Libro blanco de las ACES Pediátricas 2024

Libro Blanco de las ACES Pediátricas 2024 678 ❚ 4. Recognize the effects of inspiratory and expiratory obstruction on inspiratory to expiratory ratio c. Retractions/bulging 1. Know that intercostal and suprasternal retractions, nasal flaring, and increased rate and depth of respiration indicate increased respiratory drive and increased work of breathing 2. Know that chest wall retractions usually reflect abnormally negative intrapleural pressure and/or a highly compliant chest wall d. Chest size and shape 1. Recognize abnormal chest wall configurations, including pectus excavatum, pectus carinatum, barrel chest, scoliosis, kyphosis, “bell-shape" asphyxiating thoracic dystrophy, and rickets 2. Know the definition and differential diagnosis of an increase in the anteroposterior diameter of the chest e. Diaphragmatic function 1. Recognize the appearance of asymmetric diaphragmatic activity f. Digital clubbing/pulmonary osteoarthropathy 1. Identify diseases that predispose patients to digital clubbing/pulmonary osteoarthropathy 2. Recognize the characteristics of early digital clubbing 2. Percussion a. Understand the clinical significance of changes in percussion (dullness vs tympany vs hyper-resonance) 3. Auscultation a. Know the projections of the bronchopulmonary segments on the chest wall b. Recognize and differentiate stridor, crackles, wheezes, pleural and pericardial friction rubs c. Understand the pathophysiologic mechanisms responsible for crackles and wheezes 4. Palpation a. Recognize the causes of a deviated cervical trachea b. Recognize the importance of costochondral tenderness c. Recognize the significance of crepitus over the chest wall 5. General a. Know that pulsus paradoxus reflects the change in pleural pressure between inspiration and expiration b. Recognize the importance of a loud pulmonic valve closure sound c. Understand the importance of examining the ear canals in a patient with chronic cough C. Pulmonary function testing 1. Static lung volumes a. Spirometry 1. Know that lung volumes increase approximately in proportion to the change in body length in healthy growing children of average body size 2. Understand methods of measuring pulmonary function in infants, young children, and minimally cooperative children 3. Know that spirometry does not measure absolute lung volumes and capacities