Physical Exam

·    Pulmonary findings that define chronic stable asthma and an asthma exacerbation

·    Pertinent positives and negatives on non-pulmonary exam in patient with asthma

·    Perform a focused asthma physical exam

Differential diagnosis

·    Know additional causes of wheezing in the pediatric patient (infant, toddler, school age)

·    Know additional causes of respiratory distress in the pediatric patient (infant, toddler, school age)

·    Develop a diagnostic plan to evaluate a pediatric patient with new-onset wheezing

Diagnostic approach

·    Indications for chest radiograph in asthma

·    Indications for Pulmonary Function Testing in asthma

·    Indications for Bronchoscopy in asthma

·    Existence of other biomarkers for asthma diagnosis and management

·    Identify chest radiograph findings consistent with asthma

·    Distinguish normal and obstructive ventilatory patterns on spirometry

Therapeutics

·    Pharmacotherapy of asthma (beta-agonists, ipratropium, inhaled and oral corticosteroids, leukotriene modifiers)

·    Potential changes in outpatient regimen to improve asthma control

Disposition

·    Indications for changing outpatient asthma regimen

·    Frequency of follow-up required based on patient’s level of asthma severity and control

·    Design an asthma action plan

Prevention

·    Preventive home therapies

·    Potentially modifiable environmental triggers

·    Resources available to families for asthma education



CHRONIC RESPIRATORY FAILURE

Demonstrate* knowledge/understanding of:

Demonstrate these skills/abilities:

History

·    Assessment of respiratory failure

·    Appropriateness of current home chronic respiratory support

·    Pathophysiology that mandates chronic respiratory support in each patient

·    Comorbidities that may impair ventilation

·    Risk factors for increased susceptibility to respiratory infections in patients with chronic respiratory support

·    Perform a focused history in a patient requiring chronic respiratory support

Physical Exam

·    Important pulmonary findings in a patient  requiring chronic respiratory support

·    Pertinent positives and negatives on non-pulmonary exam

·    Anatomic and physiologic limitations that contribute to respiratory failure

·    Perform a focused physical exam in a patient requiring chronic respiratory support

·    Recognize the presentation of acute on chronic respiratory failure

Differential diagnosis

·    Know causes of respiratory  failure in the pediatric patient

·    Know causes of respiratory distress in the pediatric patient

·    Develop a diagnostic plan to evaluate a pediatric patient with chronic respiratory failure in respiratory distress

Diagnostic approach

·    Indications for a blood gas in a patient with  chronic respiratory failure

·    Indications for chest radiograph in a patient with  chronic respiratory failure

·    Indications for Bronchoscopy in a patient with  chronic respiratory failure

·    Interpret a blood gas in a patient with  chronic respiratory  failure

·    Interpret a blood gas in a patient with  acute respiratory  failure

·    Interpret chest radiograph findings in a patient with respiratory  failure

Therapeutics

·    Pharmacotherapy of pneumonia in a hospitalized pediatric patient with chronic respiratory failure

·    Indications for changing a tracheostomy tube

·    Indications for initiating non-invasive respiratory support

·    Indications for initiating or adjusting mechanical ventilation settings

·    Indications for transfer to PICU

·    Select antibiotic regimen for a patient with pneumonia and chronic respiratory failure

·    Perform a tracheostomy tube change

·    Adjust ventilator settings based on patient comfort, oxygenation and ventilation status

Disposition

·    Indications for admitting a patient with chronic respiratory failure

·    Discharge criteria for a  patient with chronic respiratory failure

·    Work with a multidisciplinary team to arrange for the safe discharge of the patient with chronic care needs to the home environment

Prevention

·    Preventive home regimen

·    Resources available to families for children with chronic care needs

·    Understand basic self-management principles for chronic disease


CYSTIC FIBROSIS

Demonstrate* knowledge/understanding of:

Demonstrate these skills/abilities:

History

·    Assessment of severity of CF lung disease

·    Triggers for a CF pulmonary exacerbation

·    Comorbidities that may increase CF pulmonary exacerbation frequency

·    Perform a focused CF history

Physical Exam

·    Pulmonary findings in a patient with a CF pulmonary exacerbation

·    Abdominal findings in a patient with Distal Intestinal Obstruction Syndrome

·    Pertinent positives and negatives of non-pulmonary exam in patient with CF

·    Signs of respiratory failure in CF

·    Perform a focused CF physical exam

·    Recognize severity of presentation of pulmonary exacerbation of CF in relation to vital signs and patient appearance

Differential diagnosis

·    Know causes of crackles and tachypnea in the pediatric patient

·    Know causes of respiratory distress in the pediatric patient

·    Understand causes of abdominal pain in a patient with CF

Diagnostic approach

·    Indications for a blood gas

·    Indications for a chest radiograph

·    Indications for a KUB

·    Indications for Pulmonary Function Testing

·    Indications for Bronchoscopy

·    Interpret a blood gas in patient with CF

·    Demonstrate chest radiograph findings consistent with CF

·    Differentiate obstructive from non-obstructive KUB findings

·    Interpret a Pulmonary Function Test

Therapeutics

·    Acute therapy of a CF pulmonary exacerbation

·    Acute therapy of Distal Intestinal Obstruction Syndrome

·    Indications for BiPAP support in CF

·    Indications for intubation and ventilation in CF

Disposition

·    Indications for admitting a patient with a CF pulmonary exacerbation

·    Indications for admitting a patient with Distal Intestinal Obstruction Syndrome

·    Indications for discharge in a patient with a CF pulmonary exacerbation

·    Indications for discharge in a patient with a Distal Intestinal Obstruction Syndrome

Prevention

·    Understand rigor and details of preventive home airway clearance regimen

·    Understand basic self-management principles for chronic disease


NEUROMUSCULAR DISEASE

Demonstrate* knowledge/understanding of:

Demonstrate these skills/abilities:

History

·    Assessment of respiratory status

·    Triggers for acute respiratory failure in a patient with neuromuscular  weakness

·    Comorbidities that may increase pneumonia risk

·    Perform a focused history in a patient with neuromuscular  weakness

Physical Exam

·    Pulmonary findings in a patient with  neuromuscular  weakness

·    Pertinent positives and negatives of non-pulmonary exam in patient neuromuscular  weakness

·    Signs of respiratory failure in a patient with neuromuscular  weakness

·    Perform a focused physical exam  in a patient with neuromuscular  weakness

·    Recognize severity of presentation of acute respiratory decompensation in a patient with neuromuscular weakness

Differential diagnosis

·    Know additional causes a weakened cough in the pediatric patient

·    Know additional causes recurrent pneumonia in the pediatric patient

·    Know additional causes of respiratory distress in the pediatric patient

·    Develop a plan to distinguish between pulmonary and non-pulmonary causes of respiratory distress in a patient with neuromuscular weakness

Diagnostic approach

·    Indications for a blood gas  in a patient with  neuromuscular  weakness

·    Indications for a chest radiograph  in a patient with  neuromuscular  weakness

·    Indications for Pulmonary Function Testing  in a patient with  neuromuscular  weakness

·    Interpret a blood gas in a patient with neuromuscular weakness

·    Demonstrate common chest radiograph findings in a patient with neuromuscular  weakness 

·    Interpret a Pulmonary Function Test in a patient with neuromuscular weakness

     Recognition of clinical signs suggestive of clinical deterioration in a patient with hypotonia- including lower saturations, tachypnea, lethargy, absence of increase work of breathing due to muscle weakness

 

Therapeutics

·    Empiric therapy of recurrent pneumonia in a patient with neuromuscular  weakness

·    Indications for BiPAP support in a patient with  neuromuscular  weakness

·    Indications for intubation and ventilation

·    Evaluate the effectiveness of non-invasive ventilation and cough assist support in a patient with neuromuscular weakness

Disposition

·    Indications for admitting a patient with neuromuscular weakness and respiratory illness

·    Indications for discharge in a patient with neuromuscular weakness and respiratory illness

Prevention

·    Preventative home cough assist regimen

·    Resources available to families for children with chronic care needs

·    Understand basic self-management principles for chronic disease


Obstructive Sleep Apnea and other Sleep Related Disorders

Demonstrate* knowledge/understanding of:

Demonstrate these skills/abilities:

History

·  Assessment of sleep symptoms, severity and triggers, sleep habits

·  Appropriateness of current home treatment or management

·  Comorbidities that may influence sleep symptoms or sleep disorders

·  Perform a focused Sleep history

·  Physical findings that may suggest or be associated to obstructive or central sleep apnea, hypoventilation, or insomnia.

·  Pertinent positives and negatives on non-pulmonary exam in patient with sleep disorders.

·  Perform a focused sleep physical exam

Differential diagnosis

·  Know additional causes of sleep maintenance difficulty, or noisy breathing in the pediatric patient (infant, toddler, school age)

·  Know additional causes of  or excessive daytime sleepiness, excessive fatigue, morning headaches or other morning symptoms in the pediatric patient (infant, toddler, school age)

·  Develop a diagnostic plan to evaluate a pediatric patient with sleep disorders, e.g., obstructive sleep apnea and restless leg syndrome

·    Develop differential diagnosis for sleep related symptoms and a plan for further evaluation

Diagnostic approach

·  Indications for polysomnography (PSG)

·   Indications for titration PSG

·  Indications for overnight saturation study

·  Indications for Airway evaluation in patients with OSA

·  Identify polysomnography findings consistent with sleep apnea

·  Distinguish normal and abnormal findings on a sleep study

Therapeutics

·  Pharmacotherapy of sleep disorders and medications to avoid

·  Potential changes in outpatient regimen to improve sleep

·  Indication and criteria for referrals to other subspecialties (sleep psychology, neurology) to address comorbid conditions that impact sleep.

Disposition

·  Follow-up on patient with sleep disorders

Prevention

·  Preventive home management and safety measures

·  Potentially modifiable environmental triggers

·  Disorders caused by untreated sleep apnea