Respiratory Disorders in Children

Question 1

where are bronchovesicular breath sounds heard

Answer 1

These are normal sounds best heard in the 1st and 2nd ICS (anterior chest) and between the scapulae (posterior chest) - ie over the mainstem bronchi.

Question 2

where are Bronchial Breath Sound heard

Answer 2

heard over the manubrium

Question 3

where are Tracheal Breath Sounds heard

Answer 3

Best heard in the neck over the trachea.

Question 4

where are the Vesicular Breath Sounds heard

Answer 4

Major normal breath sound and is heard over most of the lungs.

Question 5

in what conditions would you find hyperresonant

Answer 5

always heard in air trapping (asthma, copd)

Question 6

Egophony

Answer 6

Ask the patient to say “Eeee” several times and auscultate the chest walls. Over healthy lung areas, the sound is understandable as an “E” , with air the “E” will remain an E, If there is consolidation then the “E” will sound like an “A”

Question 7

bronchiolitis

Answer 7

seen in children less than 3 years of age
viral (RSV)
chest x-ray shows hyperinflation

Question 8

synagis IM is given monthly during RSV season when?

Answer 8

when RSV is most prevalent

Question 9

obstructive disease

Answer 9

characterized by reduced airflow rates
air trapping
decreased rates and decreased FEVI
examples- asthma, chronic bronchiolitis, cystic fibrosis

Question 10

restrictive disease

Answer 10

characterized by reduced volumes and expiratory flow rates
typically children have trouble inhaling air, thus affecting the volume
example-pneumonia

Question 11

asthma

Answer 11

widespread narrowing of the airways that change in severity either spontaneously or as a result of treatment

Question 12

pathophysiology of asthma

Answer 12

thickening of epithelial basement membrane-remodeling

Question 13

ominous signs of asthma

Answer 13

absent breath sounds
pulsus paradoxus
inability to maintain recumbency
cyanosis

Question 14

2 stages of asthma

Answer 14

intermittent and persistant

Question 15

recommend hospitalization in asthma if….

Answer 15

FEVI

Question 16

intermittent asthma

Answer 16

symptoms less than or equal to 2 days/week
nightime awakenings- less than or equal to 2/month
rescue inhaler- less than or equal to 2 days/week
interferes with normal activity- none
lung function- FEVI >80% predicted and normal between exacerbations

Question 17

mild persistent asthma

Answer 17

symptoms greater than 2 days/week
nightime awakenings- 3-4 times/month
rescue inhaler- greater than 2 days/week but not daily
interferes with normal activity- minor limitations
lung function- FEVI >80% predicted

Question 18

moderate persistent asthma

Answer 18

symptoms daily
nightime awakenings-more than once per week but not nightly
rescue inhaler-daily
interferes with normal activity- some limitations
lung function- FEVI 60%-80% predicted

Question 19

severe persistent asthma in children

Answer 19

symptoms throughout the day
nightime awakenings- nightly 
rescue inhaler-several times a day
interferes with normal activity- extremely limitations
lung function- FEVI >60% predicted

Question 20

cystic fibrosis in children

Answer 20

autosomal recessive disorder with a chromosome 7 long arm mutation
most common in the Caucasian population
life expectancy 30+
characterized by recurrent endobronchial infections, progressive obstructive pulmonary disease, and pancreatic inefficiencies with intestinal malabsorption

Question 21

s/s of cystic fibrosis

Answer 21

viscid meconium (in infants), recurrent respiratory infections, large, liquid, foul stools (steatorrhea), salt-tasting skin, chronic cough, rhinorrhea, hepatosplenomegaly, fat soluble vit. deficiencies, delayed puberty, and infertility

Question 22

lab/diagnostics of cystic fibrosis

Answer 22

pilocarpine iontophoresis sweat test
pulmonary function test: obstructive pattern
hyponatremia, hypochloremic dehydration (alkalosis)
xray: cystic lesions, atelectasis

Question 23

management for cystic fibrosis

Answer 23

refer