Pediatric Lung and Airway Topics

Question 1

Grunt Implies

Answer 1

Decreased compliance of chest wall

Trying to create PEEP

Question 2

What is Stridor

Answer 2

Turbulent inspiratory airflow below/in the larynx coming across a partly closed glottis

Question 3

What is Stertor?

Answer 3

Snoring

Question 4

When are ronchi/crackles heard? What do they mean?

Answer 4

Inspiration.
Fine = Acute inflammation
Harsh = Fibrosis

Question 5

When are rales/wheezes heard? What do they mean?

Answer 5

Expiratory

Obstruction

Question 6

Physical signs of a lung/airway problem in a peds patient

Answer 6

Tachypnea, nasal flaring, intercostal retractions, accessory muscle use, pursed lips, prolonged expiratory phase, cyanosis

Question 7

Wheeze vs. Stridor. Who is intra and who is extrathoracic?

Answer 7

Wheeze – Intrathoracic, Worse on expiration

Stridor – Extrathoracic, worse on inspiration

Question 8

Example of fixed obstruction

Answer 8

Laryngeal or tracheal web

incomplete recanalizaton of the larynx

Question 9

Variable extrathoracic problems in peds patients

Answer 9

Vocal Cord Dysfunction

Obstructive Sleep Apnea

Question 10

Variable intrathoracic obstruction problems in peds patients

Answer 10

Endobronchial or tracheal tumor

Question 11

Causes of bronchiolitis

Answer 11

RSV, hMPV,
Influenza, Parainfluenza,
Corona, Rhino, Adeno

Question 12

When does bronchiolitis hit the midwest?

Answer 12

Nov-April

Question 13

Who gets bronchiolitis?

Answer 13

Nearly all kids by age 2

Risk of 2ndary bacterial infection or otitis media

Question 14

Big risks with bronchiolitis?

Answer 14

High risk for infants with poor lung development

Can cause apnea in infants

Question 15

Treatment for bronchiolitis?

Answer 15

Supportive (Oxy., Fluids)

Prevention with Palivizumab monthly during season

Question 16

Presentation of bronchiolitis?

Answer 16

Runny Nose, Cough, Fever, tachypnea,
Intercostal retractions
Bilateral wheezing and crackles
Diffuse infiltrates

Question 17

What is a steeple sign on an X ray telling you?

Answer 17

Epiglottal Swelling, Narrowing of Airway

Question 18

Fancy word for croup

Answer 18

laryngotracheitis

Question 19

Symptoms of Croup

Answer 19

Seal-bark cough, Hoarseness, Stridor

Subglottic larynx edema/inflam.

Question 20

Which kids get croup?

Answer 20

6%, peak at 1-2 yo

Slightly more males (1.5:1)

Question 21

When do kids get croup?

Answer 21

Late fall, early winter

Question 22

Causes of croup?

Answer 22

Parainfluenza, RSV

Influenza, Coxsackie, rhino, mPNV

Question 23

Signs of H. flu

Answer 23

Unable to control secretions, fever, unimmunized, tripod position, elevated RR, thumb sign on epiglottis x ray

Question 24

How many ribs should you see on a chest xray

Answer 24

10

Question 25

Who has the membrane

Answer 25

diptheria

Question 26

What does the trachea move toward and away from

Answer 26

Away from infection | Toward collapse

Question 27

Most common causes of CAP in an under 1 month

Answer 27

Group B E coli L monocytogenes CMV, HSV

Question 28

Most common causes of CAP in an 1-3 months

Answer 28

Virus S pneumo S aureus afebrile pneumonitis pathogens

Question 29

Most common causes of CAP in a 3 month-5 years

Answer 29

Virus S pneumo S aureus

Question 30

Most common causes of CAP in school age

Answer 30

Virus M pneumoniae S pneumoniae C pneumoniae

Question 31

Tests encouraged in evaluating an outpatient peds pneumonia?

Answer 31

``` Pulse Ox Flu testing (if in season) Mycoplasma IgM (before giving a macrolide) ```

Question 32

Which test aren't encouraged, but could be fine in an outpatient peds pneumonia

Answer 32

CXR | Blood Culture if deterioration or no improvement

Question 33

4 month old. stridor of upper airways. Noisy breathing since week 2 of life. No recent illness, fevers, or coughs. What is it

Answer 33

Laryngomalacia

Question 34

What do you do for Laryngomalacia patients?

Answer 34

Surgery to remove redundant tissues

Question 35

Describe how diaphragmatic hernia patient might present

Answer 35

Newborn in resp. distress. Grunting, tachypneic, cyanotic even w/ bag valve Crackles on right, no sounds on left

Question 36

What does diaphragmatic hernia do to the lungs?

Answer 36

Causes lung hypoplasia, persistent pulmonary hypertension

Question 37

How is diaphragmatic hernia treated?

Answer 37

Medically managed with ventilatory support or ECMO | Surgical management when stable