Pulm

Question 1

Tx for asthma

Answer 1

Patient ed: use of spacer, shaking canister, home monitoring, prevention or environment control

SaβAs: albuterol, levalbuterol

LaβAs: salmeterol, formoterol

Inhaled steroids

Anticholinergics aren’t as helpful in kids

Mast cell stabilizers: cromolyn, nedocromil

Leukotriene inhibitors

Refer for acute life-threatening attack, mod-severe asthma, steroid-dependent asthma, complicated asthma, poor response to optimal therapy

Question 2

SaβAs

Answer 2

albuterol, levalbuterol

Question 3

LaβAs

Answer 3

salmeterol, formoterol

Question 4

Inhaled steroids

Answer 4

beclomethasone (required trial for Medicaid), fluticasone, budesonide, mometasone, ciclesonide, triamcinolone, flunisolide

Question 5

Mast cell stabilizers

Answer 5

cromolyn, nedocromil

Question 6

Leukotriene inhibitors

Answer 6

montelukast, zileuton, zafirlukast

Question 7

Croup etiology

Answer 7

Usually parainfluenza virus

Question 8

Croup presenttaion

Answer 8

Stridor, hoarseness, barking seal cough, low-grade fever

Rales, rhonchi, wheezing

Sx worse at night

Question 9

Croup tx

Answer 9

Supportive: cool mist humidifier

Send to ED for inhaled epinephrine if severe or if there is stridor at rest

Steroids

Question 10

Acute bronchiolitis etiology

Answer 10

RSV

Question 11

Acute bronchiolitis presentation

Answer 11

Rhinorrhea, sneezing, wheezing, low grade fever, nasal flaring, tachypnea, retractions that indicate respiratory distress

Question 12

Acute bronchiolitis w/u

Answer 12

Nasal washings for RSV cx and antigen assay

Nrml CBC and CXR

Question 13

Acute bronchiolitis tx

Answer 13

Hospitalize and admin ribavirin

Supportive tx- nebulized albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2

Question 14

signs of upper airway foreign body

Answer 14

causes abrupt onset of cough, stridor, choking, and cyanosis; complete obstruction leads to inability to cough or choke

Question 15

signs of lower airway foreign body

Answer 15

causes acute to subacute cough, unilateral persistent wheezing, and recurrent pneumonia; complete obstruction may cause a ball valve effect, resulting in distal hyperinflation and mediastinal shift, which is most apparent on expiratory films

Question 16

cystic fibrosis tx

Answer 16

Clearance of airway secretions, reversal of bronchoconstriction,
tx of respiratory infections, replacement of pancreatic enzymes, and nutritional and psychosocial support

Question 17

Hyaline Membrane Disease presentation

Answer 17

Respiratory distress and cyanosis soon after birth (usually w/in first 4 hr of life)

Tachypnea, tachycardia, chest wall retractions, nasal flaring, abd breathing

Question 18

Hyaline Membrane Disease tx

Answer 18

Inpatient with fluid balance, CPAP, exogenous surfactant

Prevention: betamethasone for women at risk for preterm deliery prior to 34 wks
If >30 wks FLM can be tested by amniocentesis

Question 19

Hyaline Membrane Disease w/u

Answer 19

CXR →x diffuse ground glass appearance w/ air bronchogram

Question 20

Pneumonia etiology

Answer 20

Bacterial: Strep pneumo, S. pyogens, S. aureus, H. flu, M. pneumo

Viral: RSV, influenza, parainfluenza, adenovirus

Question 21

Pneumonia presentation

Answer 21

Tachypnea, hyoxemia, ↑ work of breathing, fever, productive cough, difficult feedings

Crackles, ↓ breath sounds, dullness to percussion, egophany

Question 22

Pneumonia tx

Answer 22

Inpatient → IV ampicillin is 1st line, 2nd or 3rd gen cephalosporins w/ or w/o vanc, consider macrolide (in 1-3 mo)

Outpatient → first line is high dose amoxicillin alt is 2nd or 3rd gen cephalosporins or azithromycin(should have nrml O2 sat and be able to take oral fluids)

Question 23

RSV tx

Answer 23

Supportive

May need hospitalization w/ fluid and respiratory support

Albuterol trial, Steroids (not for infants)

Ribavirin for select infants

Question 24

Who should get vaccinated for RSV

Answer 24

Preemies <32 wks or who are <3 mo at start of RSV season CLD, heart defect, asthma, immunocomp

Question 25

when is RSV season

Answer 25

beg in oct and end in march