Pediatric Resp

Question 1

What are some common presentations of cystic fibrosis?

Answer 1

1. Nasal polyps/ sinusitis
2. Persistent cough/ resp infection/ refractory asthma
3. Fussy baby
4. Steatorrhea
5. Failure to thrive, malnutrition

Question 2

Laryngomalacia

Answer 2

1. Most common cause of chronic stridor
2. Worse with feeding, crying
3. Spontaneous resolution by 12-18 mo

Question 3

Congenital tracheal lesions causing stridor

Answer 3

1. Tracheomalacia
2. Anterior compression (inominate artery)
3. Vascular sling (left pulmonary artery wraps)

Question 4

Acquired structural airway lesions causing stridor

Answer 4

1. Granuloma
2. Papilloma
3. Tumours
4. Subglottic Stenosis
5. Vocal cord paresis

Question 5

Croup

Answer 5

1. Caused by parainfluenza virus
2. 3mo to 3 years
3. Febrile
4. Gradual progression of barky cough to stridor
5. May have rhinorrhea, hoarseness, conjunctivitis
6. treat with nebulized epinephrine, systemic steroids

Question 6

Bacterial Tracheitis

Answer 6

1. Caused by staph aureus, group a strep
2. 1-8 years old
3. Sick
4. Muffled voice, cough, tracheal tenderness
5. Gradual progression to stridor
6. Treatment: NPO, analgesia, antibiotics

Question 7

When do you need to rule cystic fibrosis out?

Answer 7

1. Bowel obstruction
2. Rectal prolapse
3. Family hx

Question 8

What are concerning features of a childhood cough?

Answer 8

1. Perceived to be ill
2. Losing sleep
3. Interfering with school
4. MSK pain
5. Associated vomiting

Question 9

What mutation causes cystic fibrosis?

Answer 9

F508 in the CFTR protein

Actually many mutations

Question 10

What virus causes bronciolitis?

Answer 10

RSV

Question 11

What are the risk factors for pediatric asthma

Answer 11

• pre or post natal tobacco exposure
• viral infections with RSV
• indoor/outdoor pollution

Question 12

What signs do you NOT see in pediatric asthma?

Answer 12

• clubbing, polyps (CF)
• Hyperinflation
• Hemmorrage in eye (Pertussis)

Question 13

How is pediatric asthma treated?

Answer 13

1. Usually first line is trial therapy of inhaled steroids
2. Second line is leukotriene receptor antagonist (add this on if refractory)
3. Use chamber with mask or valve depending on age
   Education is vital!
4. Usually only do PFTs if old enough (usually around 8 years old)

Question 14

What are the system based effects of cystic fibrosis?

Answer 14

Head/neck: chronic sinusitis, nasal polyps
Chest: lower resp tract infections
GI: pancreatic insufficiency, diabetes, liver disease, gall stones, steatorrhea
MSK: Osteoporosis, arthritis, finger clubbing
GU: male infertility

Question 15

How do we test for cystic fibrosis

Answer 15

1. Currently newborn screening programs in most provinces (Immune reactive trypsinogen first step, then sweat chloride, then genetic testing)
2. May also do CXR/CT/PFTs if later

Question 16

What are the signs of a life-threatening asthma attack?

Answer 16

1. Silent chest
2. Cyanosis/hypoxia
3. Bradycardia
4. Hypotension
5. Hypercapnia despite effortf

Question 17

When does bronchiolitis incidence peak?

Answer 17

1. In 2-5 month old group

2. Typically more in winter

Question 18

How do we test for OSA in children?

Answer 18

1. Polysomnography is the only real test we can do

2. Different cutoffs: moderate=5-10/h, severe >10/h

Question 19

Epiglottitis

Answer 19

1. Very quiet, very sick, rapid onset of airway obstruction- get stridor
2. Drool

Question 20

Red flags with stridor

Answer 20

1. Present since birth
2. Biphasic
3. Abnormal voice
4. Poor feeding

All of these merit further investigation as may be structural