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Question 1

18 month old male comes into ED and mom’s complain that he has worsening cough at night and clear rhinorrhea from bilateral nares, a low grade fever of 99 and a barky cough. What is your treatment?

Answer 1

CROUP
Dexamethasone 0.6mg/kg IV or IM
Racemic Epi
Humidified or cooled air mist
Supportive care
Consider Heliox
ENT consult if no improvement

6-36 months most common

STEEPLE SIGN ON XRAY

Question 2

It’s January and a 5 month old comes into your ED with increased WOB, wheeze and congestion. He is a former 31 weeker. What would you do?

Answer 2

Bronchiolitis.
DO NOT ORDER Corticosteroids. Bronchodilators and Racemic Epi are not recommended.
Supportive care.

Palivizumab=Synagis

Question 3

You are interpreting the CXR of a 6 month old with increased WOB and hypoxia. O2 sats 87% on room air. CXR shows hyper expansion, patchy atelectasis and peribronchial thickening. What is your dx?

Answer 3

Bronchiolitis.

Question 4

8 year old asthmatic comes in for follow up. Mom says his nighttime symptoms occur about 4x/month

Answer 4

Mild persistent (symptoms occur more than 2 days/week but not every day, attacks interfere with daily activities, nighttime symptoms occur 3-4x/month)

Question 5

Your asthmatic patient is requiring intubation. What med should you include in your rapid sequence?

Answer 5

Ketamine typically used for induction in asthmatics requiring intubation due to its bronchodilator effects.

Question 6

Your 3 year old patient with asthma comes in with a RR=60. He has suprasternal retractions and has a loud expiratory wheeze. His p.ox is 92%. What type of acute asthma is he experiencing?

Answer 6

Moderate

Question 7

You’re examining your 12 year old patient’s airway and you notice swollen tonsils and that the uvula is deviated to the left, what do you suspect?

Answer 7

Peritonsillar abscess

(Deviated to the opposite side)

More common in older children/adolescents

Question 8

You notice widening of the retropharyngeal soft tissue , widening of the prevertebral space on lateral neck film- you suspect your patient has… and what would you do to treat

Answer 8

RPA… Treat with broad spectrum ABX ( coverage for aerobic and anaerobic organisms) such as: unasyn, clindamycin, 3 rd generation cehpalosporin +/- flagy

Question 9

A mother of a 6 month old male complains that her child makes this funny airway noise when crying or eating. On exam, you notice an expiratory wheeze on auscultation..You think he has

Answer 9

Tracheomalacia.

Question 10

When is an aortapexy indicated

Answer 10

For tracheomalacia- suspends the anterior trachea reducing airway compromise.

Question 11

BPD: ABG will be–

Answer 11

Respiratory acidosis- C02 will be high

Question 12

ABG for a patient with chronic metabolic alkalosis

Answer 12

CF

Question 13

A 2 year old presents in your ED. They assume the tripod position and they are anxious appearing. They are drooling and have a high fever. What would you expect to see on x-ray?

Answer 13

Thumbprint sign (Epiglottitis)

*This has decreased since Hib vaccine

Usually caused by Step/Strep

Consult ENT and anesthesia

If not not intubated, provide humidified oxygen

Consider systemic steroids

Antibiotics: third generation cephalosporin plus vancomycin.

Question 14

How would a young infant infected with Bordetella pertussis present?

Answer 14

They do NOT present with whooping, often present with apnea

“because babies don’t cough”

Question 15

The abx choice for the school ages child with suspected mycoplasma pneumoniae is

Answer 15

macrolides ( azirthomycin)

Question 16

Common organism causing pneumonia in a newborn are:

Answer 16

GBS, Gram negative enteric bacili, chlamydia

Question 17

Madison, age 2, is being treated for croup- what is the manamgent

Answer 17

dexamethasone and o2