Peds :(

Question 1

4 Ds of airway obstruction

Answer 1

Dyspnea
Drooling
Dysphagia
Distress

Question 2

Laryngomalacia

Answer 2

Congenital disorder characterized by underdevelopment of cartilaginous support for supraglottic structures

Most common cause of persistent stridor in infants

Question 3

Viral croup - Pathogenesis

Answer 3

Caused by parainfluenza viral serotypes causing inflammation of the entire airway; edema formation in the subglottic space causes obstruction

Question 4

Viral croup - Presentation

Answer 4

Presents as URI prodrome followed by barking cough and stridor; fever is usually absent or low grade

Question 5

Viral croup - Imaging

Answer 5

Neck radiograph shows subglottic narrowing (“steeple sign”)

Question 6

Viral croup - Treatment

Answer 6

Mild group (barking cough w/o stridor at rest) indicates supportive therapy w/ oral hydration

Stridor at rest indicates intervention with nebulized epinephrine or glucocorticoids

Question 7

Epiglottisitis - Pathogenesis

Answer 7

Bacterial infection of the airways, most often caused by H. influenzae; inflammation and swelling of the supraglottic structures (epiglottis and arytenoids) can lead to life-threatening upper airway obstruction

Question 8

Epiglottisitis - Presentation

Answer 8

Sudden onset of high fever, dysphagia, drooling, inspiratory retractions, cyanosis, and stridor

Question 9

Epiglottisitis - Treatment

Answer 9

Immediate endotracheal intubation to protect the airway

IV antibiotics - empiric to cover H. influenzae (Ceftriaxone)

Oral antibiotics to complete a 10-day course

Question 10

Bacterial tracheitis (Pseudomembranous croup)

Answer 10

Bacterial infection of airway mucosa that occurs secondary to primary viral croup, resulting in inflammatory edema, purulent secretions, and pseudomembranes

Most often caused by S. aureus

Can be severe and life-threatening

Question 11

Bacterial Tracheitis (Pseudomembranous croup) - Presentation & Treatment

Answer 11

Early presentation is similar to viral croup; however, instead of gradual improvement patients develop higher fever, toxicity, and severe upper airway obstruction

Risk of sudden respiratory arrest or progressive respiratory failure

Question 12

Bacterial Tracheitis - Treatment

Answer 12

Endotracheal intubation
IV antibiotics to cover S. aureus
Presence of thick, purulent tracheal secretions may require debridement and suctioning

Question 13

Bronchiolitis - Pathogenesis & Presentation

Answer 13

The most common serious acute respiratory illness in infants and young children, usually caused by RSV

Presents with 1-2 days of fever, rhinorrhea, and cough, followed by sheezing, tachypnea, and respiratory distress (shallow and rapid respirations)

Question 14

Palivizumab

Answer 14

Monoclonal antibody prophylaxis against RSV for high-risk premature infants and those with chronic cardiopulmonary conditions

Question 15

Asthma - Presentation & Treatment

Answer 15

Recurrent symptoms of cough, wheeze, SOB, chest tightness; usually with a specific trigger (illness, exercise, allergen)

Symptoms improved by bronchodilator (diagnostic)

Treatment with inhaled beta-agonist and inhaled corticosteroids

Question 16

Acute bacterial / viral pneumonia

Answer 16

Presents with fever, tachypnea, cough; crackles and/or decreased breath sounds on auscultation

May occur with signs of infection at other sites (sinusitis, epiglottitis)

Question 17

Empiric antibiotic therapy for suspected bacterial pneumonia

Answer 17

Infants - IV antibiotics for 4-12 weeks; most often Staph

3 months - 5 years - Oral amoxicillin; most often Strep pneumo

> 5 years - Oral amoxicillin or Azithromycin (for atypical Mycoplasma)

Question 18

Cystic Fibrosis - Genetics

Answer 18

Single gene defect on chromosome 7 that encodes an epithelial chloride channel (CFTR)

Delta F508 is the most common mutation

Question 19

Cystic Fibrosis - Diagnosis in newborns

Answer 19

Newborn screening by measuring immunoreactive trypsin (IRT), a pancreatic enzyme in blood; patients with CF have elevated IRT

Sweat chloride testing (>60mmol/L) is confirmatory

Question 20

Cystic Fibrosis - Presentation in newborns

Answer 20

Meconium ileus
Failure to thrive
Frequent, foul-smelling, oily stools
Cough, wheezing, recurrent pneumonias, dyspnea, hemoptysis

Question 21

Cystic fibrosis - Pathogenesis

Answer 21

Chronic airway infection with bacteria (S. aureus, H. influenzae) begins in the first few months of life; eventually, Pseudomonas becomes the predominant pathogen

Chronic infection leads to progressive airway and lung destruction (bronchiectasis) which causes failure of the muco-ciliary elevator and airflow obstruction

Question 22

Cystic Fibrosis - Treatment

Answer 22

Pancreatic enzyme supplementation
High calorie/protein/fat/salt diet
Airway clearance therapy
Antibiotic treatment

Question 23

Bronchopulmonary dysplasia - Pathogenesis

Answer 23

Premature lung makes insufficient surfactant, and premature antioxidant defense mechanisms do not protect lung from toxic oxygen metabolites

Results in early inflammation, hypercellularity, followed by healing with fibrosis

Infants require high pressure ventilization, resulting in a cycle of progressive lung injury

Question 24

Bronchopulmonary dysplasia - Treatment

Answer 24

Surfactant replacement therapy

Supportive (mechanical ventilation)