Case 21 - 12 year old female with fever Flashcards
Influenza epidemiology
15-42% of preschool and school-age children are affected per year, usually self limiting and patients improve in 2-5 days
Risk factors for complications with flu
children <5 years, chronic pulmonary disease, congenital heart disease, immunosuppression
Complications of flu
- otitis media
- streptococcal pneumonia
- lower resp tract infections
- neurologic (aseptic meningitis, GBS)
- myositis and myocarditis
Obesity epidemiology in children
- 15% of kids 6-19 are overweight
- affects hispanic and african american kids more
- rates are increasing
Complications of obesity in children
- T2DM
- high cholesterol - 10% kids 2-19
- hypertension
- metabolic syndrome
- musculoskeletal - blount’s disease, SCFE
- GI disorders - steatosis, gallbladder dz
- GYN - PCOS, early menarche
- psychosocial - depression, bullying, low self-esteem
- OSA, asthma
Lung sounds indicating consolidation
egophany, tactile fremitus, dullness to percussion, crackles, whispered pectroliloquy
Lung sounds that do not indicate consolidation
wheezes ( assoc with spasms) , ronchi ( assoc with secretions)
Differential diagnosis for fever, cough, myalgias in 12 year old
- influenza - characterized by upper and lower resp tract sx accompanied by systemic sx, high fever, abrupt onset
- Pneumonia - crackles, tachypnea, consolidation, decreased breath sounds in one field
- typical pneumonia - streptococcal, atypical (mycoplasma or chlamydia), viral (flu, RSV, adeno) - Bronchitis - self limited inflammation of large airways of lung, often production of purulent sputum, usually viral, lung exam can include ronchi and wheezes
Less likely: URI, asthma exacerbation, Group A strep pharyngitis, bronchiolitis (infants)
McIsaac Score
Indicates whether to test for strep throat
- one point for fever >38, cough absent, tonsillar exudate, tender anterior cervical lymphadenopathy
- plus one point for under 15, less one point for greater than 45
- test for 2-3 points, empirically treat for 4 points or higher
Chest x-ray
- in community, only if patient is not responding to treatment
- all children with pneumonia should have x-ray if admitted to hospital
Management of influenza
- antivirals decrease duration if given within first 48 hours,
- supportive treatment - ibuprofen, fluids, cough syrup
Management of bronchitis
- albuterol for those who are wheezing
- mostly not antibiotics because mostly viral
Management of pneumonia
- children three months to adolescence - amoxicillin to treat streptocccal
- school aged children with sx of atypical pneumonia - rx with azithromycin
- admit all infants, and older chlidren if hypoxemic, grunting or having trouble feeding
Obesity management
- use motivating terminology
- advise whole family to change eating habits (5-2-1-0) - 5 fruits and veggies per day, 2 hours or less TV, 1 hours of physical activity per day, 0 surgary drinks
- set reasonable weight loss goals, reduce energy-dense foods, structured meals, diet and activity monitoring
Screening for obesity complications
- check A1c and fasting glucose in all kids >95%ile and kids >85%ile at high risk
- check fasting lipids on every child >85%ile
- treat kids with LDL >190 or >160 with risk factors
- steatosis - AST/ALT for all kids >95%ile and kids >85%ile at high risk, refer to GI for 2XULN