Respiratory Test 3

Question 0

Management of intermittent asthma mild persistent asthma

Answer 0

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Question 1

Differential diagnosis of mild,moderate,or intermittent asthma

Answer 1

Bronchiolitis inhaled foreign body,CF

Question 2

Asthma Triggers

Answer 2

Perfume smoking dust mites pollen

Question 3

Clinical manifestation of pneumonia

Answer 3

• Causative agents: bacteria, virus, mycoplasma, aspiration
• Severity: mild, moderate, severe
• WHO: No pneumonia, pneumonia, severe pneumonia
• Location: lobular, lobar, bronchopneumonia

Question 4

Clinical manifestations of Bronchiolitis

Answer 4

Respiratory syncytial virus-50%
Occurs during the 1st -2nd year of life
Ball valve type of obstruction- hypovolemia- respiratory failure
Critical phase -first 48 -72 hours
Fever cough wheeze dyspnea
CXR- increased AP diameter with hyperinflation
Mx o2 Ribavirin

Question 5

Emergent Pediatric conditions ie epiglottis

Answer 5

Bronchopulmonary Dysplasia
Epiglottis-strider tripod age 2-7 H influenza NO CULTURE
Bacterial tracheitis staph,<3 yo follows a viral infection

Question 6

Characteristics of an acute exacerbation of asthma

Answer 6

7

Question 7

Peak flow dynamics

Answer 7

Interpreting Peak Expiratory Flow Rates
•Green: (80-100% of personal best) signals all clear and asthma is under reasonably good control
•Yellow (50-79% of personal best) signals caution; asthma not well controlled; call medical provider if child stays in this zone
•Red (below 50% of personal best) signals a medical alert. Severe airway narrowing is occurring; short acting bronchodilator is indicated

Question 8

Rescue medications and indications for use

Answer 8

•Short-acting bronchodilators
–Albuterol/ventolin/proventil- drug of choice
–Terbutaline- not very common
•Long & short acting beta agonists
–Salmeterol- can use for exercise and night sx
•Mast cell inhibitor
–Intal/cromolyn- Can be used in nebulizer
–Ex Singulair- Minimizes allergies
•Corticosteroids
–Prednisone or solumedrol

Question 9

History and physical of exam of a child with asthma

Answer 9

• Onset & duration
• Asssociation symptom
• Progression with age
• Exacerbation
• Feeding pattern
• Airway procedure
• Choking episode
• Baseline noises, quality of cry and voice

Question 10

Clinical manifestations of pharyngitis

Answer 10

• Acute Pharyngitis
• “tonsillitis, tonsillopharyngitis”
• Group A b-hemolytic streptococcus
• 4 – 7 yrs. Old
• Headache, abdominal pain, vomiting, petechial mottling of soft palate (strep)
• Throat swab for strep antigen, throat culture
• Otitis media- most common complication
• Penicillin – drug of choice for strep

Question 11

S/S Respiratory Distress

Answer 11

Nasal flaring

Accessory muscles

Question 12

Diagnostic evaluation of croup

Answer 12

Viral croup west lye croup scoring system
Mild less than 2
Moderate 3-7
Sever greater than 8

Question 13

Retro pharyngeal abscess

Answer 13

•Retropharyngeal Abscess
•Complication of Bacterial pharyngitis
»Retropharyngeal space - potential space bet posterior pharyngeal wall & prevertebral fascia level T2
•Most frequent in children < 3 yr of age
•Grp A hemolytic strep, oral anaerobes, staph aureus
•Fever, difficulty of swallowing, drooling
•Bulging of posterior pharyngeal wall
•Complication: aspiration of pus,meningitis,empyema
•Meds: semisynthetic penicillin. Clindamycin, ampicillin-sulbactam
•Need for intubation, surgical drainage

Question 14

Bacterial PNA

Answer 14

•Bacterial Pneumonia
–Chidren > 2 months of age
•Most common microorganisms: S. pneumoniae
H. influenzae
•Most common symptoms: fever, cough, dyspnea

–Children < 2 months old
•Most common microorganisms: Group b strep
E. coli
•+/- fever
•Tachypnea - most reliable sign

Question 15

Staph PNA

Answer 15

–Occurs in young infants
–Associated with septicemia, skin infections, measles
–Serious, rapid progressive course of illness
–Extensive bilateral lung involvement
–CXR: nodular infiltrates, multiple abscesses, empyema, pneumothorax
–Meds: penicillinase-resistant penicillin

Question 16

Pneumococcal PNA

Answer 16

•Pneumococcal pneumonia
–90% cases
–Lobar involvement
–CXR: lobar consolidation
•H. Influenzae pneumonia
–Insidious onset
–Preceded by URI
–Nosocomial infection

Question 17

Pseudo PNA

Answer 17

–Immunocompromised, debilitating patients
•Prolonged mechanical ventilatory support
•HIV
–CXR: presence of necrosis

Question 18

Klebsiella PNA

Answer 18

–Thick-rusty sputum
–Bulging of fissures
–Pulmonary abscess & cavitation’s

Question 19

Aspiration PNA

Answer 19

–Predisposing condition
•Congenital
–Esophageal atresia
–Cleft lip/palate
–Duodenal obstruction
–GER
•Acquired
–Debilitated infants
–Cerebral palsy
•Materials commonly aspirated:
–Milk, cereals, food
–Vomitus
–Baby powder
–Lipoid materials
•Medicated oils
•Cod liver oils