Infectious Disease Pt 1 Flashcards
An 18 month old baby has had a hoarse, barking cough, rhinorrhoea, and low grade fever; he develops stridor when agitated. Findings include: rectal temperature of 101F, RR of 28 and mild stridor on agitation.
What is the Dx and Rx?
croup
In patients with croup, you can expect to hear stridor on inspiration or expiration?
Inspiration
What is the hallmark of croup in infants and young children? What about older children and adults?
barking cough in infants/young kids and horseness in older kids/adults
Croup, by definition, is inflammation of what?
larynx and trachea
What if you notice your patient has inflammation of the larynx, trachea, and bronchi? What is your diagnosis?
LTB–laryngotrachobronchitis
What typically causes croup?
viral infection
Your patient is very horse but does not have a cough, and lung sounds are normal. What is your likely diagnosis (assuming not cancer)
Laryngitis
LTBP (laryngotracheobronchopneumonitis) is a more serious “croup-like” infection. Aside from more extensive inflammation of the airways, what makes it more serious?
Often complicated by bacterial superinfection
If viral infections commonly cause croup, which ones are predominately to blame?
Most common is PARAINFLUENZA VIRUS TYPE 1. Also caused by RSV and adenoviruses. And measles in certain populations
(Rarely caused by the flu)
You suspect your patient has croup, but it does not appear to be a viral infection, what pathogens are in your differential?
Staph, strep, and s. pneumonia
What age group is most susceptible to croup? And WHEN does it usually occur?
kids 6-36 months, occurs late fall/early winter along with the parainfluenza type 1 virus
You have 2 kids that are 24 months old, it is November and they both had a recent fever, and runny nose. One of the kids has a history of bacterial pneumonia, the other has a history of seasonal allergies. Which one are you more worried about? Why?
Seasonal allergies. Because kids with hypersensitivities (like allergies or asthma) are more predisposed to clinically significant narrowing of the upper airway during a croup infection.
You suspect a young child has croup. When do you decide to order a CXR? What are you looking for to confirm your diagnosis?
CXR typically not warranted, only if child has significant obstruction or is at risk for rapid progression of airway obstruction. You will be looking for the steeple sign
You have a strong suspicion that your patient has croup, however you want to make sure the symptoms can’t be explained by anything else. What other things would you need to rule out?
1) acute epiglottitis
2) peritonsillar abscess
3) FB
4) anaphylactic rxn
5) upper airway injury
3 year old boy who recently emigrated from Mexico is brought to the emergency department because of sudden onset of high grade fever and respiratory distress. Findings include drooling, dysphagia, dysphonia and inspiratory stridor. He is sitting, leaning forward with neck hyperextended.
What is the Dx and Rx?
acute epiglottitis
What pathogen is typically responsible for epiglottitis?
could be bacterial, viral, or fungal. Most common in children is Hib (haemophilus influenza b). No telling with the adults
What are the classic signs of epiglottitis?
respiratory distress, anxiety, tripoding/sniff position, drooling, dysphagia, fever, sore throat, hot potato voice
If you notice a child with classic symptoms of epiglottitis who appears to be in distress, what should you do?
a) examination with tongue blade to confirm
b) if O2sat is stable, give them inhaled steroids
c) if O2sat is stable, oral steroids and abx
d) send them to a place where airway can be secured prior to evaluating any further
e) get Xray to check for thumbprint sign first and then treat accordingly
D! Epiglottitis poses a serious risk to airway and any irritation to airway or delay in securing airway could be life threatening
After airway is secure, what is the treatment for epiglottitis for a child 6 years?
6, check level of obstruction. >50% get intubated and <50% should be observed in ICU. Both groups get cephalosporins (ceftriaxone) AND anti staph med like vancomycin.
***Fun Fact: All children under 6 require intubation
A 4 month old previously healthy infant presents in January with a 2 day history of coughing and breathing difficulty and a 1 day history of refusing to take oral fluids. He has no history of choking. Physical examination reveals a pale infant who has dry mucous membranes, retractions, RR of 50 and breath sounds decreased bilaterally with diffuse expiratory wheezing.
What is the Dx?
bronchiolitis
