Pediatric Respiratory

Question 1

Restrictive pulmonary disease

Answer 1

• trouble inhaling air
• shallow breaths
• pneumonia

Question 2

Bronchiolitis

Answer 2

• bronchitis in kids less than 3yo
• viral (typically RSV)
• URI, fever, paroxysmal wheezing, hyperinflated lungs on x-ray
• outpatient supportive care for mild cases

Question 3

Pathophysiology of asthma

Answer 3

1. Hypertrophy of smooth muscle
2. Mucosal edema and hyperemia
3. Hypertrophy of mucous glands
4. Acute inflammation and plugging of airways by mucous
5. Remodeling of epithelial basement membrane (permanent damage)

Question 4

Ominous signs of asthma

Answer 4

• Absent breath sounds
• Pulsus paradoxus
• Inability to remain laying down
• cyanosis

Question 5

Hospitalize asthma flare patient if peak flow is…

Answer 5

Less than 60 liters/minute initially

Doesn’t improve after nebulizer treatment

Question 6

Intermittent asthma

Answer 6

Symptoms/rescue inhaler: less than 2 days per week
Night time awakenings: less than 2 times per month
Lung function: FEV1 greater than 80 perfect and normal between exacerbations
Treat: SABA

Question 7

Mild persistent asthma

Answer 7

Symptoms/rescue inhaler greater than 2 days per week
Nighttime awakenings 3-4 times per month
Lung function: FEV1 greater than 80 percent
Treat: low dose ICS (alt: Singulair) + SABA

Question 8

Moderate persistent asthma

Answer 8

Symptoms/rescue inhaler daily
Night time awakenings more than once per week
Lung function: FEV1 60-80 percent
Treat: refer to pulm, medium dose ICS + SABA, consider po steroid

Question 9

Severe persistent asthma

Answer 9

Symtpoms/rescue inhaler several times per day
Night time awakenings nightly
Lung function: FEV1 less than 60 percent
Treat: refer to pulm, medium dose ICS + SABA, consider po steroid

Question 10

Common pathogens for pneumonia by age

Answer 10

• Newborn: Group B strep, chlamydia, E. coli
• 2mo-6yo: RSV, H. influenzae, S. pneumoniae
• School age- adolescent: S. pneumoniae, Mycoplasma, chlamydia
• Immunocompromised: PJP or fungus
• up to 80 percent of all pneumonias are viral

Question 11

Pneumonia diagnosis

Answer 11

• sputum culture
• infiltrates on chest x-ray
• H. flu, S. pneu, Klebsiella- lobar consolidation
• E. coli, staph, pseudomonas- patchy infilatrates
• PJP- diffuse interstitial or upper lobe infiltrates

Question 12

Treatment of pneumonia

Answer 12

PCN, macrolides, cephalosporin

no cough suppressants less than 9 yo

Question 13

Cystic fibrosis

Answer 13

• thick secretions in respiratory and GI tracts leading to obstructive pulmonary disease and pancreatic insufficiency with malabsorption
• recurrent URI, chronic cough, steatorrhea, malabsorption, fat soluble vitamin deficiencies, failure to thrive, delayed puberty, infertility
• sweat chloride test, PFTs show obstructive pattern
• refer to pulmonology

Question 14

Obstructive pulmonary disease

Answer 14

• trouble exhaling (trapping air)
• decreased FEV1
• hyperresonant breath sounds
• asthma, cystic fibrosis

Question 15

Prevention of RSV

Answer 15

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