Smurfs & Other Respiratory Rats

Question 1

A 6 yo with an acute onset of fever, 102.5 F, and difficulty swallowing exhibits drooling and looks ill. You suspect:

Answer 1

Epiglottitis

Question 2

A 4-year-old has had a cough for 3 days and has a fever of 99.8 F. You note a stridorus barking cough. You suspect:

Answer 2

Croup

Question 3

Subglottic inflammation is consistent with what type of x-ray findings?

Answer 3

Steeple sign (croup)

Question 4

Supraglottic inflammation is indicative of what x-ray findings?

Answer 4

Thumbprint sign (epiglottitis)

Question 5

An URI more often found in prematurely born infants and presenting with copious secretions is?

Answer 5

RSV

Question 6

Define wheezes

Answer 6

Partial lower airway obstruction presenting with a musical sound found typically on exhalation.

Question 7

Define stridor

Answer 7

Partial upper airway obstruction presenting with a high-pitched sound on inspiration.

Question 8

Define crackles/ rales

Answer 8

Small clicking, bubbling, or rattling sounds in the lungs can indicate air openings or fluid in the lungs.

Question 9

A patient has had a productive cough for several days. You note rales/ rhonchi in the RLL.
You suspect:
Management:

Answer 9

Pneumonia

O2, IV, CM
Provide NS bolus

Question 10

Parents call for a 3-year-old with difficulty breathing. You note bilateral diffuse wheezes. You provide O2 via blow by. The patient is grunting with an SpO2- 86% RA.

Differentials (3):
IBW:
Low BP:
SO: Provide SO with correct dosing

Answer 10

Anaphylaxis
Asthma
FBAO
RSV
pneumonia

15 kg
SBP- 76 mm Hg

Bronchoconstriction:
Severe:
- epi [1:1,000] 0.15 mg/ 0.15 ml IM
- Nebulizer albuterol 2.5- 5 mg/ ipratropium 0.25 mg
- Repeat nebulizer with 5 mg albuterol/ 0.5 mg ipratropium
-MgSO4 50 mg/ kg max. 2 Gm SIVP
- consider intubation and ETT epi [1:1,000] 0.1 ml/kg = 1.5 ml (750 mg) via atomizer and increase I:E ratio