ped pulm test 2

Question 1

at what weeks of life is a baby highest risk for RDS (respiratory distress syndrome)

Answer 1

<28 weeks = 60 to 80%

Question 2

increased risk for RDS

Answer 2

Infants of Diabetic Mothers
Multifetal pregnancies
C-section
Family History

Question 3

Primary Cause –

Answer 3

Surfactant Deficiency

Question 4

signs of RDS

Answer 4

Signs within minutes of birth:
Tachypnea
Grunting
Intercostal and subcostal retractions
Nasal flaring
Duskiness

Question 5

PE findings in RDS

Answer 5

Diminished breath sounds

Falling blood pressure

Pallor

Progresses to, Apnea and
Mixed resp/metab acidosis

Question 6

how to DX RDS

Answer 6

Clinical Course
CXR – ground glass appearance
ABG

Question 7

RDS prevention

Answer 7

Beta methasone 48 hours prior to delivery between 23 – 34 weeks

Question 8

t/f beta methasone Should be administered at 23 – 34 weeks gestation if increased risk of preterm delivery in next 7 days

Answer 8

true

Question 9

RDS tx

Answer 9

Careful and frequent monitoring

Warm humidified O2 to keep arterial levels between 55 – 70 (sats >90%)

Question 10

when do you give surfactant in RDS

Answer 10

If intubation (or CPAP) needed at birth after initial stabilization infants

with hypoxic respiratory failure attributable to secondary surfactant deficiency

Question 11

Inflammation of the bronchioles – usually caused by an acute viral infection

Most common lower respiratory tract infection in infants and children <2yo

Answer 11

Bronchiolitis

Question 12

common causative agents in bronchiolitis

Answer 12

RSV

Adenovirus, human metapneumovirus, influenza, parainfluenza

Question 13

how to dx bronchiolitis

Answer 13

Based on history and physical exam

Routine lab and radiologic studies not recommended

Question 14

bronchiolitis upper resp presentation

Answer 14

uri, runny nose

Question 15

bronchiolitis lower resp presentation

Answer 15

Cough

Tachypnea

Increased Respiratory Effort

Question 16

other bronchiolitis findings

Answer 16

Apnea in very young infants

Elevated RR – earliest and most sensitive sign

Tachycardia
Due to dehydration and hypoxemia

Question 17

Illness severity – determined by ?

Answer 17

RR, work of breathing, hypoxia

Question 18

what days are the peak of bronchiolitis

Answer 18

3 and 4

Question 19

bronchiolitis cxr findings

Answer 19

hyperinflation, atelectasis, infiltrates,

does not correlate with disease severity or guide management

Question 20

who do you check for sepsis if they have a fever?

Answer 20

< 60 day olds

Question 21

management of bronchiolitis

Answer 21

hydration

o2

broncho dilators/steroids (not typical)

nasal suction

rivavirin (sever)

influenza antivirals

Question 22

leading cause of infant death (viral)

Answer 22

RSV

Question 23

who is RSV most sever in

Answer 23

children with cardiovascular disease,

infants born prematurely

infants with chronic lung disease

premature <6 mo old

Question 24

RSV testing

Answer 24

rapid antigen

does not alter tx

Question 25

common RSV complications

Answer 25

otitis media Bacterial pneumonia

Question 26

drug used to prevent RSV

Answer 26

synagis (big money)

Question 27

when can you use synagis

Answer 27

born at less than 29 weeks born at less than 32 weeks with O2 requirement for at least 28 days after birth (Chronic Lung Disease Infants less than 24 months of age with CLD still requiring medical intervention

Question 28

one of most common causes of ed visits

Answer 28

asthma

Question 29

common onset of asthma

Answer 29

prior to 6 yr

Question 30

what does asthma look like

Answer 30

Intermittent dry coughing and expiratory wheezing SOB and chest tightness in older children Symptoms worse at night

Question 31

asthma triggers

Answer 31

``` Physical exertion Hyperventilation (laughing) Cold or dry air Airways irritants Inhaled allergens ```

Question 32

asthma PE findings

Answer 32

Expiratory wheezing, prolonged expiratory phase Decreased Breath Sounds (regional hypoinflation due to airways obstruction) Retractions, accessory muscle use

Question 33

barky cough, hoarseness, inspiratory stridor

Answer 33

croup

Question 34

happen before croup

Answer 34

URI symptoms for 1 – 3 days before the symptoms of upper airway obstruction

Question 35

age of croup onset

Answer 35

Occurs in 3 month – 5 years of age, peak in second year of life

Question 36

what "bug" causes croup

Answer 36

parainfluenza viruses Also: influenza, RSV, adenovirus

Question 37

clinical sign on x ray of croup

Answer 37

steeple sign

Question 38

how do we manage croup

Answer 38

Usually managed at home Cool mist Steamy bathroom for exacerbations

Question 39

how do we manage croup in the hospital

Answer 39

Nebulized racemic epinephrine | Corticosteroids

Question 40

when do we hospitalize for croup

Answer 40

``` Progressive stridor Severe stridor at rest Respiratory distress Hypoxia Cyanosis Depressed mental status ```

Question 41

Acute, fulminating course of high fever, sore throat, dyspnea, rapidly progressing respiratory obstruction

Answer 41

epiglottitis

Question 42

what vaccine lowers the risk of epiglottits

Answer 42

HiB

Question 43

what currently causes epiglottits

Answer 43

due to Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus

Question 44

what do you see with epiglottitis

Answer 44

“cherry-red” swollen epiglottitis drooling tripod fast onset

Question 45

management of epiglottits

Answer 45

intubate Oxygen Culture blood, epiglottis

Question 46

abx for epiglottitis

Answer 46

Ceftriaxone, cefixime or combo of ampicillin and sulbactam

Question 47

street names for pertussis

Answer 47

Whooping cough | Bordetella pertussis

Question 48

what are the stages of pertussis

Answer 48

6 week course - Catarrhal - Paroxysmal - Convalescent

Question 49

what pertussis looks like

Answer 49

cough especially in the absence of fever, malaise, myalgia, exanthema or sore throat

Question 50

how to dx pertussis

Answer 50

Leukocytosis with absolute lymphocytosis Culture is gold standard, but do not wait on results to treat Reportable disease

Question 51

tx of pertussis

Answer 51

Erythromycin or azythromycin

Question 52

who do we hospitalize with pertussis

Answer 52

Infants under 3 months of age 3- 6 months with severe paroxysms Premature infants or children with cardiac, pulmonary, muscular or neurologic disorders