21- fever Flashcards
Whispered pectoriloquy
When you have the patient whisper words, “one-two-three,” you hear it louder with the stethoscope over areas of consolidation or cavity.
Which of the lung findings would signify that there is a lung consolidation
A. Egophony
B. Increased tactile fremitus
D. Dullness to percussion
E. Crackles
G. Whispered pectoriloquy
Modified Centor for evaluating strep throat
Give one point for each positive response:
Tonsillar exudate or erythema
Anterior cervical adenopathy
Cough absent
Fever present:
Age 3 to 14 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 point
if strep Score 4 to 5:
Treat with antibiotics
If Strep Score 2 to 3:
Perform rapid antigen test
positive: Treat with antibiotics
negative: Throat Culture (…in children only.
if Strep Score 0 to 1:
Provide Pharyngitis Symptomatic Treatment
Influenza testing is done via
nasopharyngeal swab: a flexible shaft is inserted through the nostril to the back of the throat.
bronchiolitis
Caused by viruses such as respiratory syncytial virus (RSV).
Seen in young children with the incidence peaking at 6 months of age.
Often starts as a viral illness and progresses to wheezing, cough, dyspnea, and cyanosis.
Infants require supportive treatment including oxygen if hypoxic, while they are recovering
Bacterial pneumonia
fever> 38 degrees C (100.4 degrees F) + sputum
Most commonly caused by streptococcus pneumoniae.
NO prodrome like rhinorrhea or myalgias
symptoms include pleuritic chest pain, fever, chills, and dyspnea. maybe cough. half have pleural effusion.
**Crackles , focal wheezing, whistling
Viral pneumonia
atypical presentation, i.e., chills, fever, dry, nonproductive cough, and the predominance of extrapulmonary symptoms such as GI symptoms and arthralgias.
Causes: influenza, RSV, parainfluenza, rhinovirus, adeno
More common in children aged four months to five years.
Atypical pneumonia
Adults!
Mycoplasma or Chlamydia pneumoniae
headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are other common symptoms.
Acute bronchitis
Self-limited inflammation of the large airways in the lung characterized by cough.
Inflammation leads to excessive tracheobronchial mucus production sufficient to cause purulent sputum in half of patients.
Cause is usually viral.
coughing persists for more than five days.
rhonchi, wheezes, or normal
influenza
upper and lower respiratory tract symptoms accompanied by systemic symptoms such as myalgia, high fever, headache, and weakness
abrupt! winter time
Rhonchi
Group A beta hemolytic strep pharyngitis
Typically causes fever, sore throat, and tender cervical lymphadenopathy.
supportive therapy for viral influenza
ibuprofen or acetaminophen for pain and fever, fluids, and rest.
when are antivirals for the flu given?
within 48 hours
1) if the patient has moderate to severe community acquired pneumonia with findings consistent with influenza
2) if the patient is clinically worsening at the time of the initial outpatient visit
examples of antivirals for influenza and their main goal
zanamivir, oseltamivir, amantadine, and rimantadine
decrease symptoms by a day
Acute Bronchitis Treatment
90% viral- supportive
beta2 agonists if wheezing
The most common complications of influenza are:
otitis media
lower respiratory tract infections including bronchitis and pneumonia (staph, strep)
Less common neuro complications of influenza:
aseptic meningitis
Guillain-Barre syndrome
febrile seizures
Rare complications of influenza:
myositis
myocarditis
first line antibiotic for streptococcal pneumonia and hat age group is typical
amoxacillin
age 3 mo-5 yrs
how long does flu usually last
3-5 days
when can kid with flu return to school
until most symptoms have improved and the child has been afebrile for 24 hours.
For uncomplicated pneumonia in children more than five years old,a what med is indicated
azithromycin because the prevalence of atypical pneumonia is higher.
common bacteria 3 weeks - 3 months and meds to treat
S.pneumoniae; Chlamydia trachomatis,
Adenovirus, Influenza virus, RSV, and Parainfluenza viruses
Ampicillin or penicillin G or ceftriaxone
The goal total cholesterol and LDL are
total: 170 mg/dL.
LDL: 130 mg/dL.
Drug treatment is recommended for children who
have an LDL >190 mg/dL or and LDL > 160 mg/dL with risk factors. Drug treatment is only recommended for children who are older than 10 and who are either Tanner stage 2 (male) or have achieved menarche.
strongest risk factor for high cholesterol
BMI
strongest risk factor for HTN
obesity
metabolic syndrome
adults as having at least three: hypertriglyceridemia, low HDL, elevated fasting blood glucose levels, excessive waist circumference, or hypertension,
Prevention Plus- If no improvement after 3-6 months use (5-2-1-0) counseling
5 serving of fruits and vegetables 2 hours of screen time 1 hour of physical activity 0 sugar-sweetened beverages Family meals Healthy breakfast Allow child to self-regulate meals
. Structured Weight Management
for children who have no had improvement on prevention plus
after 3-6 months if no improvement for all children with BMI > 85-94 percentile
Reduce energy-dense foods
Structured meals: plan 3 meals a day and 1 to 2 healthy snacks and no other food
1 hour of screen time
Diet and activity monitoring for 3 to 6 months
Monthly office visits
Additional support by dietitian, counselor, or exercise therapist as needed
Comprehensive Multidisciplinary Intervention
next step for children
ages 2-5; >95 percentile or
ages 6-18; 95-99 percentile
Above plus referral to multidisciplinary obesity care team and behavioral modification
Tertiary Care Intervention
for ages 6-18, final step
Above plus referral to pediatric tertiary weight management center
Risk factors for complications of Influenza are
children <5 years, increased in children less than 2 years of age,
COPD, conditions that affect the ability to handle respiratory secretions/increased risk of aspiration,
CHD, metabolic conditions, Chronic Renal Disease,
Immunosuppression, and Long term aspirin therapy.
