Pediatric Upper Respiratory Diseases Flashcards by tcarlso 3

What are the ssx of sinusitis?

Rhinitis with mucus that starts clear and then becomes cloudy or colored

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What are the three types of sinusitis?

Persistent
Severe
Worsening

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True or false: the mucus color is not significant

True

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What is a persistent sinusitis?

lasts for 10 days or more

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What are the characteristics of severe sinusitis?

Fever over 102.2 F that lasts for 3 days in a row

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What is the progression of sinusitis?

Steadily increase

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What is the progression of recurrent URI?

Sinusoidal (occurring and recurring)

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How many cold will children get in the first year of life?

6-8

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When are abx indicated?

10 days without improvement

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What is the formal name of croup?

Laryngotracheobronchitis

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What is the typical age range for croup?

between 6 months and 6 years old

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What is the classical presentation of croup?

Middle of the night with inspiratory stridor, barky cough, and stridor

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HOw long does viral croup last for?

3-7 days, with peak ssx first 1-2 nights

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Which gender is more often affected with croup?

boys

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What is virus causes croup?

Parainfluenza virus type 1

- RSV also

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What is the bacterial cause of croup? How common is this?

Mycoplasma pneumonia

Rare

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How do you diagnose viral croup?

Clinical presentation and maybe a XR of the neck

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What is the classic XR sign with croup? What is the sensitivity of this?

Steeple sign

Only about 50% of cases

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What is the treatment for croup? (2)

Dexamethasone

- Racemic Epi by neb

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When is epi indicated fro croup?

Respiratory distress

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What is the corticosteroid used for croup?

Dexamethasone

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When is hospitalization indicated for croup?

If need repeated doses of epi for stridor

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What is the most common cause of epiglottitis?

HiB

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What are the ssx of epiglottitis?

Sudden onset of fever, respiratory distress, and total airway occlusion within hours

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What is the position that patients with epiglottitis take?

Tripod

When is epiglottitis most common?

1-8 years old

What is inflamed with epiglottitis?

Epiglottis Arytenoids Arytenoepiglottici area Vocal cords

Should you use a tongue depressor to check for epiglottisi?

Should you attempt x-ray or lab work with epiglottisi?

What should you do with a pt who is in respiratory distress from epiglottitis?

Gather anesthesiologist, ENT, and ped surgeon

What is the classic XR finding with epiglottitis?

Thumb sign

What is the most common infectious agent that causes bacterial trachititis?

Staph Aureus

What is bacterial tracheitis?

Inflammation of the trachea, causing mucosal swelling at the level of the cricoid cartilage

What is the major consequence of bacterial tracheitis?

Airway obstruction

What are the ssx of bacterial tracheitis?

brassy cough, fever, and toxicity

How do you make the diagnosis of bacterial tracheitis?

Presentation High fever Copious secretions Leukocytosis w/ L shift

What is the treatment for bacterial tracheitis?

Intubation and anti-staph abx

What age is FB aspiration most common?

1-3

What are the ssx of FB aspiration?

rapid onset of wheezing/stridor

Stridor comes from what part of the airway?

Trachea

Wheezing comes from what part of the airway?

Bronchus

What spinal levels are at the beginning and end of the trachea?

C6 - T5

How do you diagnose FB aspiration?

CXR and history

What type of XR should be obtained for FB aspiration?

lateral and AP neck

What do expiratory films show with a FB obstruction?

Air trapping on afected side and mediastinal shift to the unaffected side

What do inspiratory films show with a FB obstruction?

Mediastinal shift back to affected side as the other lung aerates

FB in the trachea are seen best with what view of the neck?

Lateral

FBs in the esophagus are best seen with what view of the neck?

What is the treatment for FB aspiration?

Endoscopy

Large airway on lateral neck XR is suspicious for what?

Retropharyngeal abscess

Where do retropharyngeal abscesses usually occur?

Buccopharyngeal fascia and the prevertebral fascia

What happens to the lymph nodes with a retropharyngeal abscesses?

Suppurate from extension of a bacterial pharyngeal infection

What are the most common infectious agents for retropharyngeal abscesses?

Staph Aureus

What age group is most commonly affected with retropharyngeal abscesses?

Children less than 3 years

When does the prevertebral space close?

3-4 years

What should always be in you ddx for retropharyngeal abscesses?

Peritonsillar abscess

What are the symptoms of retropharyngeal abscesses?

Fever Sore throat Dysphagia Respiratory distress

What are the signs of a retropharyngeal abscesses? (3)

Toxic appearance Torticollis Trismus Drooling

Exam of the oropharynx with retropharyngeal abscesses will show what?

Posterior swelling which may be greater on one side than the other

How do you diagnose a retropharyngeal abscesses?

Clinical history, CT if unsure

What is the treatment for retropharyngeal abscesses?

Drainage and abx the cover gram positive organisms

Stridor that disappears with lying prone = ?

Laryngomalacia

What is the usual cause of subglottic stenosis?

Numerous Intubations at prematurity

What is Laryngomalacia?

Immaturity of the supporting structure surrounding the larynx, and abnormal neuromuscular development

What makes Laryngomalacia worse?

Crying Agitation supine position

What is the voice/cry like with Laryngomalacia?

Nomal

What is the prognosis for Laryngomalacia?

Resolves by 12-18 months

What is the treatment for Laryngomalacia?

- Reassurance if no respiratory failure | - Surgical intervention if bad

What is tracheomalacia?

a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded.

What are the ssx of tracheomalacia?

Wheezing more often than stridor

When does the retropharyngeal space close?

3-4th year of life

What is the most common cause of stridor in the newborn period?

Laryngotracheobronchitis

What is the onset time for epiglottitis?

4-12 hours (quick)

In which of the major LRTI in children does the patient appear toxic?

Epiglottitis

Which way will a coin show on a CXR if it's in the esophagus? Trachea?

``` Esophagus = coronal plane Trachea = sagittal plane ```

If a child has trismus, drooling, and stridor, what should be in your ddx?

retropharyngeal abscess

What is a major difference in the PE findings with a retropharyngeal abscess as compared to a peritonsillar abscess?

Peritonsillar will be off to one side

What is the age of range for croup?

3 mo - 3 years