Peds Pulmonary

Question 1

Viral croup

Answer 1

• fall/winter
• inspiratory stridor**
• hoarsness**
• cough, barking, “seal-like”

Question 2

Viral croup: cause

Answer 2

1. Parainfluenza virus type 1

2. RSV

Question 3

Westley Croup Score

Answer 3

Mild <2
Moderate 3-7
Severe: >8

• LOC
• Cyanosis
• Stridor
• Air entry
• Retractions

Question 4

What sign is seen on radiograph to help dx viral croup?

Answer 4

“steeple sign”

Question 5

Moderate Croup (>3) treatment

Answer 5

1. Dexamethasone IM or IV

2. Nebulized racemic epinephrine

Question 6

Epiglotitis cause

Answer 6

Haemophilus influenza type B

-bacterial

Question 7

Epiglottitis: 3 D’s

Answer 7

Dysphagia
Drooling
Distress

-Tripod posturing “sniffing dog position”*****

Don’t use a tongue blade**

Question 8

Epiglottitis: Radiograph

Answer 8

“thumb sign” [lateral neck film]

Question 9

Epiglottitis: tx

Answer 9

• Airway support

- Antibiotics: 3rd gen cephalosporin + Vancomycin

Question 10

Bronchiolitis

Answer 10

lower respiratory tract infection

• affects pts. under 2
• peaks in January and February

Question 11

Bronchiolitis: cause

Answer 11

RSV

Question 12

Bronchiolitis: signs and symptoms

Answer 12

• difficulty breathing (shallow, rapid, with nasal flaring)

- Wheezing, crackles on exam**

Question 13

Bronchiolititis: tx

Answer 13

• nasal suction

- hydration

Question 14

Respiratory Syncytial Virus

Answer 14

Most important cause of lower respiratory tract infection in children under 1 year

-causes most bronchiolitis

Question 15

RSV: xray

Answer 15

• hyperinflation*

- peribronchial thickening*

Question 16

RSV: physical exam

Answer 16

• crackles
• prolonged expiration
• wheezing
• retractions
• lots of mucus**

Question 17

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

Answer 17

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

Question 18

What is the biggest risk factor for Infant Respiratory Distress Syndrome

Answer 18

-premature birth (<37 weeks, esp if <28 weeks)

Question 19

If a lil baby has grunting what should you be concerned for?

Answer 19

imminent respiratory failure

Question 20

MCC PNA 1-12 months

Answer 20

RSV

Question 21

MCC PNA 2-5 years?

Answer 21

Viral

Question 22

MCC PNA 5-18 years

Answer 22

Bacterial (S. pneumoniae)

Question 23

What is first line treatment for PNA if they are under 5?

Answer 23

Amoxicillin

Question 24

What is the first line treatment for PNA if they are older than 5?

Answer 24

Macrolide (Azithromycin)

Question 25

What is the most common cause of afebrile pneumonia of infancy?

Answer 25

Chlamydia trachomatis

-staccato cough pattern

Question 26

Pertussis (whooping cough): cause

Answer 26

Bordatella pertussis

Question 27

What are the 3 phases of pertussis/whooping cough?

Answer 27

1. Catarrhal (URI symptoms, fever)
2. Paroxysmal ( inspiratory whooping cough, persistent paroxysmal cough)
3. Convalescent

Question 28

Pertussis: dx

Answer 28

PCR and culture of nasal secretions (gold standard)**

CXR: normal

Question 29

Pertussis: treatment

Answer 29

Macrolides ** (or TMP-SMX)

Prophylaxis for household (close contacts, even if they are vaccinated)