Pediatric Lung Disease

Question 1

What are the differences between adult and pediatric pulmonary physiology?

Answer 1

1. Infant’s larynx and trachea are significantly smaller than an adult.
2. The narrowest part of the pediatric airway is just below the vocal cords at the level of the cricoid cartilage.
   
   • The narrowest part of the adult airway is the vocal cords.
3. Pediatric airways are smaller in diameter** and **higher in resistance.
4. Intercostal muscles are weaker in kids
5. The diaphragm is relatively flat.
6. Ribs are horizontal

Question 2

True or False:

Intrathoracic airway obstruction usually causes stridor or a barking cough.

Answer 2

False:

EXTRATHORACIC airway obstruction usually causes stridor or a barking cough.

Question 3

The presence of the four Ds of upper airway obstruction indicate danger. What are the 4 Ds?

Answer 3

1. Dyspnea
2. Drooling
3. Dysphagia
4. Distress

In summary it is a drooling young kid, that cant breathe, swallow, and is in distress

Question 4

Which should not be on your differential diagnoses for acute stridor?

a. Croup
b. Bacterial tracheitis
c. Epiglottis
d. Foreign body
e. Scalding
f. Bronchiolitis

Answer 4

Stridor is representative of extrathoracic obsruction

• Bronchiolitis would not cause stridor
• Croup is the most common form of acute airway obstruction in kids.

Question 5

Which could be your diagnoses for acute stridor** and **high fever?

a. Croup
b. Bacterial tracheitis
c. Epiglottis
d. Foreign body
e. Scalding
f. Bronchiolitis

Answer 5

Epiglotitis prBacterial Tracheitis.

Stridor= upper airway

Fever=infection

Question 6

What is a potential problem that can occur in the embryonic phase and have effects after birth?

Answer 6

Larygomalacia

• Most common cause of stridor
• Usually presents by 6 weeks after birth
• Embryonic= Think upper airway

Question 7

What is a potential problem that can occur in the pseudoglandular phase?

Answer 7

Tracheobronchomalacia

•Clinically associated with a recurrent wheeze, a hoarse cough, and recurrent illnesses

Question 8

What is a potential problem that can occur in the canalicular phase?

Answer 8

•Any disruption of growth (diaphragmatic hernia, ligohydramnios) can lead to pulmonary hypoplasia

Question 9

What is a potential problem that can occur in the sacular/alveolar phase?

Answer 9

ARDS due to insuficcent surfactant production

Question 10

True or False:

Intrathoracic airway obstruction usually causes expiratory wheezing.

Answer 10

True

Question 11

Which should not be on your differential diagnoses for acute polyphonic wheeze?

Answer 11

•Lower Airways

–Viral pneumonia/bronchiolitis

–Cystic fibrosis

–Heart disease

–Aspiration pneumonia

–Asthma

Question 12

What happens when infants have bronchiolitis?

Answer 12

Nasal obstruction + Decreased Lung compliance

• Leads to Retractions
• Tachypnea (to maintain minute ventilation
• Grunting (to keep airways open)

Question 13

What is the most common acquired chronic pediatric airway disease?

Answer 13

Asthma

• Recurrent symptoms: cough, wheeze, shortness of breath (especially at night or with exercise)
• Improvement with a bronchodilator
• All other diagnoses ruled out
• 90% of all pediatric asthma is allergic

Question 14

What are some good takehome points to know about Cystic Fibrosis?

Answer 14

• Most common lethal genetic disease in Caucasians
• Cystic Fibrosis affects multiple organs
• Cystic fibrosis affects the airways and pulmonary parenchyma
• CFTR F508 is most common mutation.

Autosomal Recessive