OME Peds Lower Airway

Question 1

Foreign Body Age and Sx

Answer 1

Under 3 yo
Unattended
Sudden onset SOB
Extrathoracic is inspiratory stridor (Croup and bacteria trach)
Intra is exp wheezes (like asthma)

Question 2

FB DX

Answer 2

Xray 2 views (has to be positive coin sign for Lateral, and negative AP)

Question 3

FB Tx

Answer 3

ABX…
Rigid thing retrieve object
(bronch pulm, endoscopy for GI, Laryngoscope? for ENT)

Question 4

Exercise induced bronchoconstriction (EIB)

Answer 4

bronchial provocation tests

Exercise Challenge Test

Question 5

Asthma Classes

Answer 5

Class I: day less than 2x wek. Night less than 2 x mos. FEV1 80%

Class II: Less than once a day, but more than twice a week, Night is less than once a week. FEV 80&

Class III
Daily, Once a week night sx 60-80%

Class IV multiple times a day. Night is frequent. FEV less than 60%

Class V: Refractory

Question 6

Asthma Tx by class

Answer 6

I: SABA (intermittent)
II: SABA and ICS
III: SABA and LABA and ICS
IV: SABA and LABA and inc ICS
V: PO Steroids

Makes sure she knows how to use her inhaler

Question 7

Bronchiolitis Path, Age, Sxs

Answer 7

RSV
Under 2 yo
Wheezing, Dyspnea, Winter MOnths

Question 8

Bronchiolitis Dx

Answer 8

CXR to r/o PNA (NOPE)
Beta Agonist (NOPE)
CBC Sepsis (NOPE)
RSV Ag Ab PCR (NOPE)

Question 9

Bronchiolitis Tx:

Answer 9

Beta Agonist (NOPE)
Steroids (NOPE)
ABX (NOPE)

Oxygen
IVF
Peak at day 3-4

F/U: ARDS

Question 10

Cystic Fibrosis: Path and SXS

Answer 10

Autosomal recessive
CFTR mutation

Pt. Prenatal Screen
Meconium Ileus
Recurrent Pulm Infxns
Failure to Trhive
Salty Baby

Question 11

Cystic Fibrosis DX

Answer 11

Screen
Sweat Chloride
> 40 infant
> 60 older

Question 12

Cystic Fibrosis TX

Answer 12

Lung: Pulmonary Toilet
Pancreas: Enzymes and Vit ADEK

F/u: 45 yo, short stature, Genetic/ infertile

Question 13

Asthma Exacerbation

Answer 13

SpO2 equal to or greater than 90% is what you want to get to.
Nebulizer q 30 ming x 3
Steroids
Peak expiratory flow rate

To go home: doesn’t need oxygen, no wheezes, PEFR>70%
TX: Send them home with prednisone and Medium dose inhaler

ICU: Gets worse after initial tx. needs more oxygen, has more CO2, decrease lung sounds, PEFR less than 50%
Given them IV methyl, Continue nebs, put ventilator