pediatric pulmonolgy

Question 1

Difference between pediatric and adult airway

Answer 1

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

Question 2

What does a wheeze sounds like

Answer 2

musical, high pitched noise, mainly in expiration

Question 3

DDx of a wheeze in an infant

Answer 3

1. Bronchiolitis
2. Bronchopulmonary dysplasia
3. Foreign body aspiration
4. Wheeze

Question 4

DDx of a wheeze in a preschooler (1-4 yrs)

Answer 4

1. Viral induced wheezing
2. Asthma
3. FB aspiration
4. Wheeze

Question 5

DDx of a wheeze in a school age (5-12yrs) child AND an adolescent ( 13-18yrs)

Answer 5

1. Asthma
2. Vocal cord dysfunction
3. Wheeze

Question 6

Important history questions to ask during a wheeze CC

Answer 6

i. When did wheeze begin?
ii. Pattern to wheeze?
iii. Any associated triggers?
iv. What improves/worsens wheeze?
v. Associated medical problems?

Question 7

Things to note on physical exam in a wheeze CC

Answer 7

i. Overall appearance/degree of respiratory distress
ii. Accessory muscle use
iii. Assess HR, rhythm, pulses, capillary refill

Question 8

What views do you want for a CXR in a wheeze CC?

Answer 8

Two views always: AP and lateral on soft tissue of the neck

Question 9

MCC of stridor

Answer 9

croup

Question 10

Pathognomonic: steeple sign

Answer 10

croup

Question 11

What is stridor?

Answer 11

• Passage of air through a narrowed airway
• Air in a narrowed space = high-pitched sound
• Can also see soft tissue edema

Question 12

Signs of an upper airway obstruction

Answer 12

Nasal flaring
Grunting (in babies)
Drooling

Question 13

Describe the sound in stridor

Answer 13

Monophonic, harsh, variable-pitched sound

Question 14

A patient with history of prolonged intubation suggests?

Answer 14

Subglottic stenosis

Question 15

A patient with history of patent ductus arterious suggests?

Answer 15

vocal cord dysfunction

Question 16

What is most commonly seen in older infants (>6 months)?

Answer 16

FBS aspiration

Question 17

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?

Answer 17

Croup

Question 18

Patient presents with an acute onset of stridor with known allergen exposure. What do you think it is?

Answer 18

allergic reaction or casuistic ingestion

Question 19

If the patient presents with symptoms of stridor since birth, what is most likely the problem?

Answer 19

structural problem

Question 20

If the patient presents with symptoms of stridor worsening at 6 - 9 months of age, what is most likely the problem?

Answer 20

growing laryngotracheal hemangioma

Question 21

Cough, congestion, rhinorrhea on physical exam suggests

Answer 21

viral croup

Question 22

Drooling, trismus, torticollis, inability to extend neck on physical exam, suggests what?

Answer 22

peri-tonsillar abscess or retro-pharyngeal abscess

Question 23

Gray pseudomembrane on physical exam in a patient that does not receive vaccines suggests what diagnosis?

Answer 23

diphtheria

Question 24

Pathognomonic: thumb print sign on lateral neck x ray

Answer 24

epiglottis

Question 25

Pathognomonic: widening of the prevertebral tissues

Answer 25

Retroperitoneal abscess

Question 26

Pathognomonic: barium swallow shows indentation at esophagus

Answer 26

Vascular ring

MRI or angiography of chest is definitive