Pediatrics Flashcards
stridor
upper airway obstruction
wheezing
lower airway obstruction
most common virus in common cold of children?
RSV, seem november to march, causes bronchiolitis
what causes croup?
parainfluenza virus
when do you give Abs to kids with sinusitis?
- persistence of nasal discharge for more than 10 days w/out improvement
- severe sx: high fever for 72 hours, not eating
- worsening sx or pus filled discharge
herpangina
Discrete erythematous-based macules –> evolve into papules that vesiculate and then ulcerate centrally, creating an erythematous halo. (seen in posterior)
caused by Coxsackieviruses A 1-10, 12, 16, and 22
strep pharyngitis
sore throat, fever, h/a, GI sx, NO COUGH OR RHINORRHEA!!!
sometimes have abdominal sx along with this
exudative pharyngitis, anterior cervical lymph nodes, palatal petechiae, scarlatiniform rash (linear rash)
* rapid strep with back up culture if negative*
Can’t tell by just looking
tx: Penicillin V or Amoxicillin (tastes good!)
only seen in over 3 y/o…
peritonsillar abscess?
- most common deep neck infection in children and adolescents
- due to a collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles
** gold std for ddx: collection of pus from abscess through needle aspiration **
Symptoms include: 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
** usually polymicrobial **
Epiglottitis
4 D’s: Drooling Dysphagia Dysphonia Dyspnea
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)
** call anesthesia right away, this kid is really sick
Croup
laryngotracheitis = parainfluenza virus
Typical features of croup include : nasal congestion low-grade fever **barking-type cough **inspiratory stridor that may worsen with crying.
see “steeple sign”
or called LTB = laryngotracheobronchitis
tx of croup?
inhaled racemic epinephrine
bronchiolitis?
more than half due to RSV (in infants younger than 6 mos)
ddx: increased respiraotry effort, tachypnea, nasal flaring, chest retraction, wheezing, rales (a mix of pneumonia and asthma)
= upper respiratory sx followed by lower respiratory infection –> wheezing and or crackles
when do you admit kids with bronchiolitis?
admit if child is hypoxic or dehydrated
obscured costovertebral angles ?
indicative of pleural effusions, must be drained
adolescent pneumonia with milder sx? wheezing, dysnpea, mildly productive cough, scattered rales and wheezes, low grade fever?
mycoplasma pneumonia, most common atypical pneumonia seen in adolescents or children over 5 y/o
- 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 wheezes on lung exam may be present
viral pneumonia vs bacterial CXR?
bacterial is usually lobar, diffuse infiltrates usually indicates viral
impairment vs. risk of asthma
impairment = categories of exercise induced, intermittent, mild, moderate and severe persistence
risk = more related to severity of episodes in conjunction with frequency of events
asthma is having trouble breathing out, vs. vocal cord dysfunction is having trouble breathing air in
most important medication used on children with asthma?
inhaled corticosteroids - tx the chronic inflammation, and decreased inflammatory mediators –> results in mm. being much less likely to be hyperresponsive
15 y/o female, known asthmatic, presents with cold for week, fever, cough, SOB, vomiting - on flovent (inhaled steroid), using albuterol 2x every 4 hours.
- acute exacerbation of chronic underlying disorder - use bronchodilator for rapid response (nebulizer tx of albuterol multiple times) for the in office tx and give her O2 in the office; also give oral steroids that will kick in in 4-6 hours.
- ultimately need to change her asthma tx so that it is under control: add LABA or Leukotriene* along with inhaled steroids (medium dose, don’t want to do high dose in a younger patient) along with continued use of albuterol
other differentials for her: acute exacerbation of asthma, vocal cord dysfunction, anxiety attack
2.5 year old male, sudden onset of wheezing. no fever, coughing, vomited one time, tachypnic, using accessory respiratory mm, nasal flaring, drooling some, diffuse wheezing, decreased air exchange, pale
ddx: aspiration (worried about this due to his age and its sudden onset), anaphylaxis, asthma**
tx: give albuterol nebulizer and give O2 - short term
longer term tx: put on inhaled corticosteroids and have him come back in every few months
7 y/o presents with well check up, SOB when playing soccer, wakes up at night, pleasant boy in no acute distress
ddx: exercise induced asthma, or mild persistent asthma
Use SABA albuterol PRN, maybe use corticosteroid if needed
3 month mom notices not feeding well, cough, a little temp, fussy, see right TM that is dull with fluid level and red, lungs show scattered wheeze, rhonci and rales in bases, see tachycardia
bronchiolitis
30 week gestational age, C-section, primigravida fetal distress.
Worry about RDS
Immediate actions: surfactant administered through ET tube
decreased surfactant –> atelectasis –> uneven perfusion, hypoventilation –> acidosis –> makes it worse –> pulmonary vasoconstriction/HTN –> endothelial damage –> hyaline membrane disease and fibrin formation
Mom is found to be + for CMV
CMV infections in newborn?
DNA virus of herpes virus group
CMV infection results in characteristic massive enlargement of the affected cells that contain intranuclear and cytoplasmic inclusions
see “owl eye”
CMV infection is the most common congenital viral infection
infants have mental retardation, cerebral palsy of most commonly, hearing impairment
transmitted through person to person - can go dormant and then be reactivated during pregnancy
transmission of CMV?
prenatal: occurs after primary infection of mother - can occur anytime during pregnancy: only 10-15% of infected victims manifest sx at birth
Natal infection: can occur during birth if mom is seropositive - 50% of these become infected with disease that is manifested at 4-6 weeks of age
Postnatal: most often spread in breast milk and 50-60% of infants will become infected
clinical manifestations of CMV?
- Intrauterine growth restriction
- Hepatosplenomegaly
- Jaundice
- Petechiae or purpura
- “blueberry muffin” spots
- Microcephaly
- Chorioretinitis
- ***Sensorineural hearing loss-Occurs in 30% to 65% of symptomatic infants and 5% to 15% in asymptomatic infants
- Cerebral calcifications
Other findings: poor feeding, pneumonia, lethargy, hypotonia, seizures
Lab tests: coombs (-) hemolytic anemia, elevated liver enzymes, elevated CSF protein
bronchopulmonary dysplasia
= babies with emphysema due to O2 treatment
- a chronic lung disease occurring in premature infants with RDS that were treated with mechanical ventilation and supplemental oxygen that developed chest X-rays that showed “coarse, streaky infiltration with small areas of emphysema and occasionally appeared cystic”
- BPD is rare infants with a gestational age > 30 weeks and weights of > 1200 grams
- It is seen in 30% of babies under <1000 grams and less than 32 weeks gestation
radiographic stages of BPD
Stage I-(2-3) days after birth Chest X-ray shows typical granular appearance of RDS
Stage II-(4-10) days after birth X-ray shows complete opacifcation of the lung
Stage III-(10-20) days after birth X-ray shows round cystic lucencies with alternating opacities
Stage IV-after 1 month X-ray shows enlargement of the lucencies with increasing strands of opacity (Bubbly Lung)
chronic cough in pediatric patient?
more than 3 to 4 weeks
cough after feeding in newborn
may be overfeeding, GERD or TEF
if cough stops when cut down volume of feedings - then most likely due to overfeeding
if cough worsens with feeding associated with vomiting then think GERD
if cough worsens with feeding, no vomiting then tracheo-esophageal fistula should be considered
Both GERD and TEF can be associated with wheezing, cyanosis and tachypnea
cough associated with tachypnea?
think about sepsis
cough associated with cyanosis that is relieved with O2?
think intrapulmonary process
if cough with cyanosis thats not relieved by O2?
suggest CHD with R to L shunt - this finding with or without murmur reqs. a thorough cardiac evaluation
cough in infancy?
RSV infection-infants at higher risk include preterm infants, cyanotic heart disease or immunodeficiency
A staccato cough in the first few months of life suggests infection with Chlamydia trachomatis pneumonia
Pertussis may cause spells of whooping with apnea
cough in a toddler?
Asthma must be considered in this age group but because toddlers cannot perform spirometry it can be a difficult diagnosis
Bronchiectasis may be present if the toddler has CF, ciliary dyskinesia or immunodeficiency
The cough of bronchiectasis is described as wet
Chronic middle-ear disease, allergy and sinusitis can cause chronic cough (these have reflexes for cough)
cough in adolescent
Asthma is a common cause of chronic cough
Tumors in the chest (rare) can cause chronic cough in this age group - think mediastinal mass
Vocal cord dysfunction that is often associated with stress or exercise can mimic exercise induced asthma with sudden symptoms of inability to breathe
if suspect epiglottitis?
from H. influenza, DO NOT STICK anything down his throat to examine it - if its epiglottitis the child needs to be intubated
