EXAM #2: LOWER RESPIRATORY TRACT DISEASE IN KIDS

Question 1

What is the definition of pneumonia?

Answer 1

Infection/inflammation of the gas-exchange units of the lung

Question 2

What type of organism accounts for most LRTIs in children?

Answer 2

Virus

Question 3

What is the most common cause of bacterial pneumonia in childhood?

Answer 3

S. pneumoniae

Question 4

How does on acquire pneumonia?

Answer 4

1) Inhalation

2) Hematogenous spread

Question 5

What are the three hallmark symptoms of pneumonia in a kid?

Answer 5

1) Fever
2) Cough
3) Tachypnea

Question 6

What is the most sensitive and specific sign of pneumonia in infants?

Answer 6

Tachypnea*

*If a child doesn’t have tachypnea, probably does NOT have pneumonia. Furthermore, WHO uses tachypnea and retractions as diagnostic for pneumonia in a kid under 5 y/o

Question 7

Aside from the three hallmark findings of pneumonia in kids, what are other important clinical findings?

Answer 7

Refusal to eat

Question 8

Why do normal breath sounds in a kid NOT rule out a pneumonia?

Answer 8

In a small kid, it is possible to hear normal sounds from the opposite lung

Question 9

What are the three phases of pertussis and their associated symptoms?

Answer 9

1) 1-2 weeks= cold
2) 2-4 weeks= whooping cough and post-tussive emesis
3) 4-6 weeks= improvement

Question 10

What are the names of the three phases of whooping cough?

Answer 10

1) Catarrhal (1-2 weeks)
2) Paroxysmal (2-4 weeks)
3) Convalescent (4-6 weeks)

Question 11

What are the labs that are associated with pertussis?

Answer 11

Leukocytosis with absolute lymphcytosis

Question 12

How is pertussis treated?

Answer 12

1) Hospitalize if under 6 months
2) Oxygen/ IV fluids
3) Erythromycin
4) Isolate for 5 days

Question 13

How does influenza present?

Answer 13

1) ABRUPT onset
2) Mimics bacterial sepsis
3) Fever, coryza, myalgia, headache, malaise…etc.

Question 14

What happens in roughly 20% of hospitalized children with the flu?

Answer 14

Febrile seizures

Question 15

What is Reye Syndrome?

Answer 15

Systemic disorder of mitochondiral function that occurs during or after a viral illness

Question 16

What two viral illness is aspirin therapy leading to Reye Syndrome associated with?

Answer 16

1) Influenza

2) Varicella

Question 17

How is influenza diagnosed?

Answer 17

1) Rapid nasal swab

2) Blood count with mild leukopenia

Question 18

How is influenza treated?

Answer 18

1) Fluids
2) Fever control
3) Rest
4) Neuroaminidase inhibitors i.e
- Zanamivir
- Oseltamivir

Question 19

What pediatric patients should receive the flu vaccine?

Answer 19

Any child from 6 months to 18 years

Question 20

Describe the presentation of RSV.

Answer 20

1) Rhinorrhea
2) Sneezing
3) Coughing
4) Moderate respiratory distress
5) Nasal flaring

Question 21

What does RSV cause?

Answer 21

Bronchiolitis

Question 22

By what age have nearly all children had an RSV infection?

Answer 22

By 2 essentially all kids have had RSV

Question 23

What CXR finding is associated with bronchiolitis?

Answer 23

Right upper lobe atelectasis

Question 24

What is the treatment for RSV bronchiolitis?

Answer 24

1) Mantain patency
2) Maintain adequate hydration and nutrition
3) Optimize ventilation and oxygenation

Question 25

What things are NOT recommended routinely for RSV bronchiolitis?

Answer 25

1) Order viral testing
2) CXR
3) Rx albuterol or racemic epi
4) Rx oral steroids
5) Rx abx
6) Chest percussion therapy

Question 26

What is the typical presentation of Chlamydia Tachomatis pneumonia?

Answer 26

1) Conjunctivitis
2) Pneumonia
3) Repetitive staccato cough
4) NO FEVER, NO WHEEZING

*Under 4 months old

Question 27

What does the CXR show in chlamydia pneumonia?

Answer 27

Shaggy heart

Question 28

What is the treatment for a kid with chlamydia trachomatis pneumonia?

Answer 28

Oral azithromycin or erythromycin?

Question 29

If a child presents with chlamydial conjunctivitis without pneumonia, what do you treat with?

Answer 29

Oral erythromycin

Question 30

What does CXR show with S. pneumoniae in kids?

Answer 30

Lobar pneumonia or “round” pneumonia

Question 31

What is the best abx for a kid with S. pneumoniae pneumonia that is hypoxic in respiratory distress?

Answer 31

IV Ampicillin or Ampicillin/Sulbactam

Question 32

What is the most common cause of pneumonia in the school age child?

Answer 32

Mycopalsma pneumonia

Question 33

How can Mycoplasma pneumonia be diagnosed?

Answer 33

1) Cold agglutinins for preseumptive

2) Mycoplasma titers for definitive diagnosis

Question 34

What is the treatment of choice for Mycoplasma pneumonia (outpatient)? What about for the inpatient?

Answer 34

Macrolides

*If hospitalized, add cephalosporin to the macrolide