pediatrics

Question 1

croup

Answer 1

• viral infection
• subglottic edema
• age 6mos-6yrs
• low grade fever
• substernal retractions
• stridor
• steeple sign

Question 2

croup tx

Answer 2

1. O2 28-40% immediate
2. racemic epi 0.5-1 in 3ml saline
3. decadron if unresponsive to racemic epi

Question 3

epiglottitis

Answer 3

• supraglottic edema
• bacterial infection (haemophilus infuenza b)
• rapid progression
• high fever
• body bent at waist, head in sniffing position

Question 4

epiglottitis management

Answer 4

1. sedate and intubate
2. xray to confirm diagnosis
3. IMV 2-8breaths/min to maintain PCO295%
4. antibiotics
   * attempt extubation after upper airway leak detected

Question 5

bronchiolitis

Answer 5

-viral infection (RSV)

-

Question 6

bronchiolitis diagnosis

Answer 6

1. immunoflourescent assay (IFA) -antibody staining of nasopharyngeal secretions
2. xray- hyperinflation, alveolar infiltrates, consolidation

Question 7

bronchiolitis tx

Answer 7

1. fluid intake
2. decongestants
3. O2 w/humidity
4. bronchodilator
5. IV fluids
6. bronchial hygiene
7. antibiotics

Question 8

CF

Answer 8

• polycythemia
• cor pulmonale (end stage)
• sweat test: >60 children, >80 adults
• decreased flows, increases FRC and TLC
• Xray similar to COPD

Question 9

CF tx

Answer 9

1. aggressive CPT
2. bronchodilators
3. expectorants
4. mucolytics (acetylcysteine, pulmozyme)
5. antibiotics (aerolized tobramycin 2xday, every other month

Question 10

near drowning

Answer 10

• fluffy infiltrates
• 100% O2 therapy
• nasal/bronchoscope assisted intubation

Question 11

need for neonatal resuscitation

Answer 11

based on

1. term gestation
2. breathing/crying
3. muscle tone

Question 12

newborn HR less than 100

Answer 12

1. institute PPV 40-60 breaths/min with bag-valve device

2. pressures of 20-40cmH2O

Question 13

newborn HR less than 60

Answer 13

consider intubation

1. PPV
2. chest compressions

Question 14

meconium aspiration tx

Answer 14

1. supplemental O2
2. intubation
3. suction
4. mech ventilation
5. CPAP for hypoxemia

Question 15

RDS

Answer 15

hyaline membrane disease - deficiency in surfactant associated with prematurity

Question 16

L/S ratio

Answer 16

less than 2- increased risk for RDS

less than 1-high risk for RDS

Question 17

RDS tx

Answer 17

1. nasal CPAP (4-6 cmH20)
2. mech ventilation (PEEP, HFV)
3. surfactant replacement therapy

Question 18

infant apnea

Answer 18

cessation of breathing >15secs

Question 19

apnea tx

Answer 19

1. CPAP
2. aminophylline(theophylline)
3. O2 for hypoxemia(24-50%)
4. mechanical vent

Question 20

bronchopulmonary displasia

Answer 20

ALI or barotrauma/atelectasis due to prolonged mech vent

Question 21

bronchopulmonary displasia tx

Answer 21

1. CPAP w low FiO2
2. low volumes, PEEP, PIP
3. diuretics
4. antibiotics
5. bronchodilators (theophylline)

Question 22

right to left shunt

Answer 22

• severe/marked cyanosis
• use low PIP/PEEP
• FiO2 24-50%
  1. tetrology of fallot *boot-shaped heart
  2. transposition of great vessels *egg-shaped heart

Question 23

left to right shunt

Answer 23

• no/mild cyanosis
• use high PIP/PEEP
• FiO2 24-50%
  1. PDA
  2. coarctation of aorta