Clinical Practice Guidelines - PCAP Flashcards
1
Q
Predictors of PCAP:
3 mos. - 5 yrs.
A
tachypnea
chest indrawing
2
Q
Predictors of PCAP:
5-12 yrs.
A
fever
tachypnea
crackles
3
Q
Predictors of PCAP:
> 12 yrs.
A
fever (> 37.8°C)
tachypnea (> 20 bpm)
tachycardia (> 100 bpm)
at least 1 abnormal chest finding (rhonchi, crackles, wheezes, ↓BS)
4
Q
_____ is still the best predictor of pneumonia.
A
Tachypnea
5
Q
Tachypneic RR for 2-12 mos.
A
≥ 50 bpm
6
Q
Tachypneic RR for 1-5 yrs.
A
≥ 40 bpm
7
Q
Tachypneic RR for > 5 yrs.
A
≥ 30 bpm
8
Q
Who will require admission?
A
mod.-high risk for pneumonia-related mortality
9
Q
Patients with minimal-low risk can be managed on an _____.
A
outpatient basis
10
Q
PCAP A (Minimal Risk): Co-Morbidities
A
none
11
Q
PCAP A (Minimal Risk): Compliant Caregiver
A
yes
12
Q
PCAP A (Minimal Risk): Able to Follow-Up
A
yes
13
Q
PCAP A (Minimal Risk): Dehydration
A
none
14
Q
PCAP A (Minimal Risk): Able to Feed
A
yes
15
Q
PCAP A (Minimal Risk): Age
A
> 11 mos.
16
Q
PCAP A (Minimal Risk): Respiratory Rate
A
2-12 mos. - ≥ 50 bpm
1-5 yrs. - ≥ 40 bpm
> 5 yrs. - ≥ 30 bpm
17
Q
PCAP A (Minimal Risk): Signs of Respiratory Failure
A
none
18
Q
PCAP A (Minimal Risk): Sensorium
A
awake
19
Q
PCAP A (Minimal Risk): Complications
A
none
20
Q
PCAP A (Minimal Risk): Management
A
OPD
follow-up at the end of treatment
21
Q
PCAP B (Low Risk): Co-Morbidities
A
present
22
Q
PCAP B (Low Risk): Compliant Caregiver
A
yes
23
Q
PCAP B (Low Risk): Able to Follow-Up
A
yes
24
Q
PCAP B (Low Risk): Dehydration
A
mild
25
```
PCAP B (Low Risk):
Able to Feed
```
yes
26
```
PCAP B (Low Risk):
Age
```
> 11 mos.
27
```
PCAP B (Low Risk):
Respiratory Rate
```
2-12 mos. - ≥ 50 bpm
1-5 yrs. - ≥ 40 bpm
> 5 yrs. - ≥ 30 bpm
28
```
PCAP B (Low Risk):
Signs of Respiratory Failure
```
none
29
```
PCAP B (Low Risk):
Sensorium
```
awake
30
```
PCAP B (Low Risk):
Complications
```
none
31
```
PCAP B (Low Risk):
Management
```
OPD
| follow-up after 3 days
32
```
PCAP C (Moderate Risk):
Co-Morbidities
```
present
33
```
PCAP C (Moderate Risk):
Compliant Caregiver
```
no
34
```
PCAP C (Moderate Risk):
Able to Follow-Up
```
no
35
```
PCAP C (Moderate Risk):
Dehydration
```
moderate
36
```
PCAP C (Moderate Risk):
Able to Feed
```
no
37
```
PCAP C (Moderate Risk):
Age
```
< 11 mos.
38
```
PCAP C (Moderate Risk):
Respiratory Rate
```
2-12 mos. - ≥ 60 bpm
1-5 yrs. - ≥ 50 bpm
> 5 yrs. - ≥ 35 bpm
39
```
PCAP C (Moderate Risk):
Signs of Respiratory Failure
```
intercostal retractions
subcostal retractions
head bobbing
cyanosis
40
```
PCAP C (Moderate Risk):
Sensorium
```
irritable
41
```
PCAP C (Moderate Risk):
Complications
```
present
42
```
PCAP C (Moderate Risk):
Management
```
ward
43
```
PCAP D (High Risk):
Co-Morbidities
```
present
44
```
PCAP D (High Risk):
Compliant Caregiver
```
no
45
```
PCAP D (High Risk):
Able to Follow-Up
```
no
46
```
PCAP D (High Risk):
Dehydration
```
severe
47
```
PCAP D (High Risk):
Able to Feed
```
no
48
```
PCAP D (High Risk):
Age
```
< 11 mos.
49
```
PCAP D (High Risk):
Respiratory Rate
```
2-12 mos. - ≥ 70 bpm
1-5 yrs. - ≥ 50 bpm
> 5 yrs. - ≥ 35 bpm
50
```
PCAP D (High Risk):
Signs of Respiratory Failure
```
```
supraclavicular retractions
intercostal retractions
subcostal retractions
head bobbing
cyanosis
grunting
apnea
```
51
```
PCAP D (High Risk):
Sensorium
```
lethargic
stuporous
comatose
52
```
PCAP D (High Risk):
Complications
```
present
53
```
PCAP D (High Risk):
Management
```
ICU
| refer to specialist
54
_____ on admission was the best predictor of death.
Retractions (23x ↑)
55
The risk of death in children was highest among those with _____.
intercostal and subcostal retractions
56
Cyanosis and head bobbing correlates well with _____.
hypoxemia
57
Best Predictors of Hypoxemia
inability to cry
head bobbing/nodding
RR > 60 bpm
58
Diagnostic Aids for PCAP A and B
none
59
Diagnostic Aids for PCAP C and D
```
CXR PAL
WBC Count
Blood CS (PCAP D)
Pleural Fluid CS
Tracheal Aspirate CS
ABG
Pulse Oximetry
Sputum CS (older children)
```
60
_____ on CXR is sensitive for bacterial pneumonia.
Alveolar Consolidation
61
CXR serves 2 functions in PCAP:
1. stronger basis for stratification of risk
| 2. therapeutic intervention
62
Children who are _____ of age with a fever _____ of unknown origin may need a CXR.
< 5 years, > 39°C
63
CXR as a baseline study for PCAP is _____.
not warranted
64
PCAP is more likely when WBC count is _____.
> 15,000
65
Acute phase reactants _____ and _____ cannot differentiate between viral and bacterial PCAP.
ESR, CRP
66
Culture Studies for PCAP
Blood CS x 2 sites
Pleural Fluid CS
Tracheal Aspirate CS (1st intubation)
Sputum CS
67
ABG and pulse oximetry must be done for _____.
all patients being considered for admission
68
When is antibiotic therapy recommended in PCAP A or B?
> 2 y.o.
| high grade fever without wheeze
69
When is antibiotic therapy recommended in PCAP C?
> 2 y.o.
high grade fever without wheeze
alveolar consolidation
WBC > 15,000
70
When is antibiotic therapy recommended in PCAP D?
always
71
_____ is the best predictor of the underlying etiology of PCAP.
Age
72
During the first 2 years of life, pneumonia is usually _____ in etiology.
viral
73
As age increases, bacterial pathogens such as _____ become more prevalent.
Streptococcus pneumoniae - most common
Haemophilus influenzae Type B
Mycoplasma sp.
Chlamydia sp.
74
Features of Bacterial PCAP
fever > 38.5° C
| (-) wheeze
75
Features of Viral PCAP
fever < 38.5° C
| (+) wheeze
76
What should be given for bacterial PCAP A or B?
Amoxicillin 40-50 mkday TID x 7 days
77
What should be given for bacterial PCAP C?
Pen G 100K ukday QID (complete HiB immunization)
Ampicillin 100 mkday QID
*given for 7 days
78
What should be given for bacterial PCAP D?
consult a specialist
79
Oral Antibiotics for PCAP
Amoxicillin
Cotrimoxazole
Chloramphenicol
80
IV Antibiotics for PCAP
```
Pen G
Ampicillin
Chloramphenicol
Cefuroxime
Ampicillin-Sulbactam
```
81
What should be given for laboratory confirmed viral PCAP?
Oseltamivir 2 mkdose BID x 5 days
| Amantidine 4.4-8.8 mkday x 3-5 days
82
Neuraminidase inhibitors, Zanamivir and Oseltamivir, have been shown to reduce the duration of illness by _____.
1-1.5 days
83
Anntivirals for PCAP should be given within _____.
48 hours
84
Propylaxis of household contacts with antivirals for children _____ of age.
≥ 12 years
85
When can a patient be considered responding to the current antibiotic?
decrease in respiratory signs (tachypnea) and defervescence within 72 hours
86
If PCAP A or B does not improve within 72 hours, an _____ may be started.
oral macrolide
87
If PCAP C does not improve within 72 hours, _____ should be suspected.
Penicillin Resistant Streptococcus Pneumoniae
| complications
88
2nd-line Antibiotics for PCAP A or B
| Penicillin Resistant Streptococcus Pneumoniae
Cefuroxime Axetil
Co-Amoxiclav
Sultamicillin
Cepfodoxime
89
2nd-line Antibiotics for PCAP A or B
| Mycoplasma sp or Chlamydia sp
Erythromycin (oral macrolide)
90
When can IV antibiotics be shifted to oral?
after 2-3 days
91
Criteria for Step-Down Therapy
responding to initial treatment
able to feed
intact GI absorption
(-) complications
92
How long should step-down oral therapy be given?
4-8 days
93
Ancillary Treatment
oxygen (O2Sat ≥ 95% or pO2 ≥ 80 mmHg)
hydration
bronchodilator (wheezing)
94
How can PCAP be prevented?
vaccines
| zinc
95
Zinc Dose for PCAP
infants - 10mg
> 2 y.o. - 20mg
*given for 4-6 mos.
96
The 7-valent pneumococcal vaccine CRM 197 PCV contains S. pneumoniae serotypes _____.
4, 6B, 9V, 14, 18C, 19F, 23F
97
_____ immunity is most affeced in protein-calorie malnutrition.
Cell-Mediated
98
Complement levels are _____ in malnourished children.
low
99
In malnourished children, immunoglobulin responses that are important for _____ of invading organisms are impaired.
opsonization
100
Opportunistic pathogens such as _____ are found in malnourished children.
Acinetobacter
Corynebacterium sp
Streptococcus faecalis
101
_____ causes viral pneumonia in well-nourished children.
Respiratory Syncytial Virus (RSV)
102
_____ causes viral pneumonia in malnourished children.
Herpes Simplex Virus (HSV)
103
A child with tuberculosis can be malnourished and may thus be presumed to be _____.
immunocompromised
104
In the presence of _____ secondary to tuberculosis, patients may be predisposed to infection.
extensive pulmonary parenchymal damage
105
CHD with _____ increases the risk of developing PCAP.
large volume L→R shunt
| chamber enlargement that causes extrinsic airway obstruction
106
_____ and _____ are the most common pathogens causing pneumonia in patients with CHD.
RSV, Influenza
107
_____ has been associated with persistent type of asthma but not with acute exacerbation.
Chlamydia pneumoniae
108
Use of antibiotics in early childhood is associated with an increased risk of developing _____.
asthma
| allergic disorders
109
A simple _____ with concomitant _____ secondary to _____ because of asthma is often misdiagnosed as pneumonia.
Viral URTI, atelectasis, mucus plug
110
_____ is the most common cause of recurrent or persistent infiltrates on CXR.
Asthma
111
Treatment of PCAP:
| Amoxicillin
40-50 mkday TID x 7 days
| adult dose: 750-1500 mg
112
Treatment of PCAP:
| Azithromycin
10 mkday OD x 3 days
| adult dose: 600 mg
113
Treatment of PCAP:
| Cefpodoxime Proxetil
20 mkday BID x 7 days
| adult dose: 800 mg
114
Treatment of PCAP:
| Cefuroxime Axetil
20-30 mkday BID x 7 days
| adult dose: 1-2 g
115
Treatment of PCAP:
| Chloramphenicol Palmitate
50-100 mkday QID x 7 days
| adult dose: 2 g
116
Treatment of PCAP:
| Clarithromycin
15 mkday BID x 7 days
| adult dose: 1 g
117
Treatment of PCAP:
| Co-Amoxiclav
40-50 mkday of Amoxicillin BID x 7 days
118
Treatment of PCAP:
| Cotrimoxazole
8-10 mkday of TMP BID x 7 days
adult dose: 320 mg
40-60 mkday of SMX BID x 7 days
adult dose: 1.6 g
119
Treatment of PCAP:
| Erthromycin
30-50 mkday TID or QID x 7 days
| adult dose: 1-2 g
120
Treatment of PCAP:
| Sultamicillin
25-50 mkday BID x 7 days
| adult dose: 750-1500 mg
121
Treatment of PCAP:
| Ampicillin
100-200 mkday q6 x 7 days
| adult dose: 2-4 g
122
Treatment of PCAP:
| Ampicillin Sulbactam
150-300 mkday q6 x 7 days
| 100-200 mkday of Ampicillin
123
Treatment of PCAP:
| Ceftriaxone
50-100 mkday OD or q12 x 7 day
| adult dose: 2 g
124
Treatment of PCAP:
| Cefuroxime
75-100 mkday q8 x 7 days
| adult dose: 2-4 g
125
Treatment of PCAP:
| Penicillin G
100K-200K ukday q6 x 7 days
| adult dose: 8-12M units (max 24M units/day)
126
Treatment of PCAP:
| Amantidine
4. 4-8.8 mkday BID x 3-5 days
| max: 150 mg
127
Treatment of PCAP:
| Oseltamivir
4 mkday BID x 5 days
128
Antitussive Side Effects:
somnolence, ataxia, miosis, nausea, vomiting, rash, facial swelling, pruritus, addiction, respiratory depression, obtundation
Codeine
129
Antitussive Side Effects:
| confusion, excitation, nervousness, irritability, addiction, respiratory depression, behavioral disturbances
Dextromethorphan
130
Expectorant Side Effects:
| GI disturbance, nausea, vomiting, dizziness, headache, rash, diarrhea, drowsiness, abdominal pain
Guaifenesin
131
Mucolytic Side Effects:
| GI discomfort, increased transaminases
Bromhexine
132
Mucolytic Side Effects:
| nausea, headache, GI discomfort and bleeding, diarrhea, rash
Carbocisteine
133
Antihistamine Side Effects:
loss of appetite, nausea, vomiting, epigastric pain, constipation, diarrhea, hallucinations, excitement, insomnia, drowsiness, incoordination, dizziness, tinnitus, blurred vision, diplopia, athetosis, fixed dilated pupil, sinus tachycardia, urinary retention
Diphenhydramine
134
Decongestant Side Effects:
| headache, hypertensive crisis, seizures, arrhythmias, psychosis, insomnia, psychiatric disorders, hemorrhagic stroke
Phenylpropanolamine
135
Decongestant Side Effects:
| hypertension, pulmonary edema
Phenylephrine
