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Lifespan > Some Peds > Flashcards

Some Peds Flashcards

1
Q

What causes epiglottitis? What ages? Onset?

A

Bacterial

2-6 years

Rapid (under 24 hours)

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2
Q

What causes croup (laryngotracheobronchitis)? What ages? Onset?

A

Viral
and rarely mycoplasmas bacteria

< 2 years old

Gradual (24-72 hours)

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3
Q

What region is affected with epiglottis? What is the sign seen on xray?

A

Supraglottic structures

Swollen epiglottis or THUMB sign

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4
Q

What region is affected with croup? What is the sign seen on xray?

A

Laryngeal structures

Subglottic narrowing or STEEPLE sign

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5
Q

Clinical signs of epiglottis ?

A

High fever
Tripod breathing
4 D’s

Drooling
Dysphonia
Dyspnea
Dysphagia

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6
Q

What is the treatment for epiglottis?

A

O2
Urgent securement of airway
Antibiotics
Spontaneous induction
ENT surgeon present
Post-op in ICU

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7
Q

Signs of Croup?

A

Mild fever
Inspiratory stridor
Barking cough

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8
Q

Treatment for Croup?

A

O2
Racemic epi
Corticosteroids
Humidification
Fluids
Rarely need to be tubed

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9
Q

What is post intubation croup?

A

Laryngeal edema from using a ETT too large or with too much pressure

Occurs within 30-60 minutes - hoarseness, barky cough, stridor

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10
Q

Risk factors for post intubation croup?

A

Age less than 4
ETT is too large or with too much volume
Multiple ETT attempts
Prolonged intubation
Coughing
Head or neck surgery
Trisomy
Possible upper airway infection

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11
Q

Best way to minimize post op croup?

A

Maintain an air leak of <25 cm H2O

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12
Q

Treatment for post op croup?

A

Cool and humidified O2

Racemic Epi

Dexamethasone

Heliox (improves laminar airflow by reducing Reynolds number)

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13
Q

How does infectious croup differ from post op croup?

A

NO antibiotics needed because it is not caused by bacteria

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14
Q

What is the minimum time a patient should be observed after receiving racemic epi?

A

4 hours

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15
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Purulent nasal discharge?

A

Yes

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16
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Clear nasal drainage?

A

No

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17
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Fever > 100 or 38?

A

Yes

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18
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? No fever?

A

No

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19
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Lethargic?

A

Yes

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20
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Poor appetite?

A

Yes

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21
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Wheezes that do not clear with coughing?

A

Yes

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22
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Persistent cough?

A

Yes

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23
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Child less than 1 years old or a preemie?

A

Yes

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24
Q

Is it okay to proceed with a tonsillectomy on a child with a respiratory infection?

A

Yes but with caution

Happy
Clear lungs
Older
No fever
Active
Clear drainage

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25
Q

Ways to reduce risk of airway complications with a child that has a upper respiratory infection?

A

Avoid mechanical irritation (use mask or LMA)

Dexamethasone

Propofol

Sevo because it is non pungent

Deep Plane of anesthesia

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26
Q

What should be avoided with a child that has a upper respiratory infection?

A

Avoid ETT and make sure they are deep if placing

ETT can increase the risk of bronchospasm by 10-fold

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27
Q

Does pretreatment with inhaled bronchodilator or glyco provide a clear benefit with a child that has a upper respiratory infection?

A

No

Does not provide clear benefit

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28
Q

What is the classic triad with a child that has foreign body aspiration?

A

Cough
Wheezing
Decreased breath sounds

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29
Q

Which side does the child usually have foreign body aspiration?

A

R side

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30
Q

What will be heard with supraglottic obstruction?

A

Stridor

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31
Q

What will be heard with subglottic obstruction?

A

Wheezing

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32
Q

What are complications of a rigid bronchoscopy?

A
  • Laryngospasm
    -Bradycardia during scope insertion
    -Post op croup
    -Pneumothorax
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33
Q

What is the gold standard for retrieving foreign body?

A

bronchoscopy

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34
Q

What bug causes epiglottitis?

A

Bacteria

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35
Q

What bug causes Croup?

A

Mainly viral but rarely mycoplasma pneumonia

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36
Q

Ages for epiglottitis and croup?

A

Epiglottitis, 2-6

Croup, Under 2

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37
Q

Structures for epiglottitis?

A

Vocal cords and above

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38
Q

Structures for croup?

A

Below vocal cords

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39
Q

Neck xray for epiglottitis?

A

Thumb sign (swollen epiglottis)

lateral xray for best view

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40
Q

Neck xray for croup?

A

Subglottic narrowing (Steeples sign)

Frontal xray for best view

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41
Q

S&S for epiglottitis?

A

Tripod with 4 D’s

Drooling
Dyspnea
Dysphonia
Dysphagia

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42
Q

Fever type for epiglottitis and croup?

A

epiglottitis - High grade

Croup - Low grade

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43
Q

S&S for croup?

A

Barky cough
Vocal hoarseness
Ins Stridor
Retractions

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44
Q

Epiglottitis or croup, which is an emergency?

A

Epiglottitis

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45
Q

How is epiglottitis managed ?

A

Secure airway
Antibiotics
Post op ICU

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46
Q

Intubation for epiglottitis? How?

A

Yes must secure the airway

Spontaneous RR with CPAP

ENT surgeon must be present

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47
Q

Treatment for Croup?

A

Racemic epi
Corticosteroids
O2
Humidification
Fluids

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48
Q

Intubation for Croup?

A

Rarely

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49
Q

Rapid onset? Croup or epiglottitis?

A

epiglottitis

50
Q

Most common cause of post intubation croup? When does it occur?

A

Too large of an ET tube
Within an hour of extubation

51
Q

Can post intubation croup be caused by cuffed AND cuffless tubes?

52
Q

Should an air leak be maintained in a cuffless tube? What pressure?

A

Yes

< 25cm H2O

53
Q

Gold standard of measuring cuffed ET tube pressure?

54
Q

Preferred treatment for croup?

A

Racemic Epi

55
Q

Are antibiotics indicated for post intubation croup?

A

NO - not infectious

56
Q

What percentage of Racemic epi for croup? How much volume for NS dilution?

A

2.25%

2.5 mL

57
Q

Minimum observation time after racemic epi?

58
Q

What ages is post intubation croup seen in?

59
Q

Best inhalational gas to prevent bronchospasm

A

Sevo because it is non pungent

60
Q

Best treatment for recent upper airway infection? What is not helpful?

A

Best - .5mg/kg dexamethasone

No evidence for bronchodilator or glyco

61
Q

Reason to cancel, clear rhinorrhea?

62
Q

Reason to cancel, purulent rhinorrhea?

63
Q

Reason to cancel, fever? No fever?

A

Cancel with fever over 100

64
Q

Reason to cancel, lethargic or persistent cough?

65
Q

Reason to cancel, poor appetite?

66
Q

Reason to cancel, premature or under 1 year old?

67
Q

Reason to cancel, wheezing or rales that does not clear with coughing?

68
Q

How long should surgery be postponed for a child with a significant URI?

A

2-4 weeks from symptoms

69
Q

What will be heard with a supraglottic obstruction? Subglottic?

A

Supra - Stridor

Sub - wheezing

70
Q

Best induction for foreign body aspiration? Best maintenance?

A

Sevo with spontaneous RR

Propofol for maintenance

71
Q

Most common type of TE fistula?

72
Q

Where should the ET be placed with a TE fistula ?

A

Between the fistula and the carina

73
Q

What type of induction for a TEF?

A

Head up

Awake intubation or inhalation with spontaneous ventilation

74
Q

With a TEF, and if the patient has a G tube, what should be done?

A

Open it before induction

If no G tube, place an OG after for decompression

75
Q

What drug can be given to hasten fetal lung development? How long to take effect?

A

Betamethasone

Will start to help after 18 hours and peak at 48 hours

76
Q

When does surfactant start producing? When is peak production?

A

22 weeks

35 weeks

77
Q

Do larger or small alveoli have a higher concentration of surfactant?

A

Smaller have larger concentration

78
Q

A L/S ratio (lecithin to sphingomyelin) of what indicates adequate lung development?

A

> 2 is adequate

<2 increased risk for respiratory distress syndrome

79
Q

What may hyperoxia cause?

A

Retinopathy

80
Q

Wear are two pulse oximeters placed when monitoring pre and post ductal O2?

A

Upper R extremity
and
LE

81
Q

What may be indicated if the pre and post ductal O2’s are different?

A

Pulm HTN

R-L shunt

82
Q

What may happen if too much positive pressure is given with poor lung compliance?

A

Pneumothorax

83
Q

Most common site for congenital diaphragmatic hernia?

A

Foramen of Bochdalek on the left side

84
Q

In a neonate with a CDH (congenital diaphragmatic hernia), what should peak inspiratory pressure be under?

A

PIP < 30 cm H2O

85
Q

How long is CDH delayed? Why?

A

5-15 days to let organs develop?

86
Q

Omphalocele or Gastroschisis, which is midline and involves the umbilicus ?

A

Omphalocele

87
Q

Omphalocele or Gastroschisis, which may contain the liver?

A

Omphalocele

88
Q

Omphalocele or Gastroschisis, which has a covering present?

A

Omphalocele

89
Q

Omphalocele or Gastroschisis, which one is more common?

A

Gastroschisis

90
Q

Omphalocele or Gastroschisis, which is linked to prematurity ?

A

Gastroschisis

91
Q

Omphalocele or Gastroschisis, which one is more urgent?

A

Gastroschisis - need fluids and at-risk foe heat loss

Fix within 24 hours

92
Q

Omphalocele or Gastroschisis, which may require staging? Why?

A

Both may

As it is closed, it can increase intra-abdominal pressures which puts pressure on the lungs

93
Q

How does increased abdominal pressure effect venous return, CO, and perfusion?

A

Decreases all of them

94
Q

Omphalocele or Gastroschisis, should nitrous be used?

95
Q

Omphalocele or Gastroschisis, which should be placed in a bag to retain heat and water loss?

A

Gastroschisis

96
Q

Omphalocele or Gastroschisis, what should PIP be less than?

97
Q

Omphalocele or Gastroschisis, what happens with electrolytes and fluids?

A

Large shifts

98
Q

Which electrolyte abnormality is seen with pyloric stenosis ?

A

Hypokalemia and hyponatremia

99
Q

How does vomiting effect sodium?

A

Hyponatremia

100
Q

How does vomiting effect potassium?

A

Hypokalemia

101
Q

How does vomiting effect acid balance?

A

Causes infant to lose hydrogen so patient will present with metabolic alkalosis

102
Q

If vomiting persists and dehydration isn’t corrected, what will the pH balance be? Why?

A

Metabolic acidosis because of increased lactic acid production

103
Q

Is pyloric stenosis a medical or surgical emergency? What needs to be corrected before surgery?

A

Medical

Fluid and electrolyte balance needs to be fixed

104
Q

Urine pH with pyloric stenosis? Early vs late

A

Early - Alkalotic urine because the baby is trying to get rid of excess bicarb

Late - Acidic

105
Q

Is postop apnea common in Pyloric stenosis?

106
Q

RSI and OG for pyloric stenosis?

107
Q

When is pyloric stenosis diagnosed?

A

2-12 weeks of life

108
Q

What is an adequate SpO2 in a neonate to prevent hyperoxia? What type of O2 mixture?

A

89-94%

Use 50/50 of air and O2

109
Q

Two risk factors for NEC?

A

Prematurity (under 32 weeks)

Low birth weight (under 1,500g)

110
Q

Big concern with NEC? How is it managed?

A

Medically managed but watch for bowel perf and avoid nitrous

111
Q

Early bowel resection can lead to what later in life?

A

Short gut syndrome

112
Q

What part of the colon does NEC effect?

A

Terminal ileum and proximal colon

113
Q

What action if taken too early can cause NEC?

A

Early feeding which leads to bacterial growth and bowel perf

114
Q

Most significant risk for ROP? 2nd highest risk?

A

Prematurity

Hyperoxia

115
Q

When does retinal maturation complete?

A

44 weeks so keep SpO2 at 89-94%

116
Q

Which drug does not cause apoptosis? Which do?

A

Precedex does not

GABA and NMDA do

117
Q

What is bilirubin? Which enzyme is required for the breakdown of it?

A

-Breakdown of RBC
-Glucuronyl transferase (phase 2)

118
Q

What is kernicterus?

A

Fetal encephalopathy

119
Q

Which disease requires a preop cardiac exam?

A

Omphalocele

120
Q

Which two conditions do not have a risk factor of prematurity?

A

TEF and CDH because they were present while developing

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