Lower Airway Obstruction

Question 1

Lower Airway Obstruction

Answer 1

Bronchiolitis

Asthma

Question 2

1st 2 years of life
RSV
prodrome of cough, colds, fever

CXR - not routine

Answer 2

BRONCHIOLITIS

Question 3

Chronically inflamed airways and increased production of mucus

NOCTURNAL cough

Bronchospasm

WHEEZING

Answer 3

ASTHMA

Question 4

Signs of Lower Airway Obstruction

Answer 4

tachypnea

wheezing - EXPIRATORY
increased respiratory effort

PROLONGED EXPIRATORY PHASE

cough

Question 5

MC trigger of asthma in children

Answer 5

VIRAL URTI

Question 6

CXR findings in bronchiolitis and asthma

Answer 6

Hyperinflation
Atelectasis (+/-)
Infiltrates

Question 7

GINA Guidelines/PAPP 2021

Answer 7

Classify based on Severity

Intermittent
Persistent (mild, moderate, severe)

Classify levels of asthma control
Uncontrolled
Partly controlled
Controlled

Question 8

Consider hospital admission in asthma when patient has any of the ff clinical criteria

Answer 8

use of >6-8 SABA puffs in the past 24 hrs

PEF 50-75% of personal best

history of severe exacerbations warranting ICU admission

hospital admission or previous exacerbations for the past 12 mos

Question 9

WHO Resting RR (Normal for age)

Answer 9

1 mo - 12 mo - < 50
1-5 y/o - < 40
6-10 y/o - < 30
11-18 y/o - < 20

Question 10

Target O2 sat for 6-11 y/o with asthma

Answer 10

94-98%

Question 11

Target O2 sat for adolescents with asthma

Answer 11

93-95%

Question 12

O2 sat that is a predictor of HOSPITALIZATION

Answer 12

92%

Question 13

O2 sat that warrants AGGRESSIVE THERAPY

Answer 13

90%

Question 14

Patients not on controller meds should be started on

Answer 14

regular ICS containing Tx

Question 15

The most cost effective delivery (inhaler)

Answer 15

delivery via pMDI

Question 16

pMDI plus spacer with face mask

Answer 16

0-3 years

Question 17

pMDI plus spacer with mouthpiece

Answer 17

4-5 years

Question 18

Systemic Corticosteroids

Answer 18

Prednisone/Prednisolone
Methylprednisolone
Dexamethasone

Question 19

Should be given to prevent future severe exacerbations and hospitalizations and to reduce deaths

Answer 19

Inhaled corticosteroids

Question 20

For moderate to severe exacerbations across all ages – greater improvement in lung function and fewer hospitalizations

Answer 20

Ipratropium bromide

Question 21

NOT routinely given for acute exacerbation

Add on treatment in the 1st hour in severe exacerbations

Answer 21

Magnesium sulfate

Question 22

Level of Asthma Symptom Control

Answer 22

Well controlled - 0
Partially controlled - 1-2
Uncontrolled - 3-4

Question 23

Symptoms less than 2x a month

Answer 23

PREFERRED CONTROLLER
low dose ICS whenever SABA is taken

RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART

Question 24

Symptoms 2x a month or more but less than daily

Answer 24

PREFERRED CONTROLLER
daily low dose ICS

RELIEVER
as needed SABA or low dos ICS-formoterol reliever for MART

Question 25

Symptoms most days or waking at night once or more in a week

Answer 25

PREFERRED CONTROLLER daily low dose ICS-LABA or medium dose ICS or very low dose MART (ICS-formoterol) RELIEVER as needed SABA or low dos ICS-formoterol reliever for MART

Question 26

Symptoms most days or waking at night once a week and/or low lung function

Answer 26

PREFERRED CONTROLLER medium dose ICS-LABA or low dose ICS formoterol MART or refer RELIEVER as needed SABA or low dos ICS-formoterol reliever for MART

Question 27

(+) wheezing hx of viral infection among the family members 2 y/o

Answer 27

Bronchiolitis

Question 28

(+) wheezing hx of atopy in the family recurrent wheezing especially after mild viral infection or exercise

Answer 28

Asthma

Question 29

(+) wheezing wheezes are heard loudest over the trachea persistent wheezing never seems to go way

Answer 29

Chondromalacia

Question 30

(+) wheezing (-) breath sounds R lung 3 y/o

Answer 30

Foreign Body Airway Obstruction

Question 31

4 things to check about asthma control

Answer 31

daytime symptoms more than 2x a week night walking need for reliever > 2x a week activity limitation

Question 32

Preferred reliever for adolescents w/ asthma

Answer 32

ICS-formoterol

Question 33

MCC of stridor in infants and children

Answer 33

Laryngomalacia

Question 34

Differentiates PCAP-B from PCAP-A

Answer 34

Malnutrition | Comorbid conditions

Question 35

Respiratory signs present in PCAP D but not in PCAP C

Answer 35

Cyanosis Grunting Apnea

Question 36

MCC of pneumonia in children worldwide

Answer 36

Viruses