169. Peds diseases of lungs

Question 1

Important bacteria in ages for PNA

Answer 1

o	60-90% viral in younger
o	Chlamydia in 3-19 weks
o	Mycoplasma >5yo
o	GBS in neonates
o	Strep pneumo all groups past newborn
o	S. aureau and h flu
o	RSV and paraflu in < 1

Question 2

definition of tachypnea by age

Answer 2

o >50RR <1yo
o >40 1-5yo
o >30 >5yo

Question 3

Non-infectious causes that present as PNA

Answer 3

Poor xray tech
asthma
bronchiectasis
atelectasis
CF
pulm sequestration
FB
chemical aspiration
CHF
congenital heart disease
SCD crisis

Question 4

Most common bacteria in neonate

Answer 4

GBS
e coli
Gr -ve

Question 5

Most common bacteria in 3wk-3mon

Answer 5

S. pneumo
H flu
chlamydia

Question 6

Most common bacteria in 3m - 4y

Answer 6

S. pneumo
H flu
Gr A strep
mycoplasma
Bortadella

Question 7

Most common bacteria in > 5y

Answer 7

mycoplasma
H flu
chlamydia
strep pneumo

Question 8

Sx of mycoplasma

Answer 8

• Gradual and insidious onset
• Fever, HA, malaise and hacking non-productive cough
• Rash in 10%
• CXR
  o Unilateral in lower lobes

Question 9

Sx in chlamydia

Answer 9

• 3-19weeks after birth colonization
• May be preceded by conjunctivitis
• Staccato cough
• CXR
  o Hyperinflation with bilateral infiltrates

Question 10

Bacteria in immunocompromised

Answer 10

o P. jiroveci, CMV, fungi
o Sx similar to normal hosts
 May be more rapid and severe

Question 11

6 complications of PNA

Answer 11

• Effusion or empyema
• Abscess
• PTX
• Resp failure
• Possible multiorgan failure
• Dehydration most common

Question 12

MGMT of PNA in < 2 months

Answer 12

• Appropriate Abx and supportive therapy
• Should be admitted
• Sepsis may be subtle
• Should get full septic W/UP before abx

Question 13

MGMT PNA in 2-3 months

Answer 13

• Should get blood and urine Cx
• LP depends on suspicion of CNS infection
• Ampi and 3rd gen cephalosporin
• Need to decide if likely viral, bacterial or mycoplasma

Question 14

MGMT PNA in > 3 months

Answer 14

• Need to decide if likely viral, bacterial or mycoplasma
• Well appearing can be Tx as outpatient
  o Amoxil
  o Azithro if suspect atypical
• Should get reeval in 48 hours

Question 15

Indications for admission in >3m PNA

Answer 15

o	Toxic
o	Dehydration
o	Resp compromise
o	Multilobar
o	Effusions
o	Impaired immune
o	Unstable social environment

Question 16

3 stages of pertussis

Answer 16

o	Catarrhal 
	1-2 weeks
	Mild URTI
o	Paroxysmal
	Staccato cough
	Post cough emesis
	Fever often absent
o	Convalescence

Question 17

MGMT pertussis

Answer 17

< 6 months
o Admit
o Erythro or azithromycin

Question 18

Patho of CF

Answer 18

• Mutation of CTFR gene
• Progressive lung disease and infection is most of mortality
• Cl channel defect leads to thick mucous and trouble clearing secretions

Question 19

3 CXR findings of CF infection

Answer 19

o Emphysema
o Peribronchial thickening
o Focal infiltration

Question 20

Bacteria in CF

Answer 20

• Many colonized with pseudomonas

- Burkholderia cepacian

Question 21

MGMT CF infections

Answer 21

• Abx
  o Piperacillin + ceftazidime
• May benefit from NAC inhalation
• Possible inhaled steroids

Question 22

Define bronchopulmonary dysplasia

Answer 22

• Defined as need for O2 28 days post natal
• 40% of infants with BW < 1kg
• Great increase risk of hospitalizations