4 Flashcards
How does adenovirus typically present?
upper respiratory tract infection, pharyngitis, conjunctivitis, tonsillitis, or otitis media
How does Kawasakis present?
Fever > 5 days
Cervical adenopathy
Nonpurulent conjunctivitis
Nonspecific ("polymorphic") rash
Swelling and erythema of extremities
Mucosal inflammationHow does rash with meningococcemia typically present?
Petechial
How does measles present?
Prodrome of fever, followed by cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline.
I say cough, coryza, conjunctivitis… you say ____
measles
What do you call the red lesions with white centers found in the buccal mucosa of a kid with conjunctivits, coryza, cough?
Koplik spots of measles
Sandpaper rash that starts in folds and moves to trunk and extremities?
Scarlet fever of GAS
A kid is brought in for rash. Mom describes that lesions start red and smooth, then become raised and look like they have fluid before they become crusted over. What does the kid have?
Chicken pox from Varicella. Typically starts on trunk and moves outwards.
This infection can lead to aplastic anemia in those with underlying hemolytic disease.
Erythema infectiosum/fifth disease/slapped cheek disease
Kid has fever, and then once it resolves develops rash on trunk that moves outwards. What is likely?
Roseola HHSV6
DDx for unilateral LAD?
Kawasaki Reactive adenitis Bacterial adenitis Cat scratch disease Mycobacterial disease
Non infectious causes of generalized LAD in child?
Lymphomas Leukemia Histiocytosis Metastatic neuroblastoma Rhabdomyosarcoma
Infectious causes of generalized LAD?
Measles Mono - CMV or EBV Human immunodeficiency virus (HIV) Histoplasmosis Toxoplasmosis Mycobacteria
What 3 conditions can lead to characteristic strawberry tongue?
Streptococcal pharyngitis
Kawasaki disease
Toxic shock syndrome
Is the disease process of kawasaki disease well understood?
NO - maybe autoimmune? we know it is a pan vasculitis
What labs do you expect with Kawasaki?
Leukocytosis, neutrophil predominance Normocytic anemia Thrombocytosis (2nd week of infxn) LFTs up Hypoalbuminemia Sterile pyuria Elevated ESR
What organs can become diseased from Kawasaki?
Brain, Heart, Liver, Kidneys, MSK joints
What is tx for Kawasaki? Explain role
Aspirin and IVIG. At first, high dose aspirin for fever, followed by low dose for anti-platelet function
What should a kid on aspirin avoid?
Viral illness! Can cause Reyes disease.
Causes of cough in a child?
Viral upper respiratory tract illnesses Pneumonia Post-nasal drip due to allergies and/or sinusitis Foreign body aspiration GE reflux
Which virus most commonly causes croup?
Parainfluenza
What is the first thing to do for a kid with epiglotittis?
Secure the airway in OR!
What to do for asthmatic with acute exacerbation?
anti-inflammatory therapy (corticosteroids) and bronchodilation (beta-2 agonists - albuterol) + supportive care for hypoxemia or dehydration
Is a child’s pneumonia more likely to be bacterial or viral?
Viral = Adenovirus, RSV, Parainfluenza, Influenza
Although tx of croup is generally supportive, what can be provided in acute or severe cases?
Racemic aerosolized epinephrine can be used for acute improvement, and oral or IM dexamethasone can reduce the severity of symptoms.
What is the sound of stridor caused by?
Due to airway narrowing above the thoracic inlet.
What causes sound of crackles?
Opening and closing of airways - fluid, purulent secretions, stiff in ILD
What can decreased air movement indicate?
consolidation, atelectasis, pneumothorax, pleural effusion or airway obstruction
What are bronchial breath sounds and what are they caused by?
Lower in pitch and more hollow-sounding than normal breath sounds.
Caused by air moving through areas of consolidated lung.
What do you expect to see with FB aspiration on XR?
Hyperinflation is seen in those foreign body aspirations that result in a “ball valve” effect, in which the aspirated object creates a partial obstruction to airflow during inspiration but fully obstructs the airway during exhalation. The result is air trapping with each breath.
You have an infant with a cough. What anatomic causes should you consider?
congenital vocal cord dysfunction, laryngotracheomalacia, vascular ring, laryngeal web, tracheal stenosis or tracheoesophageal fistula
What is your differential for a barking cough?
croup
subglottic disease
foreign body
DDx for cough worse at night?
asthma
sinusitis
allergic or vasomotor rhinitis (postnasal drip)
Pt has a cough but voice has also changed. What may be the cause?
Dysphonia or hoarseness may suggest laryngeal irritation due to chronic rhinitis or gastroesophageal reflux.
When is a TST considered positive?
> 5 mm in high-risk children, > 10 mm in moderate-risk children and > 15 mm in low-risk children.
What are allergic shiners?
Darkening of the lower eyelids as a result of venous stasis
What is the allergic salute?
A gesture that involves pushing the nose upward and backward with the hand to relieve nasal itching and obstruction. Over time, this may result in the development of a transverse nasal crease.
What are dennie morgan lines?
Infraorbital creases that appear due to intermittent edema caused by allergies.
What finger finding suggests chronic hypoxia?
Change in the appearance of the fingers so that the distal phalanx is rounded and bulbous and the angle between the nail plate and the nail fold is increased past 180 degrees. This phenomenon is suggestive of chronic hypoxia.
What are rhonchi breath sounds?
Continuous low-pitched and polyphonic and may occur during either inspiration and/or expiration; they are typically thought to be due to mucus/secretions in the airways
What factors do we look at to assess asthma severity?
Frequency of daytime symptoms
Frequency of nighttime awakenings related to asthma
Interference with activity
Pulmonary function (if available)
Use of short-acting beta2-agonist medications (SABA) (if patient is already using medications)
What are the commonly prescribed ICS for asthma mgmt?
Beclomethasone, Fluticasone and Budesonide
What SE should you look for in children who take ICS chronically?
elevation in blood pressure, serum blood sugar, growth delay, and cataract development.
What is the role of PEF in asthma?
Short-term monitoring
Managing exacerbations at home and in the emergency department
Daily long-term monitoring of asthma-particularly in moderate to severe asthma
What are the most common home allergies?
House dust mites
Animal dander
Cockroaches
What three rx should you reach for in allergy mgmt?
antihistamines, nasal steroids, Leukotriene receptor antagonists
