Peds-Lower Airway

Question 1

What is the Cause of pneumonia in kids?

Answer 1

Viruses, Strep Pneumo (pyogenic)

Question 2

What are the clinical findings for pneumonia in kids?

Answer 2

Fever, cough, tachypnea (must have tachypnea)

Question 3

Describe Pertussis

Answer 3

“intense cough”
humans only host
spread via droplets, contagious

Question 4

Describe the three phases of Pertussis

Answer 4

Catarrhal phase - 1-2 weeks, runny nose, conjunctivitis, mild cough, wheeze, fever
Paroxysmal phase- 2-4 weeks, Post tussive emesis
Convalescent phase-1-2weeks, things calm down

Question 5

How do you diagnose Pertussis?

Answer 5

clinical
Leukocytosis - 80-90%
CXR - perihilar infiltrates, atelectasis, emphysema
Nasopharyngeal swab

Question 6

How do you treat Pertussis?

Answer 6

Hospitalize if infant, O2, ERYTHROMYCIN, Isolate pnt 5 days

Question 7

What causes Influenze?

Answer 7

RNA orthomyxovirus, Types A,B,C

Question 8

Describe Influenza

Answer 8

Spread in large droplets, school aged children, winter, Most infectious 24 hours b4 symptoms, can shed virus for months

Question 9

What are the symptoms of Influenza?

Answer 9

Abrupt onset of fever, coryza, myalgia, headache, malaise, conjunctivitis, THE ENTIRE RESP TREE

Question 10

What is Reye Syndrome?

Answer 10

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

Question 11

How do you diagnose Reye syndrome?

Answer 11

hypoglycemia, hyperammonemia, increased liver enzymes

Question 12

How do you treat reye syndrome?

Answer 12

limited, correct hypogycemia and treat ICP - supportive

Question 13

How do you diagnose INfluenza?

Answer 13

Based on time of year, Rapid nasal swab (inf. A and B), blood count (normal WBC or mild leukopenia)

Question 14

How do you treat Influenza?

Answer 14

Supportive - fluids, fever, rest
Neuraminidase inhibitors available for influ. a and b
Vaccinate all children

Question 15

Describe RSV

Answer 15

Most common hospitalized in infants
in adults - prod symptoms similar to cold
all kids infected by 2 years
Lives 12 hrs on hard surfaces (shopping cart)
air trapping, segmental atelectasis
Its in paramyxoviridae family. attach (G prots), Fusion (F)

Question 16

How does RSV present?

Answer 16

runny nose, sneezing, coughing for days, gets worse. respiratory distress, nasal flaring, suprasternal retractions
wheezing and rales

Question 17

How do you treat RSV?

Answer 17

Maintain airway, hydration, ventilation.

DO NOT - viral testing, CXR, albuterol, oral steroids, antibiotics, chest percussion

Question 18

How does Chlamydia Trachomatis Present?

Answer 18

Young child (

Question 19

How is chlamydia trachomatis spread?

Answer 19

Sexually, also can be passed to newborn from mother.

There are treatments for pregnant people

Question 20

How do you treat Chlamydia trachomatis?

Answer 20

Macrolides, tetracyclines, quinolones, sulfonamides.

Most Common: azithromycin for 5 days, or ERYTHROMYCIN (if evidence of chlamydia conjunctivitis) 14 days (orally)

Question 21

Describe Strep Pneumo

Answer 21

most common cause of bacterial pneumonia
may see a round pneumonia
Increased WBC. segmental consolidation, tachypnea, fever

Question 22

How do you treat Strep Pneumo?

Answer 22

Child hypoxic/resp distress-admit
ampicillin, ampicillin/sulbactam, cefuroxime, ceftriaxone IV until stable then 10 day oral abx
Child is stable - oral amoxicillin or clavulaninc acid, daily office visit until fever and tachypnea resolve

Question 23

Describe Mycoplasma Pneumonia

Answer 23

Most common in school aged children

Rare before age 3-4

Question 24

How do you diagnose Mycoplasma Pneumonia?

Answer 24

Cold aggutinins test, mycoplasma titers

Question 25

How does Mycoplasma present?

Answer 25

non productive cough, pneumonia, chills, rhinorrhea, ear pain, sinusitis

Question 26

How do you treat Mycoplasma Pneumonia?

Answer 26

Macrolides,

if hospitalized - macrolide and cephalosporin (for strep pneumo) until diagnosis is obtained