pediatric pulmonolgy Flashcards
Difference between pediatric and adult airway
Pediatrics have all of the following:
a. Smaller nasopharynx that is easily occluded during infection
b. Lymph tissues grow rapidly during early childhood
c. Smaller nares that are easily occluded
d. Small oral cavity and large tongue increase risk of obstruction
e. Long, floppy epiglottis that is prone to swell and obstruct
f. Larynx and glottis sit higher in neck = risk of aspiration
g. Immature neck cartilages that allows them to easily collapse when the neck is flexed
h. Neck cricoid cartilage is very thin and narrowed = easily obstruct the larynx/have an airway compromise
i. Fewer muscles functional in airway = less able to compensate for edema, spasm, trauma
What does a wheeze sounds like
musical, high pitched noise, mainly in expiration
DDx of a wheeze in an infant
- Bronchiolitis
- Bronchopulmonary dysplasia
- Foreign body aspiration
- Wheeze
DDx of a wheeze in a preschooler (1-4 yrs)
- Viral induced wheezing
- Asthma
- FB aspiration
- Wheeze
DDx of a wheeze in a school age (5-12yrs) child AND an adolescent ( 13-18yrs)
- Asthma
- Vocal cord dysfunction
- Wheeze
Important history questions to ask during a wheeze CC
i. When did wheeze begin?
ii. Pattern to wheeze?
iii. Any associated triggers?
iv. What improves/worsens wheeze?
v. Associated medical problems?
Things to note on physical exam in a wheeze CC
i. Overall appearance/degree of respiratory distress
ii. Accessory muscle use
iii. Assess HR, rhythm, pulses, capillary refill
What views do you want for a CXR in a wheeze CC?
Two views always: AP and lateral on soft tissue of the neck
MCC of stridor
croup
Pathognomonic: steeple sign
croup
What is stridor?
- Passage of air through a narrowed airway
- Air in a narrowed space = high-pitched sound
- Can also see soft tissue edema
Signs of an upper airway obstruction
Nasal flaring
Grunting (in babies)
Drooling
Describe the sound in stridor
Monophonic, harsh, variable-pitched sound
A patient with history of prolonged intubation suggests?
Subglottic stenosis
A patient with history of patent ductus arterious suggests?
vocal cord dysfunction
What is most commonly seen in older infants (>6 months)?
FBS aspiration
What is most commonly seen in a child 6months to 3yrs with an actue onset of stridor following an URI and presents with a barking cough?
Croup
Patient presents with an acute onset of stridor with known allergen exposure. What do you think it is?
allergic reaction or casuistic ingestion
If the patient presents with symptoms of stridor since birth, what is most likely the problem?
structural problem
If the patient presents with symptoms of stridor worsening at 6 - 9 months of age, what is most likely the problem?
growing laryngotracheal hemangioma
Cough, congestion, rhinorrhea on physical exam suggests
viral croup
Drooling, trismus, torticollis, inability to extend neck on physical exam, suggests what?
peri-tonsillar abscess or retro-pharyngeal abscess
Gray pseudomembrane on physical exam in a patient that does not receive vaccines suggests what diagnosis?
diphtheria
Pathognomonic: thumb print sign on lateral neck x ray
epiglottis
Pathognomonic: widening of the prevertebral tissues
Retroperitoneal abscess
Pathognomonic: barium swallow shows indentation at esophagus
Vascular ring
MRI or angiography of chest is definitive
