Resp and EENT

Question 1

What are the difference in ped upper airways than adults?

Answer 1

• Smaller airway diameter
• Narrower trachea
• Position of R mainstem bronchus (smaller angle)
• Increased airway resistance
• Tongue larger proportion of mouth
• Larger epiglottis

Question 2

What are the diameters of a newborn and adult’s airway?

Answer 2

4mm and 20mm

Question 3

Where is an aspirated foreign body most likely to lodge in an infant?

Answer 3

R bronchus stem

Question 4

Do adults or children breath more diaphragmatically?

Answer 4

Children until 6-7yo (adults breath w/ thoracic cavity)

Question 5

When is alveoli development complete?

Answer 5

Puberty

Question 6

What is considered in a respiratory assessment?

Answer 6

• Auscultation
• Resp effort
• Tactile (palpation)
• Observation

Question 7

Are breast sounds louder or softer in a child (vs. adult)?

Answer 7

Louder- absence of breast tissue makes auscultation louder

Question 8

When is hyperventilation seen in peds?

Answer 8

Fevers, anemia, acidosis, diarrhea

Question 9

When is hypoventilation seen in peds?

Answer 9

CNS depression, diaphragmatic paralysis, metabolic alkalosis

Question 10

What is assessed via tactile resp assessment?

Answer 10

• Fremitus (vibrations = expected; 99)

- Resonance (dull = fluid or masses)

Question 11

What can be observed in a peds patient in resp distress?

Answer 11

• Nasal flaring
• Use of accessory muscles/retractions
• Cyanosis (lips)
• Tripod position
• Tachypnea (>60)
• Grunting

Question 12

What accessory muscle retractions indicate severe resp distress?

Answer 12

Supraclavicular and suprasternal

Question 13

What can cause ARDS (acute respiratory distress syndrome)?

Answer 13

• Sepsis
• Pneumonia
• Meconium aspiration
• Smoke inhalation
• Near drowning
• Airway obstruction

Question 14

How is foreign body aspiration dx in peds?

Answer 14

• X-ray
• Visualization
• Bronchoscopy

Question 15

What is a 1st degree obstruction?

Answer 15

Air can be passed in both directions

Question 16

What is a 2nd degree obstruction?

Answer 16

Air can only travel in one direction (inhale or exhale)

Question 17

What is a complete obstruction?

Answer 17

Air cannot move in either direction

Question 18

What is an apnea machine?

Answer 18

Assesses pulse ox and beeps if patient doesn’t breath every 20 seconds

Question 19

Why are peds more susceptible to apnea than adults?

Answer 19

Babies have blunted resp. centers (less reactive to changes in CO2 concentration).

Question 20

When would a child with a URI be admitted?

Answer 20

• Younger age (2mo vs. 5yr)
• Caregiver fatigue
• Ability of parent to “make the call” at home
• Fever severity
• Cause of URI

Question 21

What are possible serial sequelae of acute strep pharyngitis?

Answer 21

• Rheumatic fever

- Glomerularnephritis

Question 22

What is the most significant risk factor of a tonsillectomy?

Answer 22

Bleeding (assess for excessive swallowing, bloody drool, or vomitus)

Question 23

How are straws and tonsils related?

Answer 23

Straws must be avoided after a tonsillectomy to prevent surgical incision extravasation.

Question 24

What are the s/s of croup?

Answer 24

• Barking cough

- Inspiratory stridor

Question 25

How is edema visualized with croup?

Answer 25

Viewed as "church and steeple" in diagnostic imaging (subglottic tissue is closed off)

Question 26

What is a respiratory clinical emergency in the peds population?

Answer 26

Acute epiglottitis

Question 27

What ped population is at highest risk of acute epiglottitis?

Answer 27

3+yo (not seen in newborns or younger infants)

Question 28

What is priority tx of acute epiglottitis?

Answer 28

- Prevent laryngospasms (vocal cord paralysis = obstructed airway) - Airway management

Question 29

What is the "thumb sign"?

Answer 29

The "thumb sign" describes the edema of the epiglottis visualized in lateral neck view imaging of a ptnt w/ acute epiglottitis.

Question 30

What is the most common cause of pediatric hospitalization?

Answer 30

Bronchiolitis (RSV)

Question 31

How is bronchiolitis dx?

Answer 31

S/s and chest x-ray

Question 32

What is the care of a child with bronchiolitis?

Answer 32

Maintain ABCs with: - O2 - Nebs - Meds - Humidifier

Question 33

What age is bronchiolitis most common?

Answer 33

2-9mo

Question 34

What meds are used to tx bronchiolitis?

Answer 34

- Steroids | - Antibiotics (if bacterial)

Question 35

What are the 3 categories of asthma classification?

Answer 35

Mild, moderate, severe

Question 36

How is asthma classified?

Answer 36

- Duration | - Amount of meds needed to control condition

Question 37

What meds are used to tx asthma?

Answer 37

- Short-term = albuterol and metered dose inhalers | - Long-term = corticosteroids

Question 38

What is status asthmaticus?

Answer 38

Continued asthma related resp distress despite intervention

Question 39

How is status asthmaticus tx?

Answer 39

Epinephrine

Question 40

What is the max dose of Epi for status asthmaticus?

Answer 40

0.3mL

Question 41

What are interventions for asthma tx?

Answer 41

- Exercise - Chest PT - Hyposensitization - Education

Question 42

What is CF?

Answer 42

Autosomal recessive disorder of the exocrine glands

Question 43

What organ systems are affected by CF?

Answer 43

- Resp - GI - Musculoskeletal - Reproductive - Skin

Question 44

How is CF dx?

Answer 44

Sweat test (2-5x increased Na+ production by body)

Question 45

Is genetic testing available for CF?

Answer 45

Yes, but it does not test for all 50 different strains of CF

Question 46

What is the 1st symptom of CF?

Answer 46

Fatty stools (linked to poor digestion as enzymes are lacking secondary to pancreatic inadequacy)

Question 47

What is a common CF-related complications in newborns?

Answer 47

SBO secondary to meconium aspiration

Question 48

What do CF r/t resp manifestations lead to?

Answer 48

- Pulm HTN - Cor pulmonale - Resp failure (death)

Question 49

What is steatorrhea?

Answer 49

Fatty stools

Question 50

What is Azotorrhea?

Answer 50

Protein-packed stools

Question 51

How are CF r/t GI conditions managed?

Answer 51

Pancreatic enzyme supplements dosed w/ every meal.

Question 52

What happens to the pancreas over time in a CF patient?

Answer 52

Eventually pancreas becomes fibrotic (secondary to mucous duct occlusion), can lead to diabetes

Question 53

How is pink eye tx?

Answer 53

- Quarantine for 24hr - Don't touch eyes - Warm compresses

Question 54

When is vision completely developed?

Answer 54

6-7yo should have 20/20 vision

Question 55

What is the most common ear disorder in peds?

Answer 55

Otitis media (middle ear infection)

Question 56

What increases the risk of otitis media?

Answer 56

Tobacco smoke exposure

Question 57

How is otitis media tx?

Answer 57

- Antibiotics | - Possible use of antipyretic (tylenol) and analgesic (ibuprofen)

Question 58

How is otitis externa dx?

Answer 58

Gentle tug on outer ear = pain

Question 59

How is otitis externa tx?

Answer 59

- Steroid and/or antibiotic drops | - Remove trapped water/fluid

Question 60

How can otitis externa (swimmer's ear) be prevented?

Answer 60

A couple drops of rubbing alcohol in each ear after swimming

Question 61

Why do ear infections occur more frequently in peds than adults?

Answer 61

Horizontal positioning of ped eustachian tube (drainage is slower)

Question 62

Why do infants have increased ear infection exposure when bottle feeding?

Answer 62

Sucking opens eustacian tubes (since tubes are horizontal, more exposure to pathogens and less drainage)