Pediatric lower respiratory conditions

Question 1

definition: pneumonia

Answer 1

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

Question 2

what type of organism accounts for most of the LRTIs in children under 1 year of age?

Answer 2

virus

Question 3

what is the most common cause of bacterial pneumonia throughout all of childhood?

Answer 3

strep pneumo

Question 4

where do most bacterial pneumonias arise?

Answer 4

bacteria colonizing the respiratory tract

Question 5

what is the most sensitive and specific sign of pneumonia in infants?

Answer 5

tachypnea

Question 6

if an infant does not have tachypnea, does s/he have pneumonia?

Answer 6

no

Question 7

what are the clinical findings of pediatric pneumonia?

Answer 7

fever
cough
tachypnea

refusal to eat 
grunting 
rales 
rhonchi 
decreased breath sounds 
cyanosis 
pallor 
accessory muscle respiration

Question 8

what is the causative organism of pertussis?

Answer 8

gram negative pleomorphic bordetella pertussis

Question 9

what are the phases of pertussis?

Answer 9

catarrhal
paroxysmal
convalescent

Question 10

symptoms: catarrhal phase of pertussis

Answer 10

1-2 weeks

rhinorrhea, conjunctival injection, mild cough, wheezing, low grade fever

Question 11

symptoms: paroxysmal phase of pertussis

Answer 11

2-4 weeks
coughing increases in frequency and intensity
whoop may be heard
POST TUSSIVE EMESIS

Question 12

symptoms: convalescent phase of pertussis

Answer 12

1-2 weeks
coughing and vomiting decrease in frequency
cough may continue for weeks

Question 13

what is the agent of choice for treatment of pertussis?

Answer 13

erythromycin

Question 14

diagnosis: pertussis (blood work, imaging)

Answer 14

leukocytosis with absolute lymphocytosis during catarrhal and paroxysmal stages

CXR may show perihilar infiltrates, atelectasis or emphysema

Question 15

febrile seizures in children can be linked to what infection?

Answer 15

influenza

Question 16

reye syndrome is usually associated with which two viruses?

Answer 16

varicella

infleunza

Question 17

diagnosis: reye syndrome

Answer 17

hypoglycemia
hyperammonemia
elevated liver enzymes

Question 18

what is the most common cause of bronchiolitis and pneumonia in children under 1?

Answer 18

RSV

Question 19

imaging: RSV

Answer 19

right upper lobe atelectasis
air trapping
increased interstitial markings

Question 20

symptoms: chlamydia trachomatis

Answer 20

non-wheezing
non-febrile
cough
age 1-3 months

Question 21

conjunctivitis
pneumonia
under 4 months of age

what should be in the ddx?

Answer 21

chlamydia trachomatis

Question 22

what is seen on CBC for chlamydia trachomatis?

Answer 22

WBC normal but with peripheral eosinophilia

Question 23

if there is evidence of chlamydial conjunctivits even without current evidence of pneumonia you would not treat with topical erythromycin but….

Answer 23

oral erythromycin

Question 24

organism characteristics: strep pneumo

Answer 24

gram positive diplococci

Question 25

“round” pneumonia is usually due to what organism?

Answer 25

strep pneumo

Question 26

what are the agents of choice for strep pneumo pneumonia if the child is hypoxemic, in respiratory distress, or hemodynamically unstable?

if the patient is stable?

Answer 26

IV abx

oral abx

Question 27

what agents are the treatment of choice for mycoplasma (walking) pneumonia?

Answer 27

macrolide abx