Nelsons

Question 1

Common combinations of pathogens in pneumonia

Answer 1

Streptococcus pneumoniae and RSV or Mycoplasma pneumoniae

Question 2

Peak age for viral pneumonia

Answer 2

2-5 years

Question 3

Peak age for bronchiolitis

Answer 3

first year of life

Question 4

Major viral pathogen in pneumonia

Answer 4

RSV

Question 5

Top three common non-viral pathogens of pneumonia

Answer 5

S. pneumoniae, M. pneumoniae, C. pneumoniae

Question 6

Most consistent clinical manifestation of pneumonia

Answer 6

Tachypnea

Question 7

Temperature difference in viral vs bacterial pneumonia

Answer 7

Bacterial generally higher temp

Question 8

Characterization of viral pneumonia in chest radiography

Answer 8

hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing

Question 9

Characterization of bacterial pneumonia in chest radiography

Answer 9

Confluent lobar consolidation

Question 10

WBC count differences: bacterial vs viral pneumonia

Answer 10

Viral pneumonia:
WBC count may be normal or elevated but usually
NOT higher than 20,000/mm3
with a lymphocyte predominance

Bacterial pneumonia:
Often associated with an elevated WBC count in the range of 15,000-40,000/mm3
Predominance of granulocytes.

Question 11

Treatment of pneumonia in a mildly ill patient (outpatient)

Answer 11

For mildly ill children who do not require hospitalization, amoxicillin is recommended. In communities with a high percentage of penicillin-resistant pneumococci, high doses of amoxicillin (80-90 mg/kg/24 hr) should be prescribed.

Therapeutic alternatives: cefuroxime axetil or amoxicillin/clavulanate.

For school-aged children and in those in whom infection with M. pneumoniae is suggested, a macrolide antibiotic such as azithromycin is an appropriate therapeutic choice.

Question 12

The empirical treatment of suspected bacterial pneumonia in a hospitalized child

Answer 12

Parenteral cefuroxime (75-150 mg/kg/24 hr) is the mainstay of therapy when bacterial pneumonia is suggested.

If features suggest staphylococcal pneumonia (e.g., pneumatoceles, empyema), initial therapy should also include vancomycin or clindamycin.

Question 13

Up to how many percent of patients with known viral infection may have co-existing bacterial pathogens?

Answer 13

30%

Question 14

Typically, patients with uncomplicated community acquired bacterial pneumonia respond to therapy with improvement in clinical symptoms after how many hours?

Answer 14

48-72 hrs

Question 15

In general, there should be radiographic evidence of improvement within 4-6 wk, but time to complete resolution varies depending on the etiologic organism.

Pneumococcal pneumonia?
Chlamydial pneumonia?
Mycoplasma pneumoniae?
Legionella, Staphylococcal, Gram negatives?
Viral pneumonia?

Answer 15

Pneumococcal pneumonias often require 1-3 mo for complete radiographic clearing. Similarly, chlamydial pneumonia can require 1-3 mo for complete resolution radiographically.

Mycoplasma pneumoniae tends to clear more rapidly, with radiographic improvement occurring within 2 wk to 2 mo.

Conversely, staphylococcal, Legionella, and enteric gram-negative pneumonias can take as long as 3-6 mo to resolve radiographically.

Children with viral pneumonia may have positive radiographic findings for many months.

Question 16

Formerly known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa

Answer 16

Kawasaki Disease

Question 17

Pathogenesis of kawasaki’s disease

Answer 17

vasculitis of the medium-sized blood vessels

Question 18

Most important manifestation of Kawasaki’s Disease

Answer 18

Cardiac involvement

Question 19

Percentage of untreated Kawasaki’s who get coronary aneurysms

Answer 19

25%

Question 20

Diagnostic Criteria for Kawasaki’s Disease

Answer 20

Fever lasting for at least 5 days

Presence of at least four of the following five signs:

1. Bilateral bulbar conjunctival injection, generally nonpurulent
2. Changes in the mucosa of the oropharynx, including injected pharynx, injected and/or dry fissured lips, strawberry tongue
3. Changes of the peripheral extremities, such as edema and/or erythema of the hands or feet in the acute phase; or periungual desquamation in the subacute phase
4. Rash, primarily truncal; polymorphous but nonvesicular
5. Cervical adenopathy, ≥1.5 cm, usually unilateral lymphadenopathy

Illness not explained by other known disease process

Question 21

3 Clinical Phases of Kawasaki’s Disease

Answer 21

1. The acute febrile phase

usually lasts 1-2 wk, is characterized by fever and the other acute signs of illness.

2. The subacute phase

begins when fever and other acute signs have abated, but irritability, anorexia, and conjunctival injection may persist. The subacute phase is associated with desquamation, thrombocytosis, the development of coronary aneurysms, and the highest risk of sudden death. This phase generally lasts until about the 4th wk.

3. The convalescent phase

begins when all clinical signs of illness have disappeared and continues until the erythrocyte sedimentation rate (ESR) returns to normal, approximately 6-8 wk after the onset of illness.

Question 22

Repeat 2dEcho in Kawasaki’s disease is usually done at __ weeks after the onset of illness

Answer 22

6-8 weeks

Question 23

Treatment during the acute phase of Kawasaki’s disease

Answer 23

Intravenous immunoglobulin 2 g/kg over 10-12 hr with aspirin 80-100 mg/kg/24 hr divided every 6 hr orally until 14th illness day

Question 24

Treatment during the convalescent phase of Kawasaki’s disease

Answer 24

Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset

Question 25

IVIG reduces the prevalence of coronary disease from ___% in children treated with aspirin alone to 2-4% in those treated with IVIG and aspirin within the first 10 days of illness.

Answer 25

20-25%

Question 26

Syndrome that is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure.

This syndrome typically occurs after a viral illness, particularly an upper respiratory tract infection, influenza, varicella, or gastroenteritis, and is associated with the use of aspirin during the illness.

Answer 26

Reye syndrome

Question 27

Giant aneurysms in Kawasaki’s disease measure >/= __mm

Answer 27

> /= 8mm