Approach To Wheeze Flashcards
What is a wheeze?
A continuous musical sound heard during chest auscultation
How is a wheeze produced?
By the oscillation of opposing walls of an airway narrowed almost to the point of closure
Wheezing requires ___ to generate airway oscillation and produce sound in addition to ___.
Sufficient airflow; Narrowing or compression of the airway
What are the causes of acute wheezing (hours-days)?
1) Asthma
2) Infections
3) Foreign body aspiration (sudden
onset)
What are the structural causes of chronic wheezing?
1) Anomalies of the tracheobronchial tree
2) Mediastinal masses
3) Retained foreign body
4) Cardiovascular disease
What are the non-structural causes of chronic wheezing?
1) Asthma
2) Aspiration syndromes
3) Bronchopulmonary dysplasia
4) Paradoxical vocal cord motion
5) Cystic fibrosis
6) Primary ciliary dyskinesia
7) Primary immunodeficiencies
8) Bronchiolitis obliterans
What is the most frequent cause of recurrent wheezing?
Asthma
Which findings support the diagnosis of Asthma?
1) Evidence of atopic disease
2) Intermittent triggered episodes of wheezing
3) Family history of asthma and/or atopy
4) Good response to asthma medications
5) Positive asthma predictive index
What are some common triggers for Asthma?
1) Upper respiratory infections
2) Weather changes
3) Exercise
4) Allergens
What is the most common cause of acute wheezing in infants <2 years?
Bronchiolitis
Which viruses commonly cause Bronchiolitis?
1) Syncytial virus RSV! (MOST COMMON)
2) Rhinovirus
3) Paramyxoviruses:
a) Parainfluenza virus
b) Metapneumovirus
Foreign Body Aspiration should be suspected in ANY patient who presents with:
Wheezing of sudden onset, especially one sided
What tests can be useful in establishing the underlying etiology of wheezing?
1) Radiographic examination
2) Pulmonary function testing (PFT)
3) Bronchoscopy
4) Sweat chloride concentration
5) Selective laboratory studies
If a wheeze presents later on in childhood to adolescence, what should you suspect?
Vocal cord dysfunction
A prolonged ___(inspiratory/expiratory) phase suggests airway narrowing
Expiratory
Focal wheezing is usually indicative of a localized and mostly structural airway abnormality, and, therefore, airway evaluation by ____ is warranted.
Imaging or bronchoscopy
Focal wheezing is usually indicative of a localized and mostly ___(structural/non-structural) airway abnormality, and, therefore, airway evaluation by imaging or bronchoscopy is warranted.
Structural
Early inspiratory crackles are often present in patients with:
Asthma
Late inspiratory crackles are often present in patients with:
1) Interstitial Lung Disease
2) Early Congestive Heart Failure
The presence of nasal polyps in children necessitates an evaluation for:
Cystic Fibrosis
A chest radiograph (AP and lateral films) should be obtained in:
1) Children with new-onset wheezing of undetermined etiology
2) Chronic, persistent wheezing not responding to therapies
