CIS Pediatric Enhancement Respiratory Dow

Question 1

stridor

Answer 1

upper airway obstruction on inspiration

Question 2

wheezing

Answer 2

lower airway obstruction on expiration

Question 3

fever is a common manifestation of what in peds

Answer 3

of the common cold during the early phase of infection

Question 4

most common cause of herpangina

Answer 4

coxsackieviruses

posterior oropharynx

Question 5

herpetic gingivioostomatitis

Answer 5

anterior oropharynx

Question 6

when is monospot testing accurate (ages)

Answer 6

not accurate under 4-5 years of age or before 2nd week of illness

Question 7

what is in the history of a peds patient with strep pharyngitis w

Answer 7

sore throat
fever
headaches
GI symptoms (abd pain, nausea, vomiting)
*** No cough or rhinorrhea (these are more viral)

poor oral intake
abrupt onset
school aged child

Question 8

what is found on physical exam of a peds pt with strep pharyngitis

Answer 8

Exudative pharyngitis or erythema of posterior orophayngeal mucosa
Enlarged tender anterior cervical lymph nodes
Palatal petechiae
Inflamed uvula
Scarlatiniform rash- streaks
Pastia’s lines

Question 9

what is the work up for strep pharyngitis

Answer 9

rapid strep with back up culture if negative

Question 10

what is the most common deep neck infection in children and adolescents

Answer 10

peritonsillar abscess

A collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles.

tonsillar asymmetry

Question 11

what is the gold standard for diagnosis of peritonsillar abscess

Answer 11

gold standard for diagnosis of peritonsillar abscess remains the collection of pus from the abscess through needle aspiration

Question 12

at what age is retropharyngeal abscess most common

Answer 12

age 2-4 years

Question 13

what image do you want to get for an abscess

Answer 13

ct with contrast so that it makes the abscess appear

“circumscribed” in white

Question 14

what are the 4 D’s of epiglottitis

Answer 14

drooling
dysphagia
dysphonia
dyspnea

Question 15

how does a child with epiglottitis appear

Answer 15

toxic appearing

tripod position, sniffing position

Question 16

how do you manage epiglottitis

Answer 16

Direct examination of the airway under anesthesia (with the availability of personnel who can perform a tracheostomy if needed

Question 17

where do you see the thumbprint sign

Answer 17

lateral film

epiglottitis

Question 18

what is croup most commonly caused by

Answer 18

parainfluenza

Question 19

what are the typical features of croup (laryngotracheitis) and how is the diagnosis made

Answer 19

nasal congestion
low-grade fever
barking-type cough *
inspiratory stridor (upper airway) that may worsen with crying.*

diagnosis made on clinical assessment
-most common in 6months-36 months, rare beyond age 6

Question 20

what is the characteristic finding on neck radiograph of a patient with croup

Answer 20

steeple sign

which reflect subglottic tracheal narrowing.

Question 21

how do you treat croup?

Answer 21

warm mist

Decadron (corticosteroid)

inhaled racemic epinephrine *** used to reduce stridor within 30 minutes, most immediate benefit
observe for at least 3 hours

Question 22

suspect this in child with….
acute onset of airway obstruction in the setting of viral upper respiratory infection and in children with laryngotracheitis who are febrile, toxic-appearing, and have a poor response to treatment with nebulized epinephrine or glucocorticoids
Definitive diagnosis of bacterial tracheitis requires direct visualization of an inflamed, exudate-covered trachea

Answer 22

bacterial tracheitis

Question 23

what is the most common cause of bronchiolitis

Answer 23

RSV

Question 24

one- to three-day history of upper respiratory tract symptoms, such as nasal congestion discharge and mild cough, followed by lower respiratory infection with inflammation, which results increased respiratory effort (eg, tachypnea, nasal flaring, chest retractions) and wheezing and/or crackles (rales).

Answer 24

bronchiolitis

pathogen:
-RSV, rhinovirus

looks like pneumonia and asthma

clinical diagnosis!

Question 25

when do you admit a patient with bronchiolitis

Answer 25

Admit if hypoxic (oxygen saturations below 90% on room air) or dehydrated

Question 26

Presenting signs/sxs
Fever
Cough
tachypnea
increased work of breathing (retractions, nasal flaring, grunting, use of accessory muscles) 
hypoxemia
adventitious lung sounds

Answer 26

pneumonia

Question 27

Adolescents*** or children over 5
Most commonly URI symptoms without pneumonia

Gradual onset and usually is heralded by headache, malaise, and ***low-grade fever

Occasionally can be more acute and mimic pneumococcal pneumonia

Nonproductive*** to mildly productive cough

Wheezing and dyspnea also may occur***

Scattered rales and wheezes on lung exam may be present***

Answer 27

mycoplasma pneumoniae

atypical pneumonia! “walking pneumonia”

Question 28

how do infants with pertussis present differently

Answer 28

infants don’t whoop

present with apnea and minimal or no cough

Question 29

what is the most likely cause of pneumonia in children?

how does it show up on CXR

Answer 29

viral process

RSV, parainfluenza, adenovirus, rhinovirus, influenza, rubeola

and it shows up as DIFFUSE infiltrates

Question 30

there is no testing or treatment of influenza unless what risk factors are present?

Answer 30

Age less than 2
Immunocompromised -asthma, CF- family member in home (including pregnant women, infants)
Asthma
Heart disease

start prophylaxis within the first 48 hrs of onset

Question 31

EV-D68

Answer 31

Many of the children had asthma or a history of wheezing

Symptoms include fever, runny nose, sneezing, cough, and body and muscle aches.

Severe symptoms may include wheezing and difficulty breathing

Cases with weakness and myelitis

Question 32

MOC reports that Ima has had cold symptoms for 4 days including clear rhinorrhea, cough, and congestion. Ima has been coughing more today, and MOC notes that she has been breathing fast. Cough is most concerning – she coughs until she gags herself. Doesn’t turn blue. Not sleeping well.

MOC has heard wheezing and states infant has had a fever to 102 this afternoon. Siblings have had colds recently.

Decreased oral intake. 3 wet diapers in past 24 hours.

sats 88% RA

tachypneic, with mild subcostal retractions, moderate expiratory wheezing and crackles bilaterally in all lung fields

Answer 32

bronchiolitis

Question 33

what is the treatment for bronchiolitis

Answer 33

Oxygen via nasal cannula to keep sats over 90%
Encourage adequate hydration
Nasal suctioning q 2 hours PRN
Tylenol/ibuprofen PRN fever

Question 34

what is the treatment for strep pharyngitis

Answer 34

Amoxicillin, push fluids, salt water gargles, throat lozenges, popsicles/milkshakes, soft diet, antipyretics PRN

Question 35

what is the treatment for peritonsillar abscess ?

Answer 35

Treatment:
Consult ENT for needle aspiration, C&S
Augmentin or Clindamycin
Fluids, soft diet, antipyretics/analgesics