Pulmonary Flashcards
(215 cards)
1
Q
What 3 things should you consider for wheezing besides asthma?
A
- Foreign Body Aspiration
- Swallowing Dysfunction
- Bronchiolitis
2
Q
What is the mneumonic for wheezing besides asthma?
A
- Aspirated drinks
- Babies with kinks
- Swallowed thinks (things)
- Vascular rinks (rings)
3
Q
Who are aspirated foreign bodies more common in?
A
Older children who are mobile (still consider this in an infant)
4
Q
Who is foreign body aspiration seen most commonly in?
A
Infants and toddlers
5
Q
What other groups besides infants and toddlers may you see foreign body aspiration in?
A
A child with developmental disability or any child with CNS depression
6
Q
In what time frame do most foreign body aspirations manifest in?
A
24 hours
7
Q
What is the classic triad for foreign body aspiration?
A
- Cough
- Wheeze
- Decreased breath sounds
8
Q
What things do infants and toddlers typically aspirate?
A
Food (especially hot dogs and popcorn)
9
Q
What things objects do older children typically aspirate?
A
Objects
10
Q
What are the clues for foreign body aspiration (whether or not they mention asthma history, signs of croup, ect.)?
A
Unlabored breathing with nonproductive cough with an expiratory wheeze heard best on the right side. History of cough of sudden onset.
11
Q
In what % of cases of foreign body aspiration is there no recollection of an actual aspiration?
A
Nearly 50%
12
Q
What are things to look for on CXR with foreign body aspiration?
A
Radiopaque object usually at right main stem bronchus. Hyperexpansion of one hemithorax in both inspiratory and expiratory films.
13
Q
With foreign body aspiration what are radiographs confirmed with?
A
Bronchoscopy (this is how FB is retrieved anyways)
14
Q
1 year old with acute onset of coughing and right sided expiratory wheeze… best test to confirm suspicions?
A
Airway fluoroscopy (in a 1 year old, most likely FB is food which is radiolucent and you can’t get a 1 year old to do inspiratory/expiratory films)
15
Q
What should be suspected in an infant with recurrent wheezing that increases with feeding and neck flexion?
A
Vascular rings, bronchogenic cysts, tracheal stenosis, double aortic arch (can cause external tracheal or esophageal compression)
16
Q
What are symptoms of things that cause vascular compression?
A
Recurrent wheezing (increases with feeding and neck flexion), stridor, dyspnea during feeding
17
Q
What is the diagnosis of things causing vascular compression (like a vascular ring) best confirmed by?
A
Barium swallow study
18
Q
Infant with recurrent coughing associated with wheezing… underlying problem?
A
Swallowing dysfunction
19
Q
How do you confirm diagnosis of swallowing dysfunction?
A
Barium swallow study with video fluoroscopy
20
Q
What are some treatment options for kids with swallowing dysfunction?
A
- Thickened feedings
- Feeding therapy
- G-tube
21
Q
What is present when a patient is incapable of compensating for the effects of respiratory compromise?
A
Respiratory failure
22
Q
What is more important in evaluation of respiratory failure than any lab value?
A
Respiratory effort
23
Q
Name 3 signs of respiratory distress?
A
- Tachypnea
- Retractions
- Pulsus paradoxus
24
Q
Name late signs of respiratory distress which indicate respiratory failure and need for intubation.
A
- Hypoxemia
- Grunting
- Agitation
- Decreased mentation
- Poor tone
- Cyanosis
- Signs of fatigue
25
If you are presented with a patient with an underlying neurological disorder who is in respiratory distress, what is the likely correct choice regarding management?
Elective intubation
26
Name some congenital malformations of the lower airway.
1. Pulmonary sequestrations
2. Bronchogenic cysts
3. Congenital adenomatoid malformations
4. Congenital lobar emphysema
27
How do congenital malformations of the lower airway present?
Recurrent respiratory symptoms (or just incidental findings on CXR)
28
What is typical treatment for congenital malformations of the lower airway?
Surgical removal
29
If you have a patient with clubbing of the fingers or toes, which 4 things should you consider?
1. Cyanotic heart disease
2. Chronic lung disease
3. Cirrhosis of the liver
4. Familial trait (with absence of other disorders)
30
What is the official term for digital clubbing?
Hypertrophic pulmonary osteoarthropathy
31
What is the first thing to do in deciding whether to intubate?
Assess respiratory effort
32
The difference in blood pressure during inspiration and expiration should not be greater than...?
10mmHg
33
What is pulsus paradoxus?
Difference in blood pressure during inspiration and expiration that is greater than 20mmHg
34
What does pulsus paradoxus suggest?
Pulmonary or cardiac problems
35
True or False: In assessing a child in respiratory distress, obtaining an ABG and lab work is the first thing to do
FALSE... assess airway (A of ABCs)
36
What is the best way to assess and confirm respiratory distress?
Watch for signs of anxiety (sweating and/or tachycardia)... respiratory rate is incorrect because a "normal" respiratory rate could be the transition from tachypnea to apnea
37
What results in chronic hypoxemia?
Any persistent condition that compromises the ability to oxygenate blood
38
What do the kidneys do when they see hypoxemia?
Produce erythropoietin (red cells get produced, HCT goes up)
39
A HCT of greater than 65 can cause what?
Headaches, joint pain, clots (pulmonary emboli), hemoptysis
40
A kid with a history of headache, joint pain, clots, or hemoptysis could point to what?
Chronic hypoxemia (kidneys making EPO, Hct going up)
41
What happens to platelets in chronic hypoxia?
Decrease (increased risk of bleeding)
42
The respiratory drive of patients with chronic lung disease is often driven by what?
Hypoxemia (rather than acidosis and hypercapnia)
43
True or False: Correction of hypoxia (by administering O2) in a patient suffering from chronic lung disease can put a patient at risk for respiratory arrest
TRUE (respiratory drive in chronic lung disease is often driven by hypoxemia)
44
What should your goals be for oxygen administration in a patient with chronic hypoxemia?
Lowest concentration needed to maintain an O2 saturation of 90% (CO2 measurements via ABG should be followed as well)
45
What are two things to make sure of regarding a pulse oximeter for the real world?
1. Make sure pulse is correlating
| 2. Ensure no mechanical or artifactual problems
46
Cyanosis with depressed sensorium
Hypoxia
47
Flushing and agitation and headaches
Hypercarbia (elevated CO2 leading to cerebral vasodilation)
48
What is elevated with carbon monoxide poisoning?
Carboxyhemoglobin
49
In carbon monoxide poisoning, what are the pulse oximetry readings?
High... overestimate the level of oxyhemoglobin and oxygenation
50
True or False: Anytime there are shock-like conditions resulting in impaired peripheral perfusion, the O2 values are unreliable
TRUE (shock will be things like heart failure, hypovolemia, septic shock)
51
Best measure of pulmonary function or hypoxemia?
ABG (don't pick capillary blood gas... has to be arterial for O2 component to be valid)
52
Central blueish discoloration of skin due to poorly oxygenated blood.
Cyanosis
53
How do you distinguish between pulmonary and cardiac cyanosis?
Hyperoxia test
54
What happens in the hyperoxia test if the cause of cyanosis is pulmonary (v. cardiac)?
After 10 min of 100% inspired O2, PaO2 would increase in most pulmonary diseases, but no in cardiac diseases
55
What pulmonary disease will you not see an increase in PaO2 after 10 minutes of 100% O2?
PPHN
56
Name 7 extrapulmonary causes of cyanosis.
1. Heart disease with right to left shunting
2. Shock
3. Methemoglobinemia
4. CNS depression
5. Cold exposure
6. Polycythemia
7. Breath holding spells
57
6 month old infant, hands and feet intermittently blue since birth, when hands and feet not blue, they are mottled... what is the cause?
Episodic acrocyanosis (no workup, just reassurance)
If this was true cyanosis needing workup (methemoglobinemia, EKG, O2 sat, ect.) you would see central blueness of lips or face
58
What is a condition in which the iron in the hemoglobin molecule is defective, making it unable to effectively carry O2 to the tissues?
Methemoglobinemia
| Hgb is not transporting O2
59
How do you get methemoglobinemia?
It can be congenital or acquired
60
Which condition causes cyanosis in the absence of cyanotic heart disease?
Methemoglobinemia
61
What is treatment for methemoglobinemia?
1. Eliminating the triggering agent
| 2. IV methylene blue
62
What are the 3 things you initially do to work up a chronic cough?
1. Sweat chloride testing
2. TB skin testing
3. CXR
63
If you have a kid with a chronic cough and normal sweat chloride, TB testing, and CXR, what's next?
Spirometry
64
What does spirometry help rule out with chronic cough?
Asthma
65
What age can you start doing spirometry?
When they can cooperate (usually around 6)
66
What is the 100 day cough?
Pertussis
67
What is a loud, brassy barking and/or honking cough that can be produced on command?
Psychogenic cough
68
What happens with a psychogenic cough at night?
Disappears during sleep
69
Harsh, dry chronic cough with fever, weight loss, night sweats
TB and fungal infections (even chest malignancies)
70
What are some conditions that impair the effectiveness of coughing?
1. Cerebral Palsy
2. Muscle Weakness
3. Vocal cord dysfunction
4. CNS disease
5. Thoracic deformities
6. Pain
(Takes TNT to clear lungs when coughing isn't effective... Thoraco Neuro (CP/CNS disease) Tied up with weakness and pain)
71
Cough suppressants?
NO... no benefit over a placebo in children
72
Name signs and symptoms consistent with CF
1. Failure to thrive
2. Steatorrhea
3. Low serum albumin
4. Low sodium
5. Pseudomonas infections
73
What is the abnormal level for a CF sweat test?
60mEq or greater is diagnostic
74
Best way to confirm suspected CF diagnosis?
Sweat test... False negatives are rare and usually due to inadequate sample or technique (don't be tempted to pick DNA analysis or genetic testing)
75
How is CF inherited?
AR (carriers show no signs)
76
What are the odds of a healthy sibling of someone with CF being a carrier?
2/3
77
If a sibling of someone with CF marries someone from the general population, what are the odds of them having a kid with CF?
(2/3) [chance of a sibling carrier] * (1/25) [chance of picking a carrier out of the general Caucasian population] * (1/4) [change of child being double recessive] = 1 in 150
78
What is the carrier rate for CF in the general Caucasian population?
1 in 25
79
If 2 carriers of CF are married, what is the risk of having a child with CF?
1/4 (double recessive trait)
80
Hypoproteinemia, anemia, steatorrhea, recurrent pulmonary symptoms in an infant?
CF
81
Are respiratory or GI symptoms more prevalent in infants with CF?
GI symptoms are more prevalent
82
What is the metabolic derangement seen in infants with CF?
Hypochloremic alkalosis
83
Which vitamin deficiency is a major problem with CF?
Vitamin E deficiency
84
When should vitamin E supplementation be started in patients with CF?
Before age 5
85
What can vitamin K malabsorption lead to (specific to CF kiddos)?
Prolonged prothrombin time
86
Name GI manifestations of CF in the neonatal period
1. Meconium ileus
2. Meconium peritonitis
3. Unconjugated hyperbilirubinemia
87
The newborn screen is what % sensitive for the detection of CF?
95%
88
Presented with newborn with symptoms suspicious for CF and normal newborn screen... is CF ruled out?
NO
89
True or False: Newborn screening is diagnostic of CF
FALSE
90
How many infants with an abnormal newborn screen for CF actually have CF after further testing?
1 in 20
91
What is the only true diagnostic test for CF?
Sweat chloride testing
92
What pre-natal finding can be seen with meconium ileus?
Polyhydramnios
93
What can you see in abdominal films with meconium ileus?
Ground glass appearance (due to decreased bowel gas)
94
How might meconium peritonitis present on XR?
Pseudocyst (calcified meconium)
95
Which presents sooner with CF...GI or Pulm manifestations?
GI
96
Which type of exacerbations are more life-threatening in CF, GI or Pulm?
Pulm
97
Name 4 bacteria seen with CF?
1. S. Aureus
2. H. Influenzae
3. P. Aeruginosa
4. Burkholderia cepacia (advanced CF)
98
Which bacteria in CF is associated with worsening lung function and poor overall outcome?
Burkholeria cepacia
99
What is treatment of an acute exacerbation in CF?
Aminoglycoside and penicillin derivative like piperacillin
100
What is used to eradicate infection in CF?
Trick Question...Infections are controlled with antibiotics, but never completely eradicated
101
Name 3 lung manifestations of CF.
1. Cor Pulmonale
2. Pneumothoraces
3. Hemoptysis
102
True or False: Kids with CF should be encouraged to complete high school and pursue college/career?
True
103
True or False: Infants and children with CF should receive all routine immunizations, including yearly influenza vaccination
True
104
What happens when pulmonary vascular resistance exceeds systemic resistance?
Persistent fetal circulation
105
What results in right to left shunting of blood at the cardiac level?
Persistent fetal circulation (when pulmonary vascular resistance exceeds systemic resistance)
106
What circumstances is right to left shunting of blood at the cardiac level common in?
Pulmonary diseases that increase pulmonary vascular resistance
107
How will an infant with right to left shunting often present?
Respiratory distress shortly after delivery, lower O2 sats in lower extremities compared to upper (desaturated blood reaches descending aorta and below)
108
What is seen on chest exam for an infant with right to left shunting?
Precordial lift or prominent precordial impulse (due to increased workload of the right ventricle)
109
Name 4 signs of cor pulmonale.
1. Lower body edema
2. Hepatomegaly
3. Gallop rhythm
4. Clubbing
110
What are most cases of cor pulmonale caused by?
Pulmonary hypertension
111
If pulmonary hypertension reversible?
No
112
What is one potentially reversible cause of cor pulmonale?
Severe upper airway obstruction (surgically correctable and reversible)
113
What can be seen in many chronic lung diseases (like CF)?
Cor pulmonale
114
What is a condition in which cilia don't function normally?
Primary ciliary dyskinesia (dysmotile cilia syndrome)
115
How is primary ciliary dyskinesia inherited?
Autosomal Recessive
116
What 2 issues can ciliary dysfunction lead to?
1. Chronic sinusitis
| 2. Bronchiectasis
117
What is responsible for the heart being positioned on the left side of the chest during fetal development?
Cilia
118
What GU problem can ciliary dyskinesia cause?
Male infertility
119
How is primary ciliary dyskinesia diagnosed?
Biopsy
120
What is a type of primary ciliary dyskinesia associated with a mirror-image orientation of the heart and other internal organs (Situs Inversus)?
Kartagener Syndrome
121
If they note heart signs on the right side of the chest, what are they getting at?
Situs inversus -> Kartagener
122
Name 9 causes of pleural effusions.
1. Pneumonia
2. Liver failure
3. Renal disease (nephrotic syndrome)
4. Congenital heart disease
5. Trauma
6. Viral disease
7. Malignancy
8. Sickle cell anemia
9. Meningitis
123
What are the electrolyte concentrations in a chylothorax close to?
Serum electrolytes
124
What is a typical triglyceride count in a chylothorax?
Over 110
125
Is the lymphocyte count increased or decreased in a chylothorax?
Increased
126
What the protein count typically greater than in a chylothorax?
3
127
What pulmonary complication might you see in a post-op patient after cardiac surgery?
Chylothorax
128
Is a transudate or exudate seen with inflammation?
Exudate
129
What should you think of (transudate v. exudate) when you have a pleural effusion in the setting of pneumonia, cancer, trauma, or inflammatory disease?
Exudate
130
What are the LDH and protein values seen in an exudate?
1. Pleural LDH are at least 2/3 of the serum LDH
| 2. Protein is at least 3
131
What is the LDH and protein values seen in a transudate?
1. Pleural LDH is less than 2/3 pleural LDH
| 2. Protein is less than 3
132
What setting are transudates typically seen in?
CHF
133
What is a collection of pu in the pleural space?
Empyema
134
What should you think of in the setting of pneumonia not improving on appropriate antibiotics?
Empyema
| especially is some initial clinical improvement is seen after treatment
135
What is the most accurate test for determining if an effusion is exudate v. transudate?
pH
136
What is the pH in a transudate?
pH >7.45 (or higher than blood pH)
137
What is the pH in an exudate?
pH <7.3
138
How are empyemas treated?
Place a chest tube and start IV antibiotics
139
How long should IV antibiotic be contniued with an empyema?
Fever has resolved, 48 hours after chest tube pulled
140
Tachypnea, tachycardia, and unilateral decreased breath sounds...?
Pneumothorax
141
What specific scenario can you see a small spontaneous pneumothorax?
Marijuana smoking in a tall, thin, adolescent
142
What can be done for a small pneumothorax?
1. Observe
| 2. O2
143
If you need to decompress a pneumothorax, what are your 2 options?
1. Needle aspiration
| 2. Chest tube placement
144
If you have someone with a suspected pneumothorax that has tracheal shift and decreased BP, what do you suspect?
Tension pneumothorax
145
What is done for a tension pneumothorax?
Emergency needle decompression and chest tube placement
146
What common pediatric respiratory condition may lead to pneumothorax?
Asthm
147
What clinical scenario can pneumothorax be seen in?
Intubation and ventilation
148
True or False: Degree of pain correlates directly with the extent of the pneumothorax?
False
149
True or False: Intubation is important in management of pneumothorax
False- this will rarely be the first thing you do or answer they want
150
Possible causes of respiratory deterioration in an intubated patient?
```
TOMB:
Tension Pneumothorax
Oxygen source interruption
Moved ET tube
Broken equipment
```
151
What is a common cause of sudden deterioration of an infant on a ventilator?
Mechanical failure
152
What is permanent dilation of a small segment of airway along with inflammation?
Bronchiectasis
153
What is the most common cause of bronchiectasis?
CF
154
What type of respiratory infections are seen with bronhiectasis?
Lower respiratory tract infections
155
What is seen on CXR in bronchiectasis?
Typically specific areas of atelectasis (like a right middle lobe atelectasis)
156
What condition do you think of when they state coughing symptom are worse with changes in position- like after lying down?
Bronchiectasis
157
What is the most helpful diagnostic test for bronchiectasis?
CT chest
158
What are some causes of bronchiectasis besides CF?
Dyskinesia (primary ciliary dyskinesia
Immunodeficiency, Infection
Lobar pneumonia, right middle lobe syndrome, enlarged lymph nodes causing compression
Aspergillosis, Vaccine preventable illnesses (measles/pertussis)
TB
Extrinsic compression caused by enlarged lymph nodes
159
What are intrinsic (prenatal) risk factors for SIDS?
African American
Male
Premature (< 37 weeks)
Prenatal maternal smoking and/or alcohol use
160
What are extrinsic (postnatal) risk factors for SIDS?
```
Prone/Side sleeping
Sleeping on adult mattress, couch, playpen, or soft bedding
Bed-sharing
URI
Maternal smoking after birth
```
161
What % of SIDS infants have a known risk factor?
99%
162
True or False: Apnea monitors are useful in reducing the risk of SIDS?
FALSE- No evidence for this
163
What is the only indication for a home apnea monitor for an infant?
Apnea of prematurity that responds to stim when occuring
164
What tool may be protective against SIDS?
Pacifiers
| May consider during naptime in first year of life (usually after 1st month for breastfeeding)
165
What is it called when an infant has an episode where they stop breathing, develop cyanosis or pallor, become unresponsive, but are resuscitated successfully?
BRUE (used to be ALTE)
166
2 month old found limp, cyanotic, and apneic. Revived with mouth-to-mouth. In ED, exam findings normal...?
BRUE
167
What is typically required for a baby coming to the ED with a BRUE?
Hospitalization, Observation, and Workup
168
What are some features that may make discharge from ED after a BRUE appropriate?
1. First episode
2. Episode brief and self-resolving
3. In setting of something like nasal congestion or reflux
4. No previous significant history of medical illness
169
What are some things on the differential for a BRUE?
NAILS
Neuro (CNS anomaly, seizure)
Abuse/Trauma
Infection (RSV, pertussis, sepsis, meningitis, ...)
Lung problems (aspiration, apnea, GERD)
Sugar is low (metabolic disorders, hypoglycemia)
170
True or False: Apnea or BRUE is a risk factor or can precede SIDS?
False: These are completely separate
171
What are 4 most likely causes of hemoptysis in children?
1, Infection (pneumonia or TB)
2. CF (bronchiectasis)
3. Foreign body aspiration
4. Hemosiderosis
172
Presented with acute hemoptysis... best next step?
Anything diagnostic... have to identify source of bleeding
173
What are some appropriate choices for diagnostic tests for hemoptysis?
1. pH
2. CBC
3. Coags
4. CXR
5. Visualize airway
174
If hemopytsis fluid is acidic, where did it likely come from?
Stomach
175
If hemopytsis fluid is alkaline, where did it likely come from?
Lungs
176
What are the 4 main causes of pneumonia in infants (3 weeks to 12 months)?
1. Chlamydia
2. RSV
3. Parainfluenza
4. Pertussis
177
How is chlamydia pneumonia transmitted to an infant?
During delivery
178
Do infants with chlamydia pneumonia have fever?
No
179
What is seen on CXR for infants with Chlamydia pneumonia?
Interstital infiltrates
180
How does RSV typically present?
Bronchiolitis with wheezing
181
When is RSV most commonly seen (time of year)?
Late fall
182
When is parainfluenza bronchiolitis typically seen?
Fall through spring
183
Does pertussis pneumonia commonly present with fever?
No
184
What is the description of the cough in pertussis?
Paroxysmal
185
What cause of pneumonia seen in infants can lead to aspiration pneumonia?
Pertussis
186
What are 3 common causes of pneumonia in pre-school (1-4) children?
1. Viral
2. S. Pneumo
3. Mycoplasma (typically kid that is close to entering school)
187
What are some of the viruses that can cause pneumonia in pre-school children?
RSV, parainfluenza, human metapneumovirus, influenza, rhinovirus
188
What the most common treatable form of pneumonia in preschool children?
S. Pneumoniae
189
What are 4 causes of pneumonia commonly seen in school age children?
1. Mycoplasma pneumoniae
2. Chlamydophilia pneumoniae
3. S. Pneumoniae
4. Mycobacterium tuberculosis
190
What is the most treatable form of pneumonia in school age children?
Mycoplasma pneumoniae
191
Which two types of pneumonia in school age children present similarly?
Mycoplasma and chlamydophilia
192
Which type of pneumonia can lead to complications (like an empyema) in school age children?
S. Pneumoniae
193
Which group of children has a higher risk for mycobacterium tuberculosis pneumoniae?
Pregnant teens
194
True or False: You need labs to diagnosis pneumonia?
False
195
When are CXR not indicated to diagnose pneumonia?
If it is minor enough that it can be treated as an outpatient
196
Which type of pneumonia typically presents with abrupt onset of productive cough and fever, with a somewhat toxic picture preceded by URI symptoms?
S. Pneumoniae
197
Which type of pneumonia can present with abdominal pain and vomiting (possible even mimicking an acute abdomen)?
S. Pneumoniae
198
How does mycoplasma pneumonia present?
Low grade fever, insidious onset
199
What is seen on CXR for mycoplasma pneumonia?
Non-focal infiltrates
200
How does viral pneumonia present?
Upper respiratory symptoms (nasal congestion/rhinorrhea). May be afebrile or have a very low grade fever.
201
Name 3 major complications of pneumonia.
1. Necrotizing pneumonia
2. Lung abscess
3. Effusion
202
What causes necrotizing pneumonia?
Toxins produced by the bacteria, leading to necrosis, and liquification of lung tissue
203
How is necrotizing pneumonia diagnosed?
XR
204
What 2 drugs can be used to treat necrotizing pneumonia?
1. Vancomycin
| 2. Clindamycin
205
What pneumonia complication should you be concerned about in a child at risk for aspiration (seizures or neurological disorders)?
Lung Abscess
206
What is done to treat a sterile effusion?
Nothing
207
What can a purulent effusion lead to?
Empyema
208
What findings on exam may be concerning for a purulent effusion?
1. Dullness on chest percussion
2. Decreased air movement
3. Generalized findings: Ill appearance, tachypnea, chest discomfort
209
True or False: Effusions should be surgically drained?
?- This is controversial so probably not right answer
210
What are the two features of true recurrent pneumonia?
1. More than 1 confirmed positive XR in 1 year
| 2. More than 3 episodes of pneumonia in a lifetime (no symptoms between episodes)
211
What is something that may be mistaken as recurrent pneumonia?
Recurrent asthma with associated atelectasis on XR being mischaracterized as pneumonia
212
Patient with diagnosis of pneumonia confirmed on XR- Best diagnostic study to confirm diagnosis?
Blood cultures
- Don't pick sputum or nasopharyngeal cultures.
- Pleural fluid or culture of lung tissue would be definitive, but probably too invasive
213
True or False: Childhood-onset scoliosis can impair pulmonary function?
True
-Thus, treatment is indicated to minimize impact on pulmonary function
214
Does adolescent-onset scoliosis have concern for impairment of pulmonary function?
Not necessarily
215
True or False: Pectus excavatum does not typically result in any pulmonary issues?
True (primarily cosmetic concern)
