Pulm part 2

Question 1

Step 1 asthma tx for 12 yrs or older

Answer 1

SABA PRN

Question 2

Step 2 asthma tx for 12 yrs or older: preferred

Answer 2

Low-dose ICS

Question 3

Step 2 asthma tx for 12 yrs or older: alternative

Answer 3

Cromolyn
LTRA
Nedocromil
or Theophylline

Question 4

Step 3 asthma tx for 12 yrs or older: preferred

Answer 4

Low-dose ICS + LABA
OR
Medium-dose ICS

Question 5

Step 3 asthma tx for 12 yrs or older: alternative

Answer 5

Low-dose ICS + either:
LTRA
Theophylline
or Zileuton

Question 6

Step 4 asthma tx for 12 yrs or older: preferred

Answer 6

Medium-dose ICS +

LABA

Question 7

Step 4 asthma tx for 12 yrs or older: alternative

Answer 7

Medium-dose ICS + either:
LTRA
Theophylline
or Zileuton

Question 8

Step 5 asthma tx for 12 yrs or older

Answer 8

High-dose ICS +
LABA
AND consider omalizumab for pts who have allergies

Question 9

Step 6 asthma tx for 12 yrs or older

Answer 9

High-dose ICS +
LABA +
oral corticosteroid
AND consider omalizumab for pts who have allergies

Question 10

MC age for foreign body aspirations

Answer 10

Children younger than 3 yrs

Question 11

Reasons children are more prone to foreign body aspirations

Answer 11

Lack of molar teeth that decreases their ability to sufficiently chew food
Propensity to talk, laugh, and run while chewing
Examination of even non-food substances in the mouth

Question 12

Presentation of foreign body aspiration

Answer 12

Often, presents after sudden episode of coughing or choking while eating with subsequent wheezing, coughing, or stridor
When not witnessed, persistent or recurring cough, wheezing, persistent or recurrent PNA, lung abscess, focal bronchiectasis, or hemoptysis

Question 13

PE of foreign body aspiration

Answer 13

New abnl airway sounds
Sounds are inspiratory if in the extrathoracic trachea.
Noises are more prominent in the central airways if in the intrathoracic trachea

Question 14

Workup of foreign body aspiration

Answer 14

Radiography
Bronchoscopy
Heimlich maneuver only if child is unable to speak

Question 15

Tx of foreign body aspiration

Answer 15

Endoscopic removal

Question 16

Causes of hyaline membrane disease

Answer 16

Occurs after the onset of breathing and is associated with an insufficiency of pulmonary surfactant

Question 17

RFs of hyaline membrane disease

Answer 17

Prematurity is the greatest risk
Delivery of a previous preterm infant with hyaline membrane disease
Maternal diabetes
Hypothermia
Fetal distress
Asphyxia
Male sex
White race
Being the second-born of twins
Delivery by C-section without labor

Question 18

Presentation of hyaline membrane dz

Answer 18

Cyanosis
Tachypnea
Nasal flaring
Intercostal and sternal retractions
Grunting

Question 19

Tx of hyaline membrane disease

Answer 19

Antenatal administration of corticosteroids to the mother 48 hrs prior to labor
After birth, intratracheal administration of exogenous surfactant
Maintain pH above 7.25
Increased concentration of warm and humidified inspired oxygen
Nasal continuous positive airway pressure
Ventilator

Question 20

Cause of cystic fibrosis

Answer 20

Autosomal recessive disorder

Mutation of the cystic fibrosis transmembrane regulator (CFTR)

Question 21

Manifestations of cystic fibrosis initially in older children

Answer 21

Poorly controlled asthma and chronic respiratory infections
Persistent or recurrent cough that is often productive of sputum
Digital clubbing
Chronic sinusitis
Nasal polyposis
Pneumothoraces
Steatorrhea
Deficiencies of fat-soluble vitamins
Distal intestinal obstruction syndrome
Insulin deficiency
Hyponatremia and hypochloremic metabolic acidosis
Reproductive dysfunction

Question 22

Presentation of cystic fibrosis in infants

Answer 22

Meconium ileus
Failure to thrive
Cholestatic jaundice
Chronic respiratory sx
Electrolyte abnormalities

Question 23

Dx of cystic fibrosis

Answer 23

DNA testing

Sweat chloride test

Question 24

Tx of cystic fibrosis

Answer 24

Chest physiotherapy
Antibiotic therapy
Enteric-coated pancreatic enzyme capsules
High-calorie diets with the addition of nutritional supplements
Insulin for CF-related diabetes
Multifactorial