Pediatric Pulmonology
Domain focus
Pediatric pulmonology tests bronchiolitis, asthma, croup, cystic fibrosis, and pneumonia, with emphasis on severity assessment and evidence-based treatment.
Core rules
- Bronchiolitis (usually RSV, age <2 years) is diagnosed clinically: rhinorrhea, cough, tachypnea, wheeze, crackles. Treatment is supportive-suction, hydration, and oxygen for SpO2 <90%. Routine bronchodilators, corticosteroids, antibiotics, and chest physiotherapy are not recommended.
- Croup: barking cough, hoarse voice, inspiratory stridor. Give dexamethasone; add nebulized epinephrine for moderate-to-severe stridor or distress.
- Asthma exacerbation: oxygen, repeated SABA, ipratropium for severe episodes, and systemic corticosteroids. Add magnesium sulfate for severe refractory cases.
- Cystic fibrosis: positive newborn screen (IRT/DNA) or symptoms; sweat chloride ≥60 mmol/L is diagnostic.
Worked example
A 3-month-old has 2 days of rhinorrhea, low-grade fever, tachypnea, and diffuse wheeze. SpO2 is 88% on room air. Reasoning: this is bronchiolitis. Admit for oxygen and supportive care; suction nares, maintain hydration, and monitor for apnea. Do not order routine albuterol or steroids; a trial is not required. Antibiotics are reserved for secondary bacterial infection.
Traps
- Treating bronchiolitis with antibiotics or steroids “just in case.”
- Missing apnea in a preterm or young infant with RSV.
- Sending home a child with croup who has stridor at rest after epinephrine without observation.