PNP AC Pulmonary Pediatric Nurse
Practitioner - Acute Care 2024 Exam Review
Questions and Answers 100% Pass
acute laryngotracheobronchitis (CROUP) - Answer>> Peak 6 months to 3 years. Viral. PARA FLU, ADENOVIRUS, RSV
Xray are not to document
the diagnosis but rather to exclude other,
more serious, causes of upper airway obstruction
that require intervention. Best seen on frontal xray. inverted V or a
church steeple
laryngotracheobronchitis (croup) LTB - Answer>> effects of Dexamethasone 0.6mg/kg steroids can be seen within 6 hours
Diff from epiglottis = history of URI symptoms, barking cough* Peds: narrowest airway is at cricotracheal junction.
laryngotracheobronchitis (CROUP) - Answer>> Subglottic airway- larynx, trachea, and bronchi High in 3 months to 3 yrs. Parainfluenza** Symptoms can last for up to 1 week .
Tx: Humidified air, fever control, one time dose of Dexamethasone 0.6mg/kg. Nebulized epineb. (0.5ml of2.25% in 3
ml of NS)- at risk for rebound for 4 hours post neb. Heliox 70-30 (improves laminar air flow through narrow airway)
Epiglotitis - Answer>> Hemophilus influenzae a paraflu, H flu ( nontypable) GAS, strep Pneumo toxic appearing.
abrupt stridor, dysphagia, fever, restlessness
The patients are typically
older than those with croup; the classically
described peak incidence occurs at age 3.5. Obtain a Lateral radiography of neck will reveal a large epiglottis with extension of the hypopharynx " thumb sign"
Epiglotitis - Answer>> pending cultures: 7-10 day course of 3rd gen cephalosporin + or - Vancomycin if MRSA is suspected.
Epiglottis - Answer>> H influenza * cases reduced since invention of vaccine. Less likely causes : S.pneumo, s. aureus, B-
hemo-strep. AP lateral neck "thumb sign" at epiglottis.
Exudative tracheitis - Answer>> purulent infection of the trachea
in which exudative plaques form along the tracheal
walls (much like those seen in diphtheria).6 to 10 years. Staph areus
Hemangioma - Answer>> Facial hemangiomas in the
"beard" distribution have been associated symptomatic
airway hemangiomas, which should raise the
providers concern for airway compromise Subglottic stenosis - Answer>> 3rd most common anomaly of larynx. Males* small cricoid cartilage with associated thickening of sub mucous layer. PE: May be NO sx until URI or cold. Stridor and barking cough. Often diagnosed with chronic laryngotracheobronchitis (CROUP). ** recurrent croup** red flag Dx made if lumen is < 4mm in term infant. Tx: Balloon dilation, tracheostomy, rib plasty.
laryngomalacia - Answer>> most common cause of stridor and congenital abnormality of larynx* males* Not necessarily in prematurity symptoms are absent at birth, arise @ 2-4w. inspiratory stridor worse when supine* poor feeding, GERD, Pt has normal cry and rarely respiratory distress. Dx: Awake laryngoscopy= elongated and laterally extended omega epiglottis, that falls posteriorly on itself on inspiration. **collapse of aryepiglottic folds on inspiration** 15 % will require trach. co-existing GERD worsens patho. Tx: Acid reflux precautions, OR for epiglottoplasty ( dividing aryepiglottic folds and trimming epiglottis)
Tracheomalacia - Answer>> trachea is floppy. collapsing during
inspiration and expiration. Primary ( deformity of tracheal rings) secondary (vascular rings, TE fistula repair). PE: stridor, wheeze, barking cough. "drying spells" - reflex apnea with Cardiac arrest
Vocal cord paralysis - Answer>> 2nd most common cause of larynx anomaly. unilateral (trauma) or bilateral (CNS dx). May spontaneously resolve by 2 yrs. Asymptomatic unless agitated.
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