Peds Resp disorders

Question 1

Bronchiolitis- Eti

Answer 1

• Most common serious resp illness
• RSV most common
• 3% require hosp
• < 2 yrs

Question 2

Bronchiolitis- Sx

Answer 2

• Fever, rhinorrhea, cough
• Wheezing, tachypnea & resp distress
• Shallow, rapid breathing
• Nasal flaring, cyanosis, retractions, and rales

Question 3

Bronchiolitis- Dx

Answer 3

• CXR NOT indicated

- If obtained, hyperinflation, peribronchal cuffing & atelectasis

Question 4

Bronchiolitis- Tx

Answer 4

• Hosp if hypoxic, tachypnea, resp distress with retractions

- Supportive care- hydration, supplemental O2

Question 5

Asthma- Eti

Answer 5

• 7 million children affects
• Boys > girls
• black > other ethnicities
• Poor
• Sx develop before 5th birthday

Question 6

Asthma-Sx

Answer 6

• Refrain from phys activity
• Wheezing
• Chest congestions, prolonged cough, exercise intolerance
• Recurrent bronchitis or pneumonia

Question 7

Asthma- Dx

Answer 7

• Reversal of airflow limitation with broncho dilators
• Bronchial hyperresponsiveness
• Spirometry
• Atopy

Question 8

Asthma- Tx

Answer 8

• SABA
• Low dose ICS
• LABA & ICS

Question 9

Foreign body aspiration- Eti

Answer 9

• Common with small round foods

Question 10

Foreign body aspiration- Sx

Answer 10

Sudden onset of coughing & resp. distress

• Difficulty vocalizing
• Inability to cough
• Cyanosis with marked distress
• Drooling, stridor

Question 11

Foreign body aspiration- Tx

Answer 11

• Incomplete obstruction- allow coughing, then intervene

- Complete obstruction, abdomen compressions or back blows for infants

Question 12

Croup- Laryngotracheobronchitis- Eti

Answer 12

• Viral croup
• 6 mo - 5 yrs
• Parainfluenza, RSV

Question 13

Croup- Laryngotracheobronchitis- Sx

Answer 13

• Barking cough with stridor
• Absent to low grade fever
• Stridor at rest
• Edema in subglottic space, airway inflammation
• Absence of drooling

Question 14

Croup- Laryngotracheobronchitis- Dx

Answer 14

• Steeple sign- neck X-ray

Question 15

Croup- Laryngotracheobronchitis- Tx

Answer 15

• Supportive tx
• O2
• Epi
• Glucocorticoids- dexamethasone

Question 16

Croup- Epiglottitis- Eti

Answer 16

• H. influenxa

- Rare due to vaccine

Question 17

Croup- Epiglottitis- Sx

Answer 17

• High fever
• Dysphagia, drooling, muffled voice
• Inspiratory retractions, cyanosis, stridor
• Neck hyperextended, chin stretched forward

Question 18

Croup- Epiglottitis- Dx

Answer 18

• Cherry red epiglottis
• Swollen arytenoids
• Thumbprint sign on neck xray

Question 19

Croup- Epiglottitis- Tx

Answer 19

• Endotracheal intubation

- Ceftriaxone

Question 20

Croup- Bacterial tracheitis- Eti

Answer 20

• Severe, life threatening form of larngotracheobronchitis

- Staph aureus

Question 21

Croup- Bacterial tracheitis- Sx

Answer 21

• Increasing fever, toxicity, severe airway obstruction

- Toxic shock & ARDS

Question 22

Croup- Bacterial tracheitis- Dx

Answer 22

• Bronchoscopy- purulent tracheal secretions, q

Question 23

Croup- Bacterial tracheitis- Tx

Answer 23

• Intubation
• Debridement of airway
• IV abx

Question 24

Cystic fibrosis- Eti

Answer 24

• Genetic disfunction on chromosome 7
• Recessive
• 1 in 22 carriers
• Caucasian

Question 25

Cystic fibrosis- Sx

Answer 25

- Birth: meconium ileus - Failure to thrive due to malabsorption - Frequent, bulky, foul-smelling oily stools - Pancreatic insufficiency - Chronic airway infection with bacteria

Question 26

Cystic fibrosis- Dx

Answer 26

- Sweat chloride concentration

Question 27

Cystic fibrosis- Tx

Answer 27

- Pancreatic enxyme supplimentation - High calorie, high protein, fat diet - Multivitamins- ADEK - Salt - Abx for airways

Question 28

Apnea- Eti

Answer 28

- Most common in preterm infants - Resp pause > 20 sec - Underlying causes or due to defect in resp signaling

Question 29

Apnea- Sx

Answer 29

- Onset first 2 wks of life | - Pause accompanied by cyanosis and bradycardia

Question 30

Apnea- Tx

Answer 30

- Caffeine citrate to increase respiration rate

Question 31

SIDS- Eti

Answer 31

- Sudden death of infant

Question 32

SIDS- Risks

Answer 32

- Teenage mother - Drug addicted - Maternal smoking - Multiparity - Croweded living

Question 33

SIDS- Dx

Answer 33

- Dx of exclusion on autopsy

Question 34

SIDS- Sx

Answer 34

- Intrathroacic petechiae - Inflammation & congestion of resp tract - Intermittent/ chronic hypoxia before death

Question 35

Pneumonia- Eti

Answer 35

- S. pneumoniae most common cause | - can also be viral

Question 36

Pneumonia- Sx

Answer 36

- Fever, tachypnea & cough - Crackles & decreased breath sounds - Otitis media, meninigitis &asinusitis are complications

Question 37

Pneumonia- Dx

Answer 37

- Thoracentesis | - CXR

Question 38

Pneumonia- Tx

Answer 38

- Ampicillin, amoxicillin or penicillin