Respiratory

Question 1

What condition is “steeple sign” seen on x-ray

Answer 1

Croup

(narrowing of the trachea in the subglottic region)

Question 2

What virus is Croup caused by

Answer 2

parainfluenza

Question 3

Pt presents with barking cough and stridor. What is the most likely Dx?

Answer 3

Croup

Question 4

Tx for croup

Answer 4

mild- oral dexamethasone

moderate (difficulty breathing, signs of distress, stridor at rest): Nebulized racemic epi + corticosteroids

Question 5

What is the MCC of bronchiolitis

Answer 5

RSV

Question 6

Dx for bronchiolitis

Answer 6

nasal washing for RSV culture and antigen assay

Question 7

When should a patient with Bronchiolitis be hospitalized? (4)

Answer 7

O2 < 95%

age < 3 months

respiratory rate > 70

atelectasis on chest radiograph

Question 8

Tx for Bronchiolitis. Which treatment is the only one shown to improvement?

Answer 8

• Tx: nasal suctioning, humidified O2, and antipyretics
• Only one to improve Bronchiolitis: Oxygen

Question 9

When is Ribavirin given to patients with bronchiolitis

Answer 9

severe lung or heart disease and in immunocompromised patients

Question 10

which cause of pneumonia also causes bullous myringitis

Answer 10

Mycoplasma

Question 11

MCC viral PNA in kids

Answer 11

RSV, 1st episode of wheezing

Question 12

outpatient tx for pneumonia

Answer 12

Doxycycline

Macrolides

Question 13

Indications for hospitalization in patients with PNA

Answer 13

> 50 with comorbidities

altered mental status

poor fluid status

Question 14

INPATIENT tx for pneumonia

Answer 14

Ceftriaxone plus azithromycin, respiratory fluoroquinolones

Question 15

which PNA has an elevated cold hemagglutinin titer?

Answer 15

Mycoplasma pneumonia

Question 16

When is the pneumovax indicated

Answer 16

Pneumovax is licensed for use in children over the age of 23 months and is indicated for all pediatric patients at increased risk for pneumococcal disease.

Question 17

when is doxycycline contraindicated and why

Answer 17

under 8y/o

Due to damaging effects on bone and teeth enamel

Question 18

When are fluoroquinolones contraindicated

Answer 18

< 18y/o

due to damaging effects on the cartilage

Question 19

What is the treatment of choice for an infant with Chlamydial pneumonia

Answer 19

Erythromycin

or

sulfisoxazole

Question 20

Tx for RSV

Answer 20

Supportive: albuterol via nebulizer, antipyretics and humidified oxygen

Steroids (controversial)

Question 21

Indications for Palivizumab (Synagis) prophylaxis

Answer 21

• Infants born at ≤ 28 weeks 6 days and <12 months at the start of RSV season
• Infants < 12 months of age with chronic lung disease (CLD) of prematurity
• Infants ≤ 12 months of age with hemodynamically significant CHD
• Infants and children < 24 months of age with CLD of prematurity necessitating medical therapy (eg, supplemental oxygen, bronchodilator, diuretic, or chronic steroid therapy) within 6 months prior to the beginning of RSV season

Question 22

“Thumbprint sign” on x-ray

Answer 22

Epiglottitis

Question 23

Tx for epiglottitis

Answer 23

Ceftriaxone

Question 24

First line tx for allergic rhinitis

Answer 24

Intranasal Glucocorticoids (fluticasone, beclomethasone, mometasone)

+/- 2nd gen antihistamine (cetirizine/loratidine)