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43 Cards in this Set

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  • Back
What is the MCC of Croup?
What is Croup?
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?
-Parainfluenza virus
Low grade fever + barking cough + intermittent inspiratory stridor = ?
Steeple sign = ?
What is given for Croup when the patient has stridor at rest?
Racemic Epinephrine & Corticosteroids (Dexamethasone IM)
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
Spasmodic croup
This usually begins as a viral laryngotracheobronchitis, which becomes a bacterial complication of a viral disease
Bacterial tracheitis
-pt usually has thick, purulent airway secretions
-S. aureus is primary cause
Child has a toxic appearance, high fever, hoarseness, acute onset of symptoms, & dyspnea
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
What is the most common pathogen of Epiglottitis?
-but has decreased due to vaccines
What is the presentation of Epiglottitis?
SUDDEN onset of high fever, dysphagia, drooling, muffled voice, & respiratory distress

Pt may sit in a tripod position w/ neck hyperextended
Lateral roentgenogram of the neck shows the "thumb print" sign
What should NEVER be done to a patient w/ suspected Epiglottitis?
use of Tongue blade to examine the pharynx b/c it may cause reflex laryngospasm & cardiorespiratory arrest
Whta are the 3 components of an Asthma attack?
1. bronchospasm
2. mucus production
3. Airway edema
Why might the liver & spleen be palpable in Asthmatic patients?
secondary to hyperinflation
Is clubbing seen in asthma?
NO, b/c asthma is reversible
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%
-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.
How does a patient with Bronchiolitis present?
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
What does Chest Roentgenogram show in Bronchiolitis?
Hyperinflation of the lungs
-air trapping & peribronchial thickening may be present
What drugs are not indicated & may be harmful in Bronchiolitis?
What is the MCC of Bronchiolitis?
Meconium ileus may indicate what disease?
Cystic Fibrosis
-failure to pass meconium in the first 24-48 hours of life
What metabolic disturbance may develop when patients with Cystic Fibrosis become dehydrated from warm weather or gastroenteritis?
Hypochloremic Alkalosis
What is the gold standard for the diagnosis of Obstructive Sleep Apnea?
Polysomnography = a sleep study test
What is the treatment for Apnea?
What are some complications of Obstructive Sleep Apnea?
Poor growth
Cor Pulmonale
Poor school performance
This occurs in premature infants less than 36 wks of GA. In these patients apnea & bradycardia are seen. Diagnosis & Treatment?
Apnea of Prematurity

Theophylline or caffeine
or Intubation
Define "Cyanotic breath-holding". What is the treatment?
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
This usually occurs after a painful stimulus. During this episode, the pt will turn pale (white) & have asystole & a seizure.

What is the treatment?
Pallid breath-holding

What are the risk factors for SIDS?
Most occur b/w midnight & 9 am
More cases occur in winter
Lack of prenatal care
Maternal smoking during pregnancy
Lower SES
Prone & Side sleep positions
What is the most common type of pneumonia in childhood?
What is the clinical triad for pneumonia?
Infant has a "staccato" cough history of eye discharge during the first 2 weeks of life
Chlamydia pneumonia
CXR shows interstitial pattern found mostly in the lower lobes. Patient appears mildly ill with a non-productive cough. CXR appears worse than symptoms
Mycoplasma pneumonia
CXR shows ground glass appearance & staccato cough
Chlamydia pneumonia
Pneumonia w/ normal WBC counts with predominance of lymphocytes
Viral pneumonia
Pneumonia w/ increased WBC & neutrophilia
Bacterial pneumonia
Pneumonia w/ normal WBC & eosinophilia
Chlamydial pneumonia
What is the treatment for Chlamydial pneunomia?
Erythromycin ethyl succinate drops by mouth for 14 days
What is the treatment for GBS, E. coli, & Listeria pneumonia?
Ampicillin + Aminoglycoside


Ampicillin + third-generation cephalosporin
What is a complication of pneumonia?
Empyema = pus in the pleural cavity