12: 10-month-old female with a cough

Question 1

What are the 4 most common causes of wheezing in infants and toddlers?

Answer 1

1. Viral bronchiolitis
2. Asthma
3. Foreign body
4. GERD

Question 2

Why is paradoxical breathing more commonly seen in infants and young children?

Answer 2

They have greater compliance of the chest wall

Question 3

What is paradoxical breathing?

Answer 3

The force of contraction generated by the diaphragm exceeds the ability of the chest wall muscles to expand the rib cage

Question 4

What is hyperpnea?

Answer 4

Increased depth of respiration

Question 5

What is hypopnea?

Answer 5

Reduced tidal volume

Question 6

Are retractions due to excessive negative pleural pressure?

Answer 6

Yes

Question 7

Which muscles are used in head bobbing?

Answer 7

Neck strap muscles

Question 8

What is the nature of an asthmatic cough?

Answer 8

Dry

Question 9

What are the names of the 3 phases of pertussis?

Answer 9

1. Cattarhal
2. Paroxysmal
3. Convalescent

Question 10

What is the cattarhal stage of pertussis?

Answer 10

1-2 weeks of URI symptoms

Question 11

What is the paroxysmal stage of pertussis?

Answer 11

4-6 weeks of the whooping cough

Question 12

What is the convalescent stage of pertussis?

Answer 12

Episodic coughing for months

Question 13

How effective is the pertussis vaccine?

Answer 13

70-90%

Question 14

Which bacteria is almost always in epiglottitis?

Answer 14

Hib

Question 15

What age range is mostly affected by epiglottitis?

Answer 15

Age 2-5

Question 16

What diagnosis should be considered in a child with fever, stridor, dysphonia, dysphagia, respiratory distress, and sitting leaning forward, with neck hyperextended and chin protruding?

Answer 16

Epiglottitis

Question 17

Which immunizable disease has a characteristic gray pseudomembrane in the pharynx?

Answer 17

Diptheria

Question 18

Which disorder is characterized by infiltration of inflammatory cells into the airway mucosa, mucus hypersecretion, mucosal edema, and bronchoconstriction?

Answer 18

Asthma

Question 19

What are CXR findings in asthma?

Answer 19

Hyperinflation due to air trapping, patchy atelectasis

Question 20

What is the best treatment for an acute asthma exacerbation?

Answer 20

Corticosteroids + B-2 agonist (alBu2erol)

Question 21

What is the best maintenance therapy for asthma with frequent symptoms?

Answer 21

Inhaled corticosteroid as daily controller + B2 agonist for breakthrough symptoms

Question 22

What is the most common cause of bronchiolitis?

Answer 22

RSV

Question 23

Where in the respiratory tract does bronchiolitis occur?

Answer 23

Lower respiratory tract

Question 24

What are the CXR findings of bronchiolitis?

Answer 24

Hyperinflation, scattered atelectasis, similar to asthma

Question 25

What part of the lung is affected by pneumonia?

Answer 25

The parenchyma

Question 26

What are the 4 most common viral causes of pneumonia in children?

Answer 26

1. Adenovirus 2. RSV 3. Parainfluenza 4. Influenza

Question 27

Are viral or bacterial pneumonias more common in kids?

Answer 27

Viral

Question 28

Are viral or bacterial pneumonias more severe in kids?

Answer 28

Bacterial

Question 29

What bacteria is the most common cause of bacterial pneumonia in kids age 0-6?

Answer 29

S. pneumoniae

Question 30

What bacteria is the most common cause of bacterial pneumonia in school-aged kids and older children?

Answer 30

M. pneumoniae

Question 31

Which 3 bacteria may be the cause of neonatal pneumonia?

Answer 31

1. GBS 2. E. coli 3. Klebsiella

Question 32

Which type of pneumonia presents with a staccato cough between age 4-12 weeks?

Answer 32

C. pneumonia | "staCcato"

Question 33

What's the difference between viral vs. bacterial pneumonia on CXR?

Answer 33

Viral: diffuse/patchy interstitial infiltrates, hyperinflation, and small pleural effusions Bacterial: airspace disease with lobar or segmental consolidation and air bronchograms

Question 34

What's the difference between viral vs. bacterial pneumonia in lab results?

Answer 34

Viral: Peripheral WBC counts tend to be normal or only slightly elevated Bacterial: Peripheral WBC counts elevated w/ neutrophilic predominance

Question 35

What is a disease which starts with cold-like symptoms that progress to inspiratory stridor and a "seal like cough," a "steeple sign" on CXR, and most commonly presents in kids around age 2 years old?

Answer 35

Croup

Question 36

What causes stridor?

Answer 36

Airway narrowing above the thoracic inlet

Question 37

What causes wheezing?

Answer 37

Airway narrowing below the thoracic inlet

Question 38

What causes Rhonchi?

Answer 38

Secretions and narrowing of airways

Question 39

What causes crackles?

Answer 39

Fluid in alveoli or opening and closing of stiff alveoli

Question 40

What causes bronchial breath sounds?

Answer 40

Air moving through areas of consolidated lung

Question 41

When does stranger danger occur?

Answer 41

9 months