MedU Clipp Cases 11 and 12 Flashcards
What is the drug of choice for Group A Strep (GAS)?
Streptococcur pyogenes (GAS)
- Penicillin (preferred but unpleasant taste)
- Amoxicillin (more palatable)
(3) Irritability in a Child?
- Meningeal irritation
- Headache from intracranial irritation
- Simple exhaustion
What is the normal HR for a 5 y.o.?
80 to 100 BPM
Flat, Discolored spot
is Derm Normenclature for?
Macule
Small, Well-defined solid bump
is Derm Normenclature for?
Papule
Small, well-defined, fluid-containing bump
is Derm Normenclature for?
Vesicle
Small, well-defined bump containing purulent material
is Derm Normenclature for?
Pustule
Small, raised, diff. patch or area on a body surface
is Derm Normenclature for?
Plaque
Shedding of the outer layer of skin surface
is Derm Normenclature for?
Desquamation
(7) DDx for a Child with Fever and Rash?
- JIA - Systemic-onset Juvenile Idiopathic Arthritis
- Kawasaki disease
- Osteomyelitis / Septic Joint
- Rocky Mountain Spotted Fever (RMSF)
- Scarlet Fever
- Stevens-Johnson Syndrome
- Viral Syndrome (Enterovirus)
(6) Infectious causes of Lymphadenopahy?
- Measles (lymph and splenomegaly)
- Mononucleosis (EBV or CMV)
- HIV
- Histoplasmosis
- Toxoplasmosis
- Mycobacteria
(5) Non-infectious causes of Lymphadenopathy?
- Lymphomas
- Leukemia
- Histocytosis
- Metastatic neuroblastoma
- Rhabdomyosarcoma
(3) Causes of Unilateral Cervical Lymphadenopathy?
- Bacterial Cervical Adenitis
- Staphylococcus aureus
- Streptococcus pyogenes
- Cat Scratch Disease
- Bartonella henselae
- Mycobacterial Infection
(4) Conditions/Diseases that cause “Strawberry Tongue”
- Group A Streptococcal pharyngitis
- Kawasaki Disease
- Toxic Shock Syndrome
- Infectious Mononucleosis
- Prolonged Fever > 5 days
- Non-purulent conjunctivitis
- Mucosal changes of Oropharynx
- Strawberry Tongue
- Red, Cracked lips
- Unilateral Cervical Adenopathy
- Erythema and/or Swelling of Hands and/or Feet
- Non-specific Erythematous Maculopapular Rash
Kawasaki Disease
(4) Diseases that cause Rashes on Palms and Soles?
- Enterovirus
- Syphilis
- Rocky Mountain Spotted Fever
- Kawasaki Disease
(6) Diagnostic Criteria for Kawasaki Disease?
- Changes in Oral Mucosa
- Extremity changes (redness / swelling)
- Unilateral cervical Lymphadenopathy
- Rash Conjunctivitis
- Irritability
- > 5 days of Fever
(5) Complications of Kawasaki Disease?
- CNS (irritability, lethargy, aseptic meningitis) (90%)
- Coronary Artery aneurysm (20-25%)
- All pts. recieve echocardiogram for tx
- Liver Dysfunction (40%)
- Arthritis (30%)
- Hydrops of the Gallbladder 10%)
(2) Treatment for Kawasaki Disease?
- Aspirin (HIgh Dose
- 80 - 100 mg/kg/day over 4 doses for 6 - 8 weeks
- IVIG- single dose
- single dose of 2 g/kg over 10 - 12 hrs
What is the Follow-up Care for Kawasaki Disease?
- Cardiology Follow-up in One to Two weeks
- Repeat Echocardiogram
(3) Characterizarion of Asthma?
- Airway Inflammation
- Mucus Hypersecretion
- Reversible Airflow Obstruction due to Bronchoconstriction
Symptoms of Astma?
- Recurrent coughing
- Recurrent wheezing
- Unresponsive to Bronchodilators (i.e. Beta-agonists)
- Unresponsive to anti-inflammatory medications and steroids
Common Triggers of Asthma?
- Upper Respiratory Tract Infections
- Allergies
- Cold air
- Exercise
- Smoke Exposure
What is Paradoxical Breathing?
- The force of Contraction generated by
the Diaphragm > the ability of the chest wall muscles to expand the rib cage - The Chest is drawn inward w/ inspiration and the Abdomen rises due to Downward Displacement of the Abdominal contents
- Indicates the MOST SEVERE respiratory distress
What is Hyperpnea?
- Increased depth of respiration
- w/out respiratory distress may suggest a non-pulmonary condition such as Fever, Acidosis, or Extreme Anxiety
- -> Hyperventilation Syndrome
What is Hypopnea?
- Reduced Tidal Volume
- Increases the proportion of each breath used to ventilate dead space
- May result in Hypoventilation, even in the setting of a normal or elevated respiratory rate
Nasal flaring?
- Enlargement of beth nares during inspiration
- Seen in small children w/ significant respiratory distress
- Indicates that accessory muscles are being used for Respiration
Head Bobbing?
- Due to use of the Accessory Muscles of Respiration (Neck strap Muscles)
- Bob forward w/ each inspiration
- Best observed during sleep
Respiratory Grunting?
- Forced expiration against a Partially Closed Glottis
- Generate Positive Pressure (PEEP) necessary to Stent their own Airway open
(4) Most Common Causes of Wheezing in Infants?
(3) Less Common?
Most Common
- Viral Bronchiolitis
- Asthma
- Foreign Body Aspiration
- Gastroesophageal (GE) Reflux
Less Common
- Tacheomalacia
- Extrinsic Compression
- CF
(5) Causes of Cough in Infants?
- Viral Upper Respiratory Tract Illnesses
- Pneumonia
- Post-nasal drip to Allergies and/or Sinusitis
- Foreign Body Aspiration
- GE Reflux
What Viral infection is a/w Croup?
- Croup - Laryngotracheobronchitis
- Parainfluenza Virus Type 1
- Barky “seal-like” cough
- Mild croup –> Inspiratory stridor
- Sever croup –> expiratory stridor
What are the (3) stages of Bordetella Pertussis?
- Catarrhal Stage (lasts 1 - 2 weeks)
- Upper Resp. Tract Inf.
- Paraxysmal Stage (lasts 4 - 6 weeks)
- Characteristic “Whoop”
- Convalescent Stage
- Paroxysms of cough
Signs of Symptoms of Epiglottitis?
- Fever
- Stridor
- Drooling
- Dysphonia
- Dysphagia
- Respiratory Distress
- Haemophilus INfluenzae type b (Hib)
(12) DDx of Cough in a 10-month old?
- Allergic rhinitis
- Asthma
- Bonchiolitis
- Croup
- Foreign body aspiration
- Community-acquired pneumonia
- Pertussis
- Sinusitis
- Viral Upper Respiratory Infection
- Cystic Fibrosis
- Anatomic abnormality
- GERD
(3) Extrinsic Causes of Wheezing?
- Vascular Ring or Sling
- Adenopathy
- Mass effect or other Lesion
What causes Stridor?
- Due to Airway Narrowing above the Thoraci inlet?
- Usually heard w/ Inspiration, but he can be biphasic if obstruction is Severe
What is Wheezing?
- Typically due to Airway Narrowing below the Thoracic inlet
- Mild airway obstruction –> expiration
- Increased obstruction –> biphasic
- Mucus plugging –> focal wheezing
- Asthma –> Polyphonic wheeze
- Focal Airway Obstruction –> Monophasic
What is Rhonchi?
- Coarse, Low-pitched Rattling sounds heard best in Expiration
- Thought to be due to Secretions and Narrowing of Airways
What are Crackles?
- Finer breath sounds heard on Inspiration
- A/w Fluid in the Alveoli
- A/w Opening and Closing of Stiff Alveoli (Interstitial Disease)
- Course Crackles–> Purulent Secretions in the Alveoli w/ Pneumonia and Pulmonary edema or Interstitial Lung Disease
(2) Tests to order for Evaluation for a Foreign Body Aspiration?
- CXR: PA and Lateral
- Bilateral Decubitus or Inspiratory / Expiratory Chest Films
Pathophysiology of Astma?
- Asthma is characterized by:
- Infiltration of Inflammaotry cells into the Airway Mucosa
- Mucus Hypersecretion
- Mucosal Edema
- Bronchoconstriction
Tx for Acute Asthma Exacerbation?
- Anti-inflammatory Therapy w/ Corticosteroids and Bronchodilation w/ Beta-2 agonists (Albuterol)
- Together w/ supportive care for Hypoxemia or Dehydration
Tx for Asthma Maintance Therapy?
- Therapy for Chronic Asthma Therapy is based on Frequency, Severity, Symptoms
- Inhaled Corticosteroid as daily
- Controller medication
- Inhaled Beta-agonist (Albuterol as needed)
- Additional Meds include (Montelukast) are also used under appropriate circumstances
Tx for Bronchiolitis?
- Supportive, aimed at maintaining adequate oxygenation and hydration
(3) Antimicrobial agents used for Pertussis?
- Azithromycin
- Clarithromycin
- Erythromycin
