Pulmonary 4 (Step up son)

Question 1

A 2yo girl comes in with a slowly progressive barking cough and inspiratory stridor. What does she likely have? what likely caused it? What should be done next?

Answer 1

This is likely croup (3m to 5yo)

Parainfluenza virus 1 and 2 are most common causes

Get a neck x-ray (Steeple sign = croup…thumbprint = epiglottitis)

Question 2

How is croup treated?

Answer 2

If stridor at rest…hospitalized
Supportive care
Inhaled epi and corticosteroids

Question 3

A 5yo boy comes in with rapidly progressive dysphagia, drooling, soft stridor, muffled voice and is seen leaning forward with his hands on his knees and has inspiratory retractions. What does he likely have? what likely caused it? What should be done next?

Answer 3

This is epiglottitis (2yo to 7yo)

H. influ b is most likely…can be strep

Nasotracheal intubation unless mild…DON’T mess around with the neck unless you are prepared to intubate

Question 4

How is epiglottitis treated?

Answer 4

7-10 days of Abx (2nd gen ceph…cefotaxime)

Question 5

What are the causes of acute stridor in a kid?

Answer 5

ABCDEFGH

A-Abscess
B-Bacterial tracheitis
C-Croup
D-Diptheria
E-Epiglottitis
F-Foreign body
G-Gas (poisonous)
H-Hypersensitivity reaction

Question 6

What is a possible complication of respiratory distress syndrome of the newborn?

Answer 6

Higher risk of developing asthma

Question 7

A mother-to-be is between 34 and 37 weeks, so an amniocentesis is done and finds either a lecithin:sphingomyelin > 2 OR phosphatidyl glycerol is present. What should be done?

Answer 7

Monitor for respiratory distress after birth

Question 8

A mother-to-be is starting to go into labor between 34 and 37 weeks, so an amniocentesis is done and finds either a lecithin:sphingomyelin less than 2 and NO phosphatidyl glycerol is present. What should be done?

Answer 8

Give mom corticosteroid in 24hrs prior to delivery

Question 9

A baby experiences meconium ileus at birth, then later in life has recurrent sinus infections, pulmonary infections, and steatorrhea. What test should be done? What causes this disease?

Answer 9

Do a sweat test…Na >60 in kids and >80 in adults –> CF

CF is caused by an autosomal recessive gene (CFTR)

Question 10

How is CF treated?

Answer 10

DNase (decreases viscosity of secretions)
Chest therapy, bronchodilators, abx
Supplemental pancreatic enzymes
Vitamins ADEK for malabsorption