II. History

  1. Sound characteristics
    1. Wheezing
    2. Stridor
    3. Rattle in chest
    4. Snurgles
  2. Onset
    1. Sudden onset: Foreign body
    2. Insidious onset: Asthma
    3. Congenital onset: Anatomic abnormality
  3. Relationship to provocative factors
    1. Exercise or activity
    2. Infection or environmental changes
    3. Feedings
  4. Effects of prior therapy
  5. Episodes of Choking or gagging
  6. Previous evaluations

III. History: Family History

IV. History: Environmental exposures

  1. Passive smoke
    1. Cigarettes
    2. Wood burning stove
    3. Kerosene heaters
  2. Allergens or irritants
    1. Dirt or dust
    2. Mold (wet basement)
    3. Air Pollution
    4. Feathers
    5. Too many stuffed animals
  3. Animal exposure
    1. Birds
    2. Cats
    3. Dogs

V. Examination

  1. Respiratory Rate
    1. Tachypnea is most sensitive marker for lung disease
  2. Respiratory effort
    1. Orthopnea
    2. Retractions
    3. Wheezing
    4. Grunting
  3. Auscultation
    1. Inspiratory Stridor (Extrathoracic)
    2. Expiratory Wheezes (Intrathoracic)
    3. Differential Wheeze from side to side (Foreign body)
  4. Digital Clubbing
    1. Cystic Fibrosis
    2. Abscess
    3. Bronchiectasis
    4. Neoplasm
  5. Pulse Oximetry

VI. Imaging

  1. Standard evaluation
    1. Chest XRay (PA and lateral views)
    2. Lateral neck film
  2. Specific indications
    1. Esophagram
    2. UGI series
    3. Chest CT scan
    4. Scintiscan
    5. Ventilation-perfusion scan

VII. Labs: As indicated

VIII. Diagnosis

  1. Pulmonary Function Testing
  2. Flexible bronchoscopy

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