12: 10-month-old female with a cough Flashcards
What are the 4 most common causes of wheezing in infants and toddlers?
- Viral bronchiolitis
- Asthma
- Foreign body
- GERD
Why is paradoxical breathing more commonly seen in infants and young children?
They have greater compliance of the chest wall
What is paradoxical breathing?
The force of contraction generated by the diaphragm exceeds the ability of the chest wall muscles to expand the rib cage
What is hyperpnea?
Increased depth of respiration
What is hypopnea?
Reduced tidal volume
Are retractions due to excessive negative pleural pressure?
Yes
Which muscles are used in head bobbing?
Neck strap muscles
What is the nature of an asthmatic cough?
Dry
What are the names of the 3 phases of pertussis?
- Cattarhal
- Paroxysmal
- Convalescent
What is the cattarhal stage of pertussis?
1-2 weeks of URI symptoms
What is the paroxysmal stage of pertussis?
4-6 weeks of the whooping cough
What is the convalescent stage of pertussis?
Episodic coughing for months
How effective is the pertussis vaccine?
70-90%
Which bacteria is almost always in epiglottitis?
Hib
What age range is mostly affected by epiglottitis?
Age 2-5
What diagnosis should be considered in a child with fever, stridor, dysphonia, dysphagia, respiratory distress, and sitting leaning forward, with neck hyperextended and chin protruding?
Epiglottitis
Which immunizable disease has a characteristic gray pseudomembrane in the pharynx?
Diptheria
Which disorder is characterized by infiltration of inflammatory cells into the airway mucosa, mucus hypersecretion, mucosal edema, and bronchoconstriction?
Asthma
What are CXR findings in asthma?
Hyperinflation due to air trapping, patchy atelectasis
What is the best treatment for an acute asthma exacerbation?
Corticosteroids + B-2 agonist (alBu2erol)
What is the best maintenance therapy for asthma with frequent symptoms?
Inhaled corticosteroid as daily controller + B2 agonist for breakthrough symptoms
What is the most common cause of bronchiolitis?
RSV
Where in the respiratory tract does bronchiolitis occur?
Lower respiratory tract
What are the CXR findings of bronchiolitis?
Hyperinflation, scattered atelectasis, similar to asthma
What part of the lung is affected by pneumonia?
The parenchyma
What are the 4 most common viral causes of pneumonia in children?
- Adenovirus
- RSV
- Parainfluenza
- Influenza
Are viral or bacterial pneumonias more common in kids?
Viral
Are viral or bacterial pneumonias more severe in kids?
Bacterial
What bacteria is the most common cause of bacterial pneumonia in kids age 0-6?
S. pneumoniae
What bacteria is the most common cause of bacterial pneumonia in school-aged kids and older children?
M. pneumoniae
Which 3 bacteria may be the cause of neonatal pneumonia?
- GBS
- E. coli
- Klebsiella
Which type of pneumonia presents with a staccato cough between age 4-12 weeks?
C. pneumonia
“staCcato”
What’s the difference between viral vs. bacterial pneumonia on CXR?
Viral: diffuse/patchy interstitial infiltrates, hyperinflation, and small pleural effusions
Bacterial: airspace disease with lobar or segmental consolidation and air bronchograms
What’s the difference between viral vs. bacterial pneumonia in lab results?
Viral: Peripheral WBC counts tend to be normal or only slightly elevated
Bacterial: Peripheral WBC counts elevated w/ neutrophilic predominance
What is a disease which starts with cold-like symptoms that progress to inspiratory stridor and a “seal like cough,” a “steeple sign” on CXR, and most commonly presents in kids around age 2 years old?
Croup
What causes stridor?
Airway narrowing above the thoracic inlet
What causes wheezing?
Airway narrowing below the thoracic inlet
What causes Rhonchi?
Secretions and narrowing of airways
What causes crackles?
Fluid in alveoli or opening and closing of stiff alveoli
What causes bronchial breath sounds?
Air moving through areas of consolidated lung
When does stranger danger occur?
9 months
