Pediatric upper respiratory conditions Flashcards
what are the three types of sinusitis?
persistent
severe
worsening
`when are antibiotics warranted?
10 days getting worse, no improvement (sinusitis)
classic presentation: laryngotracheobronchitis
retractions of chest wall nostril flaring coryza - profuse nasal discharge barking cough - INSPIRATORY appears in the middle of the night prior URI for a few days variable fever sore throat
during what ages is laryngotracheobronchitis infection most likely?
6 months - 6 years
what are the etiologies of laryngotracheobronchitis (viral croup)? which is the most common?
parainfluenza virus type 1 (most common) parainfluenza virus type 2 influenza A adenoviruses respiratory syncytial virus enteroviruses mycoplasma pneumo measles HSV corynebacterium diphtheria
what is the steeple sign? why is it not as useful?
upon CXR, tapered subglottic airway
only 50% present
what is the best medication therapy for true (rescue) airway distress in laryngotracheobronchitis (viral croup)? why?
racemic EPI
decrease in airway edema by vasoconstriction of airway blood vessels
what is the most common, and useful, medication for laryngotracheobronchitis (viral croup) in a non-rescue situation? what is the route?
dexamethasone
IM or PO
classic presentation: epiglottitis
anxious patient that prefers the sitting position, with neck in hyperextension and significant drooling
what is the most common etiology of epiglottitis?
haemophilus influenza type B
what is the treatment of epiglottitis?
anesthesia and endotracheal intubation
IV access
CBC, culture
abx
bacterial tracheitis may follow what infection?
viral croup
presentation: bacterial tracheitis
brassy cough, high fever, toxicity
what is the most common causative agent of bacterial tracheitis?
staph aureus
what is the major pathology associated with bacterial tracheitis?
mucosal swelling at cricoid level
thick, copious, purulent secretions
diagnosis: bacterial tracheitis?
respiratory distress
high fever
copious secretions
leukocytosis with left shift
treatment: bacterial tracheitis?
intubation
antistaphylococcal abx
what is seen on expiratory film for foreign body aspiration? inspiratory film?
expiratory - air trapping on affected side, mediastinal shift to unaffected side
inspiratory - mediastinal shift to affected side as other lung aerates
how are foreign bodies in the trachea visualized?
sagittal plane - lateral view
how are foreign bodies in the esophagus visualized?
coronal plane - AP view
what is a retropharyngeal abscess?
infection between buccopharyngeal fascia and prevertebral fascia - lymph nodes in this region most commonly suppurate from extension of a bacterial pharyngeal infection
what are the most common causes of retropharyngeal abscess?
strep pyogenes
oral anaerobes
staph aureus
presentation: retropharyngeal abscess
fever sore throat neck pain pregressive dysphagia respiratory distress torticollis trismus drooling stridor
what is seen in the oropharynx for a retropharyngeal abscess?
posterior swelling which may be greater on one side than the other
what is the treatment for retropharyngeal abscess?
drainage and abx that cover gram positive organisms and anaerobes
what is the most common cause of stridor in infancy
laryngomalacia
what are the causes of laryngomalacia?
- immaturity of the supporting structures surrounding the larynx
- abnormal neuromuscular development
presentation: laryngomalacia
inspiratoryo stridor that is worse with crying and while in the supine position; improves in prone position
what is the treatment for laryngomalacia?
- reassurance to parents if no respiratory insufficiency or failure to thrive
- surgical intervention sometimes necessary with epiglottoplasty or laser excision
presentation: tracheomalacia
cause wheezing more often that stridor
tracheomalacia may be associated with what condition?
TE fistula
