Peds Pulm

Question 1

Croup caused by what?

Who gets it?

XR finding

Answer 1

Parainflu! less commonly RSV or others. They are pre schoolers

Barky, harsh, seal like cough and STRIDOR

Can progress to inspiratory stridor (inhale, not exhale)

See steeple sign on XR

Question 2

Croup admission when?

Answer 2

Progressive stridor or stridor with rest.

No improvement after steroids

Respiratory distress

Question 3

Tx croup in ER?

Answer 3

Steroids

Racemic epic if stridor

Question 4

Epiglottitis is high yield! What causes it?

BIG IMPORTANT THING ABOUT THEM ON PHYSICAL

Answer 4

HIB, usually

High Fever, poor intake and drooling. UNIONIZED

Toxic appearing

Drooling, tripping trying to breath.

COMFORT THEM BY MOM!!!! don’t try to exam throat b/c can irritate more and be life threatening, wait to intubate

GIVE IV ANTIBIOTICS after airway

thumbprint sign

Question 5

Tx of epiglottis?

Answer 5

IV clinda or vanco for staph. Ceftriazone or cefotaxime for HiB

Question 6

What causes bronchiolitis?

Symptoms

Answer 6

RSV. Winter/spring and children less than 2

Wet cough, fever, poor feeding

Question 7

Who gets severe RSV?

Answer 7

Young, asthma other stuff

Tachypnea, wheeze, crackles, rhyperresonance

Resp distress. LOOKS AND SOUNDS LIKE ASTHMA (this is too young and not reversible)

Question 8

CXR for RSV?

Answer 8

Air trappin (hyperinflation) with patchy hillier infiltrates

Complication is pneumonia

Question 9

Txfor RSV?

Answer 9

If you make a cure, win NOBEL PRIZE

Supportive care with O2 and fluids

STEROIDS ARE NOT EFFECTIVE

Vaccine in premies

Question 10

When are steroids used for infection of airway in kids?

Answer 10

Croup.

NOT RSV

Question 11

Parent unable to care for child at home is an indication for hospitalization

Answer 11

Always

Question 12

Tx for croup?

Answer 12

O2, steroids, epi

Question 13

Who gets surgery for parathyroid adenoma?

Answer 13

Ca++ is high and symptomatic, Creatinine clearance below 30%, osteoporosis, less than 50 years old

Question 14

CXR in resp distress of newborn?

How is it different than transientt tachypnea of newborn?

Answer 14

Ground glass appearance with low lung volume
Diffuse GROUND GLASS with AIR BRONCHOGRAMS

TTN is increased volume and flattening of diaphragm
Suburst vascular markings from hilum
Fluid streaking in interlobular filssures

Question 15

Meconium might break down surfactant, so consider administration if Meconium aspiration syndrome

Answer 15

Babies would have cyanosis, intercostal retractions, tachypnea

INCREASED risk of reactive airway later. GIVE ANTIBIOTICS if necessary for treating… well… poop

Question 16

CF has pancreatic insufficiency, remember??

Tx for malabsorption?

Answer 16

Dietician consult

Enzymes

ADEK supplement

Question 17

Treating pulm component of CF?

Answer 17

Think keep airway clean

Beta agoniststo dilate
DNase I for sputum viscoity
Hypertonic saline for flushing
Physiotherepy
Azythromycin for when lower lung function and treat psuedomonas (or fluoroquinolone)

Question 18

What is causing stridor, wheezing and shortness of breath despite medical therapies in newborn?

Answer 18

Vascular ring