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)
2
Q
(3) Irritability in a Child?
A
- Meningeal irritation
- Headache from intracranial irritation
- Simple exhaustion
3
Q
What is the normal HR for a 5 y.o.?
A
80 to 100 BPM
4
Q
Flat, Discolored spot
is Derm Normenclature for?
A
Macule
5
Q
Small, Well-defined solid bump
is Derm Normenclature for?
A
Papule
6
Q
Small, well-defined, fluid-containing bump
is Derm Normenclature for?
A
Vesicle
7
Q
Small, well-defined bump containing purulent material
is Derm Normenclature for?
A
Pustule
8
Q
Small, raised, diff. patch or area on a body surface
is Derm Normenclature for?
A
Plaque
9
Q
Shedding of the outer layer of skin surface
is Derm Normenclature for?
A
Desquamation
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)
11
Q
(6) Infectious causes of Lymphadenopahy?
A
- Measles (lymph and splenomegaly)
- Mononucleosis (EBV or CMV)
- HIV
- Histoplasmosis
- Toxoplasmosis
- Mycobacteria
12
Q
(5) Non-infectious causes of Lymphadenopathy?
A
- Lymphomas
- Leukemia
- Histocytosis
- Metastatic neuroblastoma
- Rhabdomyosarcoma
13
Q
(3) Causes of Unilateral Cervical Lymphadenopathy?
A
- Bacterial Cervical Adenitis
- Staphylococcus aureus
- Streptococcus pyogenes
- Cat Scratch Disease
- Bartonella henselae
- Mycobacterial Infection
14
Q
(4) Conditions/Diseases that cause “Strawberry Tongue”
A
- Group A Streptococcal pharyngitis
- Kawasaki Disease
- Toxic Shock Syndrome
- Infectious Mononucleosis
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
16
Q
(4) Diseases that cause Rashes on Palms and Soles?
A
- Enterovirus
- Syphilis
- Rocky Mountain Spotted Fever
- Kawasaki Disease
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
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%)
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
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
26
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
27
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
28
Head Bobbing?
* Due to use of the Accessory Muscles of Respiration (Neck strap Muscles)
* Bob forward w/ each inspiration
* Best observed during sleep
29
Respiratory Grunting?
* Forced expiration against a Partially Closed Glottis
* Generate Positive Pressure (PEEP) necessary to Stent their own Airway open
30
(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
31
(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
32
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
33
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
34
Signs of Symptoms of Epiglottitis?
* Fever
* Stridor
* Drooling
* Dysphonia
* Dysphagia
* Respiratory Distress
* *Haemophilus INfluenzae* type b (Hib)
35
(12) DDx of Cough in a 10-month old?
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
(3) Extrinsic Causes of Wheezing?
* Vascular Ring or Sling
* Adenopathy
* Mass effect or other Lesion
37
What causes Stridor?
* Due to Airway Narrowing above the Thoraci inlet?
* Usually heard w/ Inspiration, but he can be biphasic if obstruction is Severe
38
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
39
What is Rhonchi?
* Coarse, Low-pitched Rattling sounds heard best in Expiration
* Thought to be due to Secretions and Narrowing of Airways
40
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
41
(2) Tests to order for Evaluation for a Foreign Body Aspiration?
* CXR: PA and Lateral
* Bilateral Decubitus or Inspiratory / Expiratory Chest Films
42
Pathophysiology of Astma?
* Asthma is characterized by:
* Infiltration of Inflammaotry cells into the Airway Mucosa
* Mucus Hypersecretion
* Mucosal Edema
* Bronchoconstriction
43
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
44
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
45
Tx for Bronchiolitis?
* Supportive, aimed at maintaining adequate oxygenation and hydration
46
(3) Antimicrobial agents used for Pertussis?
* Azithromycin
* Clarithromycin
* Erythromycin
