Pulm part 1

Question 1

Peak age incidence of acute bronchiolitis

Answer 1

Occurs almost exclusively during the first 2 yrs of life

Peak age at 2-6 mos

Question 2

What is a primary cause of acute bronchiolitis?

Answer 2

RSV

Question 3

Presentation of acute bronchiolitis

Answer 3

Progressive respiratory illness similar to the common cold with cough and rhinorrhea
Progresses to noisy, raspy breathing and audible wheezing
Low-grade fever accompanied by irritability

Question 4

PE of acute bronchiolitis

Answer 4

Prolongation of the expiratory phase of breathing
Nasal flaring
Intercostal retractions
Suprasternal retractions
Diffuse wheezes and crackles

Question 5

Workup of acute bronchiolitis

Answer 5

Pulse oximetry

Frequent, regular assessments and cardiorespiratory monitoring of infants

Question 6

Tx of acute bronchiolitis

Answer 6

Respiratory monitoring
Control of fever
Hydration
Upper airway suctioning
Oxygen administration

Question 7

Indications for hospitalization in acute bronchiolitis

Answer 7

Moderate to marked respiratory distress
Hypoxemia
Apnea
Inability to tolerate oral feeding
Lack of appropriate care at home

Question 8

MCC of croup

Answer 8

Parainfluenza viruses

RSV

Question 9

Most common age of croup

Answer 9

6 mos-3 yrs

Question 10

Presentation of croup

Answer 10

Harsh cough, described as barky or brassy
Hoarseness
Inspiratory stridor
Low-grade fever
Respiratory distress

Question 11

PE of croup

Answer 11

Signs of upper airway obstruction may be present, such as:
Labored breathing
Marked suprasternal, intercostal and subcostal retractions
Wheezing may be present

Question 12

Imaging of croup

Answer 12

AP radiographs of the neck show steeple sign

Question 13

Tx of croup

Answer 13

Oral or IM dexamethasone
Racemic epi for significant airway compromise
Hospitalization for children with stridor at rest

Question 14

Common organisms of bacterial pneumonia in neonates

Answer 14

Group B strep
E. coli
Other Gram-neg bacilli
S. pneumoniae

Question 15

Common organisms of bacterial pneumonia in 1-3 mos: afebrile

Answer 15

S. pneumoniae

H. influenzae

Question 16

Common organisms of bacterial pneumonia in 1-3 mos: febrile

Answer 16

C. trachomatis
M. hominis
U. urealyticum
B. pertussis

Question 17

Common organisms of bacterial pneumonia in 3 mos-5 yrs

Answer 17

S. pneumoniae

H. influenzae

Question 18

Common organisms of bacterial pneumonia in 5-18 yrs

Answer 18

M. pneumoniae
S. pneumoniae
C. pneumoniae

Question 19

S/sx of bacterial pneumonia

Answer 19

Neonates may have fever or hypoxia only
Fever
Chills
Tachypnea
Cough
Malaise
Pruritic CP
Retractions and apprehension

Question 20

PE of bacterial pneumonia

Answer 20

Higher fever
Auscultatory findings of lung consolidation
Poor diaphragmatic excursion
Dullness to percussion
Localized crackles, rhonchi and wheezes

Question 21

Labs of bacterial pneumonia

Answer 21

WBC elevated
BCx for hospitalized children
Mild eosinophilia in infants with C. trachomatis
Cold agglutinins present in Mycoplasma PCR
Tuberculin skin test if suspected
Thoracentesis with pleural effusion or empyema
Frontal and lateral radiographs

Question 22

S/sx of asthma

Answer 22

Coughing
Wheezing
Shortness of breath or rapid breathing
Chest tightness

Question 23

Exacerbating factors of asthma

Answer 23

Viral infections
Exposure to allergens and irritants
Exercise
Emotions
Change in weather/humidity

Question 24

What sx can aggravate asthma?

Answer 24

Rhinosinusitis
Gastroesophageal reflux
NSAIDs

Question 25

Presentation of acute asthma episodes

Answer 25

``` Tachypnea Tachycardia Cough Wheezing Prolonged expiratory phase As attack progresses: Cyanosis Diminished air movement Retractions Agitation Inability to speak Tripod position Diaphoresis Pulsus paradoxus ```

Question 26

Workup of asthma

Answer 26

Spirometry Therapeutic trial of controller medications Allergy skin testing for persistent asthma CXR

Question 27

What are the key components of the optimal tx of asthma?

Answer 27

Environmental control Pharmacologic therapy Pt education

Question 28

Step 1 tx of asthma for 0-4 yoa

Answer 28

SABA PRN

Question 29

Step 2 tx of asthma for 0-4 yoa: preferred

Answer 29

Low-dose ICS

Question 30

Step 2 tx of asthma for 0-4 yoa: alternative

Answer 30

Cromolyn or Montelukast

Question 31

Step 3 tx of asthma for 0-4 yoa

Answer 31

Medium-dose ICS

Question 32

Step 4 tx of asthma for 0-4 yoa

Answer 32

Medium-dose ICS + | LABA or Montelukast

Question 33

Step 5 tx of asthma for 0-4 yoa

Answer 33

High-dose ICS + | LABA or Montelukast

Question 34

Step 6 tx of asthma for 0-4 yoa

Answer 34

HIgh-dose ICS + LABA or Montelukast + Oral corticosteroids

Question 35

Step 1 tx of asthma for 5-11 yoa

Answer 35

SABA PRN

Question 36

Step 2 tx of asthma for 5-11 yoa: preferred

Answer 36

Low-dose ICS

Question 37

Step 2 tx of asthma for 5-11 yoa: alternative

Answer 37

``` Cromolyn LTRA Nedocromil or Theophylline ```

Question 38

Step 3 tx of asthma for 5-11 yoa

Answer 38

Low-dose ICS + LABA, LTRA, or Theophylline OR Medium-dose ICS

Question 39

Step 4 tx of asthma for 5-11 yoa: preferred

Answer 39

Medium-dose ICS + | LABA

Question 40

Step 4 tx of asthma for 5-11 yoa: alternative

Answer 40

Medium-dose ICS + | LTRA or Theophylline

Question 41

Step 5 tx of asthma for 5-11 yoa: preferred

Answer 41

High-dose ICS + | LABA

Question 42

Step 5 tx of asthma for 5-11 yoa: alternative

Answer 42

High-dose ICS + | LTRA or Theophylline

Question 43

Step 6 tx of asthma for 5-11 yoa: preferred

Answer 43

High-dose ICS + LABA + Oral corticosteroids

Question 44

Step 6 tx of asthma for 5-11 yoa: alternative

Answer 44

High-dose ICS + LTRA or Theophylline + Oral corticosteroids