Peds common respiratory and oral patho

Question 1

Acute viral rhinitis

Answer 1

Eti: rhinovirus…
Epi: most 5 yo have 6-12 cold per year
S/sx: clear or mucoid rhinorrhea, nasal congestion, fever, mild sore throat and cough
Tx: Symptomatic, analgesic, saline nasal rinse

Question 2

Allergic rhinitis

Answer 2

S/sx: frequent sneezing, rubbing of the nose and clear drainage
Tx: inhaled steroids, antiHist

Question 3

Sinusitis, rhinosinusitis

Answer 3

Eti: bacterial infection of the paranasal sinus.
Patho: S. pneumoniae, H. flu, M. catarrhalis, beta hemolytic strep
- Sphenoids come up by 5 yo, frontal by 7-8, sinusitis is uncommon <10yo
S/sx; URI 10+ days prior. Nasal drainage, nasal congestion, facial pressure, HA
Tx: Watch first 10 days, then mild to moderate: amoxicillin, severe or child in day care: augmentin

Question 4

Epistaxis

Answer 4

Eti: Kiesselbach area, dryness, irritation etc, von Willebrand disease.
Tx: Sit up, lean forward, pinch nose for 5 minutes
Pt. edu: Increase nasal moisture

Question 5

Aphthous stomatitis

Answer 5

aka canker sores
Eti: idiopathic
S/sx: small painful ulcer of the anterior inner lips or tongue, no fever
Tx: topical corticosteroids, bland diet to reduce pain
Pt. ed: related to bechets dz…

Question 6

Peritonsillar cellulitis, abscess

Answer 6

Eti: Beta-H strep, group D strep, S. pneumo and anaerobes
S/sx: severe ST, high fever, unilateral medial bulge of the tonsil with prominent anterior tonsillar pillar
Dx: aspiriate abscess and culutre, usually done by ENT
Tx: may consider admitting and IV abx for 12-24 hours
Comp: airway obstruction, aspiration PNA

Question 7

HSV in kids

Answer 7

Sx: first infection, 10+ small ulcers of the buccal mucosa, anterior pillars, inner lips, tongue, and gingiva, fever, tender cervical nodes.
Tx: last 7-10 days, supportive tx, can use acyclovir if caught early

Question 8

Retro-pharyngeal abscess

Answer 8

Surgical emergency - immediate drainage!
Beta-hemolytic strep and S. aureus
Epi: MC during first 2 years but very rare
S/sx: fever, drooling, respiratory symptoms, dysphagia, odynophagia, neck pain, hot potato voice, neck swelling, trismus, chest pain if medialstinal extension
Dx: CBC and culture, CT or OR eval

Question 9

Bacterial pharyngitis - strep

Answer 9

Eti: GAS (strep pyogenes)
Epi: kids 5-15: 15-30% of ST
during winter: 35-40% of ST
S/sx (kids >3): Abrupt onset, fever, HA, abd pain, N/V, ST, palatal petechiae, scarlatiniform rash (starts in groin and axilla and spreads to extremities.
(kids <3): symptoms atypical, nasal congestion, low grade fever, cervical LAD
Tx: Pen V agent of choice but amoxicillin is more palatable for kids.
Comp: Rhematic fever, glomeruler nephritis

Question 10

Mononucleosis

Answer 10

Eti: epstein-barr virus
S/sx: prolonged fever greater than 39, exudative pharyngitis, generalized LAD, 2-3 prodrome of malaise and anorexia. Can have macular, scarlatiniform or urticarial rash
Occasional: soft palate petechiae and eyelid edema
Tx: Bed rest, tylenol for fever, steroids if airway obstruction
Pt. edu: no contact sports: splenic rupture

Question 11

Fever F - C conversion

Answer 11

98.6 - 37
100.4 - 38
102.2 - 39
104 - 40

Question 12

Mumps

Answer 12

aka parotitis
Eti: rubulavirus, respiratory transmission
Sx: bilateral most often parotid gland swelling. Meningoencephalitis, pancreatitis, orchitis, oophoritis
Tx: supportive: fluids, analgesics
Pt ed: MMR vaccine at 12-18 months

Question 13

Herpangina

Answer 13

Viral pharyngitis caused by coxsackie A group viruses
Sx: ulcers are 3mm in size, surrounded by a halo and found on the anterior tonsillar pillars, soft palate and uvula
- spares anterior mouth and tonsils
Tx: self limited

Question 14

Oral candidiasis

Answer 14

Epi: common in the first weeks of life
Sx: adherent creamy white plaques on the buccal, gingival or lingual mucose
Tx; oral nystantin suspension

Question 15

Hand foot and mouth

Answer 15

Eti: viral pharyngitis, enterovirus 71, coxsackie virus A5, A10, A16
Sx: ulcers anywhere in the mouth, vesicles, pustules, or papules on the palms, soles, interdigital areas and buttocks, 3-7mm red macules become pale, white, oval vesicles with red base
Tx: self limited

Question 16

Asthma eti and dx

Answer 16

Eti: Inflammation of the airway du to hypersensitivity.
S/sx: cough (often at night and early morning), tachypnea, accessory muscle use, wheezing, hypoxia, hypoventilation.
Dx: CXR periobronchial thickening. PFTs (FEV1<80% predicted REV1/FVC <85% predicted. Increase of FEV1 by 12% after brochodilator

Question 17

Asthma basic tx

Answer 17

Tx is step wise:  ( changes by age)
Basics
Step 1: SABA PRN
Step 2: Low-dose ICS or cromolyn or montelukast
Step 3: Low-dose ICS + LABA or Medium-dose ICS
Step 4: Medium ICS + LABA
Step 5: High ICS +LABA
Step 6: High ICS+Oral Steroid + LABA

Question 18

Croup

Answer 18

Laryngotracheobronchitis
Eti: viral (parainflu primary, RSV)
Sx: fever, barking cough, stridor
CXR: steeple sign
Tx: supportive if mild, cool mist, hydration, antipyretics, possibly steroids. Mod-Sev: epinephrine, dexamethasone

Question 19

Pnuemonia

Answer 19

Eti:
Newborn: GBS, ecoli, ..
Child: S. pneumo, GAS, ...
S/sx: decreased activity, fever, cough, post-tussive vomiting, localized or diffuse rales
CXR: lobar or segmental consolidation
Tx: <5 amoxicillin, >5 azithromycin. 
Atypical: azithromycin

Question 20

Bronchiolitits

Answer 20

Eti: RSV most common
Epi: common in infant - 2yo
S/sx: clear rhinorrhea, fever, cough, tachypnea, wheezing, cyanosis, dyspnea
CXR: hyperinflation, pathcy atelectasis
Tx: supportive O2, bronchodilators, dluids, hypertonic saline