ASTHMA
This is the preferred reliever medication for rapid reversal of bronchospasm during an acute asthma exacerbation.
Albuterol (short-acting beta-agonist, SABA)
Teaching pearl:
SABAs relieve acute bronchospasm, but frequent SABA use is a marker of poor asthma control and should prompt reassessment of controller therapy.
This is the most common cause of bronchiolitis in infants.
Respiratory syncytial virus (RSV)
Teaching pearl:
Classic bronchiolitis management is mainly supportive. For boards, bronchodilators and steroids are not routinely recommended in standard bronchiolitis.
This is the most common cause of respiratory distress in a term or late-preterm infant delivered by cesarean section.
Transient Tachypnea of the Newborn (TTN)
💡 Pearl: Fluid clearance issue. TTN usually presents with tachypnea shortly after birth and improves over 24–72 hours. C-section without labor is a classic risk factor.
This organism is classically associated with chronic lung infection in older children and adolescents with cystic fibrosis and is linked to worse outcomes.
Pseudomonas aeruginosa
Teaching pearl:
In CF, chronic Pseudomonas colonization is a major turning point and often changes long-term management strategies.
This is the most common cause of obstructive sleep apnea in children.
Adenotonsillar hypertrophy
Teaching pearl:
In pediatrics, enlarged tonsils/adenoids are the classic cause of OSA, whereas obesity becomes increasingly important with age.
A school-age child has daytime asthma symptoms more than 2 days per week, nighttime awakenings 3 times per month, and some activity limitation. This level of severity is most consistent with this category.
Mild persistent asthma
Teaching pearl:
Know the difference between intermittent vs persistent, because it drives step therapy. Even mild persistent asthma usually needs an inhaled corticosteroid controller.
A toddler presents with sudden cough, unilateral wheeze, and asymmetric breath sounds after playing unsupervised. This diagnosis must be assumed until proven otherwise.
Foreign body aspiration
Sudden onset respiratory symptoms in a previously well toddler are a board classic for foreign body aspiration, even if the chest x-ray is normal.
A premature neonate develops grunting, retractions, and diffuse ground-glass opacities on chest x-ray due to surfactant deficiency. This is the diagnosis.
Neonatal respiratory distress syndrome (RDS)
💡 Pearl: surfactant administration + respiratory support- Classic RDS management.
RDS is strongly associated with prematurity. Surfactant deficiency leads to alveolar collapse, decreased compliance, and increased work of breathing.
This airway clearance strategy is a cornerstone of chronic pulmonary management in patients with cystic fibrosis.
Chest physiotherapy / airway clearance therapy
Teaching pearl:
CF management is not just antibiotics — airway clearance is foundational.
This is the gold standard diagnostic test for obstructive sleep apnea in children.
Polysomnography
Teaching pearl:
Polysomnography is the definitive test when diagnosis or severity matters.
This medication class is considered the most effective long-term controller therapy for persistent asthma in children.
Inhaled corticosteroids (ICS)
Teaching pearl:
ICS are the foundation of persistent asthma treatment. Remember that poor adherence and poor inhaler technique are among the most common reasons for “treatment failure.”
This is the confirmatory test for cystic fibrosis after a positive newborn screen.
Sweat chloride test
Teaching pearl:
Newborn screening suggests CF, but diagnosis is confirmed with sweat chloride testing and/or supportive genotyping plus clinical context.
Term infant with severe distress and patchy infiltrates after meconium-stained delivery. Risk complication?
Persistent pulmonary hypertension of the newborn (PPHN)
💡 Pearl: MAS → PPHN risk
This vitamin deficiency pattern is common in cystic fibrosis.
fat-soluble vitamins A, D, E, and K
Teaching pearl:
When CF affects the pancreas, think malabsorption, poor growth, steatorrhea, and fat-soluble vitamin deficiency.
A 2-year-old has inspiratory stridor that worsens when supine and improves when prone; symptoms began in infancy. This diagnosis is most likely.
Laryngomalacia
Teaching pearl:
Laryngomalacia is the most common cause of chronic stridor in infants. Most cases are mild and improve with time.
A child with acute severe asthma has persistent respiratory distress despite repeated albuterol and systemic steroids. This IV medication may be used because it promotes bronchodilation through smooth muscle relaxation.
IV magnesium sulfate
💡 Pearl:
IV magnesium is a classic high-yield escalation therapy in moderate-to-severe exacerbations not responding adequately to first-line treatment.
A child with recurrent pneumonia in the same lobe should raise concern for this location-wise underlying problem before assuming “just bad luck.”
Anatomic obstruction or structural airway abnormality
Recurrent pneumonia in the same location suggests a focal issue such as foreign body, bronchial obstruction, vascular compression, or congenital malformation. Different lobes suggest broader systemic causes.
This chronic lung disease of prematurity is typically defined by oxygen requirement at 36 weeks’ postmenstrual age in infants born very preterm.
Bronchopulmonary dysplasia (BPD)
Teaching pearl:
BPD results from a mix of prematurity, oxygen exposure, ventilator injury, and inflammation. Long-term issues include wheezing, feeding difficulty, pulmonary hypertension, and growth concerns.
A child with chronic productive cough and recurrent lower respiratory infections has permanent dilation of bronchi on imaging. This is the diagnosis.
Bronchiectasis
Teaching pearl:
Bronchiectasis is a structural consequence of chronic airway inflammation/infection. In pediatrics, always ask why it developed: CF, primary ciliary dyskinesia, immunodeficiency, aspiration, or prior severe infection.
This viral syndrome presents with barking cough, hoarseness, and inspiratory stridor due to upper airway inflammation.
Croup (laryngotracheitis)
Teaching pearl:
Classic croup treatment: dexamethasone, and if moderate/severe with stridor at rest, nebulized epinephrine.
In a child with recurrent wheeze, this spirometry finding strongly supports asthma: an increase in FEV1 after bronchodilator by at least this percent.
FEV1 increase of at least 12%
Teaching pearl:
For board questions, asthma is supported by reversible airflow obstruction. Normal spirometry does not exclude asthma if the child is asymptomatic at the time of testing.
A previously healthy infant with recurrent wet cough, chronic otitis, and laterality abnormality should make you suspect this disorder.
Primary ciliary dyskinesia
Teaching pearl:
Think of primary ciliary dyskinesia when you see chronic wet cough + recurrent ear/sinus disease + situs abnormalities. It is a favorite board association.
A neonate has copious oral secretions, choking with feeds, and inability to pass an NG tube. This congenital lesion should be suspected.
Tracheoesophageal fistula with esophageal atresia
Remember the classic clue: excess secretions + feeding intolerance + failed NG passage.
This inhaled medication is used in cystic fibrosis to improve mucus clearance by breaking down extracellular DNA in airway secretions.
Dornase alfa
Teaching pearl:
Dornase alfa reduces mucus viscosity and is one of the most recognizable disease-specific pulmonary therapies.
A child with drooling, tripod positioning, muffled voice, and fever should be assumed to have this life-threatening upper airway emergency until proven otherwise.
Epiglottitis
Teaching pearl:
Do not agitate the patient unnecessarily. The board principle is secure the airway first in a controlled setting and avoid provoking complete obstruction.