Respiratory

Question 1

Pathogenesis of croup?

Answer 1

Parainfluenza mostly. Sometimes RSV, influenza, others.

Question 2

How does patient with croup present?

Answer 2

With viral prodrome, seal-like cough, inspiratory stridor

Question 3

How to diagnose croup?

Answer 3

XR showing steeple sign

Question 4

How to treat croup?

Answer 4

Supportive, if not responsive, treat with racemic epi and corticosteroids (especially if patient has stridor at rest)

Question 5

Epiglottitis pathogenesis

Answer 5

H. Flu, but can also be caused by staph aureus

Question 6

How does a patient with epiglottitis present?

Answer 6

Patient is sick as shit, 3-6 years old. Tripodding, drooling, febrile >104, rapid onset

Question 7

How to diagnose epiglottitis?

Answer 7

XR showing thumbprint sign

Question 8

How to treat epiglottitis?

Answer 8

DO NOT touch trachea. Take patient to OR for intubation. Give antibiotics.

Question 9

Bacterial tracheitis pathogenesis?

Answer 9

Bacterial infection with strep pneumo or staph

Question 10

How does patient with bacterial tracheitis present?

Answer 10

Has cold/flu like symptoms and suddenly becomes incredibly febrile with horrible sore throat and stridor.

Question 11

How to diagnose bacterial tracheitis?

Answer 11

XR showing steeple sign, subglottic narrowing with hazy border.

Question 12

How to treat bacterial tracheitis?

Answer 12

No response to racemic epinephrine. Culture and give antibiotics.

Question 13

Retropharygneal abscess pathogenesis

Answer 13

Caused by bacterial infection (usually strep and staph)

Question 14

How does patient with retropharyngeal abscess present?

Answer 14

Fever and drooling with hot potato voice. Patient likes to lie supine with neck extended.
Patient usually has unilateral lymphadenopathy.

Question 15

How to diagnose retropharyngeal abscess?

Answer 15

Get a lateral XR, will show increased soft tissue swelling that expands up to 50% of vertebrae

Question 16

How to treat retropharyngeal abscess?

Answer 16

I+D, culture. Give antibiotics for strep and staph, then based on culture.

Question 17

Pathogenesis of peritonsillar abscess

Answer 17

Caused by staph and strep

Question 18

Patient with peritonsillar abscess presentation?

Answer 18

Fever, drooling, hot potato voice. Patient has tonsillar shift with visible abscess.

Question 19

How to diagnose peritonsillar abscess?

Answer 19

Clinical

Question 20

How to treat peritonsillar abscess?

Answer 20

I+D and culture

Question 21

Foreign body airway obstruction presentation?

Answer 21

Unsupervised child with sudden onset shortness of breath. Stridor if in upper airway, wheezing if in lower airway.

Question 22

How to diagnose FBAO?

Answer 22

XR AP and lateral = coin sign

Question 23

How to treat FBAO?

Answer 23

Rigid bronch.

Question 24

Bronchiolitis pathogenesis

Answer 24

RSV, sometimes parainfluenza. Inflammation of bronchioles

Question 25

Typical bronchiolitis presentation

Answer 25

Wheezing child, fever.

Question 26

How to diagnose bronchiolitis?

Answer 26

CXR and PFTS (normal)

Question 27

How to treat bronchiolitis?

Answer 27

Will resolve spontaneously, however if SpO2

Question 28

CF pathogenesis

Answer 28

Autosomal recessive mutation in the CFTR gene

Question 29

How does CF patient present?

Answer 29

Usually found on prenatal screen, salty kid with mucus plug, FTPM 2/2 mec ileus, failure to thrive, infections with pseudomonas, short stature.

Question 30

How to diagnose CF?

Answer 30

Prenatal screen or sweat chloride test

Question 31

Tx for CF?

Answer 31

Pulmonary toilet, NAC, pancreatic enzymes, treatment for pseudomonal pneumonia

Question 32

Otitis media pathogenesis

Answer 32

URI bugs (H.Flu, S. pneumo, moraxella). Middle ear inflammation

Question 33

How does patient with otitis media present?

Answer 33

Unilateral ear pain, no pain with pinna pull. Loss of light reflex, bulging TM.

Question 34

How to diagnose otitis media?

Answer 34

Pneumatic insufflation

Question 35

How to treat otitis media?

Answer 35

Amoxicillin

Question 36

Pathogenesis of otitis externa?

Answer 36

Outer ear inflammation with pseudomonas (swimmers), S. aureus (digital trauma).

Question 37

How does patient with otitis externa present?

Answer 37

Unilateral ear pain with pain on pinna pull. Erythematous canal.

Question 38

How to treat otitis externa?

Answer 38

Spontaneous or cipro gtt

Question 39

Sinusitis pathogenesis?

Answer 39

URI bugs infected sinuses

Question 40

How does sinusitis patient present?

Answer 40

Congestion, nasal discharge, purulence, pain with facial tap.

Question 41

How to diagnose sinusitis?

Answer 41

Clinical

Question 42

How to treat sinusitis?

Answer 42

Treat only if >7d OR with cough. Treat with amoxicillin

Question 43

Difference between sinusitis and a cold?

Answer 43

Cold lasts less than 7 days and does not have a cough.

Question 44

Choanal atresia pathogenesis

Answer 44

Big tonsils

Question 45

Choanal atresia pathogenesis

Answer 45

Snoring child, blue while resting, pink when crying.

Question 46

How to diagnose choanal atresia?

Answer 46

NG tube fails to pass

Question 47

How to treat choanal atresia?

Answer 47

Surgery