Term
| What are the critical elements of a pediatric history for diagnosis airway disease? |
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Definition
Birth, when did it begin, triggers, what makes it better, what is it like, does it wake you?
1) Birth history
2) Did it arise in 1st 6 months?
- congenital?
3) What are the triggers of cough or wheeze?
- Viral RI?
4) Response or lack of response to therapy?
5) Nature of cough (wet or dry)?
- asthma is dry in infants
- wet means bacterial, CF or primary ciliary dyskinesia (PCD)
6) Does the cough wake you from sleep?
- RED FLAG. |
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Term
| What is the "Atopic triad" that should be asked about in Family h/x? |
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Definition
1) Asthma
2) Eczema
3) Allergies
If emphysema, CAD, CVA, think enviornmental |
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Term
| What are the most important ROS for a pediatric respiratory exam? |
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Definition
1) GER
2) Recurrent OM (PCD but NOT CF), sinusitis, and pneumonia/bronchitis/bronchiolitis
- Humoral immunodeficiency (IgA or IgG)
3) Stool history
- Oily or greasy in CF
4) Failure to thrive
- CF |
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Term
| How can a history of OM help you narrow down your pediatric ddx? |
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Definition
| common in PCD but not CF. |
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Term
| What is meant by a child who is a "happy wheezer"? |
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Definition
Remember, all infant's chest walls are excessively compliant in first 6 months.
1) Kids with Large airway diseases (floppy trachea or bronchus) have chronic noisy breathing but NEVER have respiratory distress (NO HYPOXEMIA). |
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Term
| What does the "time constant" have to do with pediatric respiratory disease physiology? |
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Definition
Time constant (s)= Resistance (viscous flow) * Compliance (elastic recoil)
**approximately 1/3 the time for lungs to empty fully**
1) Resistance
- Small changes in airway size create large changes in Resistance
- 8nL/(pi)r^4
2) Compliance is change in volume per a change in pressure.
- Increased compliance in bronchopulmonary dysplasia (BPD) and focally in congenitl lobar emphysema (CLE) |
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Term
| Why in small airway disease of children is the time constant (t) increased, but RR also increased? |
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Definition
T is 1/3 the time for a lung unit to empty and depends on R * C
- In small airway disease like RSV, T increases because R increases.
- HOWEVER, there is V/Q mismatching, so Ve increases and "air trapping" occurs, leading to over-expansion of the lungs and pressure pushing the diaphragm from the chest wall (you see subcostal retractions). |
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Term
What do each of the following findings on pediatric chest inspection indicate?
1) RR= 50 in a 1 week old
2) Subcostal RTX
3) Intercostal/suprasternal RTX |
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Definition
1) RR of 50 is normal for 2 week and 32 is normal for 1 year)
2) Subcostal retractions (RTX) means small airway disease
3) Intercostal/suprasternal RTX means excessive negative pleural pressure in Pneumonia, RDS and interstitial lung disease.
2) Palpation
3) Percussion
4) Ascultation |
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Term
What do the following PE findings indicate?
1) Unilateral vibrations on palpation
2) Crackles (discontinuous)
3) Polyphonic Wheezing (continuous)
4) Monophonic Wheezing (continuous) |
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Definition
1) Bronchomalacia, foreign body or mucus plug
2) Interstitial lung disease (coarse or fine)
3) Polyphonic means asthma or bronchiolitis
4) Monophonic tracheo- and bronchomalacia or bronchial foregin body (single location of partial obstruction) |
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Term
A 1 year old child presents with difficulty breathing. On palpation, you notice unilateral vibrations which are accompanied by monophonic wheezing.
What are the possible diagnoses? |
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Definition
| Bronchomalacia, Tracheomalacia or Foreign body. |
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Term
| Why are symptoms from bronchiolar obstruction much more common in infants and young children than in adults? |
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Definition
Bronchioles contribute 50% of airway resistance in the younger cohort, while only 10% in the older.
Bronchiolitis is commonly acute in kids and chronic in adults. |
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Term
| What is the most common etiological agent of acute infectious bronchiolitis in kids? |
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Definition
RSV- most kids <2
- ssRNA virus that enters through nasal or conjunctival mucosa and first infects upper airway (increased secretory and circulating Ab production)
- Infects secretions are aspirated into lower airway and infect epithelial cells (replicates inside cell and is released with lysis)
- Peribronchiolar edema and mononuclear and lymphocytic infiltration occur, with stimulation of mucous production
Mycoplasma pneumoniae is also a concern. |
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Term
| What is the basic pathogenesis of RSV infection of infants? |
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Definition
Most common cause of hospitalization in kids <1
1) ssRNA virus that enters through nasal or conjunctival mucosa and first infects upper airway (increased secretory and circulating Ab production)
2) Infectious secretions are aspirated into lower airway and infect epithelial cells (replicates inside cell and is released with lysis)
3) lysed cells cause inflammation: Peribronchiolar edema and mononuclear and lymphocytic infiltration occur, with stimulation of mucous production
4) V/Q mismatching occurs and hypoxemia follows, with low compliance and high resistance |
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Term
A 1 month-old boy presents with profuse rhinorrhea and a prominent cough. He is breathing at a RR of 60 and is working hard with "short, shallow breaths."
On PE, you notice intercostal, sternal and subcostal RTX.
You also note crackles and wheezing
Why do you see this breathing pattern and what should you do next? |
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Definition
RSV for sure
1) Short rapid breathing because of decreased compliance and increased resistance (needs to conserve work).
2) Try and identify organism with nasopharyngeal wash or viral culture (ELISA and PCR are fast and reliable)
3) Treat with fluid replacement (careful), supplemental O2 and maybe bronchodilators
**Not anti-inflammatory and anti-viral agents** |
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Term
| Who should be passively immunized against RSV? |
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Definition
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Term
| What is Bronchopulmonary dysplasia and who does it affect? |
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Definition
BPD is lung disease of small, premature infants.
- Infants are born with RDS because of surfactant deficiency and lung immaturity.
- Multifactorial pathogenesis with ventilator-induced volutrauma and barotrauma, as well as oxidant injury, nutrition, corticosteroids (RSD) |
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Term
| How should babies with BPD be managed? |
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Definition
Oxygen (retinopathy concern), bronchodilators, anti-inflammatories, ect.
The clinical status of children with BPD should improve over time with continued somatic and pulmonary growth...
If it doesn’t, consider:
Airway complications
Gastroesophageal reflux, aspiration
Cardiac complications |
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Term
| What are the cardiovascular and neurological complications of BPD?1 |
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Definition
1) CV (monitor oximetry and BP closely)
- Pulmonary hypertension
- Cor pulmonale
- Heart failure
- Systemic hypertension
- Shunts
2)
- Neuromotor feeding disorders
- Developmental delay
- Spasticity - hypotonia
- Auditory loss
- Visual loss |
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