PEARS Recognizing Respiratory Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with a barky cough, inspiratory stridor at rest, and mild retractions. Which condition does this presentation most suggest?
- Bronchiolitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Epiglottitis
- Foreign body aspiration
Correct answer: Croup (laryngotracheobronchitis)
Barky cough with inspiratory stridor and mild retractions at rest is the classic presentation of croup.
Question 2: Which finding best distinguishes upper airway obstruction from lower airway obstruction in a pediatric patient?
- Presence of cyanosis
- Inspiratory stridor versus expiratory wheezing (Correct answer)
- Degree of tachycardia
- Oxygen saturation below 94%
Correct answer: Inspiratory stridor versus expiratory wheezing
Inspiratory stridor indicates upper airway obstruction, while expiratory wheezing indicates lower airway obstruction.
Question 3: A 6-week-old infant has a respiratory rate of 68/min, mild subcostal retractions, and SpO2 of 93% on room air. How should you classify this infant's respiratory status?
- Normal newborn breathing
- Respiratory distress (Correct answer)
- Respiratory failure
- Compensated respiratory distress
Correct answer: Respiratory distress
Tachypnea, retractions, and SpO2 of 93% indicate respiratory distress requiring prompt intervention.
Question 4: When assessing a child's work of breathing, which muscle group use indicates the most severe respiratory distress?
- Intercostal retractions
- Subcostal retractions
- Suprasternal retractions (Correct answer)
- Nasal flaring alone
Correct answer: Suprasternal retractions
Suprasternal (tracheal tug) retractions indicate severe upper airway obstruction and significant increased work of breathing.
Question 5: A 4-year-old with known asthma presents with diffuse expiratory wheezing, SpO2 95%, and is able to speak in full sentences. Which category best describes his respiratory status?
- Respiratory failure
- Respiratory arrest
- Respiratory distress (Correct answer)
- Normal variant
Correct answer: Respiratory distress
Wheezing with SpO2 of 95% and maintained speech indicates respiratory distress, not failure.
Question 6: Which of the following is a sign of impending respiratory failure in a child with severe asthma?
- Audible wheezing on auscultation
- Respiratory rate of 32/min
- Silent chest on auscultation (Correct answer)
- SpO2 of 94%
Correct answer: Silent chest on auscultation
A silent chest in a patient with asthma indicates minimal air movement and is an ominous sign of impending respiratory failure.
Question 7: A 2-year-old presents with sudden onset of coughing, unilateral decreased breath sounds, and mild stridor. What is the most likely diagnosis?
- Acute asthma exacerbation
- Croup
- Foreign body aspiration (Correct answer)
- Bronchiolitis
Correct answer: Foreign body aspiration
Sudden onset, unilateral decreased breath sounds, and stridor in a toddler strongly suggest foreign body aspiration.
PEARS Recognizing Respiratory Emergencies 2
A 3-year-old presents with a barky cough, inspiratory stridor at rest, and mild retractions.
Which condition does this presentation most suggest?