Pediatric Pulmonology
What to master
Know airway anatomy by age (larger head, shorter trachea, narrower subglottis) and why children obstruct easily. Understand asthma pathophysiology-airway inflammation, bronchial hyperresponsiveness, and reversible obstruction-and the stepwise controller versus reliever logic. Master cystic fibrosis genetics (autosomal recessive, CFTR), presentation (meconium ileus, failure to thrive, steatorrhea, recurrent infection), and diagnosis (sweat chloride, genetic testing). Know croup (subglottic, barking cough, steeple sign) versus epiglottitis (supraglottic, drooling, tripod position, do not examine the throat).
Concepts that recur
Bronchiolitis is usually RSV, peaks in winter, and is managed supportively-no routine bronchodilators or steroids. Pneumonia etiology varies by age: group B streptococcus and gram-negatives in neonates, viruses in toddlers, Mycoplasma and Streptococcus pneumoniae in school-age children. Know foreign body aspiration (sudden onset, unilateral wheeze, right mainstem predilection) and primary ciliary dyskinesia (situs inversus, chronic otitis). Understand spirometry patterns: obstructive (reduced FEV1/FVC) versus restrictive (reduced FVC with normal ratio).
Traps
Questions blur croup and epiglottitis by describing drooling or toxic appearance-those point to epiglottitis and demand airway readiness. Another trap is treating bronchiolitis with antibiotics; the answer is supportive. Beware asthma in a preschooler-diagnosis is clinical, and a trial of therapy may be the answer. Finally, do not confuse nocturnal cough from asthma with postnasal drip or GERD.
Rule of thumb
Stridor = upper airway; wheeze = lower airway. Barking cough with stridor is croup; drooling with high fever is epiglottitis until proven otherwise.