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  #1  
Old 10-25-2012
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Question child with cough and vomiting

Q) a 6 yr old child has been taken to the physician for evaluation of their child illness.his complaints are nonproductive cough associated with vomiting..he is unable to sleep at nighttimes due to his cough..on physical examination the physican finds an inspiratory whoop...his vaccination schedules are not upto date....his blood lab findings are unremarkable except for raised lymphocyte count..if left untreated child may develop..?

a) centrilobular emphysema
b) paraseptal emphysema
c) interstitial emphysema
d) compensatory emphysema
e) panacinar emphysema
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  #2  
Old 10-25-2012
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Originally Posted by venky2600 View Post
Q) a 6 yr old child has been taken to the physician for evaluation of their child illness.his complaints are nonproductive cough associated with vomiting..he is unable to sleep at nighttimes due to his cough..on physical examination the physican finds an inspiratory whoop...his vaccination schedules are not upto date....his blood lab findings are unremarkable except for raised lymphocyte count..if left untreated child may develop..?

a) centrilobular emphysema
b) paraseptal emphysema
c) interstitial emphysema
d) compensatory emphysema
e) panacinar emphysema
i would go with C
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Old 10-25-2012
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Quote:
Originally Posted by venky2600 View Post
Q) a 6 yr old child has been taken to the physician for evaluation of their child illness.his complaints are nonproductive cough associated with vomiting..he is unable to sleep at nighttimes due to his cough..on physical examination the physican finds an inspiratory whoop...his vaccination schedules are not upto date....his blood lab findings are unremarkable except for raised lymphocyte count..if left untreated child may develop..?

a) centrilobular emphysema
b) paraseptal emphysema
c) interstitial emphysema
d) compensatory emphysema
e) panacinar emphysema
f) subcutaneous emphysema

adding option F) subcutaneous emphysema----for better reviewing of all kinds of emphysema at a single place....thanks
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Old 10-25-2012
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I think c perhaps interstitial
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Old 10-25-2012
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Very acutely ., he might develop subcutaneous emphysema ( I cheated for this information ) but if it isn't that serious then I'd go for compensatory emphysema secondary to atelectasis ...
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Old 10-25-2012
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i go with c(interstitial emphysema)
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Old 10-25-2012
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Default Cc..bordetela pertusis inf

Cc..................
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  #8  
Old 10-25-2012
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Default my answer C

whooping cough... Bordetella ---> interstitial + lymphocitosis

dont forget "Filamentous hemagglutinin" (bind to epithelium)
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Old 10-25-2012
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Correct Answer C and F

both C) interstitial emphysema and F) subcutaneous emphysema are the right answers.....

the case presented above is classic presentation of child with whooping cough caused by B.pertussis.....it's clinical features are paroxysmal cough associated with vomiting most of the times,inspiratory whoop is heard ,also known as '100 day cough' disease.....gradually if untreated the cough intensifies and pressurises leading to severe complications like---rectal prolapse,subconjunctival hemorrhage, hernia's,GI bleeding, rib fractures,aortic dissections etc...

as both subcutaneous emphysema(due to rib fractures) and interstitial emphysema(due to rib fractures as well as intense cough itself) can be seen as rare causes,we cant distinguish the most common one...so both are right ones...the remaining options are not associated with whooping cough... both interstitial and subcutaneous emphysema are misnomers

emphysema can be many types...here are some important ones

interstitial emphysema--->air in to the interstitial tissues and peribronchium of lungs(due to intense cough in pertussis may rupture the interstitium and air enters into it.)

subcutaneous/surgical emphysema(sometimes referred both as same)----->air enter into subcutaneous tissues ,may also reach neck..(most common due to trauma,in pertussis due to rib fractures can lead to it).....>other noteworthy causes include boerrhave injury of esophagus......>a hamman crunch sign(crepitus heard at the nape of the neck and back due to air entry) can be seen sometimes

centrilobular emphysema--------> associated with smoking...most common type of all types-->dilatation of respiratory bronchioles rather than alveoli...

panacinar emphysema------> associated with alpha-1 antitrypsin deficiency---- entire acini can be involved here..can also lead to liver diseases

paraseptal emphysema----->subpleural emphysema at lung periphery which can lead to spontaneous pneumothorax....it's incidental finding

compensatory emphysema-----> usually associated with scarring or after surgery.......removed or diseased lung can be compensated by expansion of normal lung gradually...it's rare finding.

thanks
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Old 10-26-2012
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Quote:
Originally Posted by venky2600 View Post
Q) a 6 yr old child has been taken to the physician for evaluation of their child illness.his complaints are nonproductive cough associated with vomiting..he is unable to sleep at nighttimes due to his cough..on physical examination the physican finds an inspiratory whoop...his vaccination schedules are not upto date....his blood lab findings are unremarkable except for raised lymphocyte count..if left untreated child may develop..?

a) centrilobular emphysema
b) paraseptal emphysema
c) interstitial emphysema
d) compensatory emphysema
e) panacinar emphysema
whooping cough
best guess
B. Paraseptal emphysema
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