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Peds Resp Dz


Potentially life threatening = <3 mos; 101F (38.3C)
Viral rhinitis (3-8/yr): etiology rhino, corona; more bronchial = adenovirus, RSV
Viral rhinitis (50% of URIs) transmission hand, inhaled droplet; incubation 2-5 days; sx resolve 5-7 days
Viral rhinitis tx tylenol; ibuprofen if >6 mos; no ASA; sudafed/ phenylephrine; poss Afrin >2 yo; DM for cough; No Role for antihistamines
FDA: viral rhinitis tx no cough/cold meds for kids <2 yo
Purulent rhinitis s/s persistent mucopurulent nasal d/c and irreg fever; often GAS / SP
Strep tx Amox; clinda for tx failure
Sinus devt maxil / ethmoid dz most common; fully formed at birth (clinical dz at 6 mos); sphenoid 7-8 yrs; frontal early teens
Rhinosinusitis: 2 presentations in kids 1: ≥10 days nasal congestion, purulent nasal drainage and/or persistent cough; 2: abrupt onset w/ fever >101F, facial pain & purulent nasal drainage
Rhinosinusitis agents: Big 3, esp SP (declining)
Chronic Rhinosinusitis agents: alpha-hemolytic strep; SA; anaerobes
Mild-mod Rhinosinusitis tx Amox (10-14 d); if allergy, 3G ceph or macrolide
Severe Rhinosinusitis tx Augmentin; macro or ceph
Frontal osteomyelitis secondary to frontal sinusitis = Pott puffy tumor; surgical drainage & IV Abx
Rhinosinusitis: indications for referral need surgical drainage; need polypectomy; recurrent sinusitis (esp w/ exacerbation of asthma); rare/ resistant microbe; intracranial or orbital complications; suspected immunodeficiency
AOM most common in: boys; formula-fed; winter; 6 mos-3 yo (esp 6-12 mos); 2nd peak at 5 yo
AOM agents Big 3; GAS; RSV, rhino, CMV
AOM in assoc w/conjunctivitis, think: H flu
AOM: ABx for: febrile children and those < 2 years
AOM: PRSP RFs Recurrent tx w/beta-lactams; Recurrent AOM; Day care; Winter; age <2 years
AOM: indication for tubes bilateral effusion for 3 mos AND a bilateral hearing deficiency
Flu incubation 1-4 days post-exposure
Flu presentation in kids croup, bronchiolitis, GI upset, conjunctivitis, OM; sore throat, nasal congestion, conjunctivitis, nonproductive cough
Flu: comps Pneumonia; Myositis; Myocarditis, pericarditis; Aseptic meningitis; Encephalitis; Reye syndrome; Guillain-Barre syndrome
Flu: dx Epidemiologic; Virus isolation or antigen detection; Serologic
Most common clinical manifestation of acute upper airway obstruction: croup
Croup presentation stridor, barking seal; worse at night; winter; 6 mos-3 yo; males; Parainfluenza; high RR, rales, rhonchi, retractions; steeple sx
Prolonged expiratory phase, hyper-resonance to percussion, & wheezing = bronchiolitis
Bronchiolitis presentation <2 yo (peak 6 mos); M>F; winter; if cardiopulmonary dz / immunodeficiency: more severe dz; concurrent URI; low fever
Bronchiolitis agent RSV or HMPV (also poss PIV, flu or adeno)
Premies w/bronchiolitis often have: apneic spells as presenting sx
Bronchiolitis: X-ray may show: hyperinflation, atelectasis and infiltrates
Croup/bronchiolitis tx supportive; cool mist humidification; pulse ox, O2 if hypoxemia; poss bronchodilators
Pneumonia RFs CHD/ lung dz; CF; asthma; SCD; immunodeficiency syndromes
Pneumonia: viral causes more common in kids <5 yo; RSV, PIVs, Influenza, Adenovirus
Pneumonia: viral causes in neonates: consider CMV, Herpes, rubella
Pneumonia: bac causes if <1 month old GBS, SA, gram neg enteric bacilli; T. pallidum; Listeria
Pneumonia: bac causes for 1 month-5 yo SP (most common); H flu; GAS; SA (&MRSA); M. pneumo; C. pneumoniae
Pneumonia: bac causes for >5 yo M pneumo most common; SP, C pneumo; TB
Less common bac causes of pneumonia C trachomatis (afebrile pneumo in 2 wks-3 mos); pertussis, PCP
Pneumonia: dx CXR = segmental infiltrates, atelectasis, pleural effusions; poss empyema; blood cx pos in 10-30% of bac
Viral pneumonia s/s tachypnea, retractions, nasal flaring & use of accessory mx; diffuse rales, wheezing; CXR diffuse interstitial infiltrates & hyperinflation
M pneumo findings CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes; Fever, cough, HA, malaise; sore throat / OM
Created by: Adam Barnard Adam Barnard