Pediatric respiratory issues and disorders

Question 1

Egophany

Answer 1

E->A during auscultation indicated PNA

Question 2

what age can you start PFTs

Answer 2

at age 8 if cooperative

Question 3

obstructive lung disease characteristics

Answer 3

characterized by reduced airflow rates; lung volumes within normal range or larger
Typical of a child having trouble exhaling air (air trapping) which results in decreased rated and FEV1 (asthma, bronchiolitis, cystic fibrosis)

Question 4

restrictive lung disease characteristics

Answer 4

characterized by reduced volumes and expiratory flow rates. Typical of a child that has trouble inhaling air, thus affecting the volume (PNA)

Question 5

Bronchiolitis definition

Answer 5

A disease of the lower respiratory tract that causes inflammation leading to obstruction of the small respiratory airways. noted in children

Question 6

s/sx of bronchiolitis

Answer 6

URI symptoms lasting for several days, moderate fever of 102F, gradual development of respiratory distress (nasal flaring, grunting, cyanosis, prolonged expiration)
Tachypnea (60-80 bpm)
non productive cough
paroxysmal wheezing
progressive stridor
restlessness; changes in mental status
cyanosis
palpable liver and spleen (pushed down due to hyperinflation)

Question 7

chest xray presentation for bronchiolitis

Answer 7

hyper inflated lungs, may have scattered areas of consolidation

Question 8

Management of bronchiolitis

Answer 8

infants with mild distress can be treated as outpatients with supportive care
Prevention of high risk infants with (palivizumab) SYNAGIS IM monthly

Question 9

Intermittent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function

Answer 9

80% predicted and normal between exacerbations

Question 10

Mild persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function

Answer 10

> 2 days/ week
Nighttime awakenings 3-4/month
rescue inhaler use >2 days/week but not daily
interference with normal activity- minot limitation
Lung function is FEV1>80% of predicted

Question 11

Moderate persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function

Answer 11

symptoms are daily, nighttime awakening are more than once per week but not nightly
rescue inhaler use is daily
some limitation and interference with normal activity
FEV1 60%-80% predicted

Question 12

Severe persistent asthma- sx, nighttime awakenings, rescue inhaler use, interference with normal activity, lung function

Answer 12

Symptoms throughout the day, nightly awakenings, rescue inhaler use several times per day, extremely limited interference with normal activity, and lung function less than 60% of predicted

Question 13

treatment in intermittent asthma

Answer 13

step 1- SABA + PRN for all age groups

Question 14

Treatment in mild persistent asthma

Answer 14

Step 2- Low dose ICS. Alternative: Cromolyn or monteukast

Question 15

Treatment for 0-4 yo with moderate or severe asthma

Answer 15

Refer beyond mild persistent

Step 3- medium dose ICS option and consider short course of oral systemic corticosteroids

Question 16

treatment for moderate persistent asthma fort he 5-11 yo

Answer 16

step 3: Medium dose ICS option and consider short course of oral systemic corticosteroids

Question 17

treatment for the severe persistent asthma in the 5 -11yo

Answer 17

Step 3: Medium dose OR

step 5 ICS option and consider short course or oral systemic corticosteroids

Question 18

How long to see patient back after initiating or changing asthma medications? How long before you can try to decrease ICS?

Answer 18

Bring back in 2 weeks for follow-up. Wait for 3 months of controlled before decreasing the ICH, then recheck in 2 weeks

Question 19

FEV1/FVC values for intermittent, mild persistent, moderate persistent, severe persistent

Answer 19

intermittent: >85%
mild persistent: FEV1/FVC: >80%
Moderate persistent: FEV1/FVC: 75%-80%
Severe persistent: FEV1/ FVC:

Question 20

FEV1 values for intermittent, mild persistent, moderate persistent, severe persistent

Answer 20

Intermittent: >80%
mild persistent: >80%
Moderate persistent: 60-80%
Severe persistent:

Question 21

What age do you not consider lung function for asthma

Answer 21

0-4 years

Question 22

Most common agent of PNA in newborns

Answer 22

Group B strep, chlamydia, E.coli

Question 23

most common agent of PNA in infants and young children

Answer 23

RSN and H. Influenzae, strep pneumoniae (community aquired)

Question 24

most common agent of PNA in preschool through young adulthood

Answer 24

Strep pneumoniae, mycoplasma, chlamydia

Question 25

how much % of PNA is viral?

Answer 25

70%-80%

Question 26

Radiograph for H. Influenzae

Answer 26

Lobar consolidation

Question 27

Radiograph for S. Pneumonaie

Answer 27

lobar consolidation

Question 28

Radiograph for Klebsiella

Answer 28

lobar consolidation

Question 29

CXR for pneumocystis

Answer 29

diffuse interstitial, alveolar, apical or upper lobe infiltrates

Question 30

radiograph for E.Coli

Answer 30

Patchy infiltrates, pleural effusion

Question 31

Radiograph for staphylococcus

Answer 31

Patchy infiltrates

Question 32

Radiograph for Pseudomonas

Answer 32

Patchy infiltrates

Question 33

TX for CAP S. Pneomoniae

Answer 33

PCN

Question 34

TX for CAP M. Catarrhalis (walking PNA)

Answer 34

macrocodes such as azithromycin (zithromax)

Question 35

TX for CAP H. Influenze

Answer 35

Amoxicillin or cephalosporin

Question 36

TX for viral PNA

Answer 36

supportive measures: hydration and antipyretics ANX if secondary infection Humidified o2 and chest physiotherapy Bronchodilators

Question 37

Cystic fibrosis definition

Answer 37

a autosomal recessive disorder that causes a defect in epithelial chloride transport resting in dehydrated, thick secretions leading to chronic multi system disorder affecting the respiratory tract, GI, hepatobiliary and reproductive tracts

Question 38

s/sx of cystic fibrosis

Answer 38

``` viscid meconium or ileus in newborns, recurrent URI, large, liquid bulky, foul stool (steatorrhea) salt-tasting skin chronic cough rhinorrhea hepatosplenomegaly fat-soluble vitamin deficiencies FTT Delayed pubery infertility ```

Question 39

labs for cystic fibrosis

Answer 39

pilocarpine sweat test, PFTs with obstructive patter, hyponatremic hypochloremic dehydration (alkalosis) Chest radiograph: cystic lesions, atelectasis

Question 40

s/sx of croup

Answer 40

clear lungs, barking cough, low grade fever, recent uri, dyspnea

Question 41

steeples sign (narrowing of the trachea) on radiograph is indicative of

Answer 41

croup