Peds Pulm

Question 1

What are the Lungs Conditions associated with?

1) Bronchiolitis, Pulm Edema, PNA, Asthma
2) Asthma Bronchiolitis, Foreign Body
3) cystic fibrosis
4) croup, laryngomalacia, subglottic stenosis, allergic rxn, vocal cord dysfunction

Answer 1

1) Crackles (rales)
2) Wheezes
3) Rhonchi
4) Stridor

Question 2

1: Parainfluenza Virus Type 1, RSV and adenoviruses

What Viral Disease is this?

• Nasal congestion/URI sx
• usually afebrile
• Inspiratory stridor
• Hoarseness
• Cough: barking; “seal-like”

Answer 2

Viral Croup (laryngotracheobronchitis)

Question 3

How can we measure Imminent Respiratory Failure?

• Mild= ≤ 2
• Moderate=3-7
• Severe= ≥ 8

Answer 3

Westley Croup Score

Question 4

How can we Diagnose and Treat Viral Croup?

Answer 4

• Diagnosis: Clinical: retractions & X-Ray show “steeple sign”
• Mild: Supportive therapy, Cool mist
• Moderate (score > 3): Corticosteroids:Dexamethasone IM/IV (0.6 mg/kg), Budesonide as a single dose (2mg)- not routine, Nebulized racemic epinephrine
• Severe: Airway support, Corticosteroid IV, nebulized epi

Question 5

What is this disease and that is its MC cause?

• Sudden onset high fevers, inspiratory retractions, Rapid onset- stridor, muffled voice, dyspnea
• 3 D’s: dysphagia, drooling & distress
• Tri-pod posturing (“sniffing dog position”)

Answer 5

Epiglottitis

Haemophilus influenza type b (H. flu)

Question 6

How can you reduce the incidence of Epilottitis, and what can uou Never do on a patient with Epiglottitis?

Answer 6

HIB vaccination

DO NOT USE A TONGUE BLADE!

Question 7

What Antibiotics can you use empirically for Epiglottitis?

Answer 7

cephalosporin

+

Vancomycin (If MRSA)

Question 8

What disease is this?

Lower respiratory tract infection that affects the small airways (bronchioles) in pt’s < 2

Common cause of hospital admissions <2 yo

Peak 2- 6mos of age…almost all children exposed by age 3

RSV #1, Rhinovirus

Answer 8

Bronchiolitis

Question 9

What disease presents with wheezing & crackles on exam, presents with Lower Respiratory Tract sxs for 5 days, and is treated with 02, hydration, and Nasal Suction?

Answer 9

Bronchiolitis

Question 10

What is the most important cause of lower respiratory tract infection (LRTI) in children < 1 yr and the No. 1 cause of Bronchiolitis?

Answer 10

Respiratory Syncytial Virus (RSV)

Question 11

What viral infection presents with:

• Diffuse wheezing & tachypnea following URI sx
• CXR: hyperinflation, peribronchial thickening
• low grade fever
• crackles, prolonged expiration, wheezing, retractions
• congestion, lots of mucus

Answer 11

Respiratory Syncytial Virus (RSV)

Question 12

How can you Diagnose and Treat RSV infections?

Answer 12

Diag: Clinical Sxs + Rapid Assay

Tx: Ribavirin (if immunecompromised), Palivizumab (prophylaxis Only)

Question 13

What disease is the most common cause of respiratory distress in preterm infant?

Deficiency of surfactant production + surfactant inactivation by protein leak into airspaces = Pulmonary Edema

Answer 13

Infant Respiratory Distress Syndrome (RDS)
“Hyaline Membrane Disease”

Question 14

What syndrome is treated with 02, CPAP, Intubation, Steroids, and Surfactant replacement?

Answer 14

Infant Respiratory Distress Syndrome (RDS)
“Hyaline Membrane Disease”

Question 15

What is the No. 1 cause of PNA in children

1-3 months

3-12 months

2-5 years

5-18 years

Answer 15

1-3 months = S. pneumo

3-12 months = S. pneumo

2-5 years = S. pneumo

5-18 years = Atypicals (Clamydia, Mycoplamsa)

Question 16

If Grunting and Crackles are found on the physical examination for PNA, what does that mean?

Answer 16

Grunting= imminent respiratory failure

Lungs: crackles (rales), rhonchi, decreased air mvmt

Question 17

air space disease or consolidation in a lobar distribution = ________ pneumonia

interstitial or peribronchial infiltrates = ______pneumonia (or infection)

Answer 17

Bacterial

Viral

Question 18

What disease is treated with

Tx for S. pneumo: Amoxicillin 90 mg/kg per day divided BID x 10 days

If atypical is suspected, use macrolide (Azithromycin 10 mg/kg day one, then 5 mg/kg days 2-5.)

Admit if < 3-6 mo old or hypoxemic

Answer 18

Pneumonia

Question 19

What bacteria causes Whooping Cough and how is it spread?

Answer 19

Bordartella Pertussis

Spread via Respiratory droplets

Question 20

What disease is this?

•Diagnosis: (Gold standard) PCR (polymerase chain reaction) & culture of nasal secretions

CBC= leukocytosis

• Treatment: TMP-SMX
• Prophylaxis: immunization
• Hospitalize if: Decreased O2 saturation, decreased feeding

Respiratory distress, cyanosis, apnea

Answer 20

Pertussis

Question 21

What is the most common life-shortening genetic disease in white individuals AND is Autosomal Recessive?

Answer 21

Cystic Fibrosis

Question 22

What disease is this?

Hallmark: High salt in sweat with recurrent sinus infections.

Most common 2nd infections due to H.flu & S. aureus in young kids

Pseudomonas in older kids

Answer 22

Cystic Fibrosis

Question 23

How is Cystic Fibrosis diagnosed and treated?

Answer 23

Dx: Newborn screen, Sweat test & evaluation by CF specialist

Tx/management: airway clearance therapies, chest physiotherapy, regular exercise

Question 24

If Cystic Fibrosis pts are at an increased risk for developing hyponatremic dehydration, offer them _____ snacks.

Answer 24

Salty snacks