OnlineMedEd: Pediatrics - "Lower Airway"

Question 1

Describe the course of illness for foreign body obstruction.

Answer 1

The child is unattended for a brief period and when the caregiver returns there is sudden-onset dyspnea.

Question 2

What pattern of breathing sounds do you hear in extrathoracic and intrathoracic airway obstruction (such as from a foreign body in either place)?

Answer 2

• Extrathoracic (above the bronchi): inspiratory stridor
• Intrathoracic (at or below the bronchi): expiratory wheezing

This happens because expiration narrows the lower airway and inspiration lowers the upper airway.

Question 3

What is the coin sign and what can it help you decide?

Answer 3

• Because the trachea is floppy in the back and rigid in the front, objects will usually orient their long axis anterior-posterior. Thus, on an AP x-ray the object will look narrow while on a lateral view the object will look wide.
• This can help you tell if something is in the trachea. If the object has the opposite orientation, then it is likely in the esophagus.

Question 4

In a nutshell, asthma is an ________________.

Answer 4

obstructive lung disease caused by response to antigens

Question 5

The treatment for asthma is _____________.

Answer 5

• Avoidance of triggers
• Inhaled steroids daily
• Inhaled beta-agonists PRN

Question 6

How can you remember the increasing steps of chronic asthma treatment?

Answer 6

As you go up the steps of treatment, you retain the therapy from the previous level and add something else:
•I: SABA PRN
•II: SABA PRN + ICS or LTA
•III: SABA PRN + increased ICS or LTA
•IV: SABA PRN + increased ICS or LTA + LABA
•V: SABA PRN + increased ICS or LTA + LABA + oral steroid

Question 7

How does cystic fibrosis present (list several ways)?

Answer 7

• Prenatal testing for trypsin levels in blood (most common in this country)
• Meconium ileus
• Recurrent pulmonary infections in childhood
• Failure to thrive
• Salty skin (sometimes noticed by parents when they kiss their children)

Question 8

What are the two diagnostics of cystic fibrosis?

Answer 8

• Prenatal testing

* Sweat chloride testing (greater than 40 in an infant or greater than 60 in an adult)

Question 9

How is CF treated?

Answer 9

• Lung: treat infections; vibratory shaking; N-acetylcysteine
• Pancreas: replace enzymes