Pulmonary

Question 1

What is another name for Croup

Answer 1

Laryngotracheobronchitis

Question 2

What causes Croup

Answer 2

Parainfluenza

Question 3

Sx of Croup

Answer 3

Barking Cough, Inspiratory Stridor, Hoarse Voice

Question 4

Dx of Croup

Answer 4

CXR: Steeple Sign due to subglottic narrowing

Question 5

Tx of Croup

Answer 5

Steroids and nebulized racemic Epinephrine

Question 6

What is acute bronchitis

Answer 6

Upper airway disease

Question 7

What causes Acute Bronchitis

Answer 7

Viral: Influenza, Parainfluenza

Question 8

Sx of Acute Bronchitis

Answer 8

1-2 days URI (fever, rhinorrea, cough) followed by wheezing, tachypnea, respiratory distress

Question 9

Dx of Acute Bronchitis

Answer 9

Nasal Swab can be done but not necessary

Question 10

Tx of Acute Bronchitis

Answer 10

Supportive: Hydration, O2, Suction
Exposed child should avoid daycare (Quarantine)
Wash hands frequently

Question 11

What is the most common cause of Bacterial Pneumonia

Answer 11

Strep. Pneumo (95%), followed by H.Flu, Mycoplasma, Klebsiella
BUT MOST PNEUMONIA IS VIRAL

Question 12

Sx of Bacterial Pneumonia

Answer 12

Fever, Tachypnea, Cough, Dyspnea, Crackles, Diminished Lung Souunds

Question 13

Tx of Bacterial Pneumonia

Answer 13

Age Dependent but generally Ampicillin for babies and Amoxicillin for older
5yrs: Macrolide, Amoxicillin, or Penicillin G

Question 14

Dx for Asthma

Answer 14

FEV (airflow) / FVC (Air Volume)

Question 15

What categorizes Intermittent Asthma. What is the Tx.

Question 16

What categorizes Mild Persistent Asthma. What is the Tx.

Answer 16

> 2x/wk during the day
2x/month at night
Tx: SABA + Low Dose ICS (Beclomethasone, Budesonide, Flunisolone, Fluticasone, Triamcinolone)

Question 17

What categorizes Moderate Persistent Asthma. What is the Tx.

Answer 17

Daily sx
>1x/wk at night
Tx: SABA + Medium Dose ICS +/- LABA (Salmeterol, Formoterol)

Question 18

What categorizes Severe Persistent Asthma. What is the Tx.

Answer 18

Multiple times everyday
Nightly
Tx: SABA + High Dose ICS + LABA +/- Systemic Corticosteroid (Omalizumab)

Question 19

What is Hyaline Membrane Disease

Answer 19

Most common neonatal respiratory distress syndrome

Caused by surfactant deficiency

Question 20

When does Surfactant Production Begin? When is it complete?

Answer 20

Begins 24-28wks

Ends by 35wks

Question 21

Sx of Hyaline Membrane Disease

Answer 21

Difficulty breathing at birth, gets progressively worse, cyanosis, nostril flaring, tachypnea, grunting sounds, chest retractions

Question 22

Dx of Hyaline Membrane Disease

Answer 22

CXR: Ground Glass, hypoexapnsion, air bronchograms

Question 23

Tx of Hyaline Membrane Disease

Answer 23

Endotracheal Tube
O2
Surfactant Replacement

Question 24

Where is a foreign body most likely to go

Answer 24

Right bronchiole

Question 25

Sx of Foreign Body Aspiration

Answer 25

Abrupt onset of chocking, coughing, inability to vocalize, cyanosis Decreased breaths sounds, wheezing usually unilateral and localized to side of obstruction

Question 26

Dx of Foreign Body Aspiration

Answer 26

Gold Standard: Bronchoscopy | CXR

Question 27

Tx of Foreign Body Aspiration

Answer 27

Bronchoscopy | Back blows for infants 1yr

Question 28

What causes Cystic Fibrosis

Answer 28

Autosomal Recessive defect in CFTR Gene (Chloride channel issue)

Question 29

What structural problems occur with Cystic Fibrosis

Answer 29

Increased mucus buildup in lungs, pancreas, and intestines

Question 30

Sx of Cystic Fibrosis

Answer 30

Bronchiectasis: Recurrent URIs, Productive Cough, Dyspnea, Chest Pain, Chronic Sinusitis Pancreatic Insufficiency: Steatorrhea, Bulky stools and fat soluble vitamin deficiency Growth Delays: Failure to thrive Infertility GI: Meconium Ileus at birth (intestinal obstruction

Question 31

Dx of Cystic Fibrosis

Answer 31

Sweat Chloride Test is elevated | CXR: Bronchiectasis, permanent dilation of airways

Question 32

What are sputum cultures likely to show with Cystic Fibrosis

Answer 32

Pseudomonas, Staph. Auerus, and H.Flu

Question 33

Tx of Cystic Fibrosis

Answer 33

``` No Cure, just management. Airway Clearance Bronchodilators, Mucolytics Pancreatic enzyme replacement (Vit. A, D, E, K) Lung/Pancreas Replacement ```

Question 34

**Tx for Acute Bronchiolitis RSV. And what do you prophylaxis for other kids**

Answer 34

Supportive: Hydration, O2, Freq. Suctioning Quarantine affected child, avoid daycare Wash Hands

Question 35

**Dx for Asthma**

Answer 35

Both airflow and air volume are decreased, but airflow decreases more FEV1(Airflow)/FVC(Air Volume)

Question 36

**Define Moderate Persistent Asthma and how you treat it**

Answer 36

Daily Symptoms during the day with daily SABA use, Nightly sx 1x/wk Tx: SABA as needed + ICS +/-LABA SABA:Albuterol ICS: Beclomethasone, Budesonide, Flunisolone, Fluticasone, Triamcinolone LABA: Salmetrol, Formoterol

Question 37

**Sx of Hyaline Membrane Disease**

Answer 37

Difficulty breathing at birth that gets progressively worse, GRUNTING, cyanosis, nostril flaring, tachypnea, chest retraction CXR: Ground Glass

Question 38

**Dx RSV Bronchiolotis**

Answer 38

Nasal Swab can be done but necessary Starts as URI (fever, rhinorrhea, cough) that gets progressively worse to cough, tachypnea, respiratory distress, crackles or wheeze

Question 39

**H&P for newborn with Hyaline Membrane Disease**

Answer 39

Premature infant in respiratory distress. Incidence is 5% from 35-36wks and increases to 50% from 26-28wks Due to deficient surfactant production

Question 40

**Dx Hyaline Membrane Disease**

Answer 40

Premature infant that is tachypnea, cyanosis, expiratory GRUNTING CXR: Bilateral atelectasis (ground glass), air bronchograms Cyanosis, nasal flaring, doming of diaphgram and hypoinflation