Foreign body/obstruction

Question 1

Etiology of wheezing

Answer 1

• RSV and other viruses can cause airway inflammation leading to wheezing
• many wheezy kids don’t have asthma
• bronchodilators and steroids don’t really help with viral wheezing

Question 2

Asthma Pathophys

Answer 2

hetergeneous condition –> inflammation of airways, mucus hypersecretion, reversible airflow obstruction with bronchodilators

Question 3

Asthma symptoms

Answer 3

recurrent coughing and wheezing that is responsive to bronchodilators or steroids

Question 4

Asthma triggers and diagnosis

Answer 4

Triggers - URI, allergens, cold, exercise, smoke

Diagnosis - responds to therapy and has no other explanation

Question 5

Asthma vs Reactive Airway Disease

Answer 5

some people like to use RAD instead of using asthma in very young kids because they don’t want to label them as asthmatics if they truly do not have asthma

Question 6

Signs of respiratory distress

Answer 6

Paradoxical breathing - force of contraction exceeds ability of chest wall to expand (chest drawn inward during inspiration)
Tachypnea
Subcostal retractions
Nasal Flaring
Grunting
Head bobbing

Question 7

Most serious and worrisome sign of respiratory distress?

Answer 7

Paradoxical breathing

Question 8

Interventions for respiratory distress

Answer 8

Blow-by oxygen, nasal cannula, mask, or ETT

Question 9

Causes of wheezing in toddlers

Answer 9

Common - Viral bronchiolitis, asthma, foreign body, GERD

Uncommon - tracheomalacia, compression, CF

Question 10

Causes of coughs in toddlers

Answer 10

viral illness, pneumonia, post-nasal drip, foreign body, GERD

Question 11

Key history info for cough

Answer 11

Still drinking?
Fever?
Sudden onset?
Hoarse voice or cry?
Barky cough?
Other problems?
Immunizations?
Sick contacts?
Smoke exposure?

Question 12

DDx for infant with cough

Answer 12

Allergies, asthma
Bronchiolitis, croup, PNA, pertussis
foreign body, sinusitis, anatomic abnormality
Viral URI, GERD, CF

Question 13

Extrinsic causes of wheezing

Answer 13

Vascular ring or sling
adenopathy
mass or lesion

Question 14

Key findings on lung exam

Answer 14

Stridor - airway narrowing ABOVE thoracic inlet (usually inspiration)
Wheezing - airway narrowing AT thoracic inlet (mucus plugging, asthma)
Rhonchi - coarse, low-pitched rattling sound
Crackles - inspiration, fluid in alveoli
Air entry - should be noted on every exam

Question 15

Asymmetric breath sounds

Answer 15

unilateral airway obstruction –> think foreign body, PTX, atelectasis

Question 16

Evaluation for foreign body

Answer 16

1. PA and lateral chest films

2. Bilateral decubitus inspiratory/expiratory films

Question 17

Radiographic findings of asthma

Answer 17

hyperinflation of lungs due to airway trapping, increased interstitial markings, patchy atelectasis

Question 18

Treatment of asthma

Answer 18

beta-2 agonists, corticosteroids, could have inhaled corticosteroids
Prognosis dependent on severity of disease and adherence to medication regimen

Question 19

Bronchiolitis

Answer 19

viral disease of lower respiratory tract

• bronchiolar obstruction due to inflammation and edema (mucus and cellular debri)
• RSV, influenza, parainfluenza
• low grade fever, cough, tachypnea, congestion

Question 20

Bronchiolitis radiographic findings

Answer 20

hyperinflation, increased interstitial markings, peribronchial cuffing, scattered atelectasis

Question 21

Treatment of bronchiolitis

Answer 21

supportive –> maintain oxygenation and hydration

Question 22

Pneumonia

Answer 22

inflammation of lung parenchyma
Viral - adenovirus, RSV, influenza, parainfluenza
Bac - GBS, e. coli (neonates), chlamydia (4-12), strep pneumo (rest)

Question 23

Signs and symptoms of pna

Answer 23

fever, cough, tachypnea, low O2 sats, malaise

- crackles on lung exam

Question 24

Treatment of PNA

Answer 24

Viral - supportive

Bac - amoxicillin (80-90 mg/kg split BID)

Question 25

Radiographic findings of PNA

Answer 25

Viral - “fluffiness” and patchy infiltrates

Bac - consolidated opacity or infiltrates in specific lobes

Question 26

Sequelae of foreign body

Answer 26

Irritative objects can result in more inflammation –> pneumonitis or erosion of healthy tissue
If total airway obstruction –> medical emergency