Pulmonology

Question 1

Pneumonia:

When can you consider that a child has a possible pneumonia

Answer 1

Cough and/or Respiratory Difficulty/Distress

+ any of the Radiographic Pneumonia indicators

Question 2

Pneumonia:

What are the radiographic pneumonia indicators?

Answer 2

1. Tachypnea in a child 3 mos to 5 years of Age as defined by WHO (ER AND OPD SETTING)
2. Fever at any age (ER AND OPD SETTING)
3. O2 sat of < or equal to 92% in the absence of any disease that can cause desaturation (ER SETTING)

Question 3

Pneumonia:

When is an Xray needed to diagnose Pneumonia?

Answer 3

1. If with high grade fever or leukocytosis in the absence of respiratory symptoms
2. If with cough but has any of the following:
   a. malnutrition
   b. dehydration

Question 4

Pneumonia:

What are the variables used to classify Pneumonia?

Answer 4

1. Clinical

2. Diagnostic

Question 5

Pneumonia:

What clinical parameters should you watch out for in classifying Pneumonia?

Answer 5

Mnemonic: DRS Ma and Pa

D - Dehydration
R - Respiratory Rate
S - Signs of Respiratory Failure
Ma - Malnutrition
Pa - Pallor

Question 6

Pneumonia:

How is Dehydration used in classifying Pneumonia?

Answer 6

NONE or MILD - PCAP A or B
MODERATE - PCAP C
SEVERE - PCAP D

Mild - thirsty, normal or tachycardic, normal or decreased UO, normal PE

Moderate - lethargic/irritable, tachycardic, little or no UO, depressed fontanelle, sunken eyeballs, decreased tears, dry mucous membranes, decreased capillary refill time, cold extremities

Severe - no response, tachycardic with weak pulse, decreased BP, no UO, severely depressed fontanelle, very sunken eyeballs, no tears, parched mucous membranes, very delayed CRT, cold and mottled extremities

Question 7

Pneumonia:

How is RR used in classifying Pneumonia?

Answer 7

3 mos to 12 mos
PCAP A/B = 50 - 60 cpm
PCAP C = 60 - 70 cpm
PCAP D = > 70 cpm

12 mos to 5 years
PCAP A/B = 40 - 50 cpm
PCAP C and D = > 50 cpm

> 5 years
PCAP A/B = 30 - 35 cpm
PCAP C and D = > 35 cpm

Question 8

Pneumonia:

What are the signs of Respi Failure?
How are they used to classify Pneumonia?

Answer 8

1. Subcostal/Intercosal/Supraclavicular Retractions
2. Head bobbing
3. Grunting
4. Apnea
5. Cyanosis
6. Sensorial Changes

PCAP A/B = no signs
PCAP C = subcostal/intercostal retractions, cyanosis, head bobbing, irritable
PCAP D = 1 - 5 present, lethargic/coma/stuporous