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 |