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LRT Infections in Kids Flashcards

1
Q

Define lower respiratory infection?

A

any sublaryngeal airway infection is LRT

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2
Q

Define pneumonia:

A

-inflammation or infection of the lungs - especially the gas exchange units (terminal and respiratory bronchioles and interstitium)

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3
Q

most common cause of pneumonia (a LRT infection) in children (<1 year old?

A

viral

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4
Q

number 1 cause (organism) of bacterial/pyogenic pneumonia through childhood?

A

strep pneumo

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5
Q

How does pneumonia happen?

A

-deposition and replication of viral/bacterial agents on resp tract mucosa or the lung can be seeded hematogenously during bacteremia (from the blood to lungs)

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6
Q

How do bacteria often cause pneumonia?

A

-colonize the respiratory tract

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7
Q

how do viruses cause pneumonia?

A

-viral infections impair HOST DEFENSES = secondary bacterial pneumonias

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8
Q

Host defenses:

A

ALL MUST WORK

  • nasopharyngeal air filtration
  • laryngeal protection of the airway
  • mucociliary clearance
  • normal cough reflexes and strength
  • normal anatomy
  • unobstructed airway drainage
  • normal cellular and humoral immune function
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9
Q

-3 main findings of pneumonia??? -Which symptom is most specific for pneumonia?

A
  • fever
  • cough
  • tachypnea –> MOST SENSITIVE AND SPECIFIC SIGN OF PNEUMONIA IN INFANTS!
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10
Q

Clinical findings of pneumonia in children on physical exam?

A
  • refusal to eat
  • grunting
  • rales
  • rhonchi
  • dec breath sounds
  • normal breath sounds (less mass so the sounds distribute better throughout chest so may be normal sounding)
  • cyanosis
  • pallor
  • accessory muscle use/retractions
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11
Q

Global health standards for pneumonia if youre out in the world?

A

need to have tachypnea and retractions to diagnose pneumonia

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12
Q

Bordatella pertusis- info:

A

WHOOPING COUGH

  • pertussis=intense cough
  • gram NEG pleomorphic
  • humans only host
  • transmission=droplet from cough
  • very contagious
  • incubation 6 days
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13
Q

3 phases of whooping cough:

A

1) catarhal phase
- 1-2 weeks
- rhinorrhea
- conjunctival injection
- mild cough
- wheezing
- low grade fever
2) Paroxysmal phase
- 2-4 weeks coughing inc in frequency and intensity
- WHOOP** - uncommon in child <6mo
- POST TUSSIVE EMESIS***
- hypoxia and fatigue from constant cough
- apnea
3) Convalescent phase
- 1-2 weeks
- cough and vomit dec in frequency
- cough may continue for weeks

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14
Q

Pertusis testing/lab results

A
  • leukocytosis (HIGH ABS LYMPH COUNT –> DIFFERENT BC THIS ISNT VIRAL BUT LYMPHS ARE UP!!!)
  • CXR=perihilar infiltrates, atelectasis or emphysema
  • nasopharyngeal swabs for PCR
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15
Q

Pertusis TX in child:

A
  • hospitalize (if infant)
  • oxygen & IV fluids
  • erythromycin 40mg/kg divided q 6hrs for 14 days
  • isolate patient for 5 days to prevent spread
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16
Q

Antibiotic of choice for pertussis in child?

A

-erythrmycin

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17
Q

influenza - info

A

RNA orthomyxovirus

  • A, B, and C types - A and B causing epidemics
  • H1N1 predominated last year
  • H3N2 have greater mortality
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18
Q

Type A influenza surface antigens:

A

-surface antigens hemagglutinin (HA) and neuraminidase

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19
Q

3 types of hemagglutinin types:

A

H1 H2 and H3

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20
Q

2 types of neuramidase types:

A

N1 and N2`

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21
Q

Major changes of hemagglutinin type is called? Minor?

A
  • antigenic shift = major

- antigenic drift = minor

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22
Q

influenza - spread?

A

-large droplets

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23
Q

influenza - who gets? when?

A
  • school age children

- community outbreaks occur in winter and peak within 2 weeks of onset and last 4-8 weeks

24
Q

influenza - infectious?

A
  • infectious > 10 days after the onset of symptoms

- severely immunocomp patients shed virus for weeks to months

25
influenza - symptoms
- 1-4 days onset (ABRUPT) - mimics bacterial sepsis - fever - coryza (perfuse runny nose) - myalgia - headache - malaise - conjunctivitis - pharyngitis - dry cough - can localize anywhere in resp tract = URI, croup, bronchiolitis, pneumonia
26
most common secondary bacterial infection due to influenza?
- strep pneumo (MOST COMMON) | - staph aureus ( ALSO COMMON)
27
What is Reye syndrome:
-affects brain and liver post viral (varicella) or influenza infection
28
Stages of Reye syndrome:
0=vomiting 1=vomit, confusion, lethargy 2=agitation, delirium, DECORTICATE (elbows flexed) posturing, hyperventilation 3=coma and DECEREBRATE (elbows extended) posturing 4=flaccidity, apnea, and dilated fixed pupils Progression from stage 1 to 4 can happen in 24 hours -worse outcome if younger
29
What inc risk of Reye syndrome during viral illness?
-salicylates (aspirin)
30
Diagnosis of reye syndrome: | Definitive diagnosis with?
- hypoglycemia - hyperammonemia - inc liver enzymes Definitive with liver biopsy
31
Reye syndrome tx?
limited tx | -correct hypoglycemia and inc ICP
32
diagnosis of influenza:
- based on clinical presentation, time of year, and community surveillance - rapid nasal swab tests of Influ A and B - blood count short normal WBC or mild dec in leukocytes
33
Tx for influenza?
- supportive most - fluids, fever control, rest | - neuraminidase inhibitors (zanamivir & oseltamivir) in children if bad
34
Vaccination against influenza?
vaccinate everyone above 6mo | 2 doses
35
RSV epidemic when?
winter
36
RSV transmission:
-resp droplets and fomites
37
classic finding in RSV?
- WHEEZING | - otitis media
38
recovery from RSV how long?
7-12 days
39
x-ray of RSV?
- air trapping - segmental atelectasis - inc interstitial markings -DO NOT ORDER X-RAY
40
Tx for RSV bronchiolitis
- maintain patency of nasal airway - maintain adequate hydration and nutrition - optimize ventilation and oxygenation
41
Aim of tx of RSV bronchiolitis
- releive resp distress - overcome airway obstruction - enhance mucociliary clearance - return child to normal resp status
42
tachypnea + rales heard but no wheezing, no fever, 6 weeks old, conjunctivitis - organism?
-chlamydia trachomatis pneumonia
43
presentation of chlamydia trachomatis?
- 1-3 months (NONE OLDER THAN 4mo)**** - repetitive staccato cough, tachypnea, and absence of fever, wheezing some nasal stuffiness - CXR no sig abnormalities or hyperinflation (shaggy heart sometimes) - WBC usually normal with peripheral eosinophilia
44
chlamydia trachomatis - tx:
- macrolides (*ORAL AZITHROMYCIN for 5 days or ORAL ERYTHROMYCIN for 14days) - tetracyclines - quinolones - sulfonamides
45
If there is evidence of chlamydial conjunctivits without pneumonia tx how?**
-still give oral erythromycin**
46
``` 9mo female sudent onset fever to 102.5 dec activity cough lethargy hypoxemia? hgih WBC count left shift-inc bands ``` organisms? what organism present similarly?
pneumonia - strep pneumo (since its not viral strep pneumo is most common) -influenza similar BUT RARELY has hypoxemia and doesnt have high WBC
47
CXR of strep pneumo?
-lobar or segmental consolidation
48
strep pneumo if child is untable symptoms? | What Tx?
- hypoxic - resp distress - hemodynamically unstable - IV antibiotics - ampicillin / sulbactam, cefuroxime, ceftriaxone - continueuntil patient stable then give 10 day course of oral antibiotics
49
strep pneumo if child is stable tx?
- oral antibiotics | - ->amoxicillin/clavulanic acid, cefuroxime, or other 2nd gen ceph
50
mycoplasma pneumonia - info
- walking pneumonia - most common in school age child - RARE BEFORE AGE 3-4
51
presumptive diagnosis of m pneumo with what test?
cold agglutinins
52
definitive diagnosis of mycoplasma via?
-drawing mycoplasma titers
53
clinical manifestation of mycoplasma
- intractable nonproductive to mild cough *** - squeaky door breathing - chills - pharyngitis - rhinorrhea - ear pain
54
Tx of choice for mycoplasma?
-macrolides
55
mycoplasma vs chlamydia pneumophilia:
-chlam has more pharyngitis followed by cough and high fevers

Respiratory 1 (9 decks)

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