Respi

Question 1

upper respiratory infection 1–3 days, then barking

cough, hoarseness, inspiratory stridor; worse at night, gradual resolution over 1 week

Answer 1

Croup

Question 2

SIgn of Croup on Xray

Answer 2

(steeple sign if an x-ray is performed

Question 3

MC infective agents in Acute Epiglotitis

Answer 3

– Haemophilus influenzae type B (HiB) no longer number one (vaccine success)
– Now combination of Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus
aureus, Mycoplasma

Question 4

Signs of Acute Epiglotitis

Answer 4

– Toxic-appearing, difficulty swallowing, drooling, sniffing-position
– Stridor is a late finding (near-complete obstruction)

Question 5

Dx of acute epiglotiis

Answer 5

Clinical first (do nothing to upset child), controlled visualization (laryngoscopy) of cherry-red, swollen epiglottis; x-ray not needed (thumb sign if x-ray is performed) followed by immediate intubation

Question 6

Etilogy of croup vs epiglottitis

Croup ________

Epiglottitis_______

Answer 6

Parainfluenza 1,2,3

S. aureus
• S. pneumonia, S. pyogenes
• H. influenza type

Question 7

Best accurate test of croup vs epiglottitis

Croup ________

Epiglottitis_______

Answer 7

• PCR for virus • Not needed clinically

C and S from tracheal aspirate

Question 8

Definitive Treatment croup vs epiglottitis

Croup ________

Epiglottitis_______

Answer 8

Parenteral steroid
––Most common-single dose IM
Dexamethasone →
––Observation

• Airway (tracheostomy
if needed) + broadspectrum
antibiotics
• Then per sensitivities

Question 9

Most common laryngeal airway anomaly and is the most frequent cause of stridor in infants and children

Answer 9

Laryngomalacia

Question 10

Onset of Laryngomalacia

Answer 10

Starts in first 2 weeks of life, and symptoms increase up to 6 months of life; typically exacerbated by any exertion

Question 11

• Second most common cause of stridor

* Common presentation—recurrent/persistent croup, i.e., stridor (no difference supine vs. prone position

Answer 11

Congenital Subglottic Stenosis

Question 12

• Third most common cause of stridor

* May be acquired after surgery from congenital heart defects or tracheoesophageal fistula (TEF) repair

Answer 12

Vocal Cord Paralysis

Question 13

Associations of Vocal Cord Paralysis

Answer 13

Often associated with meningomyelocele, Chiari malformation, hydrocephalus

Question 14

Dx of Vocal Cord Paralysis

Answer 14

Diagnosis—flexible bronchoscopy

Question 15

Age MC for FBI

Answer 15

Most seen in children age 3–4 years

Question 16

• Most common foreign body is______

Answer 16

peanuts

Question 17

Diagnosis of FBI

Answer 17

—Chest x-ray reveals airtrapping (ball-valve mechanism). Bronchoscopy for definite diagnosis

Question 18

Therapy of FBI—removal by _______

Answer 18

rigid bronchoscopy

Question 19

Infective agents for Bronchiolitis

Answer 19

respiratory syncytial virus (RSV) (50%), parainfluenza, adenovirus, Mycoplasma, other viruses

Question 20

Pathophysio of Bronchiolitis

Answer 20

Inflammation of the small airways (inflammatory obstruction: edema, mucus, and cellular debris) → (bilateral) obstruction → air-trapping and overinflation

Question 21

Bronchiolitis

_______may be more prominent early in young infants.

Answer 21

Apnea

Question 22

Dx of Bronchiolitis

Chest x-ray (not routine)—

Answer 22

hyperinflation with patchy atelectasis (may look like early

pneumonia)

Question 23

______ not routinely used; may prevent need for mechanical ventilation in severe cases

Answer 23

Ribavirin

Question 24

Prevention of Bronchiolitis

Answer 24

Prevention—monoclonal antibody to RSV F protein (preferred: palivizumab) in high-risk patients only

Question 25

Pneumonia: ______ are predominant cause in infants and children age <5 years

Answer 25

Viruses

Question 26

VIran Pneumonia Pathogens ° Major pathogen—______ ° Others—parainfluenza, influenza, adenovirus

Answer 26

RSV

Question 27

Nonviral causes more common in children _____

Answer 27

>5 years

Question 28

MC bacterial etilogies of Pnx

Answer 28

S. pneumoniae most common with focal infiltrate in children of all ages

Question 29

° 1–3 months of age, with insidious onset ° Staccato cough ° Peripheral eosinophilia

Answer 29

Chlamydia trachomatis pneumonia:

Question 30

Xray of viral Pneumonia

Answer 30

hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing

Question 31

Xray of Pneumococcal Pneumonia

Answer 31

confluent lobar consolidation

Question 32

What organism unilateral or bilateral lower-lobe interstitial pneumonia; looks worse than presentation

Answer 32

Mycoplasma

Question 33

CBC of Chlamydia

Answer 33

Chlamydia—eosinophilia

Question 34

Abx for Hospitalized pneumonia—

Answer 34

parenteral cefuroxime (if S. aureus suspected, add vancomycin or clindamycin

Question 35

Abx for Chlamydophila or Mycoplasma—

Answer 35

erythromycin or other macrolide

Question 36

See table for pneumonia

Answer 36

okay

Question 37

* Most common life-limiting recessive trait among whites | * Major cause of severe chronic lung disease and most common cause of exocrine pancreatic deficiency in children

Answer 37

CF

Question 38

Pathogenic findings of CF

Answer 38

dysfunction of epithelialized surfaces; obstruction and | infection of airways; maldigestion

Question 39

Autosomal recessive; _____ most prevalent among northern and central Europeans

Answer 39

CF gene

Question 40

CF gene mutations occur at a single locus on long arm of

Answer 40

chromosome 7.

Question 41

Pathogenesis of CF

Answer 41

Membranes of CF epithelial cells unable to secrete Cl– in response to cyclic adenosine monophosphate–mediated signals

Question 42

Result of the pathogenesis of CF

Answer 42

Failure to clear mucous secretions; paucity of water in mucous secretions

Question 43

________—usually first presentation of pts with CF

Answer 43

Intestinal tract

Question 44

CF: 10% of newborns with ______

Answer 44

meconium ileus

Question 45

Presentation of CF because of _________ is frequent, bulky, greasy stools and failure-to-thrive.

Answer 45

pancreatic exocrine insufficiency

Question 46

Vitamin insufficiency of pancreatic exocrine insufficiency

Answer 46

ADEK

Question 47

Sweating patterns of CF

Answer 47

° Excessive loss of salt → salt depletion, especially with hot weather or gastroenteritis (serum–hypochloremic alkalosis) ° Salty taste of skin

Question 48

Diagnosis of CF Any of the following: 1 2 3 Plus Any of the Following 1 2 3

Answer 48

* Typical clinical features * History of a sibling with CF * Positive newborn screen * Two increased sweat chlorides on 2 separate days * Identification of 2 CF mutations (homozygous) * Increased nasal potential difference

Question 49

What is the best test for CF

Answer 49

Sweat test (best test): ° Difficult in first weeks of life ° Confirm positive results ° Diagnosis: >60 mEq/

Question 50

Other diagnostics if sweat test is negative

Answer 50

° Pancreatic function—72-hour fecal fat collection, stool for trypsin, pancreozymin- secretin stimulation, serum immunoreactive trypsinogen (↑ in neonates)

Question 51

PFT of pts with CF

Answer 51

° By 5 years—obstructive pulmonary disease | ° Then restrictive (fibrosis)

Question 52

Microbiologic test for pts with CF

Answer 52

finding in sputum of S. aureus first, followed by P. aeruginosa (mucoid forms) is virtually diagnostic (also B. cepacia, but is usually late finding)

Question 53

T or F NBS in CF determination of immunoreactive trypsinogen in blood spots and then confirmation with sweat or DNA testing; does not improve pulmonary and therefore long-term outcome

Answer 53

T

Question 54

Aerosolozed Abx used in CF

Answer 54

Aerosolized antibiotics—tobramycin

Question 55

Tx of hospitalized CF patients

Answer 55

° Typical 14-day treatment ° Two-drug regimens to cover pseudomonas, e.g., piperacillin plus tobramycin or ceftazidime

Question 56

sudden death of an infant, unexplained by history or by thorough postmortem examination including autopsy, investigation of death scene, and review of medical history;

Answer 56

Sudden Unexplained Infant Death Syndrome (SUIDS

Question 57

Autopsy findings of SIDS

Answer 57

infections; congenital anomaly; unintentional injury; traumatic child abuse; other natural causes

Question 58

Non-modifiable RF for SIDS

Answer 58

``` ° Low socioeconomic status ° African American and Native American ° Highest at 2–4 months of age; most by 6 months ° Highest in winter, midnight to 9 a.m. ° Males > females ```