Peds Pulm

Question 1

What conditions can cause crackles?

Answer 1

Bronchiolitis
Pulmonary edema
Pneumo
Asthma

Question 2

What conditions can cause wheezing?

Answer 2

Asthma
Bronchiolitis
FB

Question 3

What conditions can cause rhonchi?

Answer 3

Pneumo

CF

Question 4

What conditions can cause stridor?

Answer 4

Croup 
Laryngomalacia
Subglottic stenosis 
Allergic rxn
Vocal cord dysfxn

Question 5

What are sx of croup?

Answer 5

Inspiratory stridor
Hoarseness
Barking, “seal-like” cough

Question 6

What pathogens cause croup?

Answer 6

1 = parainfluenza virus type 1

RSV & adenoviruses

Question 7

What score is used to determine the severity of croup?

Answer 7

Westley Croup Score

Mild = ≤ 2
Mod = 3-7
Severe = ≥ 8

Question 8

How do you treat moderate croup?

Answer 8

Dexamethasone IM/IV
Alternative = Prednisolone PO

Nebulized racemic epinephrine (obs for 4 mins)

Question 9

What pathogen causes epiglottitis?

Answer 9

H. influenza type b

*HIB vaccine reduced # of cases

Question 10

What are the 3 D’s seen in epiglottitis? What is another hallmark sx?

Answer 10

Dysphagia, drooling, distress

Tri-pod posture (“sniffing dog position”)

Question 11

What is seen on x-ray & how do you manage epiglottitis?

Answer 11

“Thumb sign”

ET tube
3rd gen cephalosporin + vanco

Question 12

What pathogens cause bronchiolitis?

Answer 12

RSV = #1

Rhinovirus

Question 13

What are s/sx of bronchiolitis?

Answer 13

Lower respiratory tract sx develop day 3-5

Wheezing, crackles

Question 14

How do you treat bronchiolitis?

Answer 14

Hydrate

Nasal suctioning

Question 15

What is the most important cause of LRTI in < 1yo?

Answer 15

RSV

Question 16

What are sx of RSV?

Answer 16

Crackles, prolonged expiration, wheezing, retractions

Hyperinflation, peribronchial thickening

Lots of mucus

Question 17

How do you diagnose RSV?

Answer 17

Rapid assay

Question 18

How do you treat RSV?

Answer 18

Ribavirin (ONLY if immunocompromised)

Palivizumab (prophylaxis ONLY)

Question 19

What is infant respiratory distress syndrome?

Answer 19

Deficiency of surfactant production + surfactant inactivation

Question 20

What are RFs for infant respiratory distress syndrome?

Answer 20

Prematurity!!!*
Maternal DM
AMA
FH

Question 21

What are the s/sx of infant RDS?

Answer 21

Hyoxemia

Ground glass appearance on CXR

Question 22

What are RFs for peds pneumo?

Answer 22

CHD
Bronchopulmonary dysplasia
CF
2nd hand smoke 
Lack of vaccinations
Asthma
Sickle cell
Neuro, GI, or immune d/o

Question 23

What does pneumo look like on PE?

Answer 23

Grunting = imminent respiratory failure

Crackles, rhonchi, decreased air movement

Question 24

What are the causes of pneumo according to age?

Answer 24

1mos-5yrs = viral

5-18yrs = bacterial

Question 25

How do you treat pneumo?

Answer 25

Amoxicillin

If atypical –> macrolide

Question 26

What does viral vs bacterial pneumo look like on radiograph?

Answer 26

Bacterial = air space or consolidation in lobar

Viral = interstitial or peribronchial infiltrates

Question 27

What are 4 complications of bordatella pertussis?

Answer 27

Hypoxia
Apnea
Pneumo
Seizures

Question 28

What are the 3 phases of pertussis?

Answer 28

1. Catarrhal: URI, fever (1-2wks)
2. Paroxysmal: cough, “whooping”, emesis (2-6wks)
3. Convalescent: cough resolves (wks-mos)

Question 29

What is the gold standard dx test for pertussis?

Answer 29

PCR!

Question 30

How do you treat pertussis?

Answer 30

Macrolides

TMP-SMX