Pediactrics

Question 1

cough

Answer 1

brainstem reflex

Question 2

cough receptors

Answer 2

middle ear, sinuses, pericardium, diphragm, phaynx, larynx, trachea, major bronchi

Question 3

phases of cough

Answer 3

inspiration
compression
exhalation

Question 4

chronic cough in ped

Answer 4

cough more than 3-4 weeks**

Question 5

cough after eating

Answer 5

overfeeding - decreased with less food
GERD - if with vomiting
TEF - no vomiting - worse with feeding

Question 6

cough with cyanosis not relieved by O2

Answer 6

requires thorough cardiac evaluation

possible R to L shunt

Question 7

cough with tachypnea and fever

Answer 7

sepsis

Question 8

RSV

Answer 8

infants at higher risk

-preterm, cyanotic heart disease, immunodeficient

Question 9

staccato cough first few months

Answer 9

chlamydia trachomatis pneumonia

Question 10

spells with apnea

Answer 10

pertussis

Question 11

wet cough

Answer 11

bronchiectasis

Question 12

rigid bronchoscopy

Answer 12

to see foreign body AND remov\e it

flexible - cannot remove

Question 13

sore throat, fever, HA, no cough or rhinorrhea

Answer 13

strep pharyngitis

work up with rapid strep and back up culture if negative

NO COUGH OR RHINORRHEA

PE - exudative pharyngitis, tender anterior cervical lymph nodes, scarlatiniform rash, pastias lines

Question 14

drooling, dysphagia, dysphonia, dyspnea, tripod position

Answer 14

epiglottitis

examine airway under anesthesia***

can compromised airway, don’t be stupid

Question 15

barking cough, inspiratory stridor

Answer 15

croup
-paryngotracheitis

cause - parainfluenza, influenza, RSV, adenovirus

steeple sign on neck Xray

Question 16

croup tx

Answer 16

inhaled racemic epinephrine

• reduce stridor within 30 minutes
• most immediate benefit

Question 17

upper resp followed by lower resp infection, increased resp effort - tachypnea, nasal flaring, chest retractions, wheezing, crackles

Answer 17

bronchiolitis

RSV, rhinovirus

Question 18

bronchiolitis admit to hospital?

Answer 18

if hypoxic - O2 sat < 90%

-or dehydrated

Question 19

HA, malaise, low grade fever, adolescent, mildly productive cough, wheezing and dyspnea, scattered rales and wheezes

Answer 19

mycoplasma pneumonia

Question 20

premature baby

Answer 20

respiratory distress syndrome

hyaline membane disease

Question 21

CXR for respiratory distress

Answer 21

hyperinflation
air bronchograms
diffuse granularity

can look like group B strep as well
-so give antibiotics

Question 22

prematurity

Answer 22

decreased surfactant
hypoxemia and CO2 retention
acidosis, hypoperfusion
endo and epithelial damage

fibrin > hyaline membrane formation

Question 23

tx CMV

Answer 23

gangciclovir

Question 24

CMV

Answer 24

DNA herpesvirus

massive enlargement of affected cells with inclusions in cells

Question 25

most common congenital viral infection

Answer 25

CMV hearing impairment**, mental retardation, cerebral palsy

Question 26

transmission of CMV

Answer 26

prenatal or natal infection (cervical/vaginal infections

Question 27

breast milk

Answer 27

sheds CMV also blood transfusion and organ transplants

Question 28

sensorineural hearing loss

Answer 28

in CMV infants 30-65% of asymptomatic patients

Question 29

coombs negative hemolytic anemia

Answer 29

not immune mediated

Question 30

intracranial calcificaitons

Answer 30

CMV

Question 31

bronchopulmonary dysplasia

Answer 31

premature infants with following RDS -developed CXR with coarse, streaky infiltration with small ares of emphysema and occasionally appeared cystic babies on ventilators - O2 is strong oxidizer - high pressure on lungs also damages

Question 32

baby on ventilator

Answer 32

bronchopulmonary dysplasia

Question 33

stage 1 BPD

Answer 33

2-3 days after birth CXR granular appearances

Question 34

stage 2 BPD

Answer 34

4-10 days after birth X-ray shows complete opacification of lungs

Question 35

stage 3 BPD

Answer 35

10-20 days after birth X-ray shows round cystic lucencies with alternating opacities

Question 36

stage 4 BPD

Answer 36

1 month after birth CXR shows enlargement of lucencies and increasing strands of opacity bubbly lung

Question 37

stress and cytokine

Answer 37

increase surfactant production