Newman Pediatric Respiratory

Question 1

RED FLAG:

Sudden onset of symptoms children with choking/gagging, asymmetric wheezing

Answer 1

Possible DX: Foreign body

Question 2

Red Flag: Coughing and choking when eating or drinking

Answer 2

Possible DDX

1. Oropharyngeal dysphagia with aspiration
2. tracheo- esophageal fistula
3. GERD

Question 3

Poor growth and low body mass index

Answer 3

1. Cystic fibrosis

2. immunodeficiency

Question 4

Family history of sterile males

Answer 4

1. Cystic fibrosis

2. immotile cilia syndrome

Question 5

Red Flags:

• Chronic rhinorrhea and recurrent sinus infections
• Family hx of sterile males

Answer 5

1. Cystic fibrosis

2. immotile cilia syndrome

Question 6

Acute onset of SOB, tightness in chest/throat, feeling of choking, noisy breathing, hoarse voice without history of asthma in teenager

Answer 6

Vocal cord dysfunction

Question 7

Chronic wet productive cough

Answer 7

Bronchiectasis

Question 8

Chronic episodes of pneumonia

Answer 8

Immunodeficiency

Question 9

Red Flag: Wheezing associated with viral illness

Answer 9

Poss DDX:

1. Reactive airway disease
2. bronchiolitis

Question 10

DDX for Wheezing in Infants

Answer 10

1. GERD
2. Congenital abnormalities
3. CF
4. Infections
5. ciliary dyskinesia
6. Immunodeficiency

Question 11

DDX for wheezing in preschool age

Answer 11

1. Asthma
2. CF
3. GERD
4. FBA
5. Infections/ post infectious
6. Immunodeficiency
7. Congenital abnormality

Question 12

DDX for wheezing in school age child

Answer 12

1. Asthma
2. Vocal cord dysfunction
3. CF
4. Infections/post infectious
5. a-1 antitrypsin deficienct
6. FBA

Question 13

Abnormal closing of the vocal cords making it hard to move air in and out of the lungs

Answer 13

VCD = Vocal Cord Dysfunction (also called paradoxical vocal fold motion disorder

Question 14

What is often confused with asthma?

Answer 14

VCD = Vocal Cord Dysfunction (also called paradoxical vocal fold motion disorder

Question 15

Sx of Vocal Cord Dysfunction

Answer 15

SOB or difficulty getting air into or out of lungs
• Tightness in the throat or chest
• Frequent cough or throat clearing
• Feeling of choking or suffocation
• Noisy breathing (stridor, gasping, raspy sounds or wheezing)
• Hoarse voice

Question 16

• GERD
• Post-nasal drip
• URI
• Exercise
• Strong odors or fumes
• Tobacco smoke
• Strong emotions and stress

are triggers for what?

Answer 16

Vocal cord Dysfunction

Question 17

Who is at risk for vocal cord dysphasia?

Answer 17

• High achieving adolescents can be prone to this (F>M)

Question 18

What is tx of vocal cord dysphagia?

Answer 18

• Learning techniques that control the vocal cords -often taught by speech therapist or psychologist
• Stress management
• Control or avoidance of triggers

Question 19

How is asthma classified?

Answer 19

1. Impairment (symptoms)

2. Risk (# of exacerbations requiring steroids)

Question 20

Signs that Respiratory arrest is imminent?

Answer 20

1. Breathless and mute at rest
2. cannot speak
3. drowsy or confused
4. RR >30/min
5. Cannot recline
6. paradoxical thoracoabdominal movement
7. no wheexing
8. bradycardia
9. absent pulses paradoxus

Question 21

What would functional assessment show when respiratory arrest is imminent? (FEV1, PaO2, PCO2, SaO2)

Answer 21

1. FEV1<25%
2. PaO2 <60, cyanosis possible
3. PCO2>42
4. SaO2<90%

Question 22

How do you treat an acute asthma exacerbation?

Answer 22

1. Albuterol + impratropium (anticholinergic)
2. Steroids
3. Oxygen

Question 23

What is Cystic fibrosis gene?

Answer 23

• CTFR encodes for a protein that functions as a cAMP regulated Chloride channel across epithelial cells on mucous surfaces

Question 24

What chromosome is cystic fibrosis gene

Answer 24

• Autosomal Recessive

- chromosome 7

Question 25

Cystic fibrosis is a disease of what gland>

Answer 25

- Exocrie gland function --> involves many organ systems - Chronic resp infections - pancreatic enzyme insufficiency

Question 26

What contributes to the penetrance and variability of CTFR expression?

Answer 26

1. Non genetic factors - environment - air quality - level of care - nutritional status - age of onset of lung infection 2. Modifier genes that interact with CFTR to influence disease severity - Reduced MLB2 ass with increased rates of CF-related bronchiectasis

Question 27

What organisms contribute to the repeating cycle of infection and neutrophilic inflammation on the clinical presentation of CF?

Answer 27

1. S. Aureaus and Haemophylus influenza are common during early childhood (first 10 years) 2. Pseudomonas in most patient secretions 20s-30s

Question 28

Dx of CF requires

Answer 28

ONE OF 1. one or more phenotype presentation (chronic pulmonary disease, chronic sinusitis, GI/nutritional abnormalities, salt loss syndrome, obstructive azoospermia) 2. Hx of CF in sibling 3. Positive newborn screen test (immunoreactive trypsinogen) PLUS AT LEAST ONE OF 1. elevated sweat chloride concentration 2. 2 mutations known to cause CF on separate alleles 3. Abnormal post nasal potential differences test

Question 29

What are the 3 components of cardiopulmonary arrest in children?

Answer 29

1. Respiratory (O2) 2. Cardiac (pump, perfusion, BP) 3. Circulatory volume (perfusion, BP)

Question 30

What is the cause of most pediatric cardiopulmonary arrests?

Answer 30

Respiratory

Question 31

What is the pediatric assessment triangle to assess for CP arrest?

Answer 31

1. Appearance ( abnormal tone look cry or gaze, decreased interaction) 2. Breathing (Abnormal sound/positioning, retraction, flaring, apnea/gasping 3. Circulation (pillow, mottling, cyanosis

Question 32

ABCDE of pediatric CP arrest assessment

Answer 32

``` Airway Breathing Circulation Disability (depressed consciousness, unresponsiveness) Exposure ( hypothermia, bleeding, shock) ```

Question 33

What is the most common cause of infectious airway obstruction in kids ages 6-36 month

Answer 33

croup (acute laryngotracheobronchitis)

Question 34

IF you are given the following, what illness should you think? 1. Most often viral (parainfluenza virus) less often allergic. 2. Tracheitis is most often a secondary bacterial infection to this(kids are febrile, really sick) 3. Stridor􏰂 think this!

Answer 34

CROUP

Question 35

What causes epiglottis?

Answer 35

H. Flu type B

Question 36

Is there a vaccine for H. Flu?

Answer 36

yes, for HIB that has nearly eliminated HIB meningitis and epiglottis

Question 37

What is caused by 1. RSV, influenza, parainfluenza, adenovirus 2. Children less than 2 3. Characterized by URI sx --> progressive cough --> wheezing/atelectasis

Answer 37

Bronchiolitis

Question 38

Characterized by inflammation, edema, bronchospasm, mucus * Triggers include: infection, exercise, environmental irritants, stress, GERD..... * Can result in sudden worsening * Sudden changes can be due to alveolar disease and/or atelectasis. * Wheeze, prolonged expiratory phase

Answer 38

Asthma

Question 39

Wha is most common caused by food or medications and shows: * Retropharyngeal/laryngeal edema can be life threatening. * Symptoms are often sudden and associated with facial edema and urticaria * Bronchospasm in lower airways common * If an allergy is reported...ALWAYS ASK WHAT HAPPENS WHEN EXPOSED TO THE ALLERGEN

Answer 39

Anaphylaxis

Question 40

How do you treat Anaphylaxis?

Answer 40

Epinephrine oxygen steroids

Question 41

How does pneumonia present in NEWBORN? what causes it?

Answer 41

- tachypnea, retractions, grunting, hypoxemia | - Group B strep, listeria monocytogenes, gram-neg rods

Question 42

How does pneumonia present in INFANTS/CHILDREN? What causes it?

Answer 42

Cough, tachypnea, retractions, hypoxemia, congestion, fever, irritability, decreased feeding • Viruses most common cause, if bacterial...Streptococcus pneumonia is most common

Question 43

How does pneumonia present in ADOLESCENTS? What causes it?

Answer 43

• Similar symptoms (may c/o headache, pleuritic chest pain, abd pain) • Mycoplasma pneumonia