CLIPP 13

Question 1

chronic cough in kids duration

Answer 1

> 4 w

Question 2

6 yo RR

Answer 2

12-20

Question 3

acute complaints is what hour timeframe

Answer 3

<72h, and likely d/t infection or precipitating event like trauma

Question 4

dry cough

Answer 4

environmental irritant, asthma, fungal infection

Question 5

barking cough

Answer 5

croup, subglottic disease or foreign body

Question 6

brassy or honky cough

Answer 6

habitual cough, tracheitis

Question 7

paroxysmal cough

Answer 7

pertussis, Chlamydia, mycoplasma, foreign body

Question 8

worse at night cough

Answer 8

asthma, sinusitis, allergies - can result in post nasal drip–>nocturnal cough

Question 9

cough disappears at night

Answer 9

habitual cough

Question 10

cough w/ gag or choke

Answer 10

gastroesophageal reflux

Question 11

what can lobar pna in lower quadrants mimic

Answer 11

APPY

Question 12

dysphonia or hoarseness could be due to

Answer 12

laryngeal irrutaiton due to gerd orchronic rhintiis

Question 13

serious condition presenting w wheeze and cough that mimics asthma or bornchitis

Answer 13

infectious myocarditits

Question 14

headaches plus a cough

Answer 14

sinusitis often

Question 15

heritable cough things

Answer 15

ashtma, immunodef, cf

Question 16

a dx to consider w/ male sterility

Answer 16

primary ciliary dyskinesia

Question 17

sx and radiology findings in peds pulm tb

Answer 17

sx are few to none compared to radiology findings which include a primary complex (large size of hilar LAD) with sequence going from hilar LAD to hyperinflation and atelectasis

Question 18

PPD TST test positivity markers

Answer 18

A test is considered positive if it is: > 5 mm in high-risk children, > 10 mm in moderate-risk children and > 15 mm in low-risk children.

Question 19

common asthma trigger

Answer 19

URI

Question 20

peds bronchitis findigns and tx

Answer 20

sputum production, cough equal at day and ngith with no change in sx based on night or cold air or workout
-does not require abx tx

Question 21

atypical pna presenation

Answer 21

cough can persist for 8-12weeks, worse in cold air/workout, , URI sx, abnl breath sounds,

Question 22

habit cough

Answer 22

A habit cough is caused by habitual perpetuation of cough begun with a viral upper respiratory infection.
Continued coughing irritates the airway further, leading to a stronger stimulation to cough.
The cough is typically very loud, short, dry, brassy and spasmodic.
A habit cough is unchanged by exercise or cold air and classically resolves during sleep.

Question 23

what is one of the most important distinguishing characteristics of a sinusitits

Answer 23

persisting ssx w/o improvement as viral URI tends to improve over the course of a week or so.

Question 24

pale edematous turbinates aka and seen in

Answer 24

boggy, nasal allergies , can be concurrent w/ sinusitis

Question 25

cobblestoning is

Answer 25

lymphoid hyperplasia of posterior pharynx due to chronic PND and most often seen in kids w/ chronic allergic rhinitis

Question 26

in which types of pt are nasal polyps often seen

Answer 26

cf, astham, aspirin sensitive

Question 27

3 criterion in dx sinusitis

Answer 27

Persistence of bilateral nasal discharge of any quality or daytime cough, or both, lasting for more than 10 days without significant improvement (unilateral symptoms suggest a nasal foreign body), OR Worsening after initial improvement ("double-sickening") OR High fever and purulent nasal discharge for more than 3 days.

Question 28

1st line tx for sinusitis

Answer 28

amox w or w/o clav

Question 29

wheezing is the sound of

Answer 29

airflow thru narrow airways

Question 30

accessory muscles of respiration

Answer 30

inspiratory contraction of SCM at rest = severe resp distress

Question 31

hyperrres vs dullness

Answer 31

``` hyper = air dull = lobar consolidatin or atelec ```

Question 32

egophany

Answer 32

ee-->ay sound, due to lobar consolidation aka airless lung

Question 33

I:E ratio

Answer 33

full inspiration time to full expiration time, normally 1:2, or 1:# but in obstruction, expiration is prolonged thus ratio down

Question 34

2 ways in which crackles and ronchi differ

Answer 34

crackles inspiratory, discontinuous | ronchi expiratory, continous

Question 35

ronchi due to

Answer 35

mucous, secretion in airway

Question 36

atopy defn and causes

Answer 36

Atopy is defined as the genetic predisposition for the development of an IgE-mediated response to common aeroallergens, leading to the development of allergic rhinitis, asthma, and atopic dermatitis (eczema). - due to genetics and environ

Question 37

the 3 most common indoor aeroallergens that sensitize people are

Answer 37

house dust mites, animal dander, cockroaches

Question 38

most specific way of determine presence or absence of reversible airway obstruction

Answer 38

spirometry before and after bronchodil therapy if at least 5-6yo

Question 39

Bronchoprovocation with methacholine, histamine or exercise challenge

Answer 39

reserved for pts w normalish spiro but still suspected ashtam

Question 40

overreliance on SABA

Answer 40

using 1 cannister/motnh even if not using it every day

Question 41

pathophysi of asthma

Answer 41

biphasis 1. lasts 1 h - allergen triggers, mast cells and eos release PG and leukotirenes -->permeability, hyper secretion, bronchoconstriction 2. 2-3h later - worst by 4-8h, resolves by 24h, neuts eos lymphocyte infiltratio-->hyperplaia of bronchial smooth musc

Question 42

common ics in asthma and what to monitor for

Answer 42

budesonide, beclamethasone, fluticasone - monitor for htn, growth delay, glucose, cataracts

Question 43

who should be on ICS

Answer 43

any pt w/ persistent asthma - mild , mod , or severe

Question 44

In well controlled asthma, SABA should not be required more than __ x per week

Answer 44

2

Question 45

what is cromolyn sodium

Answer 45

an inhaled NSAID

Question 46

who is at rsk for severe varicella infection

Answer 46

kids on inhaled or systemic steroid

Question 47

PF meter

Answer 47

air exhaled in L/s, is effort dependent so poor effort = poor # and poor results

Question 48

exercise induced brochospoasm

Answer 48

haracterized by severe bouts of bronchospasm triggered only by exercise or cold air; may also be a marker for poorly controlled asthma.

Question 49

cough variant ashtam

Answer 49

presents only w/ cough

Question 50

non productive nocturnal cough

Answer 50

cough variant asthma is one possib

Question 51

AAP based on

Answer 51

daily sx and peak flow readings

Question 52

f/u intervals for asthma

Answer 52

q2-6 weeks til asthma is stabile then 1-6 month intervalsq

Question 53

most approp way to use peak flow

Answer 53

use kids personal best -avg of 14 days of values when control is good

Question 54

what is peak flow not good for

Answer 54

dx - use oft isntead

Question 55

intermitent astham

Answer 55

fewer than 2 d/week or 2 NIGHTS/month

Question 56

moderate astham

Answer 56

dialy sx w/more than one NIGHT/week

Question 57

mild persis astham

Answer 57

3-6d/w and 3-4NIGHTS/month