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Special Pops, Ped final > Pulm and GI > Flashcards

Pulm and GI Flashcards

1
Q

Typical vs atypical pneumonia

A

typical = acute onset, lobar consolidation on x-ray, involves pneumococcal spp

atypical = more indolent (> 24hrs) onset, lower peak temps, more prodromal sx like headache and sore throat, involves mycoplasma or chlamydia spp

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2
Q

More likely to see what kind of pneumonia in school age children

A

Atypical

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3
Q

More likely to see what kind of pneumonia in neonates

A

Group B Strep, Chlamydia

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4
Q

More likely to see what kind of pneumonia in infants outside neonate period

A

Viral pneumonia

Serious bacteria pneumonia w staph aureus, strep pneumo

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5
Q

Ill / toxic apearing child may be more likely to have what kind of pneumonia

A

Bacterial pneumo, or a complication of bacterial pneumo like empyema

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6
Q

When considering pneumonia, what else should beo n the DDX

A

Atelectasis from foreign body or mucus plug

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7
Q

A 2 year-old presents with the abrupt onset of cough, wheeze and tachypnea. He is afebrile. Physical exam reveals diminished air exchange and wheezing on the right.

What’s the DDx?

A

Foreign body aspiration
Asthma
Pneumonia
Bronchiolitis

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8
Q

Tx for complete airway obstruction

A

back slaps and chest thrusts in head down position for infants, abdominal thrusts for older children

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9
Q

Tx for partial airway obstruction

A

allow patient to cough, take to nearest emergency facility

Rigid bronchoscopy

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10
Q

Male infant born at 38 weeks by scheduled repeat cesarean section prior to onset of labor.
Maternal history – good prenatal care, negative group B Strep cultures
Apgars 8/8
Within first hour of birth:
Tachypnea
Nasal flaring
Mild retractions

What’s the DDx?

A

Transient tachypnea of the newborn
Respiratory distress syndrome
Congenital diaphragmatic hernia
Meconium aspiration syndrome

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11
Q

A 10 month-old presents with bouts of irritability during which he draws up his legs and appears to be in pain. He had a viral illness last week. His stools are heme test negative and he is very lethargic. There is abdominal distention and diffuse tenderness. What is your differential diagnosis?

A

Intussusception
Malrotation w/volvulus
Meningitis
Gastroenteritis

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12
Q

A full-term 1-week-old boy presents with bilious vomiting and lethargy
Pertinent history: normal prenatal course, uncomplicated delivery, adequate weight gain since birth
Physical exam: fussy, pale, abdomen distended and tender to palpation, blood in diaper
Most likely diagnosis?

A

Malrotation w volvulus

Gonna need surgery

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13
Q

An 8 year-old girl presents with abdominal pain, purpuric lesions on the buttocks and lower extremities, and knee and ankle pain. She reports her urine to be darker than usual.
Most likely diagnosis?

A

Henoch-Schonlein Purpura

Vasculitis:

  • *palpable purpura on lower extremities
    • hematuria, bloody stools
  • *edema
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14
Q

RLQ pain, abdominal guarding and rebound tenderness

A

Appendicitis

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15
Q

Diarrhea – possibly bloody, fever, vomiting

A

Bacterial enterocolitis

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16
Q

RUQ pain, may extend subscapular

A

Cholecystitis

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17
Q

Purpuric lesions, joint pain, blood in urine, guaiac-positive stools

A

Henoch-Schonlein Purpura

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18
Q

RUQ pain, jaundice

A

Hepatitis

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19
Q

Inguinal mass, lower abdominal or groin pain, emesis

A

Incarcerated inguinal hernia

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20
Q

Colicky abdominal pain, currant jelly stools

A

Intussusception

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21
Q

Abdominal distention, bilious vomiting, blood per rectum, usually presents in infancy

A

Malrotation with volvulus

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22
Q

Hematuria, colicky abdominal pain

A

Nephrolithiasis

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23
Q

(Severe) epigastric, abdominal pain, fever, and persistent vomiting

A

Pancreatitis

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24
Q

Emesis, history of prior abdominal surgery

A

Small bowel obstruction

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25
Q

Fever, sore throat, headache, +/- abdominal pain

A

Streptococcal pharyngitis

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26
Q

Fever, vomiting, and diarrhea in infants; back pain in older children

A

UTI

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27
Q

Irritability, pallor, bloody diarrhea, anemia, thrombocytopenia

A

Hemolytic-uremic syndrome

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28
Q

Weight loss, diarrhea, malaise

A

Inflammatory bowel disease

29
Q

CXR appearance of RDS

A

“Ground glass” - fine reticular granularity

Initial CXR may be normal, w progression over 6-12hrs

30
Q

Most common lower respiratory tract infection in infants and children <2yo

A

Bronchiolitis

31
Q

Most common causative agent of bronchiolitis

A

RSV

Adenovirus, parainfluenza, influenza

32
Q

Bronchiolitis - diagnosis studies?

A

Clinical diagnosis - labs and imaging not recommended

33
Q

Recent URI, copious rhinorrhea
Cough, tachypnea, tachycardia
Nasal flaring, grunting

A

Bronchiolitis / RSV

34
Q

Earliest, most sensitive sign for bronchiolitis / RSV

A

Tachypnea

35
Q

Bronchiolitis / RSV management

A

Hydration!!!
Oxygenation
Nasal suction

Ribavarin only for severe cases

36
Q

Leading cause of infant death from viral infection

A

RSV

37
Q

Most common complication of RSV

A

Otitis media

38
Q

Recurrent Wheezing vs Chronic Asthma

A

Recurrent wheezing more in early childhood, triggered by viral URI’s

Chronic asthma is associated w allergy and persists into later childhood / adulthood

39
Q

Intermittent dry coughing and expiratory wheezing
SOB and chest tightness in older children
Symptoms worse at night

A

Asthma

40
Q

Expiratory wheezing, prolonged expiratory phase

A

Asthma

41
Q

Acute inflammatory upper airway obstruction, ddx

A 
Croup
Epiglottitis
Aspiration of foreign body
Retropharyngeal or pertonsillar abscess
Extrinsic compression of the airway (laryngeal web, vascular ring
42
Q

URI sx for 1-3 days

Barky cough, hoarseness, inspiratory stridor

A

Croup

43
Q

Age group most common for Croup

A

3 month - 5 years, peaks at 2 yrs

44
Q

Most common etiology and long medical name for Croup

A

Parainfluenza virus

Laryngotracheobronchitis

45
Q

CXR indicating Croup

A

“Steeple sign” - upper trachea appears closed, gradually opens as it descends

46
Q

Croup management at home

A

Airway management, usually done at home

  • cool mist
  • steamy bathroom
47
Q

Croup management in ED

A

Nebulized racemic epinephrine

Corticosteroids

48
Q

When to hospitalize for croup?

A 
Severe stridor at rest
Respiratory distress
Hypoxia
Cyanosis
Depressed mental status
49
Q

Acute, fulminating course of high fever, sore throat, dyspnea, rapidly progressing respiratory obstruction

A

Acute Epiglottitis

50
Q

Epidemiology of epiglottitis

A

In the past was largely due to Haemophilus influenzae type b

now usually due to Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus

51
Q

Otherwise healthy child suddenly develops a sore throat and fever
Within few hours – toxic appearing, difficulty swallowing and breathing
Drooling

A

Acute Epiglottitis

52
Q

Diagnosis of epiglottitis

A

Visualization of a large, “cherry-red” swollen epiglottitis

Should only be performed by someone capable of maintaining airway – i.e. ENT or anesthesiologist

53
Q

CXR of acute epiglottitis

A

“thumb sign”

54
Q

Epiglottitis management

A

Airway establishment - intubation
O2
Blood Culture
Antibiotics - ceftriaxone, cefixime

55
Q

Etiology and course of whooping cough / pertussis

A

6 week course

Bordatella pertussis

56
Q

Evolves into inexorable paroxysms – hallmark of the disease

Number and intensity of paroxysms progresses over days to a week and then plateaus for days to weeks

A

Whooping cough / pertussis

reportable disease

57
Q

Suspect in patient who has predominant complaint of cough especially in the absence of fever, malaise, myalgia, exanthema or sore throat

A

Whooping cough / pertussis

reportable disease

58
Q

Pertussis tx

A

Erythromycin or azythromycin

Hospitalize infants under 3 months

59
Q

Pertussis complications

A 
Pneumonia
Seizures
Apnea
Secondary infection
Mortality 1% in < 2month olds
60
Q

Non-bilious emesis that becomes progressively forceful
Dehydration, weight loss
Birth- 3 months

A

Pyloric stenosis

61
Q

First line testing for pyloric stenosis

A

Ultrasound

Look for thickening of pyloric valve, elongation of channel

62
Q

Metabolic panel in pyloric stenosis will show

A

hypochloremic metabolic alkalosis due to loss of hydrogen ions and chloride from emesis

63
Q

Most common cause of intestinal obstruction in children aged 3 months to 6 years of age

A

Intussusception

60% occur before first birthday
80% occur before second birthday
Uncommon < 3 months, > 6 years

64
Q

Intussusception usually occurs at what part of bowel

A

ileocecal junction

65
Q

Pathophys of intussusception

A

Obstructs venous return ➔ engorgement of intussusceptum ➔ edema, bleeding from the mucosa ➔ bloody stool (CURRANT JELLY STOOL)

66
Q

Intussusception Tx

A

Hydrostatic/ pneumatic reduction – with barium or water soluble contrast
Successful 80-95% of the time
Recurrence: 10%

Surgical reduction
Manual reduction of intussusceptum
Resection for ischemia

67
Q

True diverticulum, containing all bowel layers (mucosa, submucosa and muscularis propria), in small intestine
Most common congenital GI abnormality

A

Meckel’s diverticulum

68
Q

Most common times constipation presents

A

Infancy: at transition to solid foods
Toddler: at transition to toilet training
School-age: at entry to school

69
Q

“Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 has been reached”

A

Encoparesis

4% in 5 – 6 year olds
1.5% in 11 – 12 year olds
M:F = 4-5:1

Special Pops, Ped final (4 decks)

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