Pediatrics Respiratory

banannie's version from 2016-02-28 21:32

Inspiratory Stridor

Question Answer
steeple sign croup (or bacterial tracheitis aka pseudomembranous croup)
MC cause of croupParainfluenza
presentation of croup?viral prodrome into inspiratory stridor and seal-like cough
seal like barking coughcroup
treatment for croup?nebulized racemic epinephrine
brassy coughbacterial tracheitis aka pseudomembranous croup
croup refractory to racemic epibacterial tracheitis aka pseudomembranous croup
MC cause of pseudomembranous croups. aureus (also HiB and Moraxella)
presentation of bacterial tracheitisfever, inspiratory stridor following viral infection
what is the anatomy behind the steeple sign?subglottic narrowing of soft tissue
treatment of bacterial tracheitis aka pseudomembranous croupnafcillin, ceftriaxone, vancomycin
what distinguishes presentation of epiglottitis?rapid onset, fever >104, drooling and dysphagia
thumbprint signepiglottits
treatment of epiglottitis?intubate in the OR (don't touch!), IV ceftriaxone x2-5 days
prophylaxis of epiglottitisrifampin
presentation of retropharyngeal abscess?fever, drooling, dysphagia, unilateral cervical lymphadenopathy
cause of retropharyngeal abscessstaph and strep
diagnose retropharyngeal abscessSXR: soft tissue swelling, cervical lordosis
treatment of retropharyngeal abscessI&D ampicillin-sulbactam and clindamycin
diagnose peritonsillar abscesssee tonsils shifted
age of peritonsillar abscess>10 y.o
MC anatomic cause of inspiratory stridorlaryngomalacia
when does laryngomalacia present?mc 2 weeks of life, but 0-18 months
complications of laryngomalaciaapnea, cyanosis, fail to thrive
diagnose laryngomalacialaryngoscopy
treatment of laryngomalaciaobserve (most resolve by 18 mos), alter feeding position, surgery if severe
hourglass (subglottic narrowing)congenital subglottic stenosis

Expiratory Wheezing

Question Answer
MC cause of bronchiolitisRSV
presentation of bronchiolitisasthma refractory to beta agonist, hyperinflation with apparent hepatomegaly
treat bronchiolitishospitalize: O2, IVF, ribavirin (don't give steroids)
recurrent bronchiolitisCF
prevent bronchiolitisSynagis/Palivizumab
- <29 weeks, cardiac anomalies, chronic lung disease
sudden onset sob/coughforeign body airway obstruction
coin sign on lateral filmforeign body airway obstruction, sign of hyperinflation/atelectasis
PE finding of foreign body airway obstructionunilateral wheezing
treat foreign body airway obstructionbronchoscopy (dx+rx)
key diagnostic feature of asthmareversible with bronchodilator
risk factors of asthmaallergy/atopy, smoke, low birth weight
mechanism of asthmaIgE and mast cell mediated
diagnose asthmaspirometry: FEV1/FVC <0.8, if normal methacholine challenge
histology of asthmacurschman spiral, charcot leyden crystal, SM hypertrophy


Question Answer
intermittent asthma: daytime symptoms< 2X/wk
intermittent asthma: night time symptoms<2/mo
treatment of intermittent asthmaShort-Acting B agonist
mild persistent asthma: daytime symptoms2+/wk
mild persistent asthma: night time symptoms2+/month
treatment of mild persistent asthmaInhaled corticosteroids (cromolyn)
moderate persistent asthma: daytime symptomsevery day
moderate persistent asthma: night time symptoms4+/month
treatment of moderate persistent asthmalong acting B-agonist (not with steroids!) + montelukast
severe persistent asthma: daytime symptomscontinuous
severe persistent asthma: night time symptomsfrequent
treatment of severe persistent asthmasystemic steroid, ipratropium acutely
when do you hospitalize an asthma attackSaO2<92%
how do you treat an asthma attackO2, IVF, nebulized albuterol, ipratropium, IV corticosteroid
when do you intubate an asthma attack?if pCO2 begins to normalize/increase