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Pediatric Respiratory Infections Flashcards

1
Q

The number one cause of cardiac arrest in children is

A

respiratory arrest

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2
Q

stridor is

A

upper airway obstruction

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3
Q

wheezing is

A

lower airway obsturction

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4
Q

Upper Respiratory Infections (Colds)

A
  • Children younger than six years have an average of *six to eight colds per year(up to one per month, September through April), with a typical symptom duration of *14 days
  • Young children in *daycareappear to have more colds than children cared for at home. However, when they enter primary school, children who attended daycare are less vulnerable to colds than those who did not.
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5
Q

URI cont’d: symptoms

A

Most common sxs:
–*Fevermay be the predominant manifestation of the common cold during the early phase of infection in young children. It is uncommon in older children and adults.
–Nasal *congestion, nasal discharge, and sneezing are common in children
–Erythema and swelling of the nasal mucosa and nasal discharge. Nasal discharge may be clear initially, but often becomes colored (yellow or green) within a few days
–Coughoccurs in more than two-thirds of children with the common cold

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6
Q

Abnormal middle ear pressures

A

-viral nasopharyngitismay result in Eustachian tube dysfunction and abnormal middle ear pressure, or
-abnormal middle ear pressure may result from the viral infection of the mucosa of the middle ear Eustachian tube
*predisposes to otitis media

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7
Q

Typical viral pathogens:

A

Rhinovirus (about 30-50%)

RSV

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8
Q

fever over 100.4 rectally requires

A

sepsis workup

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9
Q

Differential Diagnosis of URI

A

•Allergic, seasonal, or vasomotor rhinitis; rhinitis medicamentosa
•Acute bacterial sinusitis
•Nasal foreign body
•Inhaled foreign body
•Pertussis-classically begins with mild cough and coryza(catarrhal phase)
•Structural abnormalities of the nose or sinuses
•Influenza
–Although influenza virus may cause the common cold, it usually causes more severe illness; abrupt onset of fever (often >39°C [102.2°F]), headache, myalgia, and malaise in addition to cough, sore throat, and rhinitis
•Bacterial pharyngitis or tonsillitis

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10
Q

treatment of uri

A

Supportice care only pushe fluids antipyretics prn nasal saline with bulb suction cool mist humidifier

do not use otc cough meds/decongestants in young children

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11
Q

Acute Otitis Media

Most common affliction necessitating medical therapy for children younger than 5 years

A 
Risk factors
Prematurity and low birth weight
*Young age -anatomical differences of ear canal
Early onset
Family history
Race -Native American, Inuit, Australian aborigine
Altered immunity
Craniofacial abnormalities
Neuromuscular disease
Allergy
*Day care
Crowded living conditions
Low socioeconomic status
*Tobacco and pollutant exposure
*Use of pacifier
Prone sleeping position
*Fall or winter season
*Absence of breastfeeding, prolonged bottle use
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12
Q

Otitis Media cont’d

•Most common bacterial pathogens

A

S pneumoniae, H influenzae, Moraxella catarrhalis

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13
Q

otitis media peak incidence

A

3-18 months

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14
Q

otitis media prevention

A

Tympanostomytube placement for recurrent episodes

3 epsidosde in 6 onths

4 episodes in 1 year with 1 episode in the preceding 6 months

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15
Q

otitis media complication

A

Intratemporal-*Perforationof the tympanic membrane, acute coalescent *mastoiditis, *facial nerve palsy, acute *labyrinthitis, petrositis, acute necrotic otitis, or development of chronic otitis media

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16
Q

Sinusitis symptoms

A

Symptoms include: cough, nasal symptoms, fever, headache, facial painand swelling, sore throat, and halitosis

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17
Q

Sinusitis cont’d

•Diagnosis is based on

A
  1. *Persistence of nasal discharge: if the child has a very congested and/or runny nose for 10 days without improvement, especially when it is associated with a daytime cough (may also have a nighttime cough)
  2. *Severe symptoms: if the child has a high fever (over 39 C, which is 102.2 F) for 72 hours or has a high fever and is not eating or drinking and is difficult to calm
  3. *Worsening symptoms: A child’s cold got better and then in a day or two the child is suddenly much more ill with a fever and/or pus-filled nasal discharge
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18
Q

Did you know that kids don’t have all their sinuses developed until about

A

12 years old

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19
Q

frontal sinuses are formed around

A

8 years

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20
Q

sinusitis work up

A

ct

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21
Q

Herpangina

A

CoxsackievirusesA 1-10, 12, 16, and 22

papules that vesiculate and then ulceratecentrally

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22
Q

Herpetic gingivostomatitis

A

clusters of small vesicles

•Coalesce to form large, painful ulcers of the oral and perioral tissues

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23
Q

Acute Pharyngitis

EBV

A

Monospot testing is not accurate under 4-5 years of age or before 2ndweek of illness

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24
Q

Acute pharyngitis

Group A beta hemolytic streptococcus

A

15 to 30 percentof all cases of pharyngitis in children between the ages of 5 and 15 years

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25
Q

Strep pharyngitis

History

A

–Typically has an abrupt onset of symptoms
–Typically the school aged child
–Sore throat
–Fever
–Headache
–GI symptoms: abdominal pain, nausea, and vomiting
–Poor oral intake
–*NO cough or rhinorrhea!!Aka, no viral symptoms ( coryza, conjunctivitis, hoarseness, anterior stomatitis, discrete ulcerative lesions or vesicles)

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26
Q

Strep pharyngitis

Physical

A

–Exudative pharyngitis or erythema of posterior orophayngeal mucosa
–Enlarged tender anterior cervical lymph nodes
–Palatal petechiae
–Inflamed uvula
–Scarlatiniform rash
–Pastia’s lines

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27
Q

Strep pharyngitis

workup

A

Rapid strep with back up culture if negative

28
Q

Strep pharyngitis cont’d
•Goals of antimicrobial therapy for eradication of group A streptococcus (GAS) from the pharynx in the setting of acute streptococcal pharyngitis include:

A

–Reducing duration and severity of clinical signs and symptoms, including suppurative complications
–Reducing incidence of nonsuppurative complications (eg, acute rheumatic fever)
–Reducing transmission to close contacts by reducing infectivity
•Initiation of treatment within *9 days of onset of illness will prevent complications

29
Q

Treatment of strep pharyngitis

A

•Penicillin V
250mg PO BID or TID for 10 days for children 27 kg or adults
(liquid formulation tastes icky, by the way)
•Amoxicillin 50mg/kg/day divided BID-TID (“low dose amox”) for 10 days
(bubblegum flavor!)
•*Pen G (BenzathinePCN):
–27 kg-adult:1.2 million U/dose IM X 1

30
Q

Recurrence of strep

A

For patients with as many as six GAS infections in a single year or three to four episodes in two consecutive years, *tonsillectomy may be an appropriate therapeutic consideration

31
Q

Peritonsillar Abscess overview

A

*Most common deep neck infectionin children and adolescents, accounting for at least 50 percent of cases

32
Q

Peritonsillar Abscess

Symptoms

A 
–severe sore throat (usually unilateral)
–Fever
–*"hot potato" or muffled voice
–Pooling of saliva or drooling may be present
–*Trismus
–neck swelling and pain
–ipsilateral ear pain
–Fatigue
–Irritability
–decreased oral intake
33
Q

Peritonsillar abscess

•Treatment:

A

Treatment:
–gold standard for diagnosis of peritonsillar abscess remains the collection of pus from the abscess through needle aspiration

34
Q

Retropharyngeal abscess

A

most commonly in children between the *ages of two and four years

little kids dont get strep throat or rheumatic fever

35
Q

Retropharyngeal abscess cont’d

Symptoms:

A
  • Difficulty swallowing (dysphagia)
  • pain with swallowing (odynophagia)
  • drooling with decreased oral intake
  • Unwillingness to move the neck secondary to pain (torticollis), particularly unwillingness to extend the neck
  • Change in vocal quality (muffled, or with a *“hot potato” quality [dysphonia])
  • gurgling sound, or stertor (snoring sound)
  • Respiratory distress (stridor, tachypnea, or both); stridor develops as disease progresses
  • Neck swelling, mass, or lymphadenopathy
  • *Trismus (in approximately 20 percent)
  • Chest pain (if there is mediastinal extension
36
Q

ct with contrast when looking for

A

abcess

37
Q

Epiglottitis

4 ds

A

–Drooling
–Dysphagia
–Dysphonia
–Dyspnea

38
Q

Epiglottitis

A

h flu type b

•*Toxic appearing
•“Tripod” position, “sniffing” position
•Management if suspected:
*Direct examination of the airway under anesthesia (with the availability of personnel who can perform a tracheostomy if needed)

39
Q

Laryngotracheitis (croup) overview

A

•Most commonly occurs in children *6 to 36 months of age. It is seen in younger infants (as young as three months) and in preschool children, but it is rare beyond age six years

40
Q

Laryngotracheitis (croup)

most common caused by

A

*parainfluenza
influence
rsv
adenovirus

41
Q

Typical features of croup include

A

–nasal congestion
–low-grade fever
–barking-type cough (like a seal)
–inspiratory stridor that may worsen with crying.

42
Q

Croupcont’d

•Treatment:

A

–*Warm mist in closed bathroom with hot water running or cool night air
–Corticosteroids, usually administered orally or parenterally, have been shown to improve symptom severity and reduce hospital length of stay (dexamethasone = Decadron). (do this if they don’t have stridor at rest)
–Inhaled racemic epinephrinehas been shown to reduce stridor within 30 minutes; therefore, it will provide the most immediate benefit and should be offered to the girl described in the vignette. ED observation period of at least 3 hours to see if symptoms return after nebulized epi treatment. (do this if they have stridor at rest)
–Children who have significant respiratory distress, hypoxemia, or inability to tolerate oral intake should be hospitalized for close observation.
–Mildly affected children may do well with steam (sit in bathroom with hot water running until room is steamy) or cool air (step outside into cool night).

43
Q

croup sign

A

steeple

44
Q

Bacterial Tracheitis

A

Acute *bacterial laryngotracheobronchitis”

45
Q

Bacterial tracheitis

Suspect in child with

A

•acute onset of airway obstruction in the setting of viral upper respiratory infection and in children with laryngotracheitis who arefebrile, toxic-appearing, and have a poor response to treatment with nebulized epinephrine or glucocorticoids

46
Q

Bronchiolitis

A

Caused by RSV

Bronchiolitis is a clinical syndrome that most commonly occurs in children younger than 2 years, with a peak incidence between 2 and 6 months of age and is characterized by *upper respiratory symptoms(eg, rhinorrhea) followed by *lower respiratory(eg, small airway/bronchiole) infection with inflammation, which results in *wheezing and or crackles (rales).

47
Q

Bronchiolitis

Risk factors for severe disease:

A 
–young age
–*preterm birth (specific guidelines for immunization with Synagis = palivizumab)
–low birth weight
–chronic pulmonary disease
–cyanotic or complicated cardiac disease
–neurologic disease
–immunodeficiency or immunosuppression
–congenital defects of the airway
48
Q

Just about all kids have had RSV infection by age

A

3

49
Q

Bronchiolitis Symptoms

A

one-to three-day history of upper respiratory tract symptoms, such as nasal congestion discharge and mild cough, followed by lower respiratory infection with inflammation, which results increased respiratory effort(eg, tachypnea,nasal flaring, chest retractions) and wheezing and/or crackles (rales).

50
Q

Bronchilotis Pathogens

A

Pathogens:
–RSV, rhinovirus
–less common causes include parainfluenza virus, human metapneumovirus, influenza virus, adenovirus, coronaviruses, and human bocavirus

51
Q

bronchiolitis Treatment

A

–Admit if hypoxic (oxygen saturations below 90% on room air) or dehydrated
–IVFs if dehydrated
–Trial of albuterol nebs no longer routinely recommended (new AAP guidelines 2015)

52
Q

what do pats with bronchiolitis need?

A

oxygen

53
Q

PneumoniaPresenting signs/sxs

A 
Presenting signs/sxs
–*Fever
–*Cough
–tachypnea
–increased work of breathing (retractions, nasal flaring, grunting, use of accessory muscles)
–*hypoxemia
–*adventitious lung sounds
54
Q

Pneumonia: Bacterial

cxr

A

may reveal a focal infiltrate (segmental or lobar consolidation).

55
Q

may reveal a focal infiltrate (segmental or lobar consolidation).

A

are the most common complication occurring in up to 40% of bacterial pneumonias; progression to empyema occurs in more than 50% of these cases.

56
Q

Pneumonia: Viral

A

Most likely cause of pneumonia in children

CXR with perihilar and diffuse parenchymal infiltrates (though sensitivity and specificity may be low)

57
Q

Pneumonia:Atypical and Other Pathogens

A

•Mycoplasma pneumoniae
–Adolescents or children over 5
–Most commonly URI symptoms without pneumonia
–Gradual onset and usually is heralded by headache, malaise, and low-grade fever
–Occasionally can be more acute and mimic pneumococcal pneumonia
–Nonproductive to mildly productive cough
–Wheezing and dyspnea also may occur
–Scattered rales and wheezeson lung exam may be present

58
Q

pneumonia cxr

A

diffuse infiltrates on CXR

59
Q

Pertussis stages

A

–Cattarhal (usually 7-10 days, range 4-21 days)
–Paroxysmal (1-6 weeks, but up to 10 weeks)
–Convalescence (usually 7-10 days, range 4-21 days)

60
Q

pertusiss infants dont

A

whoop

61
Q

pertussis overview

A

check nasal wash or aspirate for pertusis (pcr)

macrolides are drug of choise
antibiotics started during the paroxysmal state will not lessen symptoms>but they are given to prevent spread of illness

 after five full days of treatment the child is no longer contagious
62
Q

influenza

No testing or treatment unless risk factors present:

A

–Age less than 2
–Immunocompromised family member in home (including pregnant women, infants)
–Asthma
–Heart disease

63
Q

influenza treatment

A

–Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset.

64
Q

Decreased oral intake. 3 wet diapers in past 24 hours.

General: coughing intermittently, appears in mild resp distress with tachypnea and subcostal retractions, no nasal flaring, no cyanosis, alert and interactive

AFSF.

tachypneic, with mild subcostal retractions, moderate expiratory wheezing and crackles bilaterally in all lung fields

A

bronchiolitis

–Oxygen via nasal cannula to keep sats over 90%
–Encourage adequate hydration
–Nasal suctioning q 2 hours PRN
–Tylenol/ibuprofen PRN fever

65
Q

appears NAD, alert and interactive, playful in room, one prolonged coughing spell with associated perioral cyanosis witnessed

A

–Nasal wash for Pertussis PCR

azithromycin (most commonly used

66
Q

Moderate erythema of posterior oropharyngeal mucosa; there is trace exudate present on both tonsils; no petechiae present. MMM.

A

Rapid strep is positive Strep pharyngitis
•Treatment:
–Amoxicillin, push fluids, salt water gargles, throat lozenges, popsicles/milkshakes, soft diet, antipyretics PRN

67
Q

Voice is hoarse and muffled.

A

Peritonsillar abscess
•Treatment:
–Consult ENT for needle aspiration, C&S
–Augmentin or Clindamycin
–Fluids, soft diet, antipyretics/analgesics

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