Pediatric lung diseases

Question 1

Causes of hypoxia

Answer 1

VQ mismatch, hypoventilation, shunt, diffusion, altitude, hemoglobinopathies

Question 2

Define compliance and minute ventilation

Answer 2

compliance= ∆V/ ∆P. Minute ventilation= respiratory rate x tidal volume

Question 3

Compare pulmonary anatomy in children vs adults

Answer 3

In Children (esp infants) The larynx is higher and more anterior and the epiglottis is floppy, the narrowest part of the airway is below the vocal cords Intercostal muscles are weaker, Diaphragm is relatively flat and ribs are horizontal

Question 4

Pediatric signs of respiratory distress

Answer 4

Lethargy, Poor feeding, Grunting (closing the glottis before the end of exhalation), Children with chronic respiratory disease may have trouble gaining weight due to increased energy expenditure with increased work of breathing and poor feeding

Question 5

Signs of upper airway obstruction in kids

Answer 5

Stridor (inspiratory, expiratory or biphasic). Signs of severe obstruction include drooling, dysphagia, and dyspnea/distress

Question 6

Increased lung volume later in life is mainly due to what?

Answer 6

alveolar expansion- Conducting airways are mostly formed by 17 weeks in utero

Question 7

Developmental pulmonary problems in first 6 weeks

Answer 7

Pulmonary agenesis, Tracheoesophageal fistula, laryngomalacia and Vascular malformation leading to airway compression
Pulmonary agenesis, Tracheoesophageal fistula, laryngomalacia and Vascular malformation leading to airway compression
Pulmonary agenesis, Tracheoesophageal fistula, laryngomalacia and Vascular malformation leading to airway compression

Question 8

Laryngomalacia- age of onset, definition, symptoms, duration

Answer 8

Congenital disorder of the upper airway that presents at birth/early in life. The cartilaginous support for the supraglottic structures is underdeveloped. Most common cause of stridor in infants. Stridor is worse with eating, crying, laying down, activity. Often outgrown by 1-2 yrs

Question 9

Developmental pulmonary problems in weeks 6-16

Answer 9

Airway/cartilage abnormalities such as tracheobronchomalacia

Question 10

Symptoms of tracheobronchomalacia

Answer 10

recurrent wheeze, a hoarse cough, and recurrent illnesses

Question 11

Croup syndrome definition

Answer 11

Acute inflammatory diseases of the larynx, including viral croup (laryngotracheobronchitis), epiglottitis (supraglottitis), and bacterial tracheitis. Patients can present with acute or subacute symptoms, including stridor

Question 12

Viral croup- cause, physiology and symptoms

Answer 12

Caused by parainfluenza virus serotypes. Edema in the subglottic space causes most of the upper airway obstruction. Symtpoms include barking cough and stridor, fever is absent or low grade, and if severe can have retractions, air hunger and cyanosis

Question 13

Viral croup- imaging and treatment

Answer 13

Neck radiograph shows subglottic narrowing (steeple sign). Mild croup (cough and no stridor at rest) is treated supportively. More severe croup (stridor at rest) is treated with nebulized epinephrine and glucocorticoids.

Question 14

Epiglottitis- cause, physiology and symptoms

Answer 14

Medical emergency! Caused by H. influenza type B usually. Inflammation and swelling of the supraglottic structures (epiglottis and arytenoids) can develop rapidly and lead to life-threatening upper airway obstruction. Sudden onset of high fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis, and soft stridor

Question 15

Epiglottitis treatment and prognosis

Answer 15

Endotracheal intubation immediately, antibiotics. Prompt treatment has good results and recurrence is unusual

Question 16

Bacterial tracheitis- cause, physiology and symptoms

Answer 16

Usually caused by staph aureus. Severe form of laryngotracheobronchitis that results in inflammatory edema, purulent secretions and pseudomembranes. Signs of viral croup that develop into high fever, toxicity, and progressive or intermittent severe upper airway obstruction that is unresponsive to standard croup therapy.

Question 17

Bacterial tracheitis- diagnosis and treatment

Answer 17

Diagnose with Bronchoscopy showing a normal epiglottis and the presence of copious purulent tracheal secretions and membranes. Treatment with endotracheal intubation, antibiotics, debridement of tracheal secretions.

Question 18

Symptoms of lower airway problems

Answer 18

hypoxemia (from VQ mismatch), wheeze (monophonic if large airway, polyphonic wheeze if smaller airways), and crackles in the alveoli

Question 19

Potential pulmonary problems drom developmental weeks 16-26

Answer 19

diaphragmatic hernia, oligohydramnios or any disruption of growth. Potters syndrome causes renal agensis so there is no fetal urine, thus there is too little amniotic fluid and the fetus does not inhale/swallow the urine and lungs are underdeveloped

Question 20

Bronchiolitis - cause and symptoms/exam

Answer 20

Acute respiratory illness from respiratory syncytial virus (RSV) usually, but can be from adenovirus, mycoplasma, etc. Characterized by acute onset tachypnea, labored breathing, and/or hypoxia, Irritability, poor feeding, expiratory Wheezing and crackles on chest auscultation.
Acute respiratory illness from respiratory syncytial virus (RSV) usually, but can be from adenovirus, mycoplasma, etc. Characterized by acute onset tachypnea, labored breathing, and/or hypoxia, Irritability, poor feeding, expiratory Wheezing and crackles on chest auscultation.

Question 21

Bronchiolitis - relevant anatomy and symptoms

Answer 21

Nasal obstruction plus decreased compliance of lungs (stiff) causes early retractions to increase tidal volume, tachypnea, and grunting (Infants close the vocal cords at end expiration to keep airways open-laryngeal breaking)

Question 22

Bronchiolitis pathophysiology

Answer 22

Decreased surface area for gas exchange leads to increased oxygen need. Permanently Thickened interstitium causes decreased compliance and increased respiratory distress

Question 23

Bronchiolitis -diagnosis and treatment

Answer 23

Diagnosis: clinical. CXR findings are non specific (hyperinflation, peribronchial cuffing, interstitial markings and atelectasis). Treatment: Most effective is prevention. Monoclonal antibodies (palivizumab or synagis) are effective. Hospitalization required in young infants, hypoxemia on room air, respiratory distress. Prognosis is good.

Question 24

Asthma- physiology and symptoms

Answer 24

Asthma is caused by airway inflammation leading to increased mucous production, bronchial hyperreactivity, and airway edema • Recurrent symptoms of airway obstruction (cough, shortness of breath, chest tightness) • At least partial reversal of bronchospasm and symptom relief with a bronchodilator (e.g. a beta agonist such as albuterol) • All other diagnoses ruled out

Question 25

At what age can PFTs be used for diagnosis

Answer 25

Over 6 years old

Question 26

Asthma -treatment, prevention and prognosis

Answer 26

Inhaled beta agonist acutely for bronchial hyperreactivity, but inhaled corticosteroids is the chronic treatment of choice. Most children who wheeze only with illness grow out of their symptoms by age 12. Allergic asthma will most likely continue after 12

Question 27

Common acquired cause of parenchymal lung disease

Answer 27

Viral or bacterial pneumonia

Question 28

What is a parenchymal disease

Answer 28

Disorders that affect the alveoli and associated structures and may also affect the airways

Question 29

Community acquired bacterial pneumonia - symptoms, physical exam and diagnosis

Answer 29

• Fever, cough, dyspnea and tachypnea. Also may have evidence of infection at other sites • Abnormal chest examination (crackles or decreased breath sounds). • Abnormal chest radiograph (infiltrates, hilar adenopathy, pleural effusion).

Question 30

Community acquired bacterial pneumonia -treatment and prognosis

Answer 30

Empiric antibiotic therapy - ampicillin and aminoglycoside (5 yrs old). All children younger than 3 months should be admitted for treatment. Prognosis is good

Question 31

Bronchopulmonary dysplasia description

Answer 31

Acute respiratory distress in the first week of life, Required oxygen therapy or mechanical ventilation, with persistent oxygen requirement at 36 weeks gestational age or 28 days of life.

Question 32

Bronchopulmonary dysplasia pathogenesis

Answer 32

The premature lung makes insufficient functional surfactant; antioxidant defense mechanisms are not mature to protect the lung from the toxic oxygen metabolites, and lungs show early inflammation and hypercellularity followed by healing with fibrosis. Progressive lung injury occurs from oxygen toxicity, barotrauma, and inflammation

Question 33

Describe compliance of infant chest walls

Answer 33

Chest walls are more compliance with less negative pressure outward/recoid. Small airways start to close at end exhalation (atelectasis at baseline)

Question 34

Bronchopulmonary dysplasia clinical course

Answer 34

Ranges from a mild increased oxygen requirement that gradually resolves over a few months to more severe disease requiring tracheostomy and chronic mechanical ventilation for the first 2 years of life.

Question 35

Bronchopulmonary dysplasia treatment and prognosis

Answer 35

Artificial surfactant, prenatal glucocorticoids, and protective ventilatory strategies. Lung function may be altered for life including hyperinflation and damage of small airways Kids have higher risk for persistent hypoxemia, airway hyperreactivity, pulm HTN, neurodevelopmental problems

Question 36

Cystic fibrosis cause

Answer 36

Autosomal recessive mutation of CF transmembrane conductance regulator (CFTR) protein. Most common is ∆F508. This results in thick secretions. It affects the airways and pulmonary parenchyma

Question 37

Cystic fibrosis symptoms, physical exam, diagnosis

Answer 37

• Greasy, bulky, malodorous stools; failure to thrive. • Recurrent respiratory infections. • Digital clubbing on examination. • Bronchiectasis on chest imaging. • Sweat chloride > 60 mmol/L. Newborn screening measures immunoreactive trypsin (pancreatic enzyme) which is elevated in CF

Question 38

Cystic fibrosis infections

Answer 38

Most common is Pseudomonas aeruginosa. Chronic infection leads to airflow obstruction and progressive airway and lung destruction resulting in bronchiectasis.

Question 39

Cystic fibrosis treatment

Answer 39

Pancreatic enzymes, high caloric diet, airway clearance therapy, antibiotics