Pulmonary Clinical Medicine V: Pediatric Pulmonology

Question 1

What is vocal cord dysfunction (aka paradoxical vocal fold motion disorder) characterized by?

What does is cause in the flow volume loop?

(HYHO)

Answer 1

1) Abnormal closing of the vocal cords making it hard to move air in and out of lungs
2) Truncated inspiratory portion of loop

Question 2

What age group is most susceptible to vocal cord dysfunction?

Which sex?

Answer 2

1) Teenagers

2) Females

Question 3

Classification of asthma is determined by assessment of?

HYHO

Answer 3

1) Impairment (symptoms)

2) Risk (# of exacerbations requiring steroids)

Question 4

What is the suspected diagnosis if a child presents as breathlessness while at rest, silent, and is noticeably drowsy/confused?

Answer 4

Imminent respiratory arrest

Question 5

What are first line options for acute exacerbation of asthma?

(HYHO)

Answer 5

1) Albuterol + ipratropium (anticholinergic)
2) Steroids
3) Oxygen

Question 6

What is the inheritance pattern of cystic fibrosis?

Where is CFTR located?

It is a disease of what function that involves multiple organ systems?

(HYHO)

Answer 6

1) Autosomal recessive
2) Chromosome 7
3) Exocrine gland function

Question 7

CFTR encodes for a protein that functions as a?

Answer 7

cAMP regulated Chloride channel across epithelial cells

Question 8

What population does CF affect the most?

HYHO

Answer 8

Ashkenazi Jewish population

Question 9

Why does CF not present the same way in every patient?

Answer 9

CFTR mutations have poor penetrance

Question 10

Most common clinical presentations of CF include?

Answer 10

1) Chronic lung disease

2) Exocrine pancreatic insufficiency

Question 11

What pathogens are common during early childhood (first 10 years of life) in CF patients?

What is ultimately isolated from the respiratory secretions of most patients by the second and third decade of life?

Answer 11

1) Staphylococcus aureus and Haemophilus influenzae

2) Pseudomonas aeruginosa

Question 12

What are the three components of cardiopulmonary arrest in children?

Answer 12

1) Respiratory (O2)
2) Cardiac (pump, perfusion, BP)
3) Circulatory volume (perfusion, BP)

Question 13

Most pediatric arrests are due to?

Answer 13

Respiratory issues

Question 14

What does restlessness, anxiety and combativeness in a child suggest?

Answer 14

Hypoxia

Question 15

What appearance of a child in not reassuring and suggests respiratory distress?

Answer 15

1) Poor tone
2) Lethargy
3) Listlessness

Question 16

What indicates a very sick child in terms of interaction?

Answer 16

If nobody can comfort or distract the child

Question 17

In terms of their appearance and behavior, what indicates a decreased level of consciousness?

Answer 17

Unfocused gaze

Question 18

The initial response to respiratory compromise is usually?

But as respiratory compromise progresses what ominous sign occurs?

Answer 18

1) Tachypnea

2) RR often decreases and has an irregular pattern

Question 19

What physical findings are indicative of respiratory distress?

Answer 19

1) Sternal retractions
2) Nasal flaring
3) Tripod position

Question 20

Pale, mottled, cool, or ashen skin are concerning in that they may indicate?

Answer 20

Hypoxia and shock

Question 21

What is done to check circulation and perfusion?

What is considered normal?

Answer 21

1) Capillary refill

2) Less than 2 seconds

Question 22

What is the most common cause of infectious airway obstruction in kids ages 6-36 months?

What sign is associated with this?

Answer 22

1) Croup (acute laryngotracheobronchitis)

2) Stridor

Question 23

While the vaccine has nearly eliminated its occurence what pathogen can cause epiglottitis?

Answer 23

Haemophilus influenzae type B

Question 24

What condition can respiratory syncytial virus (*most common), influenza, parainfluenza, and adenovirus cause?

What age range?

What is it characterized by?

(HYHO)

Answer 24

1) Bronchiolitis
2) Less than 2
3) Progressive cough and wheezing

Question 25

What is characterized by inflammation, edema, bronchospasm, and mucus?

Answer 25

Asthma

Question 26

If an allergy is reported, what should always be asked?

What is the regimen to treat anaphylaxis?

(HYHO)

Answer 26

1) What happens when exposed to allergen

2) Epi, O2, steroids

Question 27

What is the most common cause of pneumonia in newborns?

In infants/children?

In adolescents?

(HYHO)

Answer 27

1) Group B strep, listeria monocytogenes
2) Streptococcus pneumoniae
3) Mycoplasma pneumonia

Question 28

If a child presents with sudden dramatic coughing, stridor, and drooling what is the most probable cause?

Answer 28

Choking from foreign body

Question 29

What are the components of the pediatric assessment triangle?

(HYHO)

Answer 29

1) Appearance
2) Breathing
3) Circulation

Question 30

What is the goal when developing an asthma action plan?

HYHO

Answer 30

1) Symptoms < 2 days/week
2) Night time awakenings < 2 times/month
3) Short acting β2 agonist use < 2 days/week
4) No interference with normal activity

Question 31

What clinical sign is seen with cystic fibrosis newborn patients?

(HYHO)

Answer 31

Meconium ileus

Question 32

Cystic fibrosis patients have trouble absorbing what due to pancreatic enzyme deficiency?

Therefore have trouble absorbing what vitamins?

(HYHO)

Answer 32

1) Fats

2) ADEK

Question 33

Why is universal newborn screening important?

What do positive newborn screen require?

(HYHO)

Answer 33

1) Faster you intervene, the better the outcome

2) Confirmatory testing

Question 34

What is the most common cause of death in cystic fibrosis patients?

(HYHO)

Answer 34

Respiratory failure/cor pulmonale