What is the most common identifiable risk factor for venous thromboembolism in children?
A 12-year-old girl presents with a 3-week history of non-productive cough, dyspnea, and low-grade fevers. Her symptoms started shortly after her family adopted a pet cockatiel. On examination, she is tachypneic with fine crackles at the lung bases. A high-resolution computed tomography scan shows diffuse ground-glass opacities and ill-defined centrilobular nodules. Which of the following findings on bronchoalveolar lavage (BAL) would be most consistent with the suspected diagnosis?
A 16-year-old presents with a severe exudative pharyngitis and fever. A rapid antigen detection test for Group A Streptococcus is negative. The symptoms persist, and 10 days later she develops high fever, neck pain and swelling, and acute respiratory distress. A chest CT reveals multiple cavitary nodules consistent with septic pulmonary emboli. This clinical picture is caused most likely by which organism?
A 17-year-old with cystic fibrosis presents with his first episode of a moderate-sized spontaneous pneumothorax. He is hemodynamically stable. The medical team discusses definitive management, keeping in mind that he may be a candidate for lung transplantation in the future. Given the high recurrence rate of pneumothorax in cystic fibrosis and the potential need for future transplantation, which management strategy should be approached with the most caution?
A 3-year-old child has had a runny nose, nasal congestion, and a mild cough for the past 4 days. The parents ask for your recommendation on using over-the-counter medications to treat the symptoms. Based on current recommendations, what is the most appropriate advice?
