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 recurrent pneumonia  
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Author20 Posts
  #1

A 3-year-old boy presents to the emergency room with a history of recurrent cough. A review of his previous records reveals recurrent episodes of right lower lobe pneumonia. An x-ray chest in the current admission also confirms a right lower lobe pneumonia. He has no other major health issues. What is the most likely diagnosis?


1) cystic fibrosis

2) congenital lung abnormality

3) chronic granulomatous disease

4) asthma

5) bronchiectasis of the lingula





  #2

3) chronic granulomatous disease


  #3

1-cystic fibrosis ?


  #4

2?


  #5

1 cystic fibrosis?


  #6

1?


  #7

Na sorry since "no major other health issues" i would rather go for 2


  #8

yup, could be 2. but what specific congenital lung abnormality are you thinking of. i havent read much about this. will read it after a few hrs today.


  #9

found the answer in this forumsmiling face thanks a lot to all of the members of this forum!

http://www.prep4usmle.com/forum/thread/19061

"Recurrent pneumonia in a young child, when consistently localized to the same lung segment, should raise the suspicion of an underlying congenital or acquired disease. Pneumonia can be caused by an external compression of a bronchus by tuberculous or fungal lymphadenopathy, tumours or vascular rings. It can also result from obstruction by intraluminal lesions, such as a bronchial tumour or foreign body. Other conditions that may present as segmental pneumonia include localized bronchiectasis, congenital cystic adenomatoid malformations and related cystic lung pathology, such as an intralobar pulmonary sequestration. However, most of these lesions are detected through prenatal ultrasound screening programs."





  #10

The answer is cystic fibrosis.

This question comes form the sample question of MCC.

They ask you what is the most likely diagnosis?

They want you to know what is the most common things.

5 is incorrect.

They want you to give the simplest answer which is CF.

CF is the most common thing among white folks. OK

Find something you can treat, not congential stuff the parents don't know !

I teach you simple rules

Rule 1: If asymptomatic, no symptoms, doing fine, DO NOT TREAT

Rule 2: If over 60 years old, it is cancer until proven otherwise

Rule 3: Pediatric cases 1 out of 5, do not treat, watch , it is normal

Don't over-react and order all kind of tests

This only apply to MCC Medical Council of Cancil questions not USMLE !




  #11

Look very careful about the question and answer.

5 is eliminated 5 is wrong !!!!!!!

5 is brochiectasis of the lingula , very rare. I never saw that in my life.

Lingular is on the left side, did the child has recurrent pneumonia on the right or left?

On the right ! So 5 is wrong !


  #12

Its CF....coz any child between 3 to5 yrs if having recuurent chest infections.....we have to do sweat test to rule out CF


  #13

Off the bat I thought CF. After readring DetermineĀ“s post not so comfortable about CF could also be 2. Does CF give recurrent infections in same lobe? AAAAA how do u explain that?



  #14

CF would destroy virtually every segment of the lung similar to teh way of emphysema and it would not be localised.

my first suspicion while readign the q was foreign body aspiration with localised lung abscess, bronchiectasis.,..

but my choice is 2. it will give a closer presentation than the other options.

pneumonia in children is usually bronchop in this age. this by definition involves the lobules and not lobes so it will not select the same lobe every time.



  #15

interesting discussion.. i think ill vote for 2 inthe end.


  #16

hey AAAAA,

whoever u r, i must say u r incredibly funny..its interesting to note that u get this fleeting thoughts n u make ur point with a tinge of sattire or atleast thtz wht i think. i must thnak you coz u give me some hearty laughs every time i read a post by u..

so whats the final answer? 2?



  #17

Cystic fibrosis
nodnodnod
if it were congenital Lung abn--it should have started by early age like infants.not in 3yr oldnod


  #18

I would go for CF.


  #19

It says:<He has no other major health issues.>
It seems to me that we can eliminate CF.


  #20

This is another post where AAAAA is full of shit. Do you notice his authority-ass kissing skills?

It's clear that there's a focal lesion... so a systemic disease like Cystic fibrosis, chronic granulomatous disease, asthma should be ruled out. Bronchiectasis of the lingula, I don't know...how specific can you be with a such a case?

The major clue is given by 'determine' later....but AAAA (did I miss an A?) about a vascular lesion, possibly a vascular ring.





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