Kaplan Pediatrics: Chapter 16 Respiratory

Front 1

What is the MCC of Croup?

Back 1

Parainfluenza

Front 2

What is Croup?

Back 2

Laryngotracheobronchitis

Front 3

A 12-month old child is brought to your office b/c of a barky cough. The mother states that over the past 3 days the child has developed a runny nose, fever, & a cough. The symptoms are getting worse, & the child seems to have difficulty breathing. He sounds like a seal when he coughs. Diagnosis?

Back 3

Croup
-Parainfluenza virus

Front 4

Low grade fever + barking cough + intermittent inspiratory stridor = ?

Back 4

Croup

Front 5

Steeple sign = ?

Back 5

Croup

Front 6

What is given for Croup when the patient has stridor at rest?

Back 6

Racemic Epinephrine & Corticosteroids (Dexamethasone IM)

Front 7

Presentation similar to Laryngotracheobronchitis however there is usually no history of infection in the pt or their family. Although viruses may cause it, it is more often associated w/ triggers such as GER, allergic, or physchological factors

Back 7

Spasmodic croup

Front 8

This usually begins as a viral laryngotracheobronchitis, which becomes a bacterial complication of a viral disease

Back 8

Bacterial tracheitis
-pt usually has thick, purulent airway secretions
-S. aureus is primary cause

Front 9

Child has a toxic appearance, high fever, hoarseness, acute onset of symptoms, & dyspnea

Back 9

Epiglottitis

Front 10

A 2 year old presents to the ER w/ her parents b/c of high fever & difficulty swallowing. The parents state that the child had been in her usual state of health but awoke with fever of 104 F, hoarse cough, & difficulty swallowing. On exam, pt is sitting in a tripoid position. Pt is drooling, has expiratory stridor, nasal flaring, & retractions of the suprasternal notch & supraclavicular & intercostal spaces

Back 10

Epiglottitis

Front 11

What is the most common pathogen of Epiglottitis?

Back 11

HiB
-but has decreased due to vaccines

Front 12

What is the presentation of Epiglottitis?

Back 12

SUDDEN onset of high fever, dysphagia, drooling, muffled voice, & respiratory distress

Pt may sit in a tripod position w/ neck hyperextended

Front 13

Lateral roentgenogram of the neck shows the "thumb print" sign

Back 13

Epiglottitis

Front 14

What should NEVER be done to a patient w/ suspected Epiglottitis?

Back 14

use of Tongue blade to examine the pharynx b/c it may cause reflex laryngospasm & cardiorespiratory arrest

Front 15

Whta are the 3 components of an Asthma attack?

Back 15

1. bronchospasm
2. mucus production
3. Airway edema

Front 16

Why might the liver & spleen be palpable in Asthmatic patients?

Back 16

secondary to hyperinflation

Front 17

Is clubbing seen in asthma?

Back 17

NO, b/c asthma is reversible

Front 18

A 6-month-old infant presents to the physician w/ 3 day hx of URI, wheezy cough, & dyspnea. On physical exam, the pt has a temperature of 39 C, respirations of 60 bpm, alae nasi flare, & accessory muscle usage. The pt appears to be air hungry & the oxygen saturation is 92%

Back 18

Bronchiolitis
-RSV MCC
-hx of URI, rhinorrhea, & sneezing
-pt develops fever of 38.5-39 C & gradually develops respiratory distress evidenced by tachypnea, wheezing, & cough.
-pt may have difficulty feeding b/c of the rate of breathing.

Front 19

How does a patient with Bronchiolitis present?

Back 19

Rapid breathing, usually 60-80 breaths/min

wheezing, rales, & intercostal & subcostal retractions

In severe cases the patient may be restless & irritable from air hunger. Cyanosis may be present

Front 20

What does Chest Roentgenogram show in Bronchiolitis?

Back 20

Hyperinflation of the lungs
-air trapping & peribronchial thickening may be present

Front 21

What drugs are not indicated & may be harmful in Bronchiolitis?

Back 21

Corticosteroids

Front 22

What is the MCC of Bronchiolitis?

Back 22

RSV

Front 23

Meconium ileus may indicate what disease?

Back 23

Cystic Fibrosis
-failure to pass meconium in the first 24-48 hours of life

Front 24

What metabolic disturbance may develop when patients with Cystic Fibrosis become dehydrated from warm weather or gastroenteritis?

Back 24

Hypochloremic Alkalosis

Front 25

What is the gold standard for the diagnosis of Obstructive Sleep Apnea?

Back 25

Polysomnography = a sleep study test

Front 26

What is the treatment for Apnea?

Back 26

Adenotonsillectomy

Front 27

What are some complications of Obstructive Sleep Apnea?

Back 27

Poor growth
Cor Pulmonale
Poor school performance
Death

Front 28

This occurs in premature infants less than 36 wks of GA. In these patients apnea & bradycardia are seen. Diagnosis & Treatment?

Back 28

Apnea of Prematurity

Theophylline or caffeine
or Intubation

Front 29

Define "Cyanotic breath-holding". What is the treatment?

Back 29

Breath-holding spells caused by prolonged expiratory apnea & cerebral anoxia.

Pts exhibiting this entity are usually younger than 3 years of age & hold their breath b/c of anger. Fainting may be associated

Rx is reassurance

Front 30

This usually occurs after a painful stimulus. During this episode, the pt will turn pale (white) & have asystole & a seizure.

What is the treatment?

Back 30

Pallid breath-holding

Atropine

Front 31

What are the risk factors for SIDS?

Back 31

Most occur b/w midnight & 9 am
More cases occur in winter
Prematurity
Lack of prenatal care
Maternal smoking during pregnancy
Lower SES
Prone & Side sleep positions

Front 32

What is the most common type of pneumonia in childhood?

Back 32

Viral

Front 33

What is the clinical triad for pneumonia?

Back 33

Fever
Tachypnea
Cough

Front 34

Infant has a "staccato" cough history of eye discharge during the first 2 weeks of life

Back 34

Chlamydia pneumonia

Front 35

CXR shows interstitial pattern found mostly in the lower lobes. Patient appears mildly ill with a non-productive cough. CXR appears worse than symptoms

Back 35

Mycoplasma pneumonia

Front 36

CXR shows ground glass appearance & staccato cough

Back 36

Chlamydia pneumonia

Front 37

Pneumonia w/ normal WBC counts with predominance of lymphocytes

Back 37

Viral pneumonia

Front 38

Pneumonia w/ increased WBC & neutrophilia

Back 38

Bacterial pneumonia

Front 39

Pneumonia w/ normal WBC & eosinophilia

Back 39

Chlamydial pneumonia

Front 40

What is the treatment for Chlamydial pneunomia?

Back 40

Erythromycin ethyl succinate drops by mouth for 14 days

Front 41

What is the treatment for GBS, E. coli, & Listeria pneumonia?

Back 41

Ampicillin + Aminoglycoside

or

Ampicillin + third-generation cephalosporin

Front 42

-

Back 42

-

Front 43

What is a complication of pneumonia?

Back 43

Empyema = pus in the pleural cavity