pediatric respiratory tract infxns

Question 1

19 month old boy, noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils and a barking cough, follows cold sx

Answer 1

Laryngotracheobronchitis (viral croup)

Question 2

when is viral croup infxn most likely?

Answer 2

b/w 6 months-6 yrs

Question 3

harsh, high-pitched, INSPIRATORY sound characteristic of laryngeal obstruction

Answer 3

stridor

Question 4

what type of virus accounts for half of viral croup cases?

Answer 4

parainfluenza type 1

Question 5

what will you see on CXR with viral croup?

Answer 5

anteriorposterior soft tissue with steeple sign

Question 6

tx for viral croup

Answer 6

1. humidifiers
2. racemic epi by nebulization
3. dexamethasone (steroids)

Question 7

Abrupt onset with fever to 38 to 40 degree centigrade, respiratory distress to total airway occlusion within hours

Answer 7

epiglottitis

Question 8

classic presentation of epiglottitis

Answer 8

anxious patient, prefers sitting, neck in hyperextension, drooling, age 1-5

Question 9

what is epiglottitis most commonly caused by?

Answer 9

haemophilus influenza type B

Question 10

how to tx epiglottitis?

Answer 10

antibiotics (ceftriaxone, cefotaxime, unasyn) for 7-10 days

Question 11

thumb sign on CXR?

Answer 11

epiglottitis

Question 12

what infxn can follows croup?

Answer 12

bacterial tracheitis

Question 13

patients under 3, brassy cough, high fever, trachea gets filled up with pus, can cause life threatening airway obstruction

Answer 13

bacterial tracheitis

Question 14

most common cause of bacterial tracheitis?

Answer 14

staph aureus

Question 15

which URT infxn has an onset of 4-12 hrs with severe toxiciity

Answer 15

epiglottitis

Question 16

which URT infxn has an onset of 12-48 hrs w/ minimal toxicity?

Answer 16

croup

Question 17

foreign body aspiration most ccommon at what ages?

Answer 17

1-3

Question 18

cough, stridor (trachea), wheeze (bronchus), drooling, respiratiory distress, poor response to tx for respiratory infxn

Answer 18

foreign body respiration

Question 19

expiratory film of foreign body aspiration will show?

Answer 19

air trapping on affected side, mediastinal shift to unaffected side

Question 20

inspiratory film of foreign body aspiration will show?

Answer 20

mediastinal shift to affected side as other lung aerates

Question 21

if you wan to see foreign bodies in the trachea, which view to use?

Answer 21

lateral view (sagittal plane)

Question 22

if you wan to see foreign bodies in the esophagus, which view to use?

Answer 22

AP view (coronal plane)

Question 23

Infection between the buccopharyngeal fascia and the prevertebral fascia

Answer 23

Retropharyngeal Abscess

Question 24

Retropharyngeal Abscess most commonly seen in what age grp?

Answer 24

under 3 yrs

Question 25

Retropharyngeal Abscess found in _____kids, peritonsillar abscess seen in _____

Answer 25

younger, adolescents

Question 26

fever, sore throat, neck pain, progressive dysphagia and respiratory distress, ill appearing child with torticollis and trismus, Drooling and stridor Drooling and stridor

Answer 26

retropharyngeal abscess

Question 27

oropharynx will show____on exam of retropharyngeal abscess

Answer 27

bulging in back of throat on one side

Question 28

tx of retropharyngeal abscess

Answer 28

drainage + antibiotics

Question 29

4 month old, inspiratory stridor that goes away when the patient is calm and placed in the prone position, noise present since birth but progressively getting better

Answer 29

Laryngomalacia

Question 30

cause of Laryngomalacia

Answer 30

1. immaturity of the supporting structures surrounding the larynx
2. Abnormal neuromuscular development

Question 31

when does Laryngomalacia worsen?

Answer 31

when agitated and supine

Question 32

tx of Laryngomalacia?

Answer 32

reassure parents if no FTT, or surgery if needed

Question 33

is Laryngomalacia or tracheomalacia more common?

Answer 33

Laryngomalacia

Question 34

tx of tracheomalacia?

Answer 34

most improve w/o intervention

Question 35

what can tracheomalacia be assc’d with?

Answer 35

TE fistula

Question 36

what accounts for most LRTI in children?

Answer 36

viruses

Question 37

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

Answer 37

strept pneumonia

Question 38

what is the most sensitive and specific sign of pneumonia in infants under 5 yrs

Answer 38

tachypnea

Question 39

if kids presents w/ fever

& cough, but does NOT have tachypnea - can they have pneumonia?

Answer 39

no, probably not

Question 40

what does the WHO use to dx pneumonia in kids under 5?

Answer 40

tachypnea + retractions

Question 41

under 6 months, ): rhinorrhea, conjunctival injection, mild cough and wheezing with low grade fever, then post tussive emesis

Answer 41

pertussis

Question 42

fever, chills, HA, myalgia, nonproductive cough, abrupt onset, school age children

Answer 42

influenza

Question 43

what is the most common serious secondary bacterial infxn related to influenza?

Answer 43

streptococcus pneumoniae

Question 44

systemic disorder of mitochondrial function that occurs during or after a viral illness

Answer 44

reye syndrome

Question 45

things to avoid in tx of bronchiolitis in kids (6)

Answer 45

1. viral testing unecessary
2. CXR leads to false + pneumonia
3. avoid albuterol & epi
4. avoid steroids
5. avoid antibiotics
6. avoid chest percussion tx

Question 46

age 1-3 months, repetitive staccato cough and nasal congestion without fever, tachypnea, rales,bilateral exudative conjunctivitis

Answer 46

Chlamydia Trachomatis

Question 47

how to tx chlamydial conjunctivitis?

Answer 47

ORAL ERYTHROMYCIN

Question 48

round pneumonia assc’d with?

Answer 48

streptococcus pneumonia

Question 49

school aged child, nonbilous vomiting, low grade fever, non bloody productive cough; diffuse crackles/rales with no retractions

Answer 49

Mycoplasma Pneumonia