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Some Peds Flashcards

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1
Q

What causes epiglottitis? What ages? Onset?

A

Bacterial

2-6 years

Rapid (under 24 hours)

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2
Q

What causes croup (laryngotracheobronchitis)? What ages? Onset?

A

Viral
and rarely mycoplasmas bacteria

< 2 years old

Gradual (24-72 hours)

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3
Q

What region is affected with epiglottis? What is the sign seen on xray?

A

Supraglottic structures

Swollen epiglottis or THUMB sign

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4
Q

What region is affected with croup? What is the sign seen on xray?

A

Laryngeal structures

Subglottic narrowing or STEEPLE sign

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5
Q

Clinical signs of epiglottis ?

A

High fever
Tripod breathing
4 D’s

Drooling
Dysphonia
Dyspnea
Dysphagia

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6
Q

What is the treatment for epiglottis?

A

O2
Urgent securement of airway
Antibiotics
Spontaneous induction
ENT surgeon present
Post-op in ICU

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7
Q

Signs of Croup?

A

Mild fever
Inspiratory stridor
Barking cough

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8
Q

Treatment for Croup?

A

O2
Racemic epi
Corticosteroids
Humidification
Fluids
Rarely need to be tubed

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9
Q

What is post intubation croup?

A

Laryngeal edema from using a ETT too large or with too much pressure

Occurs within 30-60 minutes - hoarseness, barky cough, stridor

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10
Q

Risk factors for post intubation croup?

A

Age less than 4
ETT is too large or with too much volume
Multiple ETT attempts
Prolonged intubation
Coughing
Head or neck surgery
Trisomy
Possible upper airway infection

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11
Q

Best way to minimize post op croup?

A

Maintain an air leak of <25 cm H2O

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12
Q

Treatment for post op croup?

A

Cool and humidified O2

Racemic Epi

Dexamethasone

Heliox (improves laminar airflow by reducing Reynolds number)

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13
Q

How does infectious croup differ from post op croup?

A

NO antibiotics needed because it is not caused by bacteria

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14
Q

What is the minimum time a patient should be observed after receiving racemic epi?

A

4 hours

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15
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Purulent nasal discharge?

A

Yes

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16
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Clear nasal drainage?

A

No

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17
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Fever > 100 or 38?

A

Yes

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18
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? No fever?

A

No

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19
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Lethargic?

A

Yes

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20
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Poor appetite?

A

Yes

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21
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Wheezes that do not clear with coughing?

A

Yes

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22
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Persistent cough?

A

Yes

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23
Q

A patient with respiratory infection presents for a tonsillectomy, which S&S should the case be canceled? Child less than 1 years old or a preemie?

A

Yes

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24
Q

Is it okay to proceed with a tonsillectomy on a child with a respiratory infection?

A

Yes but with caution

Happy
Clear lungs
Older
No fever
Active
Clear drainage

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25
Ways to reduce risk of airway complications with a child that has a upper respiratory infection?
Avoid mechanical irritation (use mask or LMA) Dexamethasone Propofol Sevo because it is non pungent Deep Plane of anesthesia
26
What should be avoided with a child that has a upper respiratory infection?
Avoid ETT and make sure they are deep if placing ETT can increase the risk of bronchospasm by 10-fold
27
Does pretreatment with inhaled bronchodilator or glyco provide a clear benefit with a child that has a upper respiratory infection?
No Does not provide clear benefit
28
What is the classic triad with a child that has foreign body aspiration?
Cough Wheezing Decreased breath sounds
29
Which side does the child usually have foreign body aspiration?
R side
30
What will be heard with supraglottic obstruction?
Stridor
31
What will be heard with subglottic obstruction?
Wheezing
32
What are complications of a rigid bronchoscopy?
- Laryngospasm -Bradycardia during scope insertion -Post op croup -Pneumothorax
33
What is the gold standard for retrieving foreign body?
bronchoscopy
34
What bug causes epiglottitis?
Bacteria
35
What bug causes Croup?
Mainly viral but rarely mycoplasma pneumonia
36
Ages for epiglottitis and croup?
Epiglottitis, 2-6 Croup, Under 2
37
Structures for epiglottitis?
Vocal cords and above
38
Structures for croup?
Below vocal cords
39
Neck xray for epiglottitis?
Thumb sign (swollen epiglottis) lateral xray for best view
40
Neck xray for croup?
Subglottic narrowing (Steeples sign) Frontal xray for best view
41
S&S for epiglottitis?
Tripod with 4 D's Drooling Dyspnea Dysphonia Dysphagia
42
Fever type for epiglottitis and croup?
epiglottitis - High grade Croup - Low grade
43
S&S for croup?
Barky cough Vocal hoarseness Ins Stridor Retractions
44
Epiglottitis or croup, which is an emergency?
Epiglottitis
45
How is epiglottitis managed ?
Secure airway Antibiotics Post op ICU
46
Intubation for epiglottitis? How?
Yes must secure the airway Spontaneous RR with CPAP ENT surgeon must be present
47
Treatment for Croup?
Racemic epi Corticosteroids O2 Humidification Fluids
48
Intubation for Croup?
Rarely
49
Rapid onset? Croup or epiglottitis?
epiglottitis
50
Most common cause of post intubation croup? When does it occur?
Too large of an ET tube Within an hour of extubation
51
Can post intubation croup be caused by cuffed AND cuffless tubes?
Yes
52
Should an air leak be maintained in a cuffless tube? What pressure?
Yes < 25cm H2O
53
Gold standard of measuring cuffed ET tube pressure?
Manometer
54
Preferred treatment for croup?
Racemic Epi
55
Are antibiotics indicated for post intubation croup?
NO - not infectious
56
What percentage of Racemic epi for croup? How much volume for NS dilution?
2.25% 2.5 mL
57
Minimum observation time after racemic epi?
4 hours
58
What ages is post intubation croup seen in?
Under 4
59
Best inhalational gas to prevent bronchospasm
Sevo because it is non pungent
60
Best treatment for recent upper airway infection? What is not helpful?
Best - .5mg/kg dexamethasone No evidence for bronchodilator or glyco
61
Reason to cancel, clear rhinorrhea?
No
62
Reason to cancel, purulent rhinorrhea?
Yes
63
Reason to cancel, fever? No fever?
Cancel with fever over 100
64
Reason to cancel, lethargic or persistent cough?
Yes
65
Reason to cancel, poor appetite?
Yes
66
Reason to cancel, premature or under 1 year old?
Yes
67
Reason to cancel, wheezing or rales that does not clear with coughing?
Yes
68
How long should surgery be postponed for a child with a significant URI?
2-4 weeks from symptoms
69
What will be heard with a supraglottic obstruction? Subglottic?
Supra - Stridor Sub - wheezing
70
Best induction for foreign body aspiration? Best maintenance?
Sevo with spontaneous RR Propofol for maintenance
71
Most common type of TE fistula?
Type C
72
Where should the ET be placed with a TE fistula ?
Between the fistula and the carina
73
What type of induction for a TEF?
Head up Awake intubation or inhalation with spontaneous ventilation
74
With a TEF, and if the patient has a G tube, what should be done?
Open it before induction If no G tube, place an OG after for decompression
75
What drug can be given to hasten fetal lung development? How long to take effect?
Betamethasone Will start to help after 18 hours and peak at 48 hours
76
When does surfactant start producing? When is peak production?
22 weeks 35 weeks
77
Do larger or small alveoli have a higher concentration of surfactant?
Smaller have larger concentration
78
A L/S ratio (lecithin to sphingomyelin) of what indicates adequate lung development?
>2 is adequate <2 increased risk for respiratory distress syndrome
79
What may hyperoxia cause?
Retinopathy
80
Wear are two pulse oximeters placed when monitoring pre and post ductal O2?
Upper R extremity and LE
81
What may be indicated if the pre and post ductal O2's are different?
Pulm HTN R-L shunt
82
What may happen if too much positive pressure is given with poor lung compliance?
Pneumothorax
83
Most common site for congenital diaphragmatic hernia?
Foramen of Bochdalek on the left side
84
In a neonate with a CDH (congenital diaphragmatic hernia), what should peak inspiratory pressure be under?
PIP < 30 cm H2O
85
How long is CDH delayed? Why?
5-15 days to let organs develop?
86
Omphalocele or Gastroschisis, which is midline and involves the umbilicus ?
Omphalocele
87
Omphalocele or Gastroschisis, which may contain the liver?
Omphalocele
88
Omphalocele or Gastroschisis, which has a covering present?
Omphalocele
89
Omphalocele or Gastroschisis, which one is more common?
Gastroschisis
90
Omphalocele or Gastroschisis, which is linked to prematurity ?
Gastroschisis
91
Omphalocele or Gastroschisis, which one is more urgent?
Gastroschisis - need fluids and at-risk foe heat loss Fix within 24 hours
92
Omphalocele or Gastroschisis, which may require staging? Why?
Both may As it is closed, it can increase intra-abdominal pressures which puts pressure on the lungs
93
How does increased abdominal pressure effect venous return, CO, and perfusion?
Decreases all of them
94
Omphalocele or Gastroschisis, should nitrous be used?
No
95
Omphalocele or Gastroschisis, which should be placed in a bag to retain heat and water loss?
Gastroschisis
96
Omphalocele or Gastroschisis, what should PIP be less than?
< 30
97
Omphalocele or Gastroschisis, what happens with electrolytes and fluids?
Large shifts
98
Which electrolyte abnormality is seen with pyloric stenosis ?
Hypokalemia and hyponatremia
99
How does vomiting effect sodium?
Hyponatremia
100
How does vomiting effect potassium?
Hypokalemia
101
How does vomiting effect acid balance?
Causes infant to lose hydrogen so patient will present with metabolic alkalosis
102
If vomiting persists and dehydration isn't corrected, what will the pH balance be? Why?
Metabolic acidosis because of increased lactic acid production
103
Is pyloric stenosis a medical or surgical emergency? What needs to be corrected before surgery?
Medical Fluid and electrolyte balance needs to be fixed
104
Urine pH with pyloric stenosis? Early vs late
Early - Alkalotic urine because the baby is trying to get rid of excess bicarb Late - Acidic
105
Is postop apnea common in Pyloric stenosis?
Yes
106
RSI and OG for pyloric stenosis?
Yes
107
When is pyloric stenosis diagnosed?
2-12 weeks of life
108
What is an adequate SpO2 in a neonate to prevent hyperoxia? What type of O2 mixture?
89-94% Use 50/50 of air and O2
109
Two risk factors for NEC?
Prematurity (under 32 weeks) Low birth weight (under 1,500g)
110
Big concern with NEC? How is it managed?
Medically managed but watch for bowel perf and avoid nitrous
111
Early bowel resection can lead to what later in life?
Short gut syndrome
112
What part of the colon does NEC effect?
Terminal ileum and proximal colon
113
What action if taken too early can cause NEC?
Early feeding which leads to bacterial growth and bowel perf
114
Most significant risk for ROP? 2nd highest risk?
Prematurity Hyperoxia
115
When does retinal maturation complete?
44 weeks so keep SpO2 at 89-94%
116
Which drug does not cause apoptosis? Which do?
Precedex does not GABA and NMDA do
117
What is bilirubin? Which enzyme is required for the breakdown of it?
-Breakdown of RBC -Glucuronyl transferase (phase 2)
118
What is kernicterus?
Fetal encephalopathy
119
Which disease requires a preop cardiac exam?
Omphalocele
120
Which two conditions do not have a risk factor of prematurity?
TEF and CDH because they were present while developing

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