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DT3- EXAM 2 > Cases- Asthma/Peds (3)- Melissa > Flashcards

Cases- Asthma/Peds (3)- Melissa Flashcards

1
Q

All day cough
Fever 101
Runny nose

A

Common cold; rhino or coronavirus

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2
Q

Coughing until you vomit for weeks

A

Pertussis

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3
Q

Coughing at night***
Wheezing
Nasal discharge

A

Asthma

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4
Q

Conjunctivitis
Pharyngitis
Fever 103+

A

Adenovirus

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5
Q

Coughing, loss of appetite, retractions, nasal flaring

A

RSV; bronchiolitis

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6
Q

Barking cough + stridor at night

A

Croup;#1 parainfluenza virus (the seals!!!)

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7
Q

Resp diseases that kills kiddos (3)

A

Pertussis
Pneumonia
Flu

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8
Q

High fever
Aches
Fatigue
Kid looks SICK

A

Influenza. DONT GIVE ASPIRIN BECAUSE REYES!!!!

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9
Q

Isolated crackles and all day cough

A

Mycoplasma; walking pneumonia

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10
Q
  • Isolated dullness to percussion, rhonchi, adventitial sounds
  • Look “sick”; 103+ fever
  • sudden onset all day cough
A

Bacterial pneumonia

–> strep pneumo

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11
Q

Empiric therapy for pneumonia

A

Ceftriaxone for strep pneumo + azithromycin for mycoplasma

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12
Q

Three modes of transmission for respiratory infection

A
  • airborne (not face to face i.e .legionella, TB)
  • droplet (face to face)
  • contact (touching fomites)
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13
Q

1 place to get resp. infection for kiddos under 5

A

DAYCARE

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14
Q

What are 4 symptoms of asthma (* = dead giveaway)?
When do these kids typically present?
What are some common triggers for asthma aggravation?

A

Kids typically present UNDER 5 yoa

  1. chest tightness
  2. DRY COUGH AT NIGHT
  3. SOB
  4. wheezes (may not be audible on kids with REALLY bad obstructive disease)
    * Be on the lookout for family hx**

Triggers: exercise, pollen/ weather, tobacco smoke, RI, etc.

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15
Q

What are some common PE findings indicative of asthma in kiddos? (2)

A
  • “Allergic shiners”–kids have dark circles under eyes due to pooling of venous blood that cant drain into nares
  • LOW insp/exp (I/E) ratio due to decreased air entering into obstructed airway (normal= 1/4, asthma= 1/7)
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16
Q

when you see nasal polyps in a peds patient, what is the knee jerk reaction?

A

CF!!!! (may also be seen in asthmatic kiddos too)

17
Q

What do you see on an asthmatic’s CXR? CBC? methacholine challege?
When do we test these kids for allergies?

A
  • CXR will be normal; MAYBE see flattened diaphragm due to air trapping
  • CBC = ^ EOS (Type 1 hypersensitivity…)
  • Methacholine challenge = LOWER threshold for bronchoconstriction
  • Test for allergies in older kids whose asthma is not controlled
18
Q

Meds to treat asthma: first line and others…

A 
#1: Albuterol rescue inhaler to use only when needeed 
2. Long term managment w montelukast, steroid inhalers, combo meds

*Kids need to wait 1 min between puffs**

19
Q

***What vaccine do we ALWAYS make sure our asthmatic kiddo patients have?

A

INFLUENZA

20
Q

Three sx/ PE findings associated with the common cold:
Which virus is typically the culprit?
How long are these kids usually sick? How can we differentiate this from asthma?

A
  1. Cough
  2. Fever 101-102
  3. Rhinorrha/ Coryza with erythematous nasal passages

Typically caused by RHINOVIRUS; kids will be sick 7-10 days; asthma is NOT self limiting, whereas common cold is…

21
Q

How are we gonna treat our kids with the common cold?

A

ALL THE NORMAL SHIT EXCEPT ASN!!!

antihistamines/ antipyretics/ analgesics/ antitussives/etc.

22
Q

Coronavirus: what are the TWO REALLY BAD DISEASES caused by this type of virus?

How do we differentiate patients with severe disease from those with common cold like symptoms? (3)

A

SARS and MERS
Seriously ill patients will have common cold sx. +:
- BODY ACHE, ARD, and HYPOXIA

23
Q

List the 3 most common symptoms of resp illness caused by adenovirus + one other?
What do we see on PE? (3)

A

“Pharyngioconjunctival Fever”

  1. fever 103+
  2. red eyes (erythematous sclera bilaterally)
  3. sore throat
  4. Bloody pees (hemorrhagic cysturia) + runny poops

PE: Look for the red sclera, cervical lymphadenopathy, fever, weight loss

24
Q

Places you’ll see adenovirus outbreak (2)

A
  • military groups

- SUMMER CAMP***

25
Q

1 cause of bronchiolitis in infants (under 12 mos)

A

RSV

26
Q

5 symptoms of RSV infection?

A
  1. cough
  2. decreased wet diapers
  3. poor feeding
  4. fever
  5. dyspnea
27
Q

Common high yielf finding on RSV physical exam?

A

Prolonged capillary refill

28
Q

fevers always cause what in kiddos ?

A

tachypnea!

29
Q

What are some possible high yieldCXR findings associated with RSV (2)

A
  • air bronchogram (inflammation around bronchioles will light up lining of airway)
  • atelectasis (assocaited with the syncitia formation?)
30
Q

What do we administer to little guys at high risk for RSV infection? Who ALWAYS gets this?

A

Palivizumab (anti F protein Ab)–give for 5 consecutive mos in all kiddos born before 35 weeks no matter what

31
Q

That virus that is not RSV but likes to pretend it is?

A

Human Metapneumovirus

32
Q

What is the #1 bacterial cause of pneumonia?
What KIND of pneumonia is this typically?
How does it present and how would you differentiate this from other common bacterial pneumonias?

A

1 Strep pneumo

  • KIDS LOOK SICK***
  • sudden onset fever 100+
  • cough
  • Adventitial sounds/ ronchi
  • pneumonia is typically lobar; rusty sputum more common in adults
33
Q 
Mycoplasma pneumonia: 
What age group typically gets this? 
How do we differentiate this from strep penumo? 
What do you hear on exam? 
Treatment?
A

Typically kids 4+yoa

  • walking pneumonia: KIDS DONT LOOK SICK SICK but will COUGH ALL DAY!
  • will hear ISOLATED CRACKLES
  • possible fever fever ~100.4

*Treat with azithromycin

34
Q

When is a CXR warranted?

A

ANYTIME you can not hear breath sounds

35
Q

Is sputum stain useful in meds practice

A

not typically useful; kids spit up mostly spit

36
Q

How are most meds pneumonia cases managed?

A

Most kiddos are managed on home ABX regimen
strep pneumo = amox
mycoplasma = macrolide (azithro)

37
Q

Pediatric Influenza:
Clinical findings
CXR
Management

A
  • MYALGIA/ FATIGUE/ KID IS WIPED OUT
  • Fever and other nonspecific sx.
  • CXR with diffuse infiltrate
  • Treat with oseltamivir or Zanamivir if present within first 48
  • NEVER USE ASN***
38
Q 
Croup 
#1 cause 
What do you see on PE? 
CXR? 
Management?
A

1 Cause Parainfluenza virus (also RSV)

PE: Seal-like barking cough, inspiratory stridor, tachypnea (fever)
CXR: Steeple sign (narrow trachea)
Tx: Humidification only

39
Q

Pertussis:
Clinical presentation
Important lab finding***
Tx

A
  • WHOOPING COUGH; violent coughing spells with whoops of inspiration; infants will have apnea in lieu of whoop
  • Kids cough until they VOMIT
  • rhinorrhea, fever especially early on

***KNOW THAT THESE KIDS HAVE REALLY BAD LYMPHOCYTOSIS!!
Tx: macrolide

DT3- EXAM 2 (19 decks)

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