Module 2

Question 1

In history taking, poor feeding is asked. Why?

Answer 1

Poor feeding is a sign of severe illness

Question 2

Two types of chest wall abnormalities noted in childhood

Answer 2

Pectus excavatum (funnel chest) Pectus carinatum (chicken breast)

Question 3

True or False: in a young child, it is practical to do inspection and palpation before percussion and auscultation.

Answer 3

False. Inspection and auscultation before palpation and percussion

Question 4

Components in inspection of Chest and Lungs in children

Answer 4

Color- cyanosis or pallor Respiratory rate

Question 5

Children rely more on the _________ for breathing

Answer 5

Diaphragm

Question 6

Criteria for tachypnea according to WHO

Answer 6

0 up to 2 months old = ≥60 cycles/min

2 mos up to 12 mos old = ≥50 cycles/min

12 mos up to 5years old= ≥40 cycles/min

Question 7

Determine if child is Tachypnic: A 15-month old with a RR of 45cycles/min

Answer 7

Tachypnic ( 12mos-5years old =
≥40 cycles/min)

Question 8

Determine of the child is Tachypnic: 2 month old with RR of 30 cycles/ min

Answer 8

Normal ( 2months-12months = ≥50cycles/min)

Question 9

Determine of the child is tachypnic: 1 month old with RR of 62 cycles/min

Answer 9

Tachypnic (0 - 2 months = ≥60cycles/min)

Question 10

What are the two aspects of the infant’s breathig should be observed?

Answer 10

Audible breathing sounds and Work of breathing

Question 11

True or False: Increased rate and work of respiration are the most important signs of pneumonia in infants

Answer 11

True

Question 12

What will be the best sign for ruling OUT pneumonia in infants?

Answer 12

Absence of tachypnea

Question 13

What will be observed for work of breathing?

Answer 13

Nasal flaring

Grunting

Retractions (Chest indrawing): Supraclavicular, Intercostal and subcostal

Headbobbing

Question 14

This is an indicator of pulmonary disease before 2 years of age

Answer 14

Retractions (Chest Indrawing)

Question 15

Retractions can be observed during inspiration or expiration?

Answer 15

during inspiration

Question 16

What is Hoover’s sign?

Answer 16

Paradoxical (seesaw) breathing in. The abdomen moves outward while chest moves inward during inpiration.

Question 17

Hoover sign is an indication for what?

Answer 17

Airway obstruction or lower respiratory tract disease in infants

Question 18

What are the 5 components of APGAR score?

Answer 18

A- Appearance (Color)

P - Pulse (Heart Rate)

G - Grimace (Reflrex irritability)

A - Activity (Muscle tone)

R - Respiratory rate

Question 19

This is a subjective qualitative evaluation done at 1 and 5 minutes to determine “survivability” of the newborn.

Answer 19

Apgar Score

Question 20

A newborn was crying loudly and in active motion, has a heart rate of 102bpm, and has acrocyanosis. What is the APGAR score for this newborn? Interpret score.

Answer 20

Apgar score: 9 (1+2+2+2+2)

Normal

Question 21

Why is thermoregulation very important in newborns?

Answer 21

Variation in respiratory rate occurs if room temperature is very warm or cool: Most often tachypnea, sometimes bradypnea

Question 22

Other causes of depressed respiration in the newborn

Answer 22

Maternal environment during labor (sedatives, compromised blood supply to the child

Mechanical Obstruction by mucus

Neurological damage (birth trauma: injury to C3,C4, C5)

Question 23

True or False: Premature infants are more likely to have irregular respiratory patterns

Answer 23

True

Question 24

Sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10-15 seconds

Answer 24

Periodic breathing

Question 25

Criteria for Apnea of prematurity

Answer 25

Cessation of breathing is ≥20 seconds

Accompanied by braycardia

Centrally cyanotic (check oral cavity)

Question 26

What are the normal breath sounds?

Answer 26

Tracheobronchial = tubular sound; air being blown through a tube

Vesicular = soft and low pitched; sound of wind blowing through trees, causing the leaves to rustle

Question 27

True or False: Bronchial breath sounds heard at the bases of the lungs is normal.

Answer 27

False. Abnormal

Question 28

What are the adventitious breath sounds?

Answer 28

Crackles = cracking or bubbling sonds

Ronchi = reflect obstruction of larger airways with mucus or secretions; “halak” or harsh breath sounds

Wheeze = whistling soudn; reflect narrowing of smaller airways or bronchioles; Expiratory

Stridor = upper airway obstruction; inspiratory; high pitched, piercing sound

Grunting = Expiration; partially closed vocal cords; sign of severe respiratory distress

Question 29

True or False. Infant’s chest is normally hyperressonant throughout

Answer 29

True. Dullness = Consolidation (pneumoniar)/ mass

Question 30

This is due to lack of surfactant resulting to alveolar collapse and reduce distensibility of the lungs

Answer 30

Hyaline Membrane Disease or Respiratory Distress Syndrome

Question 31

Floppiness of the trachea

Generally bening and self-limiting with age.

PE findings: Wheezing and inspiratory stridor

Answer 31

Tracheomalacia

Question 32

Caused by parainfluenza virus which causes inflammation of subglottic area

PE findings: Harsh stridorous cough “bark of a seal”; labored breathing; retraction; inpiratory stridor; does not always present with fever

Answer 32

Croup (Laryngotracheobronchitis)

Question 33

Caused by Haemophilus influenzae type B.

Common in 3-7 years old

Acute, life-threatening: begins suddenly and progresses rapidly to full obstruction of the airway

PE findings: Unable to swallow; drooling from the open mouth; stridor; child sits straight up with neck extended, head held forward

Answer 33

Epiglottitis

Question 34

True or False: Epiglottits should be treated as a medical emergency and inserting tongue blade is a must.

Answer 34

False. Inserting tongue blade may be deadly.

Question 35

Caused by respiratory syncytial virus

Most common <6 months

Expiration becomes difficult and prolonge due to hyperinflation of lungs

PE findings: Tachypnea; Generalized retractions; Perioral cyanosis; Increased A-P diameter of thoracic cage; possible wheezing and crackles

Answer 35

Bronchiolitis

Question 36

Inflammatory response of the bronchioles and alveolar space to an infective agent (bacteria, fungal, or viral)

Answer 36

Pneumonia

Question 37

Possible PE findings in pneumonia

Answer 37

Inspection: Tachypnea; shallow breathing; nasal flaring

Palpation: Increased fremitus (due to consolidation)

Percussion: Dull (due to consolidation)

Auscultation: Crackles; Occasional ronchi; egophony, bronchophony, whispered pectoriloquy

Question 38

Inflammation of the mucus membranes of the bronchial tubes.

PE findings:

Inspection = occasional tachypnea; occasional shallow breathing

Palpation = undiminished tactile fremitus

Percussion = resonance

Auscultation = prolonged breath sounds; occasional crackles and expiratory wheeze

Answer 38

Acute Bronchitis

Question 39

Characterized by airway inflammation: mucosal edema; increased secretions; bronchoconstriction

Answer 39

Asthma

Question 40

Possible PE findings in Asthma

Answer 40

Inspections: tachypnea; dyspnea

Palpation: tachycardia; diminshed fremitus

Percussion: Hyper-resonance; limited diagphragmatic descent

Auscultation: Prolonged expiration; wheeze; diminished lung sounds