EXAM #2: LOWER RESPIRATORY TRACT DISEASE IN KIDS Flashcards
What is the definition of pneumonia?
Infection/inflammation of the gas-exchange units of the lung
What type of organism accounts for most LRTIs in children?
Virus
What is the most common cause of bacterial pneumonia in childhood?
S. pneumoniae
How does on acquire pneumonia?
1) Inhalation
2) Hematogenous spread
What are the three hallmark symptoms of pneumonia in a kid?
1) Fever
2) Cough
3) Tachypnea
What is the most sensitive and specific sign of pneumonia in infants?
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
Aside from the three hallmark findings of pneumonia in kids, what are other important clinical findings?
Refusal to eat
Why do normal breath sounds in a kid NOT rule out a pneumonia?
In a small kid, it is possible to hear normal sounds from the opposite lung
What are the three phases of pertussis and their associated symptoms?
1) 1-2 weeks= cold
2) 2-4 weeks= whooping cough and post-tussive emesis
3) 4-6 weeks= improvement
What are the names of the three phases of whooping cough?
1) Catarrhal (1-2 weeks)
2) Paroxysmal (2-4 weeks)
3) Convalescent (4-6 weeks)
What are the labs that are associated with pertussis?
Leukocytosis with absolute lymphcytosis
How is pertussis treated?
1) Hospitalize if under 6 months
2) Oxygen/ IV fluids
3) Erythromycin
4) Isolate for 5 days
How does influenza present?
1) ABRUPT onset
2) Mimics bacterial sepsis
3) Fever, coryza, myalgia, headache, malaise…etc.
What happens in roughly 20% of hospitalized children with the flu?
Febrile seizures
What is Reye Syndrome?
Systemic disorder of mitochondiral function that occurs during or after a viral illness
What two viral illness is aspirin therapy leading to Reye Syndrome associated with?
1) Influenza
2) Varicella
How is influenza diagnosed?
1) Rapid nasal swab
2) Blood count with mild leukopenia
How is influenza treated?
1) Fluids
2) Fever control
3) Rest
4) Neuroaminidase inhibitors i.e
- Zanamivir
- Oseltamivir
What pediatric patients should receive the flu vaccine?
Any child from 6 months to 18 years
Describe the presentation of RSV.
1) Rhinorrhea
2) Sneezing
3) Coughing
4) Moderate respiratory distress
5) Nasal flaring
What does RSV cause?
Bronchiolitis
By what age have nearly all children had an RSV infection?
By 2 essentially all kids have had RSV
What CXR finding is associated with bronchiolitis?
Right upper lobe atelectasis
What is the treatment for RSV bronchiolitis?
1) Mantain patency
2) Maintain adequate hydration and nutrition
3) Optimize ventilation and oxygenation
What things are NOT recommended routinely for RSV bronchiolitis?
1) Order viral testing
2) CXR
3) Rx albuterol or racemic epi
4) Rx oral steroids
5) Rx abx
6) Chest percussion therapy
What is the typical presentation of Chlamydia Tachomatis pneumonia?
1) Conjunctivitis
2) Pneumonia
3) Repetitive staccato cough
4) NO FEVER, NO WHEEZING
*Under 4 months old
What does the CXR show in chlamydia pneumonia?
Shaggy heart
What is the treatment for a kid with chlamydia trachomatis pneumonia?
Oral azithromycin or erythromycin?
If a child presents with chlamydial conjunctivitis without pneumonia, what do you treat with?
Oral erythromycin
What does CXR show with S. pneumoniae in kids?
Lobar pneumonia or “round” pneumonia
What is the best abx for a kid with S. pneumoniae pneumonia that is hypoxic in respiratory distress?
IV Ampicillin or Ampicillin/Sulbactam
What is the most common cause of pneumonia in the school age child?
Mycopalsma pneumonia
How can Mycoplasma pneumonia be diagnosed?
1) Cold agglutinins for preseumptive
2) Mycoplasma titers for definitive diagnosis
What is the treatment of choice for Mycoplasma pneumonia (outpatient)? What about for the inpatient?
Macrolides
*If hospitalized, add cephalosporin to the macrolide
