Pediatric Lung Disease

Question 1

Croup (laryngotracheobronchitis)

Answer 1

Most often caused by parainfluenza virus
Can be caused by other organisms such as RSV, influenza virus, and adenovirus
URI sx. and barking cough and stridor
low grade fever

Question 2

Croup Tx.

Answer 2

steroids: Dexamethasone 0.6mg/kg IM one dose
Barking cough, no stridor at rest: supportive therapy, hydration, minimal handling, mist therapy, cold air
Stridor at rest: Oxygen, nebulized racemic epinephrine

Question 3

Epiglottitis

Answer 3

A true medical emergency!
Most commonly due to H. flu Type B
Generally present with SUDDEN onset:
Fever
Dysphagia
Drooling
Muffled “hot potato” voice
Inspiratory retractions
Soft stridor
INTUBATE IMMEDIATELY

Question 4

Bronchiolitis

Answer 4

Inflammatory process of the smaller lower airways, usually caused by RSV
Infants with congenital heart disease, chronic lung disease (usually former premature infants), or immunodeficiencies at risk for severe disease and poorer outcomes
Presentation is usually fever, URI symptoms, and accompanied by tachypnea and wheezing

Question 5

Bronchitis

Answer 5

***URI symptoms with cough and malaise
Coarse bronchial sounds
WBC normal, CXR clear
Most of the time it is viral!
Sputum does not imply bacterial infection

Question 6

Pneumonia

Answer 6

Bacterial pneumonia presentation more abrupt! Often presentation is high fever, cough, chest pain, and shaking chills
Viral pneumonia often with prodrome of rhinorrhea, cough, low-grade fever, and pharyngitis. Most cases in children are viral but Unable to predict which cases are viral so we treat with antibiotics

Question 7

Pertussis (Whooping Cough)

Answer 7

Caused by Bordetella pertussis
Highly communicable disease
**Duration 4 – 12 weeks
starts as URI symptoms and slight fever may be present
After about 2 weeks, coughs become paroxysmal with classic “whoop” (this stage lasts 2-4 weeks)

Question 8

Pertussis (Whooping Cough) Tx.

Answer 8

Erythromycin for 14 days
Azithromycin for 5 to 7 days
Usually treat awaiting lab results if history of known exposure

Question 9

Cystic Fibrosis

Answer 9

Disease of the exocrine gland system
Defective chloride channel results in highly viscous secretions
Theory is that the decrease in chloride secretion leads to relative dehydration and abnormal mucociliary clearance

Question 10

CF: Treatment Options

Answer 10

Pulmonary: 
Bronchodilators
Mucolytics (acetylcysteine)
Steroids
Antibiotics

Pancreatic:
Pancreatic enzyme supplements
Vitamin supplements
High-caloric high protein diet