Pediatric Pulmonology

Question 1

What are the 3 components of the pediatric assessment triangle?

Answer 1

Appearance, breathing and circulation

Question 2

What are the 3 components of cardiopulmonary arrest in children?

Answer 2

Respiratory (O2), cardiac (pump, perfusion, BP), circulatory volume (perfusion, BP); occurs when there is ineffective ventilation, circulation or both

Question 3

What can cause wheezing/cough in a pediatric pt?

Answer 3

Foreign body, oropharyngeal dysphasia, tracheoesophageal dysphagia, GERD, cystic fibrosis, vocal cord dysfunction, bronchitis/RAD, pneumonia, alpha 1 anti-trypsin deficiency

Question 4

What are asthma action plans?

Answer 4

Game plan for dealing with asthma exacerbations; want everyone in the green zone which means having the sx of intermittent asthma (Sx <2 days/week, night time awakenings <2 times a month, SABA use <2days/week, no interference with normal activity)

Question 5

What is poorly controlled asthma?

Answer 5

If the pt is not in the green zone with intermittent asthma, then it is poorly controlled; also if pt is seemingly doing well but are having >2 exacerbations/year needing systemic steroids they are poorly controlled and need tx added to their regimen; any pt who has >2 exacerbations requiring steroids in the same year

Question 6

What is the tx for a pt suffering an acute asthma exacerbation?*

Answer 6

Albuterol (+/- ipratropium), steroids, oxygen

Question 7

What are the components that need to be evaluated in the appearance of pt when assessing their degree of respiratory distress?

Answer 7

Interaction with environment (bad sign if not aware of surroundings), consolability (bad sign if highly irritable, panicky or agitated), looking at things/gaze (bad sign if eyes rolling around, lack of focus), speech/cry (bad sign if unable to speak, weak/gasping cry)

Question 8

What is a bad sign when evaluating the respiratory rate in a pt?

Answer 8

Hypoxia will be compensated with tachypnea as long as the body can keep up, but when fatigue sets in, RR will start to become slow and irregular

Question 9

What are some signs of increased work of breathing?

Answer 9

Nasal flaring, intercostal, subcostal, suprasternal retractions, rocking respirations, stridor, diffuse/localized wheeze, rales, grunting, accessory muscle involvement, decreased breath sounds, tripod/leaning forward position

Question 10

What should be evaluated in the circulatory status when assessing a pt’s degree of respiratory distress?

Answer 10

Perfusion (capillary refill), cyanosis, pale/mottled/ashen skin (can be signs of hypoxemia/shock)

Question 11

What is viral croup?

Answer 11

usually caused by parainfluenza virus; laryngeal/tracheal swelling, possible stridor; kids don’t act super sick

Question 12

What is the MCC of infectious airway obstruction in kids 6-36 months old?

Answer 12

viral croup

Question 13

What is the MCC of epiglottitis?

Answer 13

H. influenza type B (but rarely seen anymore due to vaccine); kids will be febrile, leaning forward, inability to swallow own secretions

Question 14

What is bronchiolitis?

Answer 14

Wheezing caused by a viral infection (RSV the most notorious*); kids <2 yo get the sickest, really hard on former premature infants

Question 15

What pathogens are most likely to cause pneumonia in newborns?*

Answer 15

Group B strep, listeria, gram - rods

Question 16

What pathogens are most likely to cause pneumonia in infants/children?*

Answer 16

Strep pneumonia

Question 17

What pathogens are most likely to cause pneumonia in adolescents?*

Answer 17

mycoplasma

Question 18

What are the sx of pneumonia in children?

Answer 18

fever, tachypnea, cough, wheeze/rales

Question 19

What is the tx for anaphylaxis?*

Answer 19

Epinephrine, oxygen, steroids

Question 20

What are the sx of anaphylaxis?

Answer 20

retropharyngeal/laryngeal edema, facial edema and urticarial, bronchospasm

Question 21

How does aspiration pneumonia usually present?

Answer 21

Respiratory distress following a choking/gagging/coughing episode

Question 22

What is the inheritance pattern for cystic fibrosis?*

Answer 22

autosomal recessive; if both parents are carriers there is a 1/4 chance of a child having the dz

Question 23

What are the signs and sx seen with cystic fibrosis?

Answer 23

chronic respiratory sx/infections (sinusitis, bronchitis, pneumonia, bronchiectasis), pancreatic enzyme insufficiency and resulting trouble with nutrition/growth, malabsorption, clubbing of the fingers, sterility in males (congenital absence of the vas deferens), *meconium ileus

Question 24

Cystic fibrosis is the MC in which population?*

Answer 24

Ashkenazi jews (carrier frequency 1/24)

Question 25

What are the common pathogens causing respiratory infections in those with cystic fibrosis?

Answer 25

Staph aureus and H influenza in early childhood; pseudomonas by the 2nd-3rd decade

Question 26

Why do pts with cystic fibrosis require fat soluble vitamins?*

Answer 26

Because they have trouble absorbing fats due to a pancreatic enzyme deficiency and therefore fat soluble vitamins as well

Question 27

What is the importance for universal newborn screening?

Answer 27

The earlier metabolic, hematologic, endocrine, and genetic abnormalities are IDed the earlier they can be treated and the better the outcome will be

Question 28

What do positive newborn screening tests require?*

Answer 28

confirmatory testing

Question 29

What is the prognosis for pts with cystic fibrosis?

Answer 29

Median age of survival is approx 40 yo; 80% of pts should reach adulthood

Question 30

What is the MCC of death in cystic fibrosis pts?*

Answer 30

respiratory failure/cor pulmonale

Question 31

What is the criteria for the diagnosis of cystic fibrosis?

Answer 31

Commonly diagnosed with newborn screening is abnormal and confirmatory testing is performed; confirmatory testing can be elevated sweat Cl on 2 occasions and actual chromosomal testing