Pediatrics

Question 1

Pulmonary distress in infants- name disorders

Answer 1

Neonatal RDS, Transient Tachypnea of newborn, and Persistent pulmonary HTN of the newborn

Question 2

Who is most at risk for neonatal RDS?

Answer 2

Premature infants born less than 28 wks

Question 3

Cause of neonatal RDS

Answer 3

Deficiency or inactivation of surfactant

Question 4

Child born just a few minutes ago appearing blue with periods of not breathing. There is decreased urine output. Baby is in respiratory distress marked by grunting, nasal flaring, tachypnea, and shallow respirations. Diagnosis?

Answer 4

Neonatal RDS

Question 5

Dx evaluation for neonatal RDS?

Answer 5

ABG for oxygen levels, CBC, CRP to r/o sepsis, Xray showing atelactasis and ground glass appearance, low lung volume

Question 6

Tx for neonatal RDS

Answer 6

Supplemental oxygen, nasal CPAP, intubation for ventilation and surfactant- GENTLE. Surfactant can be given as prophylaxis in infants born at less than 27 weeks

Question 7

Most likely complications of neonatal RDS

Answer 7

Due to therapeutic interventions, like invasive intubations. Chronic complication= bronchopulmonary dysplasia.

Question 8

Prognosis of RDS

Answer 8

Worsens for 2-4 days after birth and slow improvement thereafter. If death occurs, most often between day 2-7.

Question 9

Prevention for RDS

Answer 9

PREVENT PREMATURE BIRTH.

Question 10

When are antenatal steroids given?

Answer 10

To pregnant women at risk of having preterm delivery

Question 11

Most common CHRONIC childhood disorder

Answer 11

Asthma

Question 12

What would make you suspicious of a child having asthma?

Answer 12

If family history, lower respiratory symptoms in 1st year of life such as coughing, wheezing triggered easily, and eczema in early months of life

Question 13

2 year old child with eczema and 2 older sisters with asthma presents to you with wheezing, cyanosis, lethargy, tachycardia, dyspnea, cough, and diaphoresis. How would you diagnose this?

Answer 13

Young child- impulse oscillometry- passive technique to spirometry. If this is not helpful, trial with asthma medications and check for resolution of symptoms.

Question 14

DDx for asthma

Answer 14

Cystic fibrosis- sweat chloride test to r/o. GERD- barium swallow to r/o.

Question 15

Classifications of asthma in pediatric population

Answer 15

Intermittent- sx of wheezing and coughing 2 or less times a week, and 2 or less night episodes per month. Mild, moderate, persistent: Episodes of sx more than 2 times a week and more than 2 nighttime episodes per month

Question 16

Classic triad of symptoms in FB aspiration

Answer 16

Wheezing, coughing, diminished breath sounds. May be complete, partial, or chronic obstruction. Complete will present with acute onset of choking, cyanosis, inability to cough or vocalize

Question 17

Dx for FB aspiration

Answer 17

Rigid bronchoscopy

Question 18

Tx for FB removal

Answer 18

Attempt removal with back blows and chest compressions in infants, heimlich maneuver in older children. Intubate until bronchoscopy can be performed. Nebulizers and chest physiotherapy after removal.

Question 19

Epiglottitis causes

Answer 19

Infectious- H. infuenza B, staph, or strep. Non-infectious: thermal injury, FB or caustic ingestions, allergic reactions

Question 20

7 year old boy presents with high fever, sore throat and in distress. He is drooling and is having difficulty eating with a “hot potato” voice. Appears toxic, with “sniffing” or “tripod” posture. How would you treat this?

Answer 20

Admit asap. Maintain patient airway. 3rd generation cephalosporings and antistaph agent active against MRSA, corticosteroids, supportive care.

Question 21

Causes of bronchiolitis

Answer 21

RSV, rhinovirus

Question 22

Population most often affected with bronchiolitis

Answer 22

Infants less than age 2

Question 23

1 year old child presents to you in January with symptoms of nasal congestion and cough. He has a fever and cough, with associated otitis media. Auscultation shows wheezing upon exhalation and fine and coarse crackles. Hyperresonant percussion sounds, and hyperexpanded chest. You notice nasal flaring and grunting. Tachypnea is present. Child looks dehydrated. What is the diagnosis?

Answer 23

Bronchiolitis- inflammation of the smaller airways. Common in kids less than 2, often in winter months

Question 24

Diagnosis of Bronchiolitis

Answer 24

Usually done clinically. can order CBC and CXR in more severe cases

Question 25

Tx of Bronchiolitis

Answer 25

Admit if hypoxemia, cyanosis, dehydrated, lethargy. Otherwise, trial of inhaled bronchodilators.

Question 26

Complications of bronchiolitis

Answer 26

bronchiolitis obliterans, asthma, secondary bacterial infection, apnea, respiratory failure

Question 27

RSV Infection - risk factors

Answer 27

Infants less than 6 months, infants born less than 35 week gestation, chronic lung dz or congestive heart dz in kids, innunocompromised, if live at high altitude

Question 28

Define RSV infection

Answer 28

Virus that causes upper respiratory tract infection, 20-30% of patients will also develop lower respiratory infection (more common in infants/young kids than older children/adults

Question 29

How is RSV spread

Answer 29

Direct contact and aerosol droplets

Question 30

It's January, and a 1 year old child presents to you with rhinitis, sinusitis, nasal congestion, sore throat. Mother says child has not been feeding well and has periods of apnea. Child has fever and looks lethargic. You hear wheezes and crackles, and prolonged expiration. You can feel the spleen and liver on abdominal exam d/t hyperinflation of lungs. Dehydration present. Tachypnea present. What is the diagnosis

Answer 30

infant presents with both upper and lower respiratory tract symptoms. Child is young and it's winter season. Influenza vaccine taken. RSV infection confirmed by throat and nasopharyngeal swab

Question 31

Diagnosis of RSV infection

Answer 31

Analysis of respiratory secretions through nasal wash, nasopharyngeal swab, or throat culture. Rapid antigen assay, PCR assay also available.

Question 32

Tx for RSV infection

Answer 32

Supportive care, beta-agonist therapy if lower airway obstruction to open up bronchioles, DON'T use corticosteroids, ribavirin only used if at risk for severe lower respiratory infection

Question 33

Most likely to see viral laryngotracheitis?

Answer 33

Children 6 months- 3 years

Question 34

Cause of viral laryngotracheitis

Answer 34

Parainfluenza virus type 1

Question 35

3 year old child presents with fever and nasal congestion and coryza x 4 days. You notice respiratory distress, and hoarseness, barking cough, and inspiratory stridor. There is a prolonged inspiratory phase. Appears dehydrated with mild tachypnea. How would you diagnose this?

Answer 35

Suspect viral laryngotracheitis. Often clinical diagnosis- Xray may show "steeple sign" which demonstrates subglottic narrowing

Question 36

Tx for viral laryngotracheitis

Answer 36

Supportive care, single dose of systemic corticosteroids, nebulized epinephrine (bronchodilator)

Question 37

Cause of bacterial tracheitis?

Answer 37

Staph or strep

Question 38

Presentation of bacterial tracheitis

Answer 38

Initial symptoms similar to viral, with nasal congestion and coryza, but appear more toxic.

Question 39

Diagnostic evaluation of bacterial trachetis

Answer 39

Leukocytosis, Xrays reveal severe subglottic and tracheal narrowing

Question 40

Tx for bacterial tracheitis?

Answer 40

Supportive care, hospitaliztaion, IV abx

Question 41

Mother complains of son waking up at night with severe barking cough and inspiratory stridor, and hoarseness. This only happens during the night and duration is short. What is the diagnosis and how to treat?

Answer 41

Spasmodic or frequent recurrent croup- comfort anxious child and administer humidified air

Question 42

Phases of pertussis

Answer 42

Catarrhal, paroxysmal, convalescent

Question 43

Catarrhal phase

Answer 43

Nonspecific, 1-2 weeks

Question 44

Paroxysmal

Answer 44

Persistent coughing attacks lasting 2-6 weeks

Question 45

Convalescent

Answer 45

Cough decreases over several weeks to months

Question 46

Mode of transmission of pertussis

Answer 46

Direct contact- most contagious during catarrhal stage and first 2 weeks of paroxysmal stage

Question 47

Incubation period for pertussis

Answer 47

Takes 7-10 days for symptoms to show

Question 48

In what kind of people will you see atypical presentation of pertussis?

Answer 48

Vaccinated individuals who get infected, and children

Question 49

Child presents with whooping cough. Nasopharyngeal and throat cultures are positive for bordatella pertussis. CBC reveals leukocytosis and lymphocytosis. What is the next step of action?

Answer 49

Report pertussis to public health authorities, supportive care. Begin abx therapy if caught early in catarrhal stage- macrolides x 7-14 days. May use bronchodilator therapy, avoid antitussives and opioid cough suppressants- little effect. Child can return to school after 5 days of abx therapy.

Question 50

Pertussis prevention

Answer 50

Vaccination with DTaP or Tdap. Abx prophylaxis for individuals in close contact of infected individuals- macrolides

Question 51

2 year old child appears with fever, cough, malaise. PE reveals tachypnea, emesis, decreased breath sounds, bronchial breath sounds, crackles, wheezes, egophony, bronchophony, tactile fremitus increased, dullness to percussion. Also hypoxemic. Very fussy restless, and not feeding well. Diagnosis and tx.

Answer 51

CBC, acute phase reactants. Serum electrolytes for dehydration. Blood and sputum, nasopharyngeal swabs. CXR not needed, but because child is less than 4 years old, use AP view. (PA for above 4).

Question 52

Pneumonia causes in kids

Answer 52

Neonatal 1-30 days: Group B strep. Less than 5 years, viral more common- measles, varicella, HSV. More than 5 years- Strep, M pneumonia, chlamydophilia