PULM

Question 1

How is a child’s tongue differ in comparison to adults?

Answer 1

Huge tongue in comparison to a small airway

Question 2

What are sxs of respiratory distress?

Answer 2

Tachycardia, retractions, grunting, nasal flaring, head bobbing, abdominal breathing, and tripod position

Question 3

If a child has a cough that sounds like the bark of a seal with inspiratory stridor, with coughing fit at night, what diagnosis? What causes it?

Answer 3

Croup

Caused by parainfluenza affecting the larynx

Question 4

How do you confirm diagnosis of croup? How do you treat it?

Answer 4

Diagnosis = chest xray looking for the steeple sign (can be diagnosed clinically)

Treat = cool air/moist air & single dose decadron (steroid); respiratory distress racemic epi + O2

Question 5

If a child has rapid onset of severe respiratory distress, high fever, drooling, stridor and no cough, but they’re in the tripod position – what diagnosis?

Answer 5

Epiglottitis

Question 6

How do you diagnose epiglottitis?

Answer 6

NEVER ATTEMPT TO VISUALIZE THE AIRWAY Do a lateral neck xray for “thumb sign”

Question 7

What vaccine prevents epiglottitis? How do you treat it?

Answer 7

HiB vaccine

Treat with Abx & secure the airway

Question 8

If a child has myalgia’s, fever, chills, with a runny nose, and sore throat – what diagnosis do you need to think of?

Answer 8

Influenza

Question 9

How do you diagnose influenza?

Answer 9

PCR nasal swab & negative chest-xray

Question 10

How do you treat influenza?

Answer 10

antipyretics for fever, oseltamivir (within 48 hours), Relenza, and close F/U of 6mo-1 year olds

Question 11

If an infant had a recent URI exposure with increase in nasal congestion and cough. And has a gradual onset of fever, poor feeding, expiratory wheeze (respiratory distress) – what diagnosis?

Answer 11

RSV (AKA Bronchiolitis)

Question 12

How would you confirm diagnosis of RSV and what might you see on PE?

Answer 12

Confirm with RSV nasal swab & hyperinflation chest xray

PE you might see retractions, “junky” lung sounds, and low O2 sat

Question 13

What stage of pertussis would see post-tussive vomiting & and an inspiratory whoop?

Answer 13

2nd Paroxysmal stage (lasts 1-6 weeks)

Question 14

What abx do you use to treat pertussis?

Answer 14

Macrolide (Azith & clarithro)

Question 15

If you hear focal crackles, rales in a child with fever and lethargy – what diagnosis?

Answer 15

Pneumonia

Question 16

How do you confirm diagnosis of pneumonia?

Answer 16

Chest xray (consolidation & “round appearing)

Question 17

How do you treat pneumonia?

Answer 17

High dose Amoxicillin (or macrolide)

Question 18

At what point do you admit a child?

Answer 18

O2 sat 70 in infants or >50 in children

Question 19

If a child has recurrent respiratory infections with thick mucus/cough – what diagnosis do you not want to miss?

Answer 19

Cystic fibrosis

Question 20

What is occurring in cystic fibrosis? What else do you need to ask about with recurrent respiratory infections with thick mucus cough (that you suspect is cystic fibrosis)?

Answer 20

Abnormalities of salt/water transport → mucus retention. Always ask about stools!!! Greasy, foul-smelling stools that float indicate cystic fibrosis

Question 21

How do you confirm diagnosis of cystic fibrosis?

Answer 21

Positive sweat test >60mEq/L

Question 22

If a child has a cough and wheeze every time they work out – what diagnosis?

Answer 22

Asthma (exercise induced)

Question 23

How do you diagnose asthma?

Answer 23

PFT’s! Showing a low FEV1/FVC ratio; then give a bronchodilator – if it improves by 12% = asthma

Question 24

In general, how do you treat asthma?

Answer 24

Albuterol & Steroids (once older you can use higher dose steroids)

Question 25

When does SIDS peak? And when does it occur?

Answer 25

2-4 months

Occurs during sleep

Question 26

What are some risk factors for SIDS?

Answer 26

Exposure to cigarette smoke, mom less than 20, premature/low birth weight, sleeping on stomach, soft bedding with blankets, and sharing a bed with a child less than 3 months

Question 27

IF a premature neonate begins to show signs of respiratory distress within the first few hours of life – what diagnosis do you need to think of and what diagnostic do you need to do?

Answer 27

Hyaline membrane disease (RDS)! Get a chest xray to see “ground glass appearance”

Question 28

What’s occurring in RDS?

Answer 28

Deficiency in surfactant, in a premature baby (less than 37 weeks)

Question 29

How do you treat hyaline membrane disease?

Answer 29

Give corticosteroids & surfactant (especially during labor if less than 37 weeks)