Peds 12 Flashcards
What finding on presentation indicates the most severe respiratory distress?
Paradoxical breathing
S/s: cough, wheezing, tachypnea and dyspnea, with wheezing and diminished air exchange on chest exam
CXR: hyperinflation due to air trapping, increased interstitial markings and patchy atelectasis
Most likely dx and how to treat?
Asthma
Corticosteroids and bronchodilator (albuterol)
S/s: mild upper respiratory tract symptoms and often a fever of 38.5-39 C. Respiratory symptoms progressing to cough, wheezing, dyspnea.
CXR: hyperinflation, increased interstitial markings, peribronchial cuffing, and scattered atelectasis from bronchial obstruction
Most likely dx and how to treat?
Bronchiolitis
Supportive
Additionally, corticosteroids, bronchodilators, and hypertonic saline
S/s: cold-like symptoms (congestion, coryza, sore throat, cough, and fever). This progresses to inspiratory stridor and a “seal-like” or “barky” cough.
CXR: narrowing in the subglottic region (“steeple sign”)
Most likely dx and how to treat?
Croup
- Treatment is generally supportive.
- Breathing humidified air or mist therapy can improve laryngospasm.
- Racemic aerosolized epinephrine can be used for acute improvement
- oral or IM dexamethasone can reduce the severity of symptoms.
Anna is a 10-month-old female with a one-week history of respiratory illness and an acutely worsening cough. She has mild respiratory distress and asymmetric breath sounds with unilateral wheezing in the right lung fields in the absence of fever and cyanosis.
What’s the most likely dx?
Foreign body aspiration
What imaging do you order if you suspect foreign body aspiration?
- Bilateral decubitus or inspiratory/expiratory chest films
- PA and lateral chest films
A 12-year-old boy presents to the ED with reports of anorexia, weight loss, persistent cough, with nocturnal coughing fits that have been waking him from sleep for the past three weeks. He reports no fever, chills, myalgia, sore throat, or rhinorrhea. The patient presented to his primary care clinician one week prior with the same report, and was treated with amoxicillin and bronchodilator therapy. His chest x-ray was negative for infiltrates at that visit. The patient’s symptoms did not improve with this regimen. The cough became more frequent, sometimes causing emesis. Which of the following is the most likely diagnosis?
A. Atypical pneumonia due to Mycoplasma pneumoniae
B. Foreign body aspiration
C. Infection with Bordetella pertussis in the paroxysmal
D. Laryngotracheobronchitis
E. Reactive airway disease
C. Infection with Bordetella pertussis in the paroxysmal
The paroxysmal stage of pertussis lasts four to six weeks and is characterized by repetitive, forceful coughing episodes, followed by massive inspiratory effort. This massive inspiratory effort is what results in the characteristic “whoop”-sounding cough. This is consistent with the patient’s presentation and duration of illness. The forceful coughing fits in pertussis can even lead to conjunctival hemorrhages and pneumothoraces from the increased intrathoracic and intracranial pressures from Valsalva. The antimicrobial agents of choice for treatment of pertussis are azithromycin, clarithromycin, and erythromycin. Antibiotics given in the paroxysmal phase will reduce communicability but will not alter the clinical course.
A 12-month-old previously healthy girl presents with cough and mild subcostal retractions. She is afebrile, and physical exam reveals asymmetric wheezing. Chest x-ray demonstrates unilateral air trapping. What is the most likely diagnosis?
A. Acute bronchiolitis B. Asthma C. Croup D. Foreign body aspiration E. Pneumonia
D. Foreign body aspiration
A 10-month-old infant is brought to the pediatrics emergency department by her parents, who say she has been coughing persistently for the past three hours. The parents were watching a movie at home when they first noticed their daughter coughing. Patient is a vaccinated, well-nourished infant in moderate distress with retractions, nasal flaring, and grunting. Physical examination reveals diminished breath sounds in the right lung with normal breath sounds on the left. What other associated physical exam findings are expected on auscultation?
A. Asymmetric wheeze B. Bronchial breath sounds C. Crackles D. Rhonchi E. Stridor
A. Asymmetric wheeze
A 3-year-old girl is brought into the clinic by her mother because she has a gradually worsening cough and she has been having trouble breathing. Her mother says the patient sounds like she is barking when she coughs. She is up to date with her vaccinations. Her mom always watches her when she’s playing. Physical examination of the child reveals inspiratory stridor. She does not have wheezing, there are no retractions, and she has symmetrical breath sounds. No pseudomembranes are appreciated. What is the most likely diagnosis?
A. Croup (laryngotracheobronchitis) B. Epiglottis C. Foreign body aspiration D. Pertussis E. Pneumonia
A. Croup (laryngotracheobronchitis)
A previously healthy 11-month-old male with 5-day history of a “cold,” is brought to the ED by his mother for one day of acute worsening cough and intermittent wheezing. Per the mother, the cough was initially dry but has become more “phlegmy,” making it difficult for the infant to breathe, particularly when he is feeding or more active. His immunizations are up to date, and he has no known allergies. His family history is significant for a 6-year old sister who was diagnosed with asthma four years ago. On exam, the infant is afebrile, mildly tachypneic with normal O2 saturation. He has prominent nasal flaring and mild subcostal retractions. He has clear rhinorrhea but no evidence of oropharyngeal erythema. Lung exam reveals decreased breath sounds and wheezes on the right. What is the most likely diagnosis?
A. Asthma B. Epiglottitis C. Foreign body aspiration D. RSV bronchiolitis E. Viral URI
C. Foreign body aspiration
What is the management plan for suspected or confirmed foreign body aspiration?
Rigid bronchoscopy under general anesthesia in the OR
A 3 year child presents with fever, stridor, drooling, dysphonia, dysphagia, and respiratory distress. What is the most concerning dx that this could be? What would be your priority tx?
Epiglottitis
Secure the airway w/ an ETT
