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unit 2 68 > Ch 40 PEDS infections: Viral, rickets, enteroviruses/parecho, Rashes (hand,foot,mouth) > Flashcards

Ch 40 PEDS infections: Viral, rickets, enteroviruses/parecho, Rashes (hand,foot,mouth) Flashcards

1
Q

What are common predisposing illnesses that can lead to bacterial respiratory infections?

(SOAP)

A

Otitis media
Sinusitis
Pneumonia
Acute otitis media/menigitis (bacterial CAP)

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2
Q

Symptoms often found in a common cold include:

A 
runny nose (rhinorrhea)
nasal congestion
sore throat
tearing
cough
sneezing
low-grade fever
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3
Q

What pathogens frequently cause common cold symptoms?

A 
Rhinoviruses
Adenoviruses
RSV
Parainfluenza
Human metapneumovirus
Influenza
Enteroviruses
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4
Q

What are some expected outcomes of the common cold?

MAL

A

morbidity for 5 - 7 days
local mucosal swelling
altered local immunity (precursors for more severe illness, OM, pneumonia, sinusitis)

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5
Q

T/F Prescribing antibiotics for the common cold may prevent complications and limit duration of purulent rhinitis

A

FALSE - antibiotics cannot PREVENT complications and will not LIMIT duration of purulent rhinitis

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6
Q

How should the NP treat a child that is < 2 years old for the common cold?

A

Supportive measures such as:

hydration
humidified air
suctioning

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7
Q

How should the NP treat a child that is over the age of 2 for the common cold?

A

PO antihistamines
PO decongestants
PO cough suppressants

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8
Q

What treatments have no/limited effective reliability to improve symptoms for the common cold?

A

topical decongestants
Vitamin C
Zinc

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9
Q

Childhood ______ is caused mostly from enteric adnoviruses in children less than 4 years old

A

diarrhea

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10
Q

Adenovirus

What is the incubation period?
Early s/s?
Associated rash?
Lab test findings?

A

incubation: 4 - 5 days
early s/s: URI, cough, fever
rash: Morbilliform (petechial) resembles MMR
lab: leukopenia sometimes

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11
Q

What viruses have an incubation period greater than 2 weeks (14 days)?

A

Mononucleosis

Rubella

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12
Q

What specific adenovirus presents with fever, adenopahty, exudative tonsillitis, rhinitis, and influenza-like systemic illness findings? This is also the most common adenovirus disease.

A

Pharyngitis

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13
Q

What specific adenovirus will have no lower respiratory symptoms, conjunctivitis associated with preauricular adenopathy, fever, pharyngitis, and cervical adenopahty?

A

Pharyngoconjunctival fever (viral pharynigitis)

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14
Q

What two specific adenoviruses may present with a foreign-body sensation in the eye?

A

Pharyngoconjunctival fever

Epidemic keratoconjunctivitis

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15
Q

What specific adenovirus presents with severe conjunctivitis, photophobia, swelling of the eyelids, and subconjunctival hemorrhage?

A

Epidemic keratoconjunctivitis

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16
Q

On chest XRAY, bilateral peribronchial and patchy ground-glass interstitial infiltrates are present in the lower lobes. What should the NP suspect? What kind of virus may have caused this?

A

Pneumonia

adenovirus

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17
Q

What are complications of adenovirus pneumonia? What serotype is unusually severe and fatal in children and adults?

A

Bronchiectasis (hard to clear mucus)
Bronchiolitis (inflammation)
Bronchiolitis Obliterans (inflammatory obstruction of the lung’s)

serotype 14

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18
Q

What rash is absent in adenovirus?

A

kolpik spots

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19
Q

What adenovirus serotypes are causes of short-lived diarrhea in afebrile children? What age range is this finding common in?

A

serotype 40 and 41

< 4 years old

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20
Q

Any treatment specific for adenovirus illness?

What would you consider for the immunocompromised patient with severe pneumonia?

A

none!

IV IG for immunnocompromised patients

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21
Q

What types of diagnostic tests can identify adenoviruses?

A

Viral culture - 48 hours
PCR - rapid
ELISA - diarrheal

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22
Q

What viral infection presents as fever, cough, pharyngitis, malaise, congestion, pneumonia, and encephalitis in late fall to mid spring?

A

Influenza

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23
Q

Influenza

What is the incubation period?
Early s/s?
Young children specific findings?
Older children specific findings?
Lab test finding?
A

incubation: 2 - 7 days
early s/s: sudden high fever, severe mylagia, headache and chills
young children: abdominal pain, fever, diarrhea, vomitting
older children: high fever/mylagia/HA/chills, dehydrating enteritis, adenopathy
lab: low leukocytes

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24
Q

What specific diagnostic tools are preferred for influenza illness?

A

PCR*

Rapid culture technique

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25
Q

What two other viral illnesses present similarly to influenza?

A

Parainfluenza

RSV

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26
Q

What should a NP rule out in a suspected influenza child with protracted vomitting or irrational behavior during flu season?

A

Rule out Reye Syndrome!

most common causes are varicella and influenza type B

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27
Q

What are prevention methods for Influenza?

A

flu vaccine

can still get if allergic to eggs, consider inpatient vaccination setting

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28
Q

What two medications can be considered as prophylaxis for Influenza? What are the age requirements and/or contraindications of those medications?

A

> 3 months = Oseltamivir (Tamiflu)

> 5 years old = inhaled Zanamivir (NO ASTHMA/chronic pulmonary diseases)

all antivirals need to be given 48 hours after symptom onset and for 5 days

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29
Q

A child under the age of five presents with an acute onset fever, nasal congestion, sore throat, a cough and inspiratory stridor. What viral respiratory illness is this?

A

Parainfluenza - Croup

30
Q

There are four types of human parainfluenza viruses (HPIV). What are the types? Age specific and occurrence

A

Type 1 and 2 - croup causing, infect children < 5 years old and during fall

type 3 is within the first 3 years of life (commonly 1 year old)

type 4 is year-round and less pathogenic

31
Q

Parainfluenza (Croup)

What is the incubation period?
Early s/s? (general and croup specific)
Which type occurs most often?
Lab tests?

A

incubation: 2 - 7 days
early s/s: acute febrile URI, laryngitis, tracheobronchitis, croup, bronchiolitis (second most common)
Croup specific s/s: barking cough, inspiratory stridor, hoarseness
Type: Type 1 - croup, laryngitis, and tracheobronchitis
Labs: PCR, conventional or rapid culture techniques, or direct immunofluorescence of secretions

32
Q

What is the treatment for Parainfluenza (croup)?

A

no specific treatment; manage symptoms

33
Q

A one year old child presents with diffuse wheezing, variable fever, cough, tachypnea, and is having a difficult time feeding. What do you suspect this child has?

A

RSV

34
Q

What respiratory virus is the cause of lower tract illness in young children?

A

RSV

35
Q

RSV

What is the duration of illness?
Early s/s?
XRAY findings?
Lab tests?

A

duration: 3 - 7 days (previously healthy children)
classic s/s: bronchiolitis characterized by diffuse wheezing, variable fever, cough, tachypnea, difficulty feeding. Severe = cyanosis
XRAY: hyperinflation (causing palpable spleen and liver) and peribronchiolar thickening
Lab: real time PCR (too expensive), rapid antigen or ELISA

36
Q

What is a differential diagnosis that should be considered in an infant < 6 months old with a prominent cough when RSV is suspected?

A

Pertussis

37
Q

A child with suspected RSV presents to the ED. The NP found an elevated WBC on lab work. What differential diagnoses would this finding indicate?

A

Bacterial infection or Pneumonia

38
Q

What treatment specific guidelines are suggested for RSV children that cannot maintain oxygen saturation, are very hypoxic or unable to eat due to respiratory distress?

A

oxygen therapy for oximetry reading < 90%

hospitalize any infant with poor feeding/hypoxia and give humidifed oxygen and NGT feedings

39
Q

What treatments are NOT approved for children with RSV?

A

Antibiotics
decongestants
expectorants
albuterol/salbutamol or epinephrine

40
Q

What medication is approved for infants with RSV that also have significant anatomic or immunologic defects?

A

Ribavirin antiviral aerosolization therapy

41
Q

What finding evolves later in childhood after a hospitalized infection with RSV?

A

wheezing

42
Q

What precursor is found post RSV infection in infancy?

A

asthma

43
Q

A child with a cough, coryza (inflammation of the nose), and sore throat presents in your office. What do you suspect this viral illness is?

A

Human Metapneumovirus Infection (hMPV)

44
Q

What two other respiratory illnesses may occur in children that acquire hMPV before the age of two?

A

Bronchiolitis
Pneumonia
dual infection with RSV may occur

45
Q

What is the preferred method of diagnosis for hMPV (human metapneumovirus)?

A

PCR on respiratory specimens

46
Q

What is the definitive diagnosis of human coronaviruses?

A

PCR

47
Q

Human Coronaviruses

What is the incubation period?
Manifestation of s/s?
How can this group of viruses also present?

A

Incubation: 2 - 5 days for non-severe
S/S: rhinorrhea, sore throat, cough, occasionally fever
Present as: acute otitis media, trigger asthma exacerbation, and acute gastroenteritis

48
Q

T/F Children with SAR-CoV-2 are severely symptomatic

A

FALSE! - children are asymptomatic or have milder s/s of fever, cough, myalgia, mild diarrhea, and abdominal pain

49
Q

What complications may occur in children with SAR-CoV-2?

A

multiorgan dysfuntion (known as MIS-C)

50
Q

What lab finding is present in symptomatic cases of SAR-CoV-2?

A

elevated procalcitonin

51
Q

What viral respiratory illnesses are associated with enterovirus causes?

A 
Acute febrile pharyngitis
Herpangina
acute Lymphonodular Pharyngitis
Hand, food, mouth disease
Pleurodynia (Bornholm disease, Epidemic Myalgia)
52
Q

Enterovirus

What is the incubation period?
Early s/s?
Associated rash?
Lab test findings?

A

incubation: 2 - 7 days
s/s: variable fever, chills, myalgia, sore throat
Rash: variable - macular/maculopapular on trunk or palms, soles or vesicles or petechiae (H/F/M or pharyngeal)
Lab: PCR

53
Q

Parovirus (erythema infectiosum)

What is the incubation period?
Early s/s?
Associated rash?
Labs?

A

Incubation: 10 - 17 days (rash)
s/s: mild, flu-like
rash: maculopapular on cheeks “slapped cheek”, forehead, chin, limbs, trunk, buttocks
Labs: IgM-EIA, PCR

54
Q

Acute Febrile Pharyngitis (enterovirus) presents with what findings in older children? Duration?

A 
sore throat
headache
myalgia
abdominal discomfort
lasting 3 - 4 days
55
Q

What presents on the pharynx in acute febrile pharyngitis (enterovirus)?

A

vesicles or papules on the pharynx without exudate

56
Q

What enterovirus presents with an acute onset fever with posterior pharyngeal grayish white vesicles that quickly form ulcers? The child may also be drooling, vomiting and has dysphagia.

A

Herpangina

57
Q

How long do the symptoms last with Herpangina?

A

4 - 5 days

58
Q

What specific viruses are associated with Herpangina?

A

Coxsackie A viruses (epidemics)

Coxackie B/echovirus (sporadic)

59
Q

What enterovirus presents with febrile pharyngititis with nonulcerative yellow-white posterior pharyngeal papules along the posterior palate?

A

Acute Lymphonodular Pharyngitis

60
Q

What is the treatment of choice for acute lymphondular pharyngitis (enterovirus) and what is the duration of the virus?

A

Supportive treatment

1 - 2 weeks

61
Q

What clinical diagnosis would be suspected for a child with vesicles or red papules found on the tongue, oral mucosa, hands and feet, near the nails, and on the heals?

A

Hand-Foot-Mouth (enteriovirus)

62
Q

What type of virus (strands) occur in Hand-Foot-Mouth?

A

Coxsackieviruses - A5, A10, A16

63
Q

How long will the rash of hand-foot-mouth be present?

A

1 - 2 weeks, rash may appear when fever reduces, simulating roseola

64
Q

What enterovirus presents as an abrupt onset of unilateral or bilateral spasmodic pain of variable intensity over the lower ribs or upper abdomen?

What other symptoms by be present?

A

Pleurodynia (Bornholm Disease, Epidemic Myalgia)

DISEASE OF THE MUSCLES!

headache, fever, vomiting, myalgia, abdominal/neck pain, decreased thoracic excursion, and friction rub

65
Q

What virus is associated with Pleurodynia (Bornholm disease, Epidemic Myalgia)?

How long do symptoms last? (duration)

A

Coxsackie B

1 week duration

66
Q

What treatment options would you consider for a child with Pleurodynia (Bornholm disease, Epidemic myalgia)?

A

Analgesics!!!

chest splinting - friction rub symptom

67
Q

Nonpolio enteroviruses that are caused by _________ will present as what two cardiac involvement symptoms?

A

Coxsackieviruses - type B
Myocarditis
Pericarditis

68
Q

What two lab findings are significant in acute myocarditis?

A

Elveated creatine phosphokinase

Troponin

69
Q

Severe neonatal infection presents with what clinical manifestations?

A 
fever
rash
pneumonitis
meningo-encephalitis
hepatitis
gastroenteritis
myocarditis
pancreatitis
myositits
70
Q

What differential diagnosis should be included in an infant with severe neonatal infection with rash?

A

bacterial and herpes simplex infections
necrotizing entercolitis
heart or liver failure causes
metabolic diseases

71
Q

What specific lab findings will help diagnosis an infant with severe neonatal rash?

A

CSF mononuclear pleocytosis
Enterovirus detection on RNA in stool or pharynx
PCR in CSF, blood, or urine

unit 2 68 (32 decks)

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