Pulmonary

Question 1

Describe the sound of rales/crackles. When do you predominantly hear it?

Answer 1

Scratchy, bubbly

Inspiration

Question 2

What mainly causes rales/crackles in peds?

Answer 2

Bronchiolititis

Question 3

Describes wheezes

Answer 3

continuous, high pitches

Expiration

Question 4

Describe Rhonchi

Answer 4

continuous, low pitched

Snoring

Question 5

Causes for Rhonchi

Answer 5

1. Pneumonia

2. Cystic Fibrosis

Question 6

Describe Stridor

Answer 6

High pitch, harsh

Inspiration

Question 7

What is the main cause for stridor?

Answer 7

Croup

Question 8

si/sx’s of Viral Croup (laryngotrachobronchitis)

Answer 8

1. Inspiratory stridor
2. Hoarseness
3. Cough: barking, “seal-like”

Question 9

What is the #1 cause for viral croup? other MC?

Answer 9

#1=Parainfluenza Virus Type 1
Other= RSV

Question 10

What are the 5 components of the Westley Croup Score?

Answer 10

1. Level of consciousness
2. Cyanosis
3. Stridor
4. Air entry
5. Retractions

Question 11

List the signs of imminent respiratory failure

Answer 11

1. Fatigue and listlessness
2. Marked retractions
3. Decreased/absent BS
4. Depressed LOC
5. Tachycardia out of proportion to fever
6. Cyanosis/pallor

Question 12

Based on the Westley Croup Score, what is considered Mild Croup? Treatment plan?

Answer 12

Score= <2

1. Supportive tx
2. Cool mist

Question 13

Based on the Westley Croup Score, what is considered Moderate Croup? Treatment plan?

Answer 13

Score=3-7

1. Corticosteroids: Dexamethasone IM/IV
2. Nebulized racemic Epi

Question 14

Radiographic findings in Viral Croup

Answer 14

Steeple Sign

Question 15

Epiglottitis etiology

Answer 15

Hib: Haemophilus influenza type b

Question 16

Epiglottitis si/sx’s

Answer 16

3 D’s + Tri-pod posturing:

1. Dysphagia
2. Drooling
3. Distres

Question 17

Epiglottitis radiograph findings

Answer 17

“Thumb sign”

Question 18

Epiglottitis treatment

Answer 18

1. Airway supports! ET tube

2. Abx: 3rd generation Cephalosporing + Vancomycin

Question 19

What age is Bronchiolitis MC in?

Answer 19

Age <2

Question 20

What is the #1 cause of Bronchiolitis?

Answer 20

RSV

Question 21

Si/sx’s in Bronchiolitis

Answer 21

1. Tachypnea, labored breathing
2. Cough
3. Hypoxia

Question 22

Lung exam findins in Bronchiolitis?

Answer 22

Wheezing

Crackles

Question 23

Bronchiolitis treatment

Answer 23

1. Oxygen
2. Maintain hydration
3. Nasal suctioning

Question 24

What is the most important cause of LRTI in children <1 yr

Answer 24

Respiratory Syncytial Virus: RSV

Question 25

RSV si/sx's

Answer 25

1. Crackles 2. Prolonged expiration wheezing 3. Retractions 4. MUCUS!!!

Question 26

CXR findings in RSV

Answer 26

Hyperinflation | Peribronchial thickening

Question 27

RSV diagnosis

Answer 27

Rapid assay (nasal swab/wash)

Question 28

When would you give Ribavirin for tx of RSV?

Answer 28

ONLY if immunocompromised

Question 29

What is the MCC of respiratory distress in preterm infants?

Answer 29

Respiratory Distress Syndrome (RDS)= "Hyaline Membrane Disease"

Question 30

Etiology of Respiratory Distress Syndrome (RDS)

Answer 30

Deficiency of Surfactant production + surfactant inactivation by protein leak into airspaces

Question 31

CXR findings in RDS

Answer 31

"Ground-glass appearance"= Atelectasis

Question 32

RDS treatment

Answer 32

1. Oxygen, nasal CPAP, intubation 2. Surfactant replacement 3. Steroids

Question 33

When do you admit for pneumonia?

Answer 33

<3-6 mos. old | Hypoxemic

Question 34

Pneumonia abx treatment

Answer 34

Amoxicillin 90 mg/kg per day

Question 35

If atypical pneumonia suspected, abx treatment?

Answer 35

Azithromycin

Question 36

Pertussis (whooping cough) etiology

Answer 36

Bordatella pertussis

Question 37

Phase 1 of pertussis

Answer 37

1-2 weeks: URI sx's Fever

Question 38

Phase 2 of pertussis

Answer 38

2-6 weeks: Persistent paroxysmal cough Inspiratory "whooping" postussive emesis

Question 39

Phase 3 of pertussis

Answer 39

Weeks to Months: | Cough gradually resolves

Question 40

Complications of pertussis

Answer 40

1. Hypoxia 2. Apnea 3. Pneumonia 4. Seizures

Question 41

Pertussis treatment

Answer 41

Macrolides TMP-SMX *Tx everyone in the household