Week 4 Solomon Pediatric Respiratory Medicine

Front 1

Is stridor a noise of inspiration or expiration?

Back 1

More commonly inspiration but can be both.

Front 2

What is a barking cough suggestive of?

Back 2

subglottic or tracheal obstruction

Front 3

What is the DDx of Acute Upper Airway obstruction?

Back 3

Croup
Epiglottitis
Bacterial tracheitis
Foreign body
Anaphylaxis

Front 4

What is a common cause of chronic upper airway obstruction?

Back 4

Congenital, i.e. laryngomalacia

Front 5

What is the peak age range, clinical picture and causative agent in...

Epiglottitis

Back 5

H flu B (+++) or GAS (+). Age 2-6 years.
Toxic, severe, drooling in tripod sit, signs of difficulty breathing.

Front 6

What is the peak age range, clinical picture and causative agent in...
Croup

Back 6

6 mos - 4 yrs (M>F)
Viral parainfluenza, RSV
Non toxic, stridor, barking cough, hoarsness, coryza

Front 7

What is the peak age range, clinical picture and causative agent in...
Bacterial tracheitis

Back 7

any age
S. aureus, pneumococcus, H. influenzae

Toxic: croup like cough; stridor

Front 8

Management: Croup (mild)

Back 8

Avoid agitation
po fluids, humidity (?)
cold air

Front 9

What is an indication for hospitalization with Croup?

Back 9

Stridor at rest.

Front 10

Management severe croup

Back 10

02
Dexamethasone po / IV
Racemic epinephrine by mask inhalation (requires observation for rebound)

Front 11

Epiglottis: Management

Back 11

Keep child calm.
No invasive exam!
Anesthesia / ENT / intubation
IV antibiotics

Front 12

What is Tx of laryngomalacia?

Of laryngeal web?

Back 12

Often nothing.

Web: remove w/ laser.

Front 13

What are the three most common causes of wheeze / cough in infants / young children?

Back 13

Asthma
Bronchiolitis
Recurrent aspiration

Front 14

Asthma Def'n

Back 14

Chronic inflammatory disorder of lower airways causing recurrent episodes of wheezing, breathlessness etc.

Front 15

Why should normal pCO2 be taken warily during asthma episode?

Back 15

Could be
a) normal b/c no problem
b) normal b/c rising from low C02 hyperventilatory state to normal C02 / hypoventilatory state due to fatigue

Front 16

Rank in order of severity and in reverse order of onset:
nasal flaring, indrawing, tracheal tug

Back 16

1) flaring (only in kids)
2) tracheal tug
3) indrawing

Front 17

What are some signs of severe asthma?

Back 17

- dyspnea
- silent chest / feeble effort (no wheezing if airflow is low)
Cyanosis
Evidence of pneumothorax (e.g. SC emphysema)

Front 18

Management: Asthma

Back 18

ABCs
Oxygen (humidified)
Consider ABGs / CXR

Front 19

Asthma Management: Severe / In Hospital

Back 19

1. Nebulized B2 agonist + / - nebulized ipratropium
2. O2 / fluids
3. IV steroids
4. No response: IV B2 agonists + / - assisted ventilation.

Front 20

Asthma Management: Moderate / ER

Back 20

1. Nebulized B2 agonist / ipratropium
2. Respond: home on B2 agonist and oral steroid
No response: see previous card

Front 21

What is the blue puffer?

Back 21

Ventolin = B2 agonist (Salbutamol)

Front 22

DDx of Chronic Cough

Acute Chronic

Back 22

Infection
Foreign body
PE
Pulmonary Hemorrhage

Front 23

DDx of Chronic Cough

Chronic Chronic

Back 23

Infections, chronic; e.g. TB
Cough variant asthma
Irritants
Anatomical, e.g. TEF
GER
Post nasal drip / sinusitis etc

Front 24

Cystic Fibrosis

When did screening start?
Should negative screening test reassure clinician who suspects CF?

Back 24

April 2008.
Not used to r/o CF!

Front 25

What is a classic newborn sign of CF?

Back 25

Meconium ileus.

Front 26

What are three bacteria which often cause infection leading to bronchiectasis in CF?

Back 26

SA
H. influenza
pseudomonas

Front 27

Why does rectal prolapse occur in CF patients?

Back 27

Bulky stool leading to straining.
Low sphincter tone.

Front 28

Dx CF: Sweat Chloride Ranges

Back 28

> 60 = positive
30 - 59 = gray zone
< 30 = negative

Front 29

What is the newborn screening test?

Back 29

Immunoreactive trypsinogen, tested by heel prick. +ve screen--> genetics

Front 30

What is the most common CF mutation?

Back 30

deltaF508 (75%)

Front 31

CF Management

Nutritional

Back 31

Pancreatic enzymes and ADEK
Caloric intake

Front 32

CF Management

Pulmonary

Back 32

Abx / chest physio 2x / day

Front 33

CF Management

Other

Back 33

Follow up
Eduction
Transplants!!!