✔️ AceQbank MCCQE1 – Updated March 2023 – Self-Assessment 1 + 2 (PDF)*✔️ AceQbank MCCQE1 – Updated March 2023 – Qbank (PDF)*

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AceQbank MCCQE1 – Updated March 2023 – Self-Assessment 1 + 2 (PDF)

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✅Explanation: OF THIS QUESTION

✔The correct answer is B.

This child's illness is consistent with viral laryngotracheitis, or croup. Croup is a viral respiratory illness that occurs in children age <3. It is characterized by rhinorrhea, low-grade fever, and a barky cough that may improve with cool or humidified air. Children with significant upper airway inflammation develop inspiratory stridor that typically worsens with activity. The diagnosis is typically based on clinical presentation. Patients with atypical or severe symptoms may undergo anteroposterior neck radiographs that reveal subglottic narrowing ("steeple" sign). Moderate to severe croup (strider present at rest) is treated with nebulized racemic epinephrine and a single dose of dexamethasone. Some patients with mild croup also benefit from glucocorticoids.

❌Choice A is not correct:
Children with epiglottitis are generally ill-appearing with high fever, distress, drooling, and dysphagia. Children may also assume the characteristic tripod posture. A thickened epiglottis on lateral neck x-ray, known as the thumbprint sign, may also be seen.

❌Choice C is not correct:

Retropharyngeal abscesses are found in children age 2-4 and present with a high fever, sore throat, difficulty swallowing, and neck stiffness. Cervical lymphadenopathy and posterior oropharyngeal erythema are also common. Prevertebral soft tissue thickening is seen in lateral neck x-rays.

❌Choice D is not correct:

Viral bronchiolitis is a lower respiratory tract infection that occurs in children age <2. Bronchiolitis presents with a prodrome of viral upper respiratory symptoms, followed by tachypnea and wheezing.

❌Choice E is not correct:

Viral upper respiratory illnesses present with rhinorrhea, nasal congestion, and sneezing but are not accompanied by a barky cough or inspiratory strider.

?Summarized Points:

Croup (viral laryngotracheitis) is characterized by low-grade fever, rhinorrhea, a barky cough, and inspiratory strider. Anteroposterior neck radiographs reveal subglottic narrowing (steeple sign). Patients with inspiratory strider at rest should receive corticosteroids and nebulized racemic epinephrine.

?References

Based on Objective number 27-3 (Pediatric Respiratory Distress) of Objectives for the Qualifying Examination, 3rd edition. Cherry JD. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, et al., eds. Feigin & Cherry’s Textbook of Pediatric Infectious Diseases. 7th ed., vol. 1.Philadelphia, Pa.: Elsevier Saunders; 2014:241-260

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#ACEQBANK #MCCQE1   #part1  Q8

A 1-year-old boy is brought to the emergency department by his parents for evaluation of a "funny noise" during breathing. He has had "a very runny nose" and a cough that have been worsening over the past 2 days. His temperature is 37.8 C (100 F), pulse is 112/min, and respirations are 32/min. His pulse oximetry is 94% on room air. Examination shows a tired-appearing boy with inspiratory strider and subcostal and intercostal retractions at rest

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✅Explanation: OF THIS QUESTION

✔The correct answer is D.

The 3 most common causes of chronic cough (lasting >8 weeks) are upper-airway cough syndrome (postnasal drip), asthma, and gastroesophageal reflux disease (GERD). Upper airway cough syndrome is caused by rhinosinus conditions including rhinitis (allergic, perennial nonallergic, vasomotor), acute nasopharyngitis, and sinusitis. Cough is caused by mechanical stimulation of the afferent limb of the cough reflex in the upper airway in these conditions.

Based on her history, this patient's dry cough is most likely due to postnasal drip associated with allergic rhinitis. The diagnosis is confirmed by the improvement of the nasal discharge and cough with the use of first-generation antihistamines. Chlorpheniramine is a specific H1 antihistaminic receptor blocker that reduces the action of histamine on H1 receptors, decreasing the allergic response. In addition to blocking H1 histamine receptors, chlorpheniramine exhibits anti-inflammatory effects by blocking histamine release from mast cells and limiting the secretory response to inflammatory cytokines.

❌Choice A is not correct:

Acid reflux can irritate the cough reflex and is also a common cause of chronic cough. Empiric therapy of GERD includes dietary and lifestyle modifications and proton pump inhibitors, which suppress stomach acid secretion. Antihistamines would not help the cough associated with GERD.

❌Choice B and E are not correct:

Asthma can also cause chronic cough. It is characterized by variable and recurring symptoms, airflow obstruction, bronchial inflammation, and airway hyperreactivity. Empiric treatment involves inhaled corticosteroids, which reduce airway inflammation, and β-adrenergic agonists, which dilate bronchial smooth muscle. Antihistamines have no role in asthma management.

❌Choice C is not correct:

About 5%-20% of patients treated with an angiotensin-converting enzyme (ACE) inhibitor develop dry cough due to ACE inhibition causing decreased degradation of bradykinin and substance P. Accumulation of these substances causes cough. Cough improves only with discontinuation of an ACE inhibitor and not with antihistamines.

?Summarized Points:

The 3 most common causes of chronic cough are upper airway cough syndrome (postnasal drip), asthma, and gastroesophageal reflux disease. The diagnosis of upper-airway cough syndrome is confirmed by the elimination of nasal discharge and cough with the use of H1 histamine receptor antagonists.

?References

Objectives number 18 (Cough) of Objectives for the Qualifying Examination, 3rd edition. Benich JJ, Carek PJ. Evaluation of the patient with chronic cough. Am Fam Physician. 2011; 84 (8): 887-892.

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#ACEQBANK #MCCQE1   #part1  Q7
A 32-year-old woman presents with a dry cough that she has had for the last 2 months. It often awakens her at night. There is no associated fever, shortness of breath, chest pain, or wheezing. The patient’s past medical history is significant for chronic rhinorrhea and an occasional itching skin rash. She takes no medications. Chest x-ray shows no abnormalities. One week of treatment with chlorpheniramine significantly improves her symptoms.

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✅Explanation: OF THIS QUESTION

✔The correct answer is E.
Bronchiolitis is common in children age <2. The most common pathogens include respiratory syncytial virus (RSV), rhinovirus, parainfluenza, and influenza. Bronchiolitis typically begins with viral upper respiratory symptoms (e.g., rhinorrhea, congestion) that progress to lower respiratory tract symptoms such as tachypnea, cough, and wheezing. Symptoms typically peak on days 5-7 of illness, but full recovery can take up to a month. The diagnosis of bronchiolitis is based on history and examination findings. Virologic testing also should not be performed unless the patient is receiving palivizumab prophylaxis.

Bronchiolitis is a self-limited illness, and supportive management is the mainstay of treatment. Oral feeding can be continued for patients in mild distress. Nasogastric feeds or intravenous fluids should be administered for patients who cannot tolerate oral feeds. Supplemental oxygen should be administered for oxygen saturation <90%. Inpatient admission is indicated for patients with severe respiratory distress, those requiring supplemental oxygen, and those at risk for apnea. Infants born prematurely and those age <2 months are at the greatest risk of apnea. Admission is not indicated as this patient is age 6 months and has only mild distress.

❌Choice A is not correct:

Patients with severe respiratory distress, those who need supplemental oxygen, and those who are at risk of apnea should be admitted to an inpatient facility. Apnea is most common in premature infants and those under the age of two months.

❌Choice B is not correct:

A chest x-ray is not necessary to confirm the diagnosis and should only be ordered if an alternate diagnosis, such as pneumonia or effusion, is suspected.

❌Choice C is not correct:

Bronchodilators (e.g., albuterol) are not recommended routinely for bronchiolitis as randomized controlled trials fail to show consistent benefit. They do not reduce the course of illness, need for hospitalization, or length of stay in hospitalized patients.

❌Choice D is not correct:

Oral corticosteroids are used to treat acute asthma exacerbations. They generally do not reduce admission rates or improve clinical outcomes in bronchiolitis.

⭐Summarized Points:

Bronchiolitis is a viral lower respiratory tract infection that presents with rhinorrhea, cough, and wheezing, and occurs in children age <2. Supportive care is the mainstay of therapy.

⭐References

Based on Objective number 27-3 (Pediatric Respiratory Distress) of Objectives for the Qualifying Examination, 3rd edition. Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014; 35 (12): 519-530.

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#ACEQBANK #MCCQE1   #part1  Q6

A 6-month-old girl is brought to the physician with a runny nose and cough for the past 2 days. She has been breastfeeding normally and has no changes in urine output. Her brother, who attends daycare, has been sick and accidentally sneezed in her face a few days ago. The girl was born full-term by uncomplicated vaginal delivery and has been healthy. Her temperature is 37.2 C (99 F), pulse is 130/min, and respirations are 46/min. Pulse oximetry is 96% on room air. Examination shows an alert infant with nasal flaring, mild subcostal and intercostal retractions, and scattered wheezes bilaterally. There is no grunting.

?THE QUESTION

?EXPLANATION

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