PAEA PEDIATRICS EOR CORE MAIN QUESTIONS AND
ANSWERS SET A+
✔✔what is Samter's triad? - ✔✔asthma, nasal polyps, ASA/NSAID allergy (associated
w/ atopic dermatitis)
✔✔what are the 3 pathophysiology mechanisms behind asthma? - ✔✔1. airway
hyperreactivity (to allergies, smoke, viral URIs, etc.)
2. bronchoconstriction
3. inflammation
✔✔Dx? inability to speak in full sentences, PEFR <40% predicted, AMS (ominous),
pulus paradoxus (inspiratory dec in SBP >10), cyanosis, "tripod position", "silent chest"
(no air exchange) or wheezing, tachycardia, severe tachypnea - ✔✔dx: severe asthma
or status asthmaticus
✔✔how is asthma diagnosed? - ✔✔1. PFT showing reversible obstruction (dec FEV1,
dec FEV1/FVC ratio)
2. bronchoprovocation: 1) methacholine challenge (>/=20% *dec* in FEV1) 2)
bronchodilator challenge (>/=12% *inc* in FEV1) 3) exercise challenge (>/=15% *dec* in
FEV1)
3. peak expiratory flow rate (PEFR): best way to measure asthma exacerbation in ER
(nml 400-600)
4. pulse ox <90% = significant distress
5. ABG to assess hypoxia/hypercapnia
6. CXR to r/o other etiologies; may show hyperinflation
✔✔what are the 3 types of drugs used to treat an acute exacerbation of asthma? & their
MOA? - ✔✔1. short acting beta agonist (SABA)- albuterol, levalbuterol, terbutaline,
epinephrine (given 3x Q20 min or continuously then re-evaluated) bronchodilators
2. anticholinergics- ipratropium (central bronchodilator, reducing vagal-mediated
bronchosconstriction & inhibits nasal secretions; synergy w/ B agonists) but beware of
can't pee, see, spit, shit S/Es
,3. corticosteroids- prednisone, methylprednisolone, prednisolone (anti-inflammatory)
✔✔what are the maintenance control medications for asthma? & their MOAs? - ✔✔1.
*inhaled corticosteroids* (DOC for maintenance meds)- beclomethasone, flunisolide,
triamcinolone; works by cytokine and inflammation inhibition
2. long acting Beta agonist (*LABAs*)- salmeterol, formoterol but only show to have
positive effects if given WITH a ICS (there are combo meds); bronchodilators
3. mast cell modifiers- cromolyn, nedocromil; given as prophylaxis only decreasing
airway reactivity to cold air, exercise, sulfites, etc.)
4. leukotriene modifiers/receptor antagonists (LTRA)- montelukast, zafirlukast, zileuton;
prophylaxis only- best for pts w/ allergic rhinitis/ASA induced asthma; blocks
leukotriene-mediated neutrophil migration, capillary permeability, smooth muscle
contraction
5. theophylline- leukotriene inhibiting bronchodilator used only for prophylaxis but has
many side effects and a narrow therapeutic index
6. *omalizumab*- anti-IgE Ab; injection given Q2 wks for mod-severe persistent allergic
asthma
✔✔how often are asthma symptoms present that require SABA usage per day and per
week for intermittent, mild, moderate, vs severe asthma? - ✔✔-intermittent: ≤2/day,
≤2/wk
-mild: >2 days/wk
-moderate: daily
-severe: multiple times a day
✔✔what will the FEV1 and FEV1/FVC ratio of pts w/ intermittent, mild, moderate, vs
severe asthma be? - ✔✔-intermittent: FEV1 > 80% predicted, FEV1/FVC nml
-mild: FEV1 ≥ 80% predicted, FEV1/FVC nml
-moderate: FEV1 60-80% predicted, FEV1/FVC reduced by 5%
-severe: FEV1 <60% predicted, FEV1/FVC reduced >5%
✔✔what are the daily treatment recommendations for intermittent, mild, moderate, and
severe asthma control? - ✔✔-intermittent: SABA prn
-mild: SABA prn + low dose ICS daily
-mod: low dose ICS + LABA OR med dose ICS +/- LTRA
-severe: high dose ICS + LABA +/- Omalizumab
*remember all forms of asthma need a rescue inhaler/SABA to use prn*
✔✔the most commonly acquired causes of neonatal PNA are? tx? - ✔✔-*group B strep*
(streptococcus agalactiae) found in vagina/rectum of mother, listeria monocytogenes,
GNR (e. coli, klebsiella pneumoniae- currant jelly sputum)
-tx: *ampicillin DOC*, augmentin if unresponsive, macrolides or cephalosporins good
too
, ✔✔community acquired pneumonia is most commonly caused by? how does sputum
appear? tx? - ✔✔-*strep. pneumoniae*
-sputum: rusty (blood-tinged)
-tx: *macrolide*, doxycycline, B lactam, or broad spectrum FQ if severe
✔✔"walking pneumonia" is most commonly caused by? what else is seen on PE?
workup? tx? - ✔✔-*mycoplasma pneumoniae*- seen in school-aged children, college
students, and military recruits
-ear pain, bullous myringitis, persisitent non-productive cough
-w/u: PCR, serum cold agglutinin test & serology/enzyme immunoassays (serum or
sputum Ab detection)
-tx: macrolide or tetracycline
✔✔what is the most common cause of viral pneumonia in children/infants? tx? - ✔✔-
*RSV* & parainfluenza
-tx: supportive + bronchodilators, corticosteroids, ribavirin in immunosuppressed pts or
those w/ severe lung/heart dz
✔✔what congenital heart defect is the 2nd MC and usually asymptomatic until 30 years
old, causes a systolic ejection murmur best heard at the pulmonic (L upper sternal
border) area, *widely split fixed S2*? tx? - ✔✔-atrial septal defect
-tx: observation- most close spontaneously unless symptomatic then can perform
surgical correction usually b/t 2-4 y/o
✔✔what is the most common location of atrial septal defects? - ✔✔1. ostium secundum
(80%)
2. ostium primum
3. sinus venosus
✔✔what are the cyanotic congenital heart conditions? - ✔✔5 T's: tetraology of fallot,
TOGA (transposition of great arteries), TAPVC (total anomalous pulmonary venous
return), truncus arteriosus, tricuspid atresia
✔✔Dx? systolic murmur radiating to back/scapula/chest, inc BP in upper > lower
extremities, rib notching on XR (collateral flow), LVH on ECG, bilateral LE claudication
(pain), "3 sign" of descending aorta on CXR; tx? - ✔✔dx: coarctation of aorta
tx: surgical correction, balloon angioplasty +/- stent, prostaglandin preoperatively to
improve blood flow to LE
✔✔what other common abnormality is found in patients w/ coarctation of the aorta? -
✔✔70% also have bicuspid aortic valves
✔✔patent ductus arteriosus is a communication between what 2 vessels? what can
occur if PDA is left untreated? - ✔✔-pulmonary artery and descending aorta
ANSWERS SET A+
✔✔what is Samter's triad? - ✔✔asthma, nasal polyps, ASA/NSAID allergy (associated
w/ atopic dermatitis)
✔✔what are the 3 pathophysiology mechanisms behind asthma? - ✔✔1. airway
hyperreactivity (to allergies, smoke, viral URIs, etc.)
2. bronchoconstriction
3. inflammation
✔✔Dx? inability to speak in full sentences, PEFR <40% predicted, AMS (ominous),
pulus paradoxus (inspiratory dec in SBP >10), cyanosis, "tripod position", "silent chest"
(no air exchange) or wheezing, tachycardia, severe tachypnea - ✔✔dx: severe asthma
or status asthmaticus
✔✔how is asthma diagnosed? - ✔✔1. PFT showing reversible obstruction (dec FEV1,
dec FEV1/FVC ratio)
2. bronchoprovocation: 1) methacholine challenge (>/=20% *dec* in FEV1) 2)
bronchodilator challenge (>/=12% *inc* in FEV1) 3) exercise challenge (>/=15% *dec* in
FEV1)
3. peak expiratory flow rate (PEFR): best way to measure asthma exacerbation in ER
(nml 400-600)
4. pulse ox <90% = significant distress
5. ABG to assess hypoxia/hypercapnia
6. CXR to r/o other etiologies; may show hyperinflation
✔✔what are the 3 types of drugs used to treat an acute exacerbation of asthma? & their
MOA? - ✔✔1. short acting beta agonist (SABA)- albuterol, levalbuterol, terbutaline,
epinephrine (given 3x Q20 min or continuously then re-evaluated) bronchodilators
2. anticholinergics- ipratropium (central bronchodilator, reducing vagal-mediated
bronchosconstriction & inhibits nasal secretions; synergy w/ B agonists) but beware of
can't pee, see, spit, shit S/Es
,3. corticosteroids- prednisone, methylprednisolone, prednisolone (anti-inflammatory)
✔✔what are the maintenance control medications for asthma? & their MOAs? - ✔✔1.
*inhaled corticosteroids* (DOC for maintenance meds)- beclomethasone, flunisolide,
triamcinolone; works by cytokine and inflammation inhibition
2. long acting Beta agonist (*LABAs*)- salmeterol, formoterol but only show to have
positive effects if given WITH a ICS (there are combo meds); bronchodilators
3. mast cell modifiers- cromolyn, nedocromil; given as prophylaxis only decreasing
airway reactivity to cold air, exercise, sulfites, etc.)
4. leukotriene modifiers/receptor antagonists (LTRA)- montelukast, zafirlukast, zileuton;
prophylaxis only- best for pts w/ allergic rhinitis/ASA induced asthma; blocks
leukotriene-mediated neutrophil migration, capillary permeability, smooth muscle
contraction
5. theophylline- leukotriene inhibiting bronchodilator used only for prophylaxis but has
many side effects and a narrow therapeutic index
6. *omalizumab*- anti-IgE Ab; injection given Q2 wks for mod-severe persistent allergic
asthma
✔✔how often are asthma symptoms present that require SABA usage per day and per
week for intermittent, mild, moderate, vs severe asthma? - ✔✔-intermittent: ≤2/day,
≤2/wk
-mild: >2 days/wk
-moderate: daily
-severe: multiple times a day
✔✔what will the FEV1 and FEV1/FVC ratio of pts w/ intermittent, mild, moderate, vs
severe asthma be? - ✔✔-intermittent: FEV1 > 80% predicted, FEV1/FVC nml
-mild: FEV1 ≥ 80% predicted, FEV1/FVC nml
-moderate: FEV1 60-80% predicted, FEV1/FVC reduced by 5%
-severe: FEV1 <60% predicted, FEV1/FVC reduced >5%
✔✔what are the daily treatment recommendations for intermittent, mild, moderate, and
severe asthma control? - ✔✔-intermittent: SABA prn
-mild: SABA prn + low dose ICS daily
-mod: low dose ICS + LABA OR med dose ICS +/- LTRA
-severe: high dose ICS + LABA +/- Omalizumab
*remember all forms of asthma need a rescue inhaler/SABA to use prn*
✔✔the most commonly acquired causes of neonatal PNA are? tx? - ✔✔-*group B strep*
(streptococcus agalactiae) found in vagina/rectum of mother, listeria monocytogenes,
GNR (e. coli, klebsiella pneumoniae- currant jelly sputum)
-tx: *ampicillin DOC*, augmentin if unresponsive, macrolides or cephalosporins good
too
, ✔✔community acquired pneumonia is most commonly caused by? how does sputum
appear? tx? - ✔✔-*strep. pneumoniae*
-sputum: rusty (blood-tinged)
-tx: *macrolide*, doxycycline, B lactam, or broad spectrum FQ if severe
✔✔"walking pneumonia" is most commonly caused by? what else is seen on PE?
workup? tx? - ✔✔-*mycoplasma pneumoniae*- seen in school-aged children, college
students, and military recruits
-ear pain, bullous myringitis, persisitent non-productive cough
-w/u: PCR, serum cold agglutinin test & serology/enzyme immunoassays (serum or
sputum Ab detection)
-tx: macrolide or tetracycline
✔✔what is the most common cause of viral pneumonia in children/infants? tx? - ✔✔-
*RSV* & parainfluenza
-tx: supportive + bronchodilators, corticosteroids, ribavirin in immunosuppressed pts or
those w/ severe lung/heart dz
✔✔what congenital heart defect is the 2nd MC and usually asymptomatic until 30 years
old, causes a systolic ejection murmur best heard at the pulmonic (L upper sternal
border) area, *widely split fixed S2*? tx? - ✔✔-atrial septal defect
-tx: observation- most close spontaneously unless symptomatic then can perform
surgical correction usually b/t 2-4 y/o
✔✔what is the most common location of atrial septal defects? - ✔✔1. ostium secundum
(80%)
2. ostium primum
3. sinus venosus
✔✔what are the cyanotic congenital heart conditions? - ✔✔5 T's: tetraology of fallot,
TOGA (transposition of great arteries), TAPVC (total anomalous pulmonary venous
return), truncus arteriosus, tricuspid atresia
✔✔Dx? systolic murmur radiating to back/scapula/chest, inc BP in upper > lower
extremities, rib notching on XR (collateral flow), LVH on ECG, bilateral LE claudication
(pain), "3 sign" of descending aorta on CXR; tx? - ✔✔dx: coarctation of aorta
tx: surgical correction, balloon angioplasty +/- stent, prostaglandin preoperatively to
improve blood flow to LE
✔✔what other common abnormality is found in patients w/ coarctation of the aorta? -
✔✔70% also have bicuspid aortic valves
✔✔patent ductus arteriosus is a communication between what 2 vessels? what can
occur if PDA is left untreated? - ✔✔-pulmonary artery and descending aorta
