Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Peds Resp Dz
Pediatrics
| Question | Answer |
|---|---|
| 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
Popular Medical sets