Resp Flashcards
- (Repeat) 2 month old child is found to have respiratory distress and focal right- sided crackles on exam. A CXR was done showing a defect of the right diaphragm, CHD vs evantration. What is the next test?
- Diaphragm Fluoroscopy
- MRI chest
- CT chest
- Exploratory laparoscopy
Consensus: A Diaphragm fluoroscopy
As per Mindy A is best option though not readily available and never done. Usually do ultrasound. Cannot necessarily tell on CT depending on how large it is
What is the best measure to decrease the likelihood of asthma in child?
a. breastfeeding
b. avoid second hand smoke
c. elimination of environmental allergens
-second hand smoke
Child with daytime sleepiness, snores at night. Weight 95th percentile. Best first line management option
a. T&A
b. CPAP
T&A first line
For older children with obesity, CPAP would be most effective
There is no paediatric evidence to guide volumes but in adults it is suggested that the drain should be clamped for 1 hour once 10 ml/kg body weight is initially removed. In adults and, by extrapolation, larger children and adolescents, it is suggested that no more than 1.5 litres should be drained at one time or drainage slowed to about 500 ml/hour,95 although again there is no evidence to guide figures. Care must be taken if the drain is clamped in case an air leak has developed during drain insertion, as this then risks a tension pneumothorax https://pediatrics.aappublications.org/content/pediatrics/130/3/e714.full.pdf
3 3yo with gradually increasing oxygen requirement over the last 3 hours. He had a chest tube inserted for empyema, which drained 500mL over the last 6 hours, and
Confusing Questions by Topic - R4 master list
continues to drain well. He is tachycardic, tachypneic, chest exam with decreased air
entry on the side with the empyema. He is afebrile and well perfused. X-ray that shows a marked reduction in the size of the empyema. He has been given ceftriaxone, acetaminophen and ibuprofen. What is your next step in management?
A) Clamp chest tube
B) Add vancomycin
C) Bolus 20ml/kg
D) Give morphine
clamp
2 yo child with recurrent viral wheezing. What is proven therapy? a. ventolin PRN
b. prednisone 5 days
c. fluticasone 3 weeks
Consensus: A Ventolin
- What will predict the persistence of asthma in adulthood? a. Severe RSV pneumonia with intubation
b. Allergic rhinitis
b
2012, question 33: An asthmatic comes to ER mod/severe, treated with ventolin, atrovent and steroids (oral dex), on 1Litre of O2 and sats well, several hours later, still moderate work of breathing what is the next step?
A. Magnesium sulfate
B. Intubate and ventilate C. Aminophyliine
D. IV methylpred
Consensus: A Mag sulf
Mag sulf is [part of] the next step, but usually when I’ve got a kiddo not responding well to asthma management and I’m thinking of giving IV mag sulf I’m also usually planning to give IV methylpred
2011 Q35. 8 year-old girl, Obese. Decline in school performance. She has been snoring a lot and having episodes overnight where she stops breathing. What is the most appropriate intervention?
a. Adenotonsillectomy
b. CPAP
c. Uvuloplasty
d. ??
Consensus: A T&A
T & A probably first line assuming tonsillar hypertrophy but says nothing about tonsil size. If there are normal tonsils then CPAP?
