Pediatric Respiratory

Question 1

Foreign Body Aspiration (FOB) Key Characteristics

Answer 1

• Laryngeal FB
• Rapid onset of hoarseness/chronic
  croupy cough
• Unilateral wheezing, recurrent
  pneumonia
• Tracheal FB
• Brassy cough hoarseness, dyspnea,
  cyanosis
• Homophonic wheeze
• Bronchial FB
• Most in right lung

Question 2

FOB Signs & Symptoms

Answer 2

Initial episode of coughing, gagging,
choking
* No s/s of respiratory infection
* Blood-streaked sputum
* Limited chest expansion, decreased
vocal fremitus, atelectasis
* Crackles, rhonchi, wheezes

Question 3

FOB Evaluation and Management

Answer 3

Pulse Ox
* Inspiratory and expiratory CXRs
* Referral to pulmonary specialist for
bronchoscopy
* Treat secondary lung infections,
bronchospasm

Question 4

Bronchiolitis

Answer 4

Obstruction of the lower
respiratory tract as a result of
acute inflammation, edema, and
necrosis of the epithelial cells of
the small bronchioles

Question 5

Bronchiolitis Key Characteristics:

Answer 5

Viral illness, primarily RSV
* <24 months of age
* Presents in late fall through early
spring

Question 6

Bronchiolitis Signs & Symptoms

Answer 6

URI symptoms: cough, coryza,
rhinorrhea
* Gradual development of respiratory
distress
* Low-grade to moderate fever
* Decreased appetite
* Coryza, conjunctivitis, pharyngitis, otitis
media
* Tachypnea, substernal/intercostal
retractions
* Expiratory wheezing, fine/coarse
crackles
* Varying respiratory distress

Question 7

Bronchiolitis
* Evaluation:

Answer 7

• History and physical examination
  alone can diagnose
• RSV rapid antibody
• CXR not indicated unless severe to
  rule out pneumonia
• Routine virologic testing not
  recommended unless hospitalized

Question 8

Bronchiolitis
Management

Answer 8

Management
* EBP: no longer supports trial of
bronchodilators
* Nebulized hypertonic saline for
hospitalized infants
* Antibiotics not used
* Supportive care: hydration,
antipyretics
* Supplemental oxygen if low saturations
* Fluid intake monitoring
* Smaller volumes more frequently
* Nasal suctioning; avoid deep airway
suctioning
* Close parental supervision
* Follow-up in 24 hours

Question 9

Pertussis

Answer 9

• Manifestations vary by age, stage of
  disease, immunization status,
  antibodies
• Early- Stage: Rhinorrhea, low grade
  temp, mild occasional cough
• Later-Stage
• Infants: may have cough “fits” with or
  without inspiratory high pitched
  “whoop”
• Tachypnea
• Poor feeding
• Cyanosis with feedings/coughing
• Vomiting during or after coughing fit
• Apnea

Question 10

Pertussis Evaluation

Answer 10

Collection from nasopharynx
* Organism found most frequently
during catarrhal or early paroxysmal
stage

Question 11

Pertussis Management

Answer 11

Macrolide antibiotics
(Azithromycin)
* TMP-SMX as alternative
* Corticosteroids, beta 2-adrenergic
medications (not supported by
evidence)

Question 12

Pneumonia Key Characteristics

Answer 12

Lobar pneumonia: “typical”
pneumonia:
* usually bacterial (10-20%)
* Atypical pneumonia: patterns of
consolidation not localized:
* mycoplasma
* Viral pneumonia sets stage for
bacterial pneumonia
* most common (70-80%)

Question 13

Pneumonia Key Characteristics Infant

Answer 13

Slower onset of respiratory symptoms

Question 14

Pneumonia Key Characteristics child/adolescent

Answer 14

Child/adolescent
* History of mild URI, abrupt high fever,
restlessness, shaking chills,
apprehension, shortness of breath,
malaise, pleuritic chest pain, vomiting

Question 15

Pneumonia S&S

Answer 15

Respiratory distress, apnea, tachycardia
* Nasal flaring, grunting, retractions
* Tachypnea, tachycardia, air hunger,
cyanosis
* Fine crackles, dullness, diminished breath
sounds

Question 16

Pneumonia Bacterial

Answer 16

Bacterial
* Fever, hypoxia, lethargy
* Splinting affected side, tachypnea,
retractions
* Pleural effusion

Question 17

Pneumonia Viral

Answer 17

Wheezing
* Downward displacement of liver/spleen

Question 18

Pneumonia Primary atypical

Answer 18

Repetitive, staccato cough – C. trachomatis

Question 19

Pneumonia evaluation

Answer 19

Chest x-ray
* CBC with diff
* Blood cultures if fails to improve
* Rapid tests for viruses

Question 20

Pneumonia management

Answer 20

-Treat presumptively to cover bacterial
pneumonia

Presumptive Bacteria- Amoxicillin

Presumptive Atypical- Azithromycin

-Encourage fluids, use
antipyretic/analgesic, avoid cough
suppressants, teach parents s/s of
respiratory distress and dehydration