Respiratory illness of children

Question 1

What age range does croup impact?

Answer 1

6 months to 3 years

Question 2

What causes stridor in Croup? What are the other symptoms?

Answer 2

• subglottic inflammation (steeple sign)

- 2 days of viral prodrome following by a seal-like cough, thats worse at night and inspiratory stridor

Question 3

What vaccine helped lower the rates of epiglottis?

Answer 3

Hib

Question 4

What age group gets epiglottis?

Answer 4

6-12 years old

Question 5

A patient presents to your clinic in Arizona with a 3 hour history of high fever and difficulty breathing. His mother accompanies him and does not speak much english. She is able to tell you that this just started. The child is in obvious distress with stridor, retractions, and drooling. He is leaning forward in the chair with his neck raised towards the ceiling. How should you proceed?

Answer 5

Send them straight to the nearest hospital with an OR to secure the airway. Then get an AP film looking for a thumb print sign. Treat with antibiotics.

Question 6

How could you differentiate bacterial tracheitis form croup?

Answer 6

It presents in older children (age 5-7) who are very ill appearing and do not respond to eli.

Question 7

When does a bacterial tracheitis usually occur?

Answer 7

following a viral URI

Question 8

A 5-year-old with refusal to move his neck, a “hot potato” voice, UL cervical lymphadenopathy and drooling –> what should you do?

Answer 8

CT scan to confirm abscess presence. Surgical drainage and antibiotics.

Question 9

In a teenager with recent tonsillitis, presenting with “hot potato voice” and a deviated uvula, what should be done?

Answer 9

Surgical drainage and antibiotics that cover polymicrobial infections

Question 10

What is the only upper airway bug that responds to recemic epinephrine?

Answer 10

Croup

Question 11

What area of the lung is most susceptible to foreign body aspiration?

Answer 11

right main stem bronchus due its straighter path

Question 12

Why will you see a “coin sign” on a lateral x-ray of a child with a tracheal foreign body?

Answer 12

The tracheal rings prevent displacement in all directions, except posterior.

Question 13

What is the hallmark PFT finding in asthma?

Answer 13

decreased FEV1/FVC that significantly improves with a bronchodilator

Question 14

What asthma medication should never be used alone?

Answer 14

LABA

Question 15

For a teenage kid with difficulty breathing whose chest X-ray shows diffuse, puffy infiltrates, what is the antibiotic of choice?

Answer 15

Azithromycin for atypical pneumonia

Question 16

What causes bronchiolitis and what age group gets it?

Answer 16

RSV causing inflammation of the small airways from sloughed cells

Children <2 years old

Question 17

What would the CXR of a patient with bronchiolitis show?

Answer 17

bronchiole inflammation, hyperinflation

Question 18

What should be given to premature infants to prevent RSV infection?

Answer 18

Palivizumab

Question 19

When is a sweat chloride test positive?

Answer 19

if >40 in infants and >60 otherwise

Question 20

What causes pertussis?

Answer 20

gram negative bacillus and because the vaccine immunity wanes with time.