Laryngeal/Tracheal infections Flashcards
Obstructive sleep apnea sxs
Snoring, gasping, apnea 30-45 s
Obstructive sleep apnea Dx
Sleep study
Obstructive sleep apnea Tx
- Adenoidectomy w/ possible tonsillectomy
- CPAP
Vocal cord dysfunction sxs
chocking sensation, stridor
Vocal cord dysfunction Dx
Dont respond to albuterol in the office (no obstruction on spirometry)
Vocal cord dysfunction Tx
Speech therapy, reassurance
Asthma sxs
Cough (nocturnal), wheezing, chest tightness, triggers
Asthma risk factors
Viral infections
tobacco smoke
pollution
family hx
Asthma xtics
- Inflammation
- Hyper-responsiveness
- Reversible obstruction
Asthma Dx
- Hx
- Pulmonary function test (spirometry)- FEV/FVC decreased = obstructive; improves with bronchodilator
At what age can you perform spirometry on a child
5yr and over (younger and the results aren’t accurate)
Asthma Tx
- Short acting bronchodilators
- Inhaled corticosteroids
- Long acting bronchodilators (w/ inhaled corticosteroid)
- Leukotriene antagonists
When you need more than just rescue bronchodilator
Rule of twos
>2x /wk
>2x /night
>2 refills/yr
Effects of corticosteroids
Minimal: Bone density (high doses)
Normal: growth achievement
Mostly safe
Infant respiratory distress syndrome xtics
Deficiency of surfactant at birth
Infant respiratory distress syndrome sxs
Rest distress (tachypnea, nasal flaring, grunting, cyanosis) w/in minutes - hrs after birth to 2-3days
Infant respiratory distress syndrome Dx
Blood gases = hypoxic
CXR= ground glass appearance
Infant respiratory distress syndrome risk factors
- Premie
- Diabetic mom
Infant respiratory distress syndrome Tx
O2, IV fluids (surfactant)
Glucocorticoids 24hr before birth
Pneumonia
consolidation of alveolar spaces - parenchymal infection
Pneumonia etiology
Viral (1-3mo, 3-12mo,2-5yrs), Bacterial (5-18yrs)
& atypicals
Pneumonia sxs
Fever, cough (myalgia if viral) abdominal pain-older chn/not feeding well,restless-infants
Afebrile pneumonia
Think Chlamydia
conjunctivitis w/ pneumonia
Think chlamydia
Pneumonia exam findings
Tachypnea, tachycardia, fever, decreased O2 sats, Rales, Rhonchi, dull to percussion, wheezing (atypical/viral)
Pneumonia Dx
- CXR (not required)
- Blood culture (if toxic/admission)
Pneumonia Tx (outpatient)
Empirical w/ follow up
infant/preschool- Amox/2nd-3rd gen Ceph/Clinda
School age- Amox/Azithro/Doxy for atypical
Pneumonia Tx (inpatient)
Ampicillin/sulbactam 200mg/kg/24hr q6h
Cefuroxime 150mg/kg/24hr q8h
Ceftriaxone 50-100mg/kg/24hr q12-24h
When to admit
At any age if
- Family can’t take care of child
- Comorbidities
- Family can’t come back for follow up
Vaccines against Pneumonia
- Strep pneumonia
- Varicella
- Measles
- H influenza
- Influenza
pertussis
Prolonged cough that can cause vomiting.
Pertussis mortality due to
Apnea
Pertussis etiology
Bordatella pertussis
Pertussis sxs
Paroxysmal coughing w/ inspiratory “whoop”
Stages of pertussis
- Catarrhal (URI,fever; 1-2wks)
- Paroxyxmal cough w/post tussle emesis (2-6wks)
- Convalescent-recovering cough (10-12wks)
Pertussis Dx
Nasopharyngeal culture (gold std)
CBC -elevated lymphocytes
CXR-subsegmental atelectasis
Pertussis Tx
Macrolides- Azithro/Erythro
RSV sxs
Cough, conjunctivitis, nasal congestion (a lot of mucus) fever
Major complication of RSV
Bronchiolitis
RSV Dx
Nasopharyngeal culture
RSV Tx
*Prevention (wash hand, avoid infected etc)
RSV prophylaxis
Palivizumab (high risk
Bronchiolitis etilogy
RSV
Rhinovirus
Bronchiolitis sxs
2-3day cold, low grade fever, wheezing, tachypnea, nasal flaring
Bronchiolitis Dx
- Based on sxs, time of year, age
- +/- nasopharyngeal swab (ER)
Time of year when RSV is common
Winter (Nov-April)
Bronchiolitis Tx
Supportive, duration 1-2wks, suction mucus,
Hospitalized if in need of airway support/increase fluids/oxygenation
Cause of Cystic fibrosis
Autosomal recessive mutation in CFTR gene (Chloride channel transporter)
What causes death in Cystic fibrosis
Recurrent lung infections
Cystic fibrosis sxs
Persistent productive cough, viscous mucus secretion, hyperinflation of lungs on CXR
Cystic fibrosis Dx
Sweat chloride > 60meq/L
Bronchiectasis
Abnormal dilation of bronchi, walls damaged by inflammation
Sxs of Bronchiectasis
Chronic cough and sputum (think cystic fibrosis)
Dx bronchiectasis
Pulmonary fxn test- obstructive pattern
Croup etiology
Parainfluenza, RSV
Croup sxs
Barking seal like cough with inspiratory stridor, hoarseness, low grade fever
Croup Dx
Clinical (CXR-steeple sign)
Croup Tx
Mild: Supportive, cool mist, steam bath
Moderate: steroids, Dexamethasone 0.6mg/kg or Nebulized Epi
Severe: Airway support
Croup predominant season
Fall & winter
Epiglottitis etiology
Emergent
-Hemophilus influenza B
Epiglottitis sxs
Rapid onset of high fever, muffled hot potato voice, 3Ds (drooling, dysphagia, distress), pain in ant part of neck
Epiglottitis Dx
Clinical (CXR thumb sign - lateral neck)
Epiglottitis Rx
- Airway support
- Steroids
- Ceftriaxone for H influenzae
Tracheomalacia
abnormal collapse of trachea due to not being well developed
What exacerbates tracheomalacia
crying
Tracheomlacia sxs
Barking cough, expiratory stridor
Tracheomalacia Tx
self resolving, CPAP
Foreign body aspiration sxs
Abrupt onset of cough, insp/exp stridor(upper airway) unilateral wheezing (lower airway)
where so most foreign body aspirates end up
Right bronchus
Foreign body dx
Bronchoscopy (may or may not show up on CXR) do if have high suspicion and -ve result on CXR
Foreign body asp tx
Removal
What aspirate is most fatal
Balloon
most common respiratory disorder in chn
Asthma
most common cause of LRI in chn
RSV
Most common fatal autosomal dominant recessive disease
CF
Leading cause of death in can under 5yo worldwide
Pneumonia
