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Pediatrics: Case Files > MedU Clipp Cases 11 and 12 > Flashcards

MedU Clipp Cases 11 and 12 Flashcards

1
Q

What is the drug of choice for Group A Strep (GAS)?

Streptococcur pyogenes (GAS)

A
  • Penicillin (preferred but unpleasant taste)
  • Amoxicillin (more palatable)
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2
Q

(3) Irritability in a Child?

A
  • Meningeal irritation
  • Headache from intracranial irritation
  • Simple exhaustion
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3
Q

What is the normal HR for a 5 y.o.?

A

80 to 100 BPM

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4
Q

Flat, Discolored spot
is Derm Normenclature for?

A

Macule

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5
Q

Small, Well-defined solid bump
is Derm Normenclature for?

A

Papule

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6
Q

Small, well-defined, fluid-containing bump
is Derm Normenclature for?

A

Vesicle

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7
Q

Small, well-defined bump containing purulent material
is Derm Normenclature for?

A

Pustule

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8
Q

Small, raised, diff. patch or area on a body surface
is Derm Normenclature for?

A

Plaque

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9
Q

Shedding of the outer layer of skin surface
is Derm Normenclature for?

A

Desquamation

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10
Q

(7) DDx for a Child with Fever and Rash?

A
  • JIA - Systemic-onset Juvenile Idiopathic Arthritis
  • Kawasaki disease
  • Osteomyelitis / Septic Joint
  • Rocky Mountain Spotted Fever (RMSF)
  • Scarlet Fever
  • Stevens-Johnson Syndrome
  • Viral Syndrome (Enterovirus)
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11
Q

(6) Infectious causes of Lymphadenopahy?

A
  • Measles (lymph and splenomegaly)
  • Mononucleosis (EBV or CMV)
  • HIV
  • Histoplasmosis
  • Toxoplasmosis
  • Mycobacteria
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12
Q

(5) Non-infectious causes of Lymphadenopathy?

A
  • Lymphomas
  • Leukemia
  • Histocytosis
  • Metastatic neuroblastoma
  • Rhabdomyosarcoma
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13
Q

(3) Causes of Unilateral Cervical Lymphadenopathy?

A
  • Bacterial Cervical Adenitis
    • Staphylococcus aureus
    • Streptococcus pyogenes
  • Cat Scratch Disease
    • Bartonella henselae
  • Mycobacterial Infection
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14
Q

(4) Conditions/Diseases that cause “Strawberry Tongue”

A
  • Group A Streptococcal pharyngitis
  • Kawasaki Disease
  • Toxic Shock Syndrome
  • Infectious Mononucleosis
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15
Q
  • 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
A

Kawasaki Disease

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16
Q

(4) Diseases that cause Rashes on Palms and Soles?

A
  • Enterovirus
  • Syphilis
  • Rocky Mountain Spotted Fever
  • Kawasaki Disease
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17
Q

(6) Diagnostic Criteria for Kawasaki Disease?

A
  • Changes in Oral Mucosa
  • Extremity changes (redness / swelling)
  • Unilateral cervical Lymphadenopathy
  • Rash Conjunctivitis
  • Irritability
  • > 5 days of Fever
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18
Q

(5) Complications of Kawasaki Disease?

A
  • 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%)
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19
Q

(2) Treatment for Kawasaki Disease?

A
  • 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
20
Q

What is the Follow-up Care for Kawasaki Disease?

A
  • Cardiology Follow-up in One to Two weeks
  • Repeat Echocardiogram
21
Q

(3) Characterizarion of Asthma?

A
  • Airway Inflammation
  • Mucus Hypersecretion
  • Reversible Airflow Obstruction due to Bronchoconstriction
22
Q

Symptoms of Astma?

A
  • Recurrent coughing
  • Recurrent wheezing
  • Unresponsive to Bronchodilators (i.e. Beta-agonists)
  • Unresponsive to anti-inflammatory medications and steroids
23
Q

Common Triggers of Asthma?

A
  • Upper Respiratory Tract Infections
  • Allergies
  • Cold air
  • Exercise
  • Smoke Exposure
24
Q

What is Paradoxical Breathing?

A
  • 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
25
Q

What is Hyperpnea?

A
  • Increased depth of respiration
  • w/out respiratory distress may suggest a non-pulmonary condition such as Fever, Acidosis, or Extreme Anxiety
  • -> Hyperventilation Syndrome
26
Q

What is Hypopnea?

A
  • 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
27
Q

Nasal flaring?

A
  • Enlargement of beth nares during inspiration
  • Seen in small children w/ significant respiratory distress
  • Indicates that accessory muscles are being used for Respiration
28
Q

Head Bobbing?

A
  • Due to use of the Accessory Muscles of Respiration (Neck strap Muscles)
  • Bob forward w/ each inspiration
  • Best observed during sleep
29
Q

Respiratory Grunting?

A
  • Forced expiration against a Partially Closed Glottis
  • Generate Positive Pressure (PEEP) necessary to Stent their own Airway open
30
Q

(4) Most Common Causes of Wheezing in Infants?
(3) Less Common?

A

Most Common

  • Viral Bronchiolitis
  • Asthma
  • Foreign Body Aspiration
  • Gastroesophageal (GE) Reflux

Less Common

  • Tacheomalacia
  • Extrinsic Compression
  • CF
31
Q

(5) Causes of Cough in Infants?

A
  • Viral Upper Respiratory Tract Illnesses
  • Pneumonia
  • Post-nasal drip to Allergies and/or Sinusitis
  • Foreign Body Aspiration
  • GE Reflux
32
Q

What Viral infection is a/w Croup?

A
  • Croup - Laryngotracheobronchitis
  • Parainfluenza Virus Type 1
  • Barky “seal-like” cough
  • Mild croup –> Inspiratory stridor
  • Sever croup –> expiratory stridor
33
Q

What are the (3) stages of Bordetella Pertussis?

A
  • Catarrhal Stage (lasts 1 - 2 weeks)
    • Upper Resp. Tract Inf.
  • Paraxysmal Stage (lasts 4 - 6 weeks)
    • Characteristic “Whoop”
  • Convalescent Stage
    • Paroxysms of cough
34
Q

Signs of Symptoms of Epiglottitis?

A
  • Fever
  • Stridor
  • Drooling
  • Dysphonia
  • Dysphagia
  • Respiratory Distress
  • Haemophilus INfluenzae type b (Hib)
35
Q

(12) DDx of Cough in a 10-month old?

A
  1. Allergic rhinitis
  2. Asthma
  3. Bonchiolitis
  4. Croup
  5. Foreign body aspiration
  6. Community-acquired pneumonia
  7. Pertussis
  8. Sinusitis
  9. Viral Upper Respiratory Infection
  10. Cystic Fibrosis
  11. Anatomic abnormality
  12. GERD
36
Q

(3) Extrinsic Causes of Wheezing?

A
  • Vascular Ring or Sling
  • Adenopathy
  • Mass effect or other Lesion
37
Q

What causes Stridor?

A
  • Due to Airway Narrowing above the Thoraci inlet?
  • Usually heard w/ Inspiration, but he can be biphasic if obstruction is Severe
38
Q

What is Wheezing?

A
  • 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
39
Q

What is Rhonchi?

A
  • Coarse, Low-pitched Rattling sounds heard best in Expiration
  • Thought to be due to Secretions and Narrowing of Airways
40
Q

What are Crackles?

A
  • 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
41
Q

(2) Tests to order for Evaluation for a Foreign Body Aspiration?

A
  • CXR: PA and Lateral
  • Bilateral Decubitus or Inspiratory / Expiratory Chest Films
42
Q

Pathophysiology of Astma?

A
  • Asthma is characterized by:
    • Infiltration of Inflammaotry cells into the Airway Mucosa
    • Mucus Hypersecretion
    • Mucosal Edema
    • Bronchoconstriction
43
Q

Tx for Acute Asthma Exacerbation?

A
  • Anti-inflammatory Therapy w/ Corticosteroids and Bronchodilation w/ Beta-2 agonists (Albuterol)
  • Together w/ supportive care for Hypoxemia or Dehydration
44
Q

Tx for Asthma Maintance Therapy?

A
  • 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
45
Q

Tx for Bronchiolitis?

A
  • Supportive, aimed at maintaining adequate oxygenation and hydration
46
Q

(3) Antimicrobial agents used for Pertussis?

A
  • Azithromycin
  • Clarithromycin
  • Erythromycin

Pediatrics: Case Files (16 decks)

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