Pulmonology

Question 1

acute bronchiolitis in peds is mc caused by

Answer 1

RSV

Question 2

3 sx of acute bronchiolitis

Answer 2

tachypnea
respiratory distress
wheezing

Question 3

dx for acute bronchiolitis

Answer 3

nasal wash culture and assay

Question 4

CXR findings of acute bronchiolitis

Answer 4

normal bro!

Question 5

only tx that improves sx of bronchiolitis

Answer 5

O2

Question 6

indications for hospitalization w. RSV infxn (6)

Answer 6

O2 sat 95-96%
< 3 mo old
RR > 70
nasal flaring
retractions
atelectasis on CXR

Question 7

med NOT recommended for bronchiolitis in previously well kiddos

Answer 7

systemic steroids

Question 8

med for RSV if kid has severe lung/heart dz or is immunocompromised

Answer 8

ribavarin

Question 9

prophylaxis for RSV for high risk kiddos (immunocompromised, lung dz, premature, neuromuscular d.o)

Answer 9

palivizumab

Question 10

2 PMH findings associated w. asthma

Answer 10

eczema
seasonal rhinitis

Question 11

spirometry findings of asthma (2)

Answer 11

FEV1:FVC < 80%
FEV increase > 10% after bronchodilator

Question 12

tx for asthma

Answer 12

Question 13

tx for acute asthma attack (3)

Answer 13

O2
nebulized SABA/SAMA
steroids

Question 14

what is this showing

Answer 14

steeple sign -> croup

narrowing of the trachea in the subglottic region

Question 15

croup is caused by _ virus
and is mc in _ year olds

Answer 15

parainfluenza
3-6 mo

Question 16

tx for croup

Answer 16

supportive
severe: IVF, nebulized racemic epi, steroids

Question 17

growth retadation
recurrant PNA
chronic diarrhea/steatorrhea

Answer 17

cystic fibrosis

Question 18

PE findings of CF

Answer 18

scattered ronchi bilat
dullness to percussion
mild hepatomegaly
mild LE edema

Question 19

3 CXR findings of CF

Answer 19

focal atelectasis
mucus plugging
hyperinflation

Question 20

dx for CF

Answer 20

sweat chloride test

Question 21

CF is an autosomal recessive mutation in the _ gene

Answer 21

CFTR

Question 22

CF is associated w. recurrant respiratory infxns caused by

Answer 22

pseudomonas

Question 23

management of CF

Answer 23

chest physiotherapy
high fat diet
fat soluble vitamin supplements
exacerbations: abx

Question 24

mcc of foreign body aspiration

Answer 24

food

Question 25

5 rf for foreign body aspiration

Answer 25

institutionalization advanced age poor dentition etoh sedatives

Question 26

mc location for aspiration

Answer 26

mainstem right lobar bronchus

Question 27

3 PE findings of foreign body aspiration

Answer 27

foul smelling nasal d.c inspiratory stridor wheezing +/- decreased breath sounds

Question 28

CXR finding of foreign body aspiration

Answer 28

expiratory film: hyperinflation of affected side

Question 29

_ is necessary for appropriately evaluating/monitoring ventilation

Answer 29

ABG

Question 30

what type of bronchoscopy is preferred in peds

Answer 30

rigid

Question 31

what should you consider administering prior to removal of a nasal foreign body object

Answer 31

**oxymetazoline drops** -> shrinks mucous membrane

Question 32

2 topical pain agents useful when flushing foreign body in ear

Answer 32

benzocaine anti-pyrene

Question 33

what 2 substances can be used to immobilize buggies in the ear prior to removal

Answer 33

viscous lidocaine mineral oil

Question 34

what is this showing

Answer 34

rust ring -> metallic foreign body

Question 35

management of intraocular foreign bodies (3)

Answer 35

topical anesthetic topical vs systemic abx immediate ophtho referral

Question 36

what pathogen are you worried about w. eye injuries associated w. soil/vegetation

Answer 36

bacillus cereus

Question 37

dz that affects premature infants that are born before the lungs produce adequate amounts of surfactant

Answer 37

hyaline membrane dz

Question 38

mcc of respiratory distress in preterm infants

Answer 38

hyaline membrane dz

Question 39

CXR findings of hyaline membrane dz

Answer 39

diffuse bilat atelectasis -> ground glass appearance

Question 40

rf for hyaline membrane dz

Answer 40

infants < 30 weeks gestation at birth

Question 41

what 3 antenatal tx can help with hyaline membrane dz

Answer 41

-antenatal betamethasone IM x 2 w.in 24-48 hr of birth -artificial surfactant thru endotracheal tube -PEEP

Question 42

mcc cause PNA in peds vs adults

Answer 42

peds: RSV adults: flu

Question 43

CXR finding associated w. viral PNA

Answer 43

bilateral interstitial infiltrates

Question 44

management of viral PNA

Answer 44

tamiflu w.in 48 hr SABA fluids

Question 45

what makes you think viral PNA vs bacterial

Answer 45

rapid onset milder sx

Question 46

4 sx of bacterial PNA

Answer 46

fever dyspnea tachycardia/pnea +/- sputum

Question 47

CXR findings of bacterial PNA

Answer 47

patchy, segmental lobar, multilobar consolidation

Question 48

dx for bacterial PNA (2)

Answer 48

blood cultures x 2 sputum gram stain

Question 49

outpt vs inpt tx for bacterial PNA

Answer 49

**outpt:** doxy, macrolides **inpt:** ceftriaxone + azithro/FQ

Question 50

RSV is the mcc of _ in peds (2)

Answer 50

bronchiolitis PNA