Foreign Body Management — MCQs

10 questions

A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

Which of the following investigations is contraindicated in patients with metallic foreign body?

Best management for an inhaled foreign body in an infant is?

A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

A patient presents with acute appendicitis. What is NOT to be done?

What is the preferred method for removing a foreign body from the lung in children?

In a patient with a metallic foreign body in the eye, which investigation should NOT be done?

Best method of detection of a retained glass intraocular foreign body is

Q10

6 years old girl with vaginal spotting. Diagnosis is –

Foreign Body Management Indian Medical PG Practice Questions and MCQs

Question 1: A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –

A. Staphylococcal bronchopneumonia
B. Foreign body aspiration (Correct Answer)
C. Congenital lobar emphysema
D. Aspiration pneumonia

Explanation: ***Foreign body aspiration*** - A **foreign body** partially obstructing a bronchus acts as a **one-way valve**, allowing air to enter the lung on inspiration but trapping it on expiration, leading to **hyperinflation** of the distal lung. - This is a common cause of acute respiratory distress and unilateral lung hyperinflation in children, as they frequently aspirate small objects. *Staphylococcal bronchopneumonia* - This typically presents with **consolidation** and **infiltrates** on chest X-ray, rather than hyperinflation. - While it can cause respiratory distress, it does not characteristically lead to **unilateral hyperinflation** as its primary X-ray finding. *Congenital lobar emphysema* - This causes **progressive hyperinflation of a single lobe** (typically upper or middle lobe), not the entire lung, due to abnormal bronchial cartilage or extrinsic compression. - While it can present acutely in infancy, the X-ray shows **lobar** hyperinflation with mediastinal shift, distinct from the **whole lung** hyperinflation seen with foreign body aspiration. *Aspiration pneumonia* - Aspiration pneumonia is caused by inhaling gastric contents or other substances, leading to **inflammation and infection** of the lung parenchyma. - It typically presents with **infiltrates**, **consolidation**, or **abscess formation** on X-ray, not unilateral hyperinflation.

Question 2: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

A. FB in larynx
B. Angioneurotic edema (Correct Answer)
C. Parapharyngeal abscess
D. FB bronchus

Explanation: Andioneurotic edema - The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1]. - This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2]. *FB in larynx* - While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3]. - A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3]. *Parapharyngeal abscess* - A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario. - The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess. *FB bronchus* - A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck. - Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.

Question 3: Which of the following investigations is contraindicated in patients with metallic foreign body?

A. CT Scan
B. MRI (Correct Answer)
C. VER
D. ERG

Explanation: ***MRI*** - Magnetic resonance imaging (MRI) uses a powerful **magnetic field** and radio waves to create detailed images of organs and tissues. - The strong magnetic field can cause **ferromagnetic metallic objects** to move, heat up, or malfunction, posing a significant safety risk. *CT Scan* - A CT scan uses **X-rays** to produce cross-sectional images of the body and is generally safe in the presence of metallic foreign bodies. - While metallic objects can cause **artifacts** (streaks or distortions) in CT images, this does not pose a direct safety risk to the patient. *VER* - **Visual Evoked Response (VER)**, also known as VEP (Visual Evoked Potential), is an electrophysiological test that measures the electrical activity of the brain in response to visual stimuli. - It does not involve strong magnetic fields or radiation and is therefore **safe** for patients with metallic foreign bodies. *ERG* - An **Electroretinogram (ERG)** measures the electrical responses of the retina to light stimulation, assessing retinal function. - It is a non-invasive test that does not use magnetic fields or X-rays and is **not contraindicated** in the presence of metallic foreign bodies.

Question 4: Best management for an inhaled foreign body in an infant is?

A. IPPV
B. Tracheostomy
C. Corticosteroids
D. Bronchoscopy (Correct Answer)

Explanation: ***Bronchoscopy*** - **Bronchoscopy** is the definitive and most effective procedure for both diagnosing and removing an inhaled foreign body in an infant. - It allows direct visualization of the airways and the precise retrieval of the foreign object, preventing complications like **atelectasis** or **pneumonia**. *Tracheostomy* - **Tracheostomy** is an emergency procedure to create a surgical airway, usually reserved for severe upper airway obstruction that cannot be managed by less invasive means. - It is not the primary line of treatment for removing an inhaled foreign body, which is typically found further down in the **bronchial tree**. *Corticosteroids* - **Corticosteroids** are used to reduce inflammation and edema in the airways, but they do not remove the foreign body itself. - While they might be used as an adjunct in managing airway inflammation after removal, they are not the definitive treatment for the foreign body. *IPPV* - **Intermittent Positive Pressure Ventilation (IPPV)** is a method of respiratory support used for patients with respiratory failure. - It does not address the physical obstruction caused by an inhaled foreign body and may even push the object further into the airway or cause **pneumothorax**.

Question 5: A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:

A. Emergency tracheostomy
B. Humidified oxygen
C. Heimlich maneuver (Correct Answer)
D. Cricothyroidotomy

Explanation: ***Heimlich maneuver*** - The sudden onset of **aphonia** and **respiratory distress** during dinner indicates **foreign body airway obstruction** (FBAO). - The **Heimlich maneuver** is the immediate, life-saving intervention for conscious individuals with complete airway obstruction. *Emergency tracheostomy* - This is an invasive surgical procedure performed when other methods to clear the airway have failed or are not possible due to severe obstruction or trauma. - It is not the **first-line intervention** for a conscious child with FBAO. *Humidified oxygen* - While supportive of respiratory function, humidified oxygen alone will not resolve an **acute foreign body obstruction** causing aphonia and severe distress. - It does not address the underlying mechanical blockage of the airway. *Cricothyroidotomy* - This is an emergency procedure to establish an airway, typically used in adults when other methods of intubation or airway clearance have failed. - It is generally **contraindicated in children under 12** due to the risk of damaging the cricoid cartilage, which is a major part of the child's airway.

Question 6: A patient presents with acute appendicitis. What is NOT to be done?

A. Give antibiotics
B. Do primary survey
C. Perform appendectomy
D. Check for visual acuity (Correct Answer)

Explanation: ***Check for visual acuity*** - **Visual acuity** assessment is not relevant to the diagnosis or management of **acute appendicitis**. - This examination is typically performed in cases of suspected eye injury, vision changes, or neurological issues that affect vision. - In the context of acute appendicitis, checking visual acuity would be inappropriate and waste valuable time. *Give antibiotics* - **Antibiotics** are crucial in managing **acute appendicitis** to prevent progression to perforation and reduce postoperative infection risk. - They are typically administered preoperatively and continued postoperatively, especially in cases of complicated appendicitis. - Broad-spectrum antibiotics covering **gram-negative organisms and anaerobes** are standard practice. *Do primary survey* - A **primary survey** (ABCDE approach) is essential in any emergent patient presentation to assess and manage immediate **life-threatening conditions**. - While appendicitis itself may not be immediately life-threatening, ensuring patient stability and ruling out other serious conditions is critical. - This is standard emergency medicine practice and should always be performed. *Perform appendectomy* - **Appendectomy** (surgical removal of the appendix) is the definitive treatment for **acute appendicitis**. - This is the standard of care and should be performed once the diagnosis is confirmed and the patient is stable. - Either open or laparoscopic approach can be used depending on clinical factors and surgeon expertise.

Question 7: What is the preferred method for removing a foreign body from the lung in children?

A. Rigid bronchoscopy (Correct Answer)
B. Chest x-ray
C. Flexible endoscopy
D. Direct laryngoscopy

Explanation: ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Question 8: In a patient with a metallic foreign body in the eye, which investigation should NOT be done?

A. X-ray
B. MRI (Correct Answer)
C. CT
D. USG

Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is contraindicated in patients with suspected **metallic foreign bodies** in the eye. - The powerful magnetic fields of an MRI can cause the metallic object to move, potentially leading to further **tissue damage** or even loss of vision. *X-ray* - **X-rays** are often the initial investigation of choice for detecting **radio-opaque foreign bodies** within the eye. - They can effectively localize larger metallic objects and are readily available in most emergency settings. *CT* - **Computed Tomography (CT)** scans provide detailed cross-sectional images and are excellent for precisely localizing **intraocular foreign bodies**, especially smaller ones. - CT can differentiate between metallic and non-metallic objects and assess for associated injuries like orbital fractures. *USG* - **Ultrasound (USG)** of the eye can be useful for detecting **intraocular foreign bodies**, especially if they are non-metallic or located in the posterior segment. - It can also assess for associated complications such as **retinal detachment** or vitreous hemorrhage.

Question 9: Best method of detection of a retained glass intraocular foreign body is

A. USG
B. Radiography
C. Tonometry
D. CT scan (Correct Answer)

Explanation: ***CT scan*** - **CT scans** are highly sensitive and specific for detecting **retained glass intraocular foreign bodies** due to their excellent spatial resolution and ability to visualize foreign materials with different densities. - Unlike MRI, CT is safe with metallic foreign bodies and provides precise localization, aiding surgical planning. *Radiography* - While helpful for detecting radio-opaque foreign bodies like metal, **plain X-rays display limited soft tissue contrast** and may struggle to visualize small or less dense objects like glass effectively within the complex orbital structures. - **Glass foreign bodies can be difficult to discern** from surrounding bony structures or soft tissues on conventional radiographs, leading to false negatives. *USG* - **Ultrasound (USG)** is effective for imaging soft tissues and can detect some foreign bodies, but its utility is limited when the object is small, non-reflective, or located deep within the globe, especially behind structures like the lens or iris. - **Acoustic shadowing** and artifact creation can also obscure the foreign body or mimic its presence, reducing diagnostic accuracy for glass. *Tonometry* - **Tonometry measures intraocular pressure** and is primarily used to screen for or monitor glaucoma. - It provides no information about the presence or location of **intraocular foreign bodies**.

Question 10: 6 years old girl with vaginal spotting. Diagnosis is –

A. Ovarian cancer
B. PID
C. Foreign body (Correct Answer)
D. Sexual abuse

Explanation: ***Foreign body*** - **Most common benign cause** of vaginal spotting in prepubertal girls - Typically presents with **foul-smelling discharge**, spotting, and irritation - Common objects include toilet paper, small toys, or other inserted items - Diagnosis confirmed by **gentle examination** ± vaginoscopy - **However:** Foreign body insertion itself may indicate curiosity, accident, OR behavioral concerns that warrant evaluation *Sexual abuse* - **MUST be considered and ruled out** in ANY prepubertal vaginal bleeding - Can present with spotting, discharge, lacerations, bruising, or behavioral changes - May have **NO obvious physical findings** in many cases - **Critical point:** Presence of foreign body does NOT exclude abuse - All cases require **careful history, examination, and consideration of child protection protocols** - If **PID or STI** is found in a prepubertal child, sexual abuse is highly likely *PID* - Pelvic inflammatory disease requires ascending infection, almost exclusively in **sexually active** females - In a 6-year-old, PID or STI should **immediately raise suspicion for sexual abuse** - Not a typical cause of isolated spotting in this age group *Ovarian cancer* - Extremely **rare** in prepubertal children - Ovarian tumors (especially granulosa cell tumors) can cause **precocious puberty** with breast development and menstrual-like bleeding - Would present with additional findings: abdominal mass, hormonal changes, not isolated spotting **Clinical Approach:** While foreign body is statistically most common, every case of prepubertal vaginal bleeding requires thorough evaluation including detailed history (with child alone if appropriate), complete examination (may need anesthesia), and maintaining high index of suspicion for abuse.

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