Cardiology and Pulm

Question 1

Inspiratory stridor

Answer 1

Obstruction above the glottis

• Laryngomalacia (4-6wk old, stridor worse supine or agitated; omega shaped epiglottis)
• Vocal cord paralysis (hoarse/weak cry; stridor at rest, can be expiratory too)
• Pertussis (whoop and paroxysmal cough)
• Croup (barky cough; steeple sign on Xray)
• Mass

Question 2

Expiratory stridor

Answer 2

Obstruction in the lower trachea

• Tracheomalacia (4-6wk old, stridor worse supine)
• Vascular ring (trouble feeding since birth, dx with barium swallow)

Question 3

Biphasic stridor

Answer 3

Fixed obstruction/stenosis
-Subglottic stenosis
Epiglottitis (supraglottic stenosis; thumbprint sign, drool)

Question 4

Choanal atresia

Answer 4

Loud sonorous breathing since birth, better when agitated, worse at rest

Question 5

Intermittent asthma

Answer 5

• Daytime symptoms twice or less per week
• Nighttime symptoms twice or less per month (none if <4yo)
• %PredictedFEV1 >80%
• Tx: Intermittent inhaler

Question 6

Mild persistent asthma

Answer 6

• Daytime symptoms three or more times per week
• Night: three or more times per month (twice per month if <4yo)
• %PredictedFEV1 >80%
• Tx: Intermittent inhaler plus regular inhaled corticosteroids

Question 7

Moderate persistent asthma

Answer 7

• Day: Daily symptoms
• Night: Weekly (three or more times/month if <4yo)
• %PredictedFEV1 60-80%
• Tx: Intermittent inhaler, plus regular inhaled corticosteroids, plus long-acting beta agonist

Question 8

Severe persistent asthma

Answer 8

• Day: Continuous symptoms (multiple times per day)
• Night: Nightly (or weekly if <4yo)
• %PredictedFEV1 <60%
• Tx: Intermittent inhaler, plus regular inhaled corticosteroids, plus long-acting beta agonist

Question 9

Premature beats

Answer 9

Abnormal in fetus -> get fetal ECHO to eval for congenital heart disease.
In older kids, 3-4/min is okay. If >5, check electrolytes and get an EKG.