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Peds II > Exam 3 - Respiratory > Flashcards

Exam 3 - Respiratory Flashcards

1
Q

What is the most common etiology of Croup?

A

Parainfluenza

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2
Q

What are some common signs/symptoms of Croup?

A
  • Barking cough
  • Hoarsness
  • Stridor
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3
Q

While Croup is typically diagnosed clinically, what can be seen on x-ray?

A

Steeple signs

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4
Q

What would classify mild croup and how do you treat?

A

No stridor at rest

Supportive care, cool mist, +/- steroid

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5
Q

What would classify moderate croup and how do you treat?

A

Stridor and some retractions

Corticosteroids, nebulized racemic epinephrine with observation for 3-4 hours after treatment

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6
Q

What would classify severe croup and how do you treat?

A

Stridor, retractions, agitation

ER for airway support/admission

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7
Q

Mother brings in her child with the following symptoms:

  • Sudden onset high fever and sore throat
  • Dysphagia, drooling, distress
  • Muffled or “hot potato” voice

What is your clinical diagnosis?

A

Epiglottitis

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8
Q

What is the 3 D’s triad of epiglottitis?

A

Dysphagia, drooling, distress

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9
Q

While epiglottitis is typically diagnosed clinically, how can you obtain a definitive diagnosis?

What will be seen on lateral neck x-ray?

A

Direct laryngoscopy for definitive diagnosis

“Thumb sign” is classic for epiglottitis

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10
Q

What is the treatment for epiglottitis?

A

EMERGENT

  • Consult airway specialist for airway management
  • 3rd generation cephalosporin (ceftriaxone)
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11
Q

Mother brings in her 3 year old son due to an abrupt onset of cough, choking, and wheezing. You also note that patient appears mildly cyanotic. Patient was previously healthy prior to onset of symptoms. What is your clinical suspicion?

A

Foreign body aspiration

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12
Q

When would you perform a rigid bronchoscopy?

A

If no foreign body identified on CXR, but clinical suspicious is high

Both diagnostic and curative

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13
Q

What are signs and symptoms of tracheomalacia?

A
  • Recurrent harsh, barking cough or stridor typically during expiration
  • Worse with respiratory infections and agitation
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14
Q

What is the treatment for tracheomalacia?

A
  • Most spontaneously improve within 6-12 months

- CPAP if severe

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15
Q

What is the classic triad of symptoms associated with Pertussis?

A
  • Paroxysms of cough
  • Inspiratory whoop
  • Post-tussive emesis
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16
Q

What is the gold standard for diagnosis of Pertussis?

What other test can confirm the diagnosis?

A

Nasal culture

PCR from nasopharyngeal swab

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17
Q

What is the treatment for Pertussis?

A
  • Supportive care
  • Antibiotics (macrolides or Bactrim)
  • Hospitalization if complications
  • Post-exposure prophylaxis for close contacts and exposed individuals at high risk
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18
Q

What is the most common viral etiology of Bronchiolitis?

A

RSV

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19
Q

What is a lower respiratory tract infection affecting the small airways in children < 2 yo?

A

Bronchiolitis

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20
Q

What is the leading cause of hospitalization in infants and young children?

A

Bronchiolitis

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21
Q

During the fall, a 1 year old child is brought to the clinic with low grade fever, cough, tachypnea, retractions, and wheezing. Mother reports that the patient was experiencing URI symptoms for 1-3 days before the development of his current symptoms. What is your likely diagnosis?

A

Bronchiolitis

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22
Q

What is treatment for non-severe bronchiolitis?

A
  • Hydration
  • Nasal suctioning
  • 1-2 day follow-up
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23
Q

What is treatment for moderate-severe bronchiolitis?

A
  • Hospitalization
  • Trial of albuterol
  • Fluid maintenance, nasal suctioning, respiratory support
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24
Q

What are signs/symptoms associated with RSV?

A

Similar to bronchiolitis, but may have pneumonia or apnea

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25
Q

How is RSV diagnosed?

A

Clinically

PCR only if results alter treatment

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26
Q

What populations would possibly receive RSV prophylaxis (palivizumab)?

A

High risk children < 2 yo

  • Bronchopulmonary displasia
  • Congenital heart disease
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27
Q

What is the most common etiology for pneumonia in 1 month to 5 years old?

5-18 years old?

A

1-5: Viral (RSV)

5-18: Bacterial (S. pneumoniae, atypical)

28
Q

What is the most common bacterial pathogen of pneumonia for ages 1 months to 18 years old?

A

S. pneumoniae (atypical is equal in 5-18 years old)

29
Q

What are some “classic” symptoms of pneumonia?

A

Cough, chest pain, shortness of breath, difficulty breathing

30
Q

What will be heard on the lung exam in a patient with pneumonia?

A
  • Crackles/Rales
  • Decreased breath sounds
  • Pulmonary consolidation
  • Wheezing (viral/atypical)
31
Q

When would you obtain a CXR to evaluate for pneumonia in an infant/toddler?

A

Fever and at least one of the following:

  • Tachypnea
  • Nasal flaring
  • Retractions
  • Grunting
  • Rales
  • Decreased breath sounds
  • Respiratory distress
32
Q

What is the treatment for pneumonia, regardless of etiology?

A

Supportive care with antipyretics, hydration, gentle suctioning

Avoid anti-tussives!

33
Q

What is the outpatient treatment for suspected viral pneumonia?

A
  • Neuraminadase inhibitor (Oseltamivir/Tamiflu)

- NO abx

34
Q

What is the outpatient treatment for suspected bacterial pneumonia?

A

6 months - 5 years:

  • Amoxicillin
  • Cefdinir, clindamycin, macrolide if PCN allergy

5 years or older:

  • Macrolide or doxycycline for atypical bacteria
  • Amoxicillin for typical CAP
35
Q

When should you consider hospitalization for pneumonia?

A
  • Infant < 6 months old
  • O2 < 90%
  • Dehydration, inability to tolerate PO fluids
  • Moderate to severe respiratory distress
  • Toxic appearance
  • Failure of OP treatment (worsening or no response in 48-72 hours)
36
Q

How is pneumonia prevented?

A
  • Hib vaccine
  • PCV-13 vaccine
  • Annual influenza vaccine
37
Q

What is the etiology of cystic fibrosis?

A

Mutation in the CFTR gene causing abnormal chloride transport and results in the production of abnormally thick mucus in various organ systems

38
Q

What are some common presenting symptoms of cystic fibrosis?

A
  • Respiratory symptoms
  • Failure to thrive
  • Meconium ileus
39
Q

How is Cystic Fibrosis diagnosed after presentation of symptoms?

A
  • Sweat chloride testing (> 60 mmol/L) *diagnostic
  • Hyperinflation of lungs on CXR
  • PFTs show obstructive pattern
  • Genetic testing
40
Q

What is diagnostic for cystic fibrosis?

A

Sweat chloride testing (> 60 mmol/L)

41
Q

What is the treatment for Cystic Fibrosis?

A
  • CFTR modulator therapy if appropriate
  • Airway clearance (chest physiotherapy)
  • Prevent infection (abx, immunizations)
  • Decrease obstruction symptoms (mucolytics, bronchodilators, steroids)
42
Q

What is abnormal dilation and distortion of the bronchial tree resulting in chronic obstructive lung disease?

A

Bronchiectasis

43
Q

What is the etiology of broncbiectasis?

What is the most common cause of Bronchiectasis in children?

A

Obstruction with inadequate mucus clearance and infection

Cystic Fibrosis

44
Q

The following signs/symptoms are associated with what disorder?

  • Chronic cough with purulent sputum
  • Crackles, rhonchi
  • Digital clubbing
  • Increased AP diameter
A

Bronchiectasis

45
Q

How is Bronchiectasis diagnosed?

A
  • CXR with “tram tracks” or “ring shadows”

- PFTs show obstructive pattern

46
Q

What is the treatment for Bronchiectasis?

A

Same as Cystic Fibrosis:

  • CFTR modulator therapy if appropriate
  • Airway clearance (chest physiotherapy)
  • Prevent infection (abx, immunizations)
  • Decrease obstruction symptoms (mucolytics, bronchodilators, steroids)
47
Q

What is Infant Respiratory Distress Syndrome also known as?

A

Hyaline membrane disease

48
Q

What is Infant Respiratory Distress Syndrome due to?

A

Deficiency in production of surfactant leading to alveolar collapse and decreased gas exchange resulting in hypoxia

49
Q

What is the #1 risk factor for Infant Respiratory Distress Syndrome?

A

Prematurity

50
Q

When do symptoms begin in Infant Respiratory Distress Syndrome and what do they consist of?

A

Symptoms begin almost immediately after birth

Tachypnea, chest wall retractions, nasal flaring, expiratory grunting, cyanosis

51
Q

How is Infant Respiratory Distress Syndrome diagnosed?

A
  • Hypoexmia on ABG

- Diffuse bilateral atelectasis with “ground glass appearance” and air bronchograms on CXR

52
Q

How is Infant Respiratory Distress Syndrome prevented?

A

Antenatal corticosteroid therapy

  • Betamethasone or dexamethasone given to mothers b/w 23-34 weeks gestation at risk for pre-term labor within the next week
  • Hastens lung maturity
53
Q

What is the treatment for Infant Respiratory Distress Syndrome?

A
  • Oxygen given with small amount of CPAP
  • IV fluids
  • Endotracheal tube
  • Exogenous surfactant
54
Q

The following are revealed in an infant immediately after birth, what do you suspect?

  • Tachypnea, chest wall retractions, nasal flaring, expiratory grunting, cyanosis
  • Hypoexmia on ABG
  • “Ground glass appearance” and air bronchograms on CXR
A

Infant Respiratory Distress Syndrome

55
Q

What is the rule of twos to decide if your patient needs two meds for asthma if using SABA?

A
  • More than two times/week?
  • More than two times/month at night?
  • More than two times/year to refill?
56
Q

What are symptoms associated with Vocal Cord Dysfunction?

A
  • Stridor
  • Dyspnea
  • Throat tightness
  • Choking sensation
  • Cough
57
Q

How is Vocal Cord Dysfunction diagnosed?

A

Laryngoscopy

58
Q

What is the treatment for Vocal Cord Dysfunction?

A
  • Reassurance
  • Breathing maneuvers
  • Avoidance of triggers
  • Speech therapy
59
Q

What are risk factors for obstructive sleep apnea in children?

A
  • Adenotonsillar hypertrophy

- Obesity

60
Q

What are nighttime and daytime signs/symptoms of Obstructive Sleep Apnea?

A
  • Nighttime: Snoring > 3 nights/week, gasping, apnea, mouth breathing, restless sleep

Daytime: Mouth breathing, nasal voice, poor school functioning or behavior concerns, headaches, daytime sleepiness

61
Q

What is the treatment for Obstructive Sleep Apnea?

A
  • Adenotonsillectomy

- CPAP

62
Q

What is the etiology of epiglottitis?

A

Bacterial

Hib was most common cause, but has reduced due to vaccine

63
Q

On CXR, where are foreign bodies most commonly found?

A

Right mainstem bronchus

64
Q

While macrolide antibiotics (azithromycin, clarithromycin) are used in the treatment of pertussis, what is a risk associated with them in pediatric patients?

A

Pyloric stenosis

65
Q

Is asthma a restrictive or obstructive pattern?

What findings support the diagnosis of asthma in the methacholine challenge test?

A

Obstructive

Increase in FEV1 by 12% or greater and > 200 mL following bronchodilator use (indicates that it is reversible)

Peds II (11 decks)

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