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Peds Resp Dz

Pediatrics

QuestionAnswer
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 SP, H flu, M cat; GAS; RSV, rhino, CMV
AOM associated with conjunctivitis suggests: H flu
Use Abx in AOM for which patients? febrile children and those < 2 years
AOM: risk factors for penicillin resistant Strep pneumo (PRSP) Recurrent tx w/beta-lactams. Recurrent AOM (>3 episodes in 6 months or >4 episodes/year). 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
Prolonged expiratory phase, hyper-resonance to percussion, and wheezing = bronchiolitis
Bronchiolitis presentation <2 yo (peak 6 mos); M>F; winter. 100,000 hospitalizations/year. Daycare / secondary smoke exposure. If cardiopulmonary dz / immunodeficiency: more severe disease
Bronchiolitis agent RSV or human metapneumovirus (hMPV). Also possibly Parainfluenza adenovirus
Premature infants with bronchiolitis often have: apneic spells as presenting sx
Bronchiolitis: X-ray may show: hyperinflation, atelectasis, infiltrates, peribronchial cuffing
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 bacterial 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
Mycoplasma pneumoniae findings CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes; Fever, cough, HA, malaise; sore throat / OM
Pathology of hyaline membrane disease (HMD) Deficiency/inactivation of pulmonary surfactant => decreased alveolar surface tension => poor lung compliance & atelectasis => hypoxemia
HMD incidence 5% of infants born at 35-36 weeks. >50% in infants born <28 weeks.
HMD risk factors C-section. Birth asphyxia. Diabetic mom. Siblings with hx of HMD.
HMD mgmt Steroids to mom in preterm labor. Artificial surfactant in delivery room for infant born <27 weeks. O2, nasal CPAP, intubation PRN.
Croup bugs parainfluenza types I to III, adenovirus, RSV
Croup sx/sx Afebrile, normal sats. Concurrent URI. Retractions, tachypnea, audible stridor. Stridor, barking seal cough, worse at night. Steeple sx on neck xray.
Croup mgmt if not emergent Neb mist, O2, possibly racemic epinephrine nebs. Steroids (dexamethasone) if stridor at rest
Bronchiolitis sx/sx Tachy/tachy, low fever. Nasal flaring, retractions, rales, wheezes, long exp phase. Hypoxia on ABG
Croup presentation 3 months-3 years old. M:F 3:1. october-April. 100-1000x more common than epiglottitis
Epiglottitis bug H flu (HiB)
Epiglottitis presentation M:F 2:1. 3 months - 6 yrs old. Any season
Epiglottitis sx/sx Sudden rapid progression. Pharyngitis, dysphagia, odynophagia. High fever. Inspiratory stridor, tachypnea, tripod posture.
If Epiglottitis is suspected, DO NOT: examine mouth or neck: may cause spasm and worsen upper airway obstruction
Epiglottitis workup Soft tissue neck x-ray: thumb sign (swollen & posteriorly displaced epiglottis). BC often positive.
Epiglottitis mgmt Hospitalize. Manage ABCs. Anesthesia for prn nasotracheal or orotracheal intubation. IVF & humidified O2. IV Abx: cefotaxime, CTX, or Unasyn
Croup mgmt if emergent (if upper airway obstruction) Intubate (watch for post pulmonary edema)
Pertussis pathology Tracheal cytotoxin, dermonecrotic factor, and adenylate cyclase => local epithelial damage => resp sxs
Pertussis stages Cararrhal (1-2 weeks): prodrome, most contagious, URI sxs. Paroxysmal (2-4 weeks): severe cough. Convalescent (1-2 weeks): sxs decrease
Pertussis mgmt Erythromycin (aborts dz in catarrahl stage, does not limit duration in later stage), azithro (kids <1 mo), clarithromycin. Steroid aerosols, mist O2.
AOM tx Amox 90 mg/kg/day x10 days (azithro if allergy). If tx failure, use Augmentin 80-90 mg/kg/day
Created by: Abarnard