Peds pathology (Phumiruk) Flashcards

Question

Upper Respiratory Infections (Colds)

Answer 1

Acute, self-limiting viral syndrome of the upper respiratory tract Children younger than six years have an average of * six to eight colds per year (up to one per month, September through April), with a typical symptom duration of 14 days Young children in * daycare appear to have more colds than children cared for at home. However, when they enter primary school, children who attended daycare are less vulnerable to colds than those who did not. Older children and adults have an average of two to four colds per year, with a typical symptom duration of five to seven days Symptoms: rhinorrhea, congestion, sneezing, and may include fever

Answer 2

Fever, otalgia, cough, rhinorrhea Symptoms may be nonspecific in infants (feeding difficulties, irritability) Older children have more classic presentation May be a complication of URI Tympanic membrane shows evidence of acute inflammation Pathogens: Viral Bacterial top three organisms: * Strep pneumoniae, * Moraxella catarrhalis * H. flu nontypables Treatment: First line: * amoxicillin (high dose = 80-90 mg/kg/day) Second line: amoxicillin-clavulinic acid (Augmentin) or second generation cephalosporin

Answer 3

Diagnosis is based on: 1. Persistence of nasal discharge: if the child has a very congested and/or runny nose for 10 days without improvement, especially when it is associated with a daytime cough (may also have a night cough) 2. Severe symptoms: if the child has a high fever (over 39 C, which is 102.2 F) for 72 hours or has a high fever and is not eating or drinking and is difficult to calm 3. Worsening symptoms: a child's cold got better and then in a day or two the child is suddenly much more ill with a fever and/or pus-filled nasal discharge

Answer 4

= laryngotracheobronchitis * Steeple sign (if you get an xray) *** Subglottic narrowing of trachea Most common cause of inspiratory *stridor in peds Viral in origin Most commonly parainfluenza Sx: Coryza 1-2d prior to * croupy cough, hoarseness, & stridor Tx: if severe, inhaled racemic epinephrine & oral steroids

Answer 5

Invasive exudative bacterial infection of the soft tissues of the trachea = Acute bacterial laryngotracheobronchitis – similar to croup but worse Pathogens: - Staphylococcus aureus, - Streptococcus pneumoniae - Gram-negative enteric bacteria - Pseudomonas aeruginosa Predisposing viral infections with: * influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza virus, measles, and enterovirus

Answer 6

CMV Adenoviruses HSV Influenza viruses Enterovirus EBV - Monospot testing is not accurate under 4-5 years of age or before 2nd week of illness - Really long incubation period (4-6 wks) - Exudative pharyngitis is accompanied by fever, generalized adenopathy, hepatosplenomegaly, heterophile antibodies -- Sometimes treated with steroids in complicated cases Supportive care

Answer 7

Group A beta hemolytic streptococcus * 15 to 30 percent of all cases of pharyngitis in children between the ages of 5 and 15 years - Peaks during the winter and early spring - Rapid strep in office, back up culture Other bacterial pathogens - Group C and group G strep: acute rheumatic fever is not a complication of infection due to these organisms - Arcanobacterium hemolyticum - Corynebacterium diphtheriae - Tularemia

Answer 8

History: - Typically has an abrupt onset of symptoms - Typically the school aged child * Sore throat * Fever * Headache * GI symptoms: abdominal pain, nausea, and vomiting Poor oral intake ** NO cough or rhinorrhea!! Aka, no viral symptoms ( coryza, conjunctivitis, hoarseness, anterior stomatitis, discrete ulcerative lesions or vesicles). Younger children may present with fever, abdominal pain, vomiting Physical: * Exudative pharyngitis or erythema of posterior orophayngeal mucosa - Enlarged tender * anterior cervical lymph nodes Palatal * petechiae Inflamed uvula * Scarlatiniform rash * Pastia’s lines Work Up: * Rapid strep with back up culture if negative How can you possibly get a sample?? Use two swabs at once; double tongue depressor for stronger kids, have smaller child pant like a puppy dog Wear a mask because you’ll probably get coughed on

Answer 9

* Most common deep neck infection in children and adolescents, accounting for at least 50 percent of cases – can be a complication of strep pharyngitis Symptoms: Severe sore throat (usually unilateral) Fever * “Hot potato" or muffled voice Pooling of saliva or drooling may be present * Trismus Neck swelling and pain * Asymmetric tonsils on exam Treatment: needle aspiration: antimicrobial therapy (amoxicillin/clavulinic, cephalosporins, and clindamycin), and supportive care (hydration, analgesia)

Answer 10

Most commonly in * young children between the ages of two and four years Symptoms: Difficulty swallowing (dysphagia) pain with swallowing (odynophagia) drooling with decreased oral intake Unwillingness to move the neck secondary to pain (torticollis), particularly unwillingness to extend the neck * "hot potato" quality [dysphonia] Gurgling sound, or stertor (snoring sound) Respiratory distress (stridor, tachypnea, or both); * stridor develops as disease progresses Neck swelling, mass, or lymphadenopathy * Trismus (in approximately 20 percent)

Answer 11

Respiratory virus affecting nasal passages and lungs Almost all children will be infected by 2 years of age Recovery within 1-2 weeks of infection May be severe in premature or very young infants - Risk factors for severe disease: young age --- preterm birth (specific guidelines for immunization with Synagis = palivizumab) - low birth weight - chronic pulmonary disease - cyanotic or complicated cardiac disease - neurologic disease - immunodeficiency or immunosuppression congenital defects of the airway Newborns with bronchiolitis may present with apnea * RSV is the most common cause of bronchiolitis - -> Inflammation of small airways of lung ``` Other causes of bronchiolitis include: * rhinovirus * parainfluenza * influenza * human metapneumovirus * adenovirus Seen most often in fall, winter & early spring ```

Answer 12

* Important cause of chronic cough in toddler Nasal * Unilateral purulent drainage - Foul smelling Lower respiratory tract - DDx: recurrent viral infections and asthma - PE and CXR may be unrevealing

Answer 13

Often begins in infancy Signs/symptoms: - Vomiting - Poor weight gain - Substernal CP - Abdominal pain - Dysphagia - Esophagitis * Diagnosis often based on clinical presentation Tests: - Upper GI (r/o other abnormalities) - 24 hr esophageal pH probe Treatment: - Smaller feedings more frequently, positioning post feeds - Acid suppressive meds - OMT

Answer 14

Rotavirus - Most common cause of diarrhea in young children throughout the world - Normally self-limiting but can cause severe dehydration - Sx: fever, vomiting, diarrhea - Highly contagious, lasting 3-9 days Fecal-oral spread Vaccination in early infancy Rotateq 3 dose series Rotarix 2 dose series

Answer 15

in the esophagus- coin lays flat in the trachea on its side Urgent or emergent intervention: When the object is sharp, long, or consists of magnets When the object is a * disk battery in the esophagus If * airway compromise, such as tracheal compression, is present If there is evidence of esophageal obstruction (eg, the patient is unable to swallow secretions) If there are signs or symptoms suggesting inflammation or intestinal obstruction (fever, abdominal pain, or vomiting) If the object is in the esophagus and the suspected ingestion occurred 24 or more hours prior to the evaluation, or if the time of ingestion is unknown

Answer 16

Neonates Result of thick suprapubic fat Resolve as infant grows

Answer 17

1:250 male births Infants should not be circumcised - Dorsal preputial skin may be needed for repair Repair usu. at 6 months of age

Answer 18

Common in prepubertal age group Fusion of labia minora ?inflammation of thin labial mucosa that adheres in midline Severe fusion may result in dysuria& urinary problems including UTIs * Tx: mechanical separation then petroleum ointment to diminish irritation - estrogen creams (Premarin)

Answer 19

Congenital Normal valve mechanics of ureterovesicular junction is impaired Reflux from bladder to ureter or kidney Grades I --> III high rate of spontaneous resolution Suppressive prophylactic antibiotics

Answer 20

Girls>boys * Don’t trust a culture from a bag urine sample!! Catheterized sample only in infants * Infants may present with vomiting only Clean catch if potty trained

Answer 21

3-5% of healthy toddlers will have seizure caused by fever (9m-5 yrs) Tends to run in families - Likely to have more than one febrile seizure if: - There is a family history of febrile seizures - The first seizure happened before age 12 months - The seizure occurred with a fever below 102oF

Answer 22

* Simple febrile seizure * Lasts a few seconds to 5-10 minutes * Generalized Followed by a period of drowsiness or confusion (30 minutes post-ictal) * Complex febrile seizure * Lasts longer than 15 minutes * Focal - in just one part of the body * Occurs again during the same illness

Answer 23

Progressive degeneration of skeletal muscle 1:3500 male births X-linked recessive Early onset, symmetrical, begins w/ pelvic/pectoral girdle involvement Confined to wheelchair by adolescence Death from cardioresp. Insufficiency by age 20 * Gower maneuver