Peds Lower Resp Tract Infection

Question 1

Where does lower Resptract begin?

Answer 1

After the larynx

Question 2

What is Pneumonia?

Answer 2

Inflammation or infection of the lung gas exchange units (terminal and respiratory bronchioles

Question 3

What is the most common broad cause of pneumonia?

Answer 3

Viruses 90%

Strep Pneumo is most common cause of BACTERIAL Pneumonia

Question 4

How can pneumonia microbes be transferred into the lungs?

Answer 4

Either deposition and colonization of the resp tract
OR Hematogenous (systemic spread)

Question 5

What are the different host defenses that affect the Resp tract?

Answer 5

Nasopharyngeal air filtration
Laryngeal protection of the airway
Mucocilliary clearance
Normal cough reflex and strength
Normal anatomy
Unobstructed airway drainage
Normal cellular and humoral immune function

Question 6

What diseases affect the Mucocilliary escalator?

Answer 6

Kartagener’s syndrome

Question 7

What is the most common clinical findings in Pneumonia?

Answer 7

Fever
Cough
TACHYPNEA
(most sensitive and specific sign of pneumonia in infants)

Question 8

What is the WHO diagnosis criteria?

Answer 8

Tachypnea and retractions to diagnose pneumonia in children younger than 5yo.

Question 9

What is charicteristic of Pertussis?

Answer 9

"Whoop" sound heard on inspiration
Post tussive emesis(vomit)
G- Pleomorphic bacilli
Transmission from cough droplets
Very contageous
6 days incubation

Question 10

How is Pertussis Diagnosed?

Answer 10

80-90% lymphocytes
Leukocytosis with absolute lymphocytosis
CXR shows perihilar infiltrates, atelectaisis or emphysema
Nasopharyngeal swabs sent for PCR

Question 11

What is Tx of pertussis?

Answer 11

Erythromycin
Isolate Pt for 5 days
O2, IV fluids
Hospitalize if an infant

Question 12

What is charicteristic of Influenza?

Answer 12

Spread by large droplets
School age children
Community outbreak in winter
Children infectious for >10 days

Question 13

What is Reye Syndrome?

Answer 13

Systemic disorder of Mitochondrial function occurring during or after viral illness
Vomiting
Agitation, delirium, decorticate posturing
Flaccidity, Apnea

Question 14

How is influenza diagnosed?

Answer 14

Clinical

Nasal swab test

Question 15

What is Tx of the FLU?

Answer 15

Zanamivir and Oseltamivir

Resistant to amantidine and rimantidine

Question 16

What type of virus is RSV?

Answer 16

Paramyxovirus

Question 17

How is RSV transmitted?

Answer 17

Droplets, paticles and fomites
survives 6 hrs on stethoscope
12 hrs on hard surfaces

Question 18

What are the signs and symptoms of RSV?

Answer 18

Mild to severe

Right upper lobe atelectaisis

Question 19

What are the 2014 AAP guidelines for Tx of Bronchiolitis?

Answer 19

NO: viral testing
no CXR
no albuterol or racemic EP
no Oral Steroids
no Abtx
no chest percussion

Question 20

What is the presentation of a child with Chlamidia Trachomatis?

Answer 20

Repeditive Staccato cough. Conjunctivitis 
Tachypnea and rales
ABSENCE of fever and wheezing
CXR not abn
WBC normal

Question 21

What is the Tx of Chlamidia Trachomatis? Conjunctivitis?

Answer 21

Oral Erythromycin or azithromycin

Macrolides tetracyclines, quinolones, sulfonamides

Question 22

What is charicteristic of mycoplasma pneumonia?

Answer 22

Dx made by cold aglutinin test

Definitive test is by mycoplasma titer

Question 23

What is the Tx of mycoplasma Pneumonia?

Answer 23

Macrolides

Double cover with cephalosporin til definitive Dx is made.