peds pulm review

Question 1

Epiglottitis clnical features and age

Answer 1

common in 2-7 yrs old
abrupt onset of rapidly progressive upper obstructions. may have high fever, muccled speech, dysphaia with drooling, or tripoding. complete resp arrest may occur suddenly.

Question 2

Most common casue of epiglottitis

Answer 2

was HIB, now GAS, s. pneumon, and staph

Question 3

DDx epiglottitis

Answer 3

croup, bacterial tracheitis, retropharyngeal abscess

Question 4

treatment of epiglottitis

Answer 4

intubation, minimize stimulation, humidified oxygen. 2nd or 3rd gen chephalosphorin. if secondary to HIB,rifampin prophylaxis for household contacts <4 years

Question 5

croup definition

Answer 5

inflammation and edema of the subglottic larynx, trachea, and bronchi

Question 6

epidemiology and etiology of croup

Answer 6

1. viral: most common cause of stridor. 3 mo-3 years. M>F. parainfluenza most common cause (others are RSV, rhino, adeno, flu)
2. spasmotic croup: preschool kids; usually d/t hypersensitivity rxn

Question 7

clinical features of croup

Answer 7

1. URI prodrome 2-3 days, then stridor/cough
2. inspiratory stridor, fever, barky cough, hoarse voice. lasts 3-7 days
3. sx worse at night and when agitated
4. wheezing
5. steeple sign of subglottic narrowing on imaging

Question 8

treatment of croup

Answer 8

1. supportive care
2. systemic corticosteroids (dexamethasone) for kids with stridor at rest
3. If in resp. distress, give racemic epinephrine aerosols
4. albuterol if wheezing

Question 9

bacterial tracheitis

Answer 9

• acute inflammation of the trachea
• S. aureus, strep, untyped h flu
• abrupt onset, high fever/toxicity, mucus/pus in trachea
• abx, airway support

Question 10

bronchiolitis

Answer 10

inflammation of the bronchioles that usually causes inflammatory bronchiolar obstruction. most common lower resp infection in first 2 years of life.

Question 11

risk factors for bronchiolitis

Answer 11

day care, siblings, tobacco, lack of breast feeding

Question 12

risk for severe disease with bronchiolitis

Answer 12

chronic lung disease, congenital heart disease, prematurity, immunodeficiency, age <12 wks. may give prophulactic RSV monoclonal ab (palivizumab) for kids with hx prematurity, chronic lung disease, congenital heart disease.

Question 13

clinical features bronchiolitis

Answer 13

gradual, tachypnea/raleswheezes, hypoxemia, apnea, , hyperinflation. improvement within 2 wks

Question 14

chlamydia trachomatis pna

Answer 14

afebrile PNA at 1-3 mo
staccato cough, dyspnea, absence of fever. may have hx conjunctivitis. may have eosinophilia and CXR with interstitial infiltrates

Question 15

clinical phases of pertussis

Answer 15

incubation 7-10 days

1. catarrhal: 1-2 wks. URI sx
2. paroxysmal stage: 2-4 wks. whoop rarely heard in young infants. infants may have cyanosis, apnea, choking. afebrile, appear well between paroxysms
3. convalescent phase: weeks to months

Question 16

pertussis management

Answer 16

1. hospitalize young infants (risks of cyanosis, apnea, choking)
2. abx to prevent spread of infection
3. respiratory isolation for at least 5 days