CLIPP 12 - Foreign Body

Question 1

DDX wheezing (7)

Answer 1

• viral bronchiolitis
• asthma
• foreign body aspiration
• GERD
• tracheomalacia
• extrinsic compression
• cystic fibrosis

Question 2

Components of an asthma history (3)

Answer 2

• prior hospitalizations
• ICU admissions
• intubations

Question 3

Signs of respiratory distress (6)

Answer 3

• paradoxical breathing (chest draws inward on inspiration)
• tachypnea (hyperpnea vs hypopnea)
• retractions (accessory muscle use)
• nasal flaring (nares enlarge during inspiration)
• grunting (forced expiration against partially closed glottis)
• head bobbing (Accessory muscle use)

Question 4

DDX cough (5)

Answer 4

• URI
• pneumonia
• post-nasal drip (allergies/sinusitis)
• foreign body aspiration
• GERD

Question 5

Bordatella Pertussis (course, complications, immunization)

Answer 5

• course: triphasic (catarrhal/URI - 1-2wks, paroxysmal/whoop 4-6wks, convalescent-months)
• complications: difficulty feeding, apnea
• immunization: acellular vaccine recommended for all children

Question 6

Epiglottitis (8 symptoms)

Answer 6

• uncommon since Hib vaccine
• fever, stridor, drooling, dysphonia, dysphagia, respiratory distress
• sniffing position
• thumb sign

Question 7

Diphteria (1 symptom)

Answer 7

• uncommon is US due to immunization

- grey pseudomembrane

Question 8

Asthma pathophys (4)

Answer 8

• infiltration of inflammatory cells into airway mucosa
• mucus hypersecretion
• mucosal edema
• bronchoconstriction

Question 9

Acute asthma presentation (7)

Answer 9

-cough, wheezing, tachypnea, dyspnea, diminished air exchange, cyanosis, pulsus paradoxus

Question 10

asthma radiographic findings (3)

Answer 10

• hyperinflation
• increased interstitial markings
• patchy atelectasis

Question 11

bronchiolitis (causes, symptoms, CXR findings, treatment)

Answer 11

• viral disease of lower respiratory tract (RSV, influenza, parainfluenza)
• cough, wheezing, dyspnea, fever
• hyperinflation, increased interstitial markings, peribronchial cuffing, scattered atelectasis on CXR
• supportive treatment

Question 12

Pneumonia (causes, symptoms, treatment)

Answer 12

• adenovirus, RSV, parainfluenza, influenza
• GBS, E. coli, Klebsiella (neonates)
• C. pneumonia (staccato cough), Strep pneumo, mycoplasma
• URI, worsening cough, fever, tachypnea, crackles
• treat bacterial pneumonia with abx

Question 13

Croup (causes, findings, treatment)

Answer 13

• parainfluenza, rhinovirus, RSV, influenza, adenovirus
• steeple sign (narrowed subglottic region)
• barky cough
• supportive care

Question 14

Wheezing Radiographic studies (3)

Answer 14

• inspiratory/expiratory (unilateral airtrapping)
• PA (hemidiaphragm flattening)
• R/L decubitus (mediastinal shift)

Question 15

cough history key information (8)

Answer 15

• oral intake
• fever
• witnessed foreign body ingestion
• onset
• hoarseness
• barky cough/wheezing/stridor
• immunization status
• other medical problems