Dr. Newman Pulmonary Pediatrics

Question 1

What physical exam finding helps us think of Asthma and what are the two things that asthma classification depends on?

Answer 1

• WHEEZING (but wheezing doesn’t ALWAYS mean asthma)

Classification of asthma severity depends on symptoms (impairment) AND risk (# of exacerbations requiring steroids)

Question 2

What is Vocal Cord Dysfunction and what does it look like on Spirometry Loop?

What group of patients are prone to this condition?

Answer 2

• paradoxical vocal fold motion disorder due to abnormal closing of vocal cords making it harder to move air in/out of lungs
• has TRUNCATED INSPIRATORY LOOP and NORMAL expiratory loop
• commonly seen in high achieving adolescents (F > M)

Tx: learning techniques that control vocal cords from speech therapist of psychologist

Question 3

What 3 drugs are used to treat Acute Exacerbation of Asthma? (AI/S/O)

Answer 3

1. albuterol and impratropium (anticholinergic)
2. steroids
3. oxygen

Question 4

Cystic Fibrosis

What genetics are associated with it, what chromosome is the mutation found on, what function does it impair, and who is at the highest risk for developing this disease?

Answer 4

• autosomal recessive mutation in CFTR gene (encodes protein that functions as a cAMP regulated chloride channel across epithelial cells on mucosal surfaces)
• mutation found on Chromosome 7 that impairs EXOCRINE GLAND FUNCTION
• CAUCASIANS (Ashkenazi Jews) have highest risk (most common LETHAL hereditary disease in white population of U.S.)

Question 5

Cystic Fibrosis

What are the two most common clinical presentations of this disease (PLD/EPI), what 2nd infections are seen in pts < 10 yrs vs pts in 2nd-3rd decade of life, and what screening can be done for newborns (IRT)?

Answer 5

PE: progressive lung disease and exocrine pancreatic insufficiency

< 10yrs: S. aureus/H. influenzae
2nd-3rd: P. aeruginosa (WORSE)

Newborns: get screening for CF before they leave; test for immunoreactive trypsinogen (pancreatic enzymes may be inc.; if high, repeat IRT or sweat chloride)

Question 6

What are the 3 components of Respiratory Arrest in children (R/C/CV)?

What is the most common cause of cardiac arrest in infants/children?

Answer 6

1. respiratory (oxygen)
2. cardiac (pump, perfusion, BP)
3. circulatory volume (perfusion, BP)

• unlike adults, most common cause if pediatric arrest is RESPIRATORY

Question 7

Pediatric Assessment Triangle (PAT) for CP Arrest

What are the 3 components of this triangle (A/B/C)

Answer 7

1. appearance
   
   • bad: not interacting, cannot console
   • bad: eyes “rolling around”, unfocused gaze
   • bad: weak cry or no cry at all
2. breathing
   
   • bad: tachypnea that becomes slow RR
   • bad: flared nostrils, grunting, dec. breath sounds
3. circulation
   
   • bad: skin cooling, pale/mottled/cool/ashen skin
   • normal cap refill is < 2 sec (PADS/Nail Beds)

Question 8

What are two common causes for Respiratory Distress in kids (RA/PA) and what do they sound like?

Answer 8

Retropharyngeal Abscesses and Peritonsillar Abscesses

• HOARSE voices is common (“hot potato” voice)
• pain, swelling, difficulty swallowing

Question 9

Croup (acute laryngotracheobronchitis)

What is it, what is it most often caused by, and what sound is related to it?

Answer 9

• most common cause of infectious airway obstruction in kids ages 6-36 months
• due to PARAINFLUENZA virus (most commonly viral) but could be caused by 2nd bacterial infection from Tracheitis (kids are febrile and REALLY sick)

STRIDOR = think CROUP

Question 10

Epiglottitis

What is it caused by, what do children look like, and where would exam need to be performed?

Answer 10

• caused by H. Flu type B
• children would be SICK with inflamed epiglottis on examination
• exam should be done in OR with possible intubation if needed

Question 11

Bronchiolitis

What is it commonly caused by, which pts is it seen in, and what are its 3 physical exam findings (US/PC/WA)

Answer 11

• typically caused by Respiratory Syncytial Virus (RSV) but also influenza, parainfluenza, adenovirus
• seen usually in children < 2 yo

PE: URI symptoms –> progressive cough –> wheezing and atelectasis

Tx is really only supportive until symptoms resolve

Question 12

Anaphylaxis

What is it caused by, what PE findings are seen (FE/U/BS), and what are the 3 treatments given to pts. with this condition (E/O/S)

Answer 12

• caused by food or medication allergy

PE: facial edema, urticaria, bronchospasm

Tx: epinephrine, oxygen, steroids

Question 13

What is the most common cause of pneumonia in school-aged children?

Answer 13

Viruses are most common, but if bacterial it is Strep. Pneumonia

adolescents would see bacterial Mycoplasma pneumonia