Pulmo Flashcards
most common agent causing HFMD
Coxsackie A16
What is Lemierre syndrome?
Internal jugular vein septic thrombophlebitis
- caused by F. necrophorum
gold standard for diagnosing streptococcal pharyngitis
throat culture plated on blood agar
suppurative complications of GAS pharyngitis
peritonsillar abscess
cervical adenitis
primary benefit and intent of antibiotic treatment of GAS pharyngitis
prevention of acute rheumatic fever (ARF)
this is a diagnostic physical finding in peritonsillar cellulitis/abscess
asymmetric tonsillar bulge with displacement of the uvula
best known clinical syndrome caused by Epstein-Barr virus (EBV)
Infectious mononucleosis
Primary EBV infections in adolescents manifests in 30-50% cases as the classic triad of?
Fatigue, Pharyngitis and generalized lymphadenopathy
three mechanisms by which viruses cause common cold spread
-direct hand contact
-inhalation of small-particle aerosols
-deposition of large-particle aerosols and land on nasal or conjunctival mucosa
most common pathogens associated with the common cold
human rhinoviruses
Young children have an average of ___ colds per year
6-8 colds
most common complication of colds
Acute otitis media
most common bacterial pathogen in children 3 weeks to 4 years of age in PCAP
Streptococcus pneumoniae
most frequent bacterial pathogen in children 5 years and older seen in PCAP
Mycoplasma pneumoniae
Chlamydophila pneumoniae
most common causes of lower respiratory tract infections in infants and children older than 1 month but younger than 5 yr of age
Viral pathogens
— most common are RSV and rhinoviruses
definition of recurrent pneumonia
2 or more episodes in a single year or
3 or more episodes ever
with radiographic clearing between occurences
most consistent clinical manifestation of pneumonia
Tachypnea
recommended antibiotic for mildy ill children with PCAP who do not require hospitalization
Amoxicillin, usually high dose (90 mkday)
According to PPS guidelines, PCAP is considered in patients when these symptoms are present
Cough or fever + any of the ff:
1. tachypnea
2. retractions or chest indrawing
3. nasal flaring
4. O2 saturation <95% at room air
5. grunting
based on the PPS guidelines, what antibiotics should be given for patients with nonsevere PCAP?
Amoxicillin (40-50 mkday) q8 x 7 days or 80-90 mkday q12 x 5-7 days or
Co-amox (80-90 mkday) q12 x 5-7 days or Cefuroxime (20-30 mkday) q12 x 7 days if with penicillin-resistance pneumococci or beta lactamase h. influenzae
According to PPS guidelines, patients with PCAP severe should be given with what antibiotics?
Pen G (200,000 IU/kg/day) q6 if complete Hib, Ampicillin (200 mkday) q6 if no or incomplete or unknown HIb vaccine OR
Cefuroxime (100-150 mkday) q8 or Ceftriaxone (75-100 mkday) q12-q24 or Ampi-Sulbactam (200 mkday) q6 if with documented high level penicillin-resistance
add Clindamycin (20-40 mkday) q6-q8 if Staphylococcal pneumonia is highly suspected
if sepsis and shock, add Vancomycin (40-60 mkday) q6-q8
if viral etiology is considered for PCAP, according to PSS, what should be given
Oseltamivir, to be started immediately within 36 hours of laboratory confirmed influenza infection
good response to therapy in PCAP non severe is presented by
improvement of cough or normalization of core body temperature in the absence of antipyretics within 24-72 hours after initiation of treatment
what is strongly recommended as adjunctive treatment for measles pneumonia
Vitamin A
a child with suspected asthma is placed on low dose ICS and as needed SABA over how many weeks?
8-12 weeks
2 diagnostic features in diagnosing asthma in older children and adolescents (6-18 yo)
history of variable respiratory symptoms
confirmed variable expiratory airflow limitation
most serious complication of foreign body aspiration
complete obstruction of the airway
narrowest portion of the upper airway in children <10 yo
cricoid cartilage encircling the airway
Stridor is a sign of ______ airway obstruction
upper
75% of cases of croup is caused by this organism
Parainfluenza virus
most common form of acute upper respiratory obstruction
Croup/Laryngotracheobronchitis
The child has barking cough, hoarseness and inspiratory stridor. What condition is this?
Croup
Chest xray will reveal typical subglottic narrowing or steeple sign on the posteroanterior view
Croup
This virus is associated with severe laryngeotracheobronchitis
Influenza A
This condition is characterized by an acute rapidly progressive and potentially fulminating course of high fever, sore throat, dyspnea and rapidly progressing respiratory obstruction
Acute epiglottitis
classic radiograph of this condition: thumb sign
Epiglottitis
established treatment for moderate or severe croup
Nebulized racemic epinephrine
Aside from racemic epi for croup, what other medication should be given as part of the treatment?
Oral corticosteroids
most commonly isolated pathogen of bacterial tracheitis
S. aureus
this condition typically present in child with “brassy” cough
Bacterial tracheitis
this etiologic agent is responsible for more than 50% of cases of bronchiolitis
Respiratory Syncytial Virus (RSV)
This condition presents initially as rhinitis then 3-4 days later, a frequent dry hacking cough develops, which may or may not be productive
Acute bronchitis
walking pneumonia
M. pneumoniae
sinuses that are present at birth
Ethmoidal
Maxillary
3 bacterial pathogens causing acute bacterial sinusitis in children
S. pneumoniae
nontypeable H. influenzae
Moraxella catarrhalis
Definition of sinusitus according to duration
ACUTE: <30 days
SUBACUTE: 1-3 months
CHRONIC: >3 months
Diagnosis of sinusitis
2 major or 1 major and >=2 minor symptoms
MAJOR:
Purulent anterior nasal discharge
Purulent or discolored posterior nasal discharge
Nasal congestion/obstruction
Facial congestion/fullness
Facial pain/pressure
Hyposmia/anosmia
Fever
MINOR:
Headache
Ear pain, pressure or fullness
Halitosis
Dental pain
Cough
Fever
Fatigue
the only accurate method of diagnosis in sinusitis
Sinus aspirate culture
initial therapy given to children with uncomplicated mild to moderate severity acute bacterial sinusitis
Amoxicillin (45 mkday) BID
duration of therapy for acute sinusitus
minimum of 7 to 10 days
orbital complications such as periorbital and orbital cellulitis are most often secondary to acute bacterial infection of what sinus?
Ethmoid sinus
Osteomyelitis of the frontal bone
Pott Puffy tumor
whooping cough
Pertussis
Describe the stages of Pertussis
- Catarrhal stage (1-2 wks): nondistinctive symptoms of congestion and rhinorrhea with low grade fever, sneezing, lacrimation and conjunctival suffusion
- Paroxysmal stage (2-6 wks): cough begins as a dry, intermittent, irritative hack and evolves into inexorable paroxysms — hallmark
- Convalescent stage
characteristic lab finding in the catarrhal stage of pertussis
Leukocytosis (15,000-100,000 cells/uL)
drug of choice in all age groups for patients with Pertussis, as well as for postexposure prophylaxis
Azithromycin
most common esophageal disorder in children of all ages
Gastroesophageal reflux disease
infant reflux peaks at what age and when does it resolve
peaks at 4 months, resolves by 12 months in 88% of infants, nearly all by 24 months
positions that can be used to minimize reflux in infants
prone position
upright carried position
most common congenital anomaly of the esophagus
Esophageal atresia
suggestive of this condition is the inability to pass a NGT or OGT in the newborn
Esophageal atresia
what is the gap between atretic ends of the esophagus in EA that is not operable thru primary repair
> 3 to 4 cm (>3 vertebral bodies)
complication of surgery in EA
anastomotic leak
refistulization
anastomotic stricture
current standard surgical approach in EA with TEF
Primary end-to-end anastomosis of the esophagus and surgical ligation of the TEF
definitive diagnoses of tracheomalacia and bronchomalacia
flexible or rigid bronchoscopy
low pitched inspiratory snoring sound typically produced by nasal or nasopharyngeal obstruction
Stertor
inspiratory, low-pitched sound produced when there is upper airway obstruction
Stridor
diagnostic confirmation of laryngomalacia
flexible laryngoscopy
Infection from oropharynx which extends to cause septic thrombophlebitis of the IJV and embolic abscesses in the lungs
Lemierre disease
etiologic agent for Lemierre disease
Fusobacterium necrophorum
how many cc of fluid is present in the pleural space
10 mL
rapid removal of >1L of pleural fluid may be associated with the development of ???
Reexpansion pulmonary edema
predominant source of the organisms causing abscesses
Aspiration of infected materials or a foreign body
duration of treatment for primary lung abscess
2-3 weeks of IV antibiotics
to complete with oral antibiotics for a total of 4-6 weeks
most often involved lobe in children with atelectasis
right upper lobe
accumulation of extrapulmonary air within the chest
Pneumothorax
this happens occasionally in teenagers and young adults who are male, tall, thin without trauma or underlying lung disease
Primary spontaneous pneumothorax
accumulation of extrapulmonary air within the chest
Pneumothorax
principal features of pneumomediastinum
dyspnea
transient stabbing chest pain that may radiate to the neck
“spinnaker sail sign” or “angel wing sign”
Pneumomediastinum
— occurs when air deviates the thymus upward and outward
pathognomic for pneumomediastinum
mediastinal “crunch”/Hamman sign
pathognomic for pneumomediastinum
mediastinal “crunch”/Hamman sign
targeted oxygen saturation in patients with BPD outside of the NICU
=>92%
Wheezing at rest caused by Tracheomalacia usually resolves by what age?
3 years old
Most common bacterial agents of PCAP in children 5 yr and older (give top 3)
Mycoplasma pneumonia - S. pneumoniae - Chlamydophylia pneumonia
What are included in the McIsaac criteria
1 point for each
- history of temp >38 C
- absence of cough
- tender anterior cervical adenopathy
- tonsillar swelling or exudates
- age 3-14 yo
subtracts 1 point for age >45 yo
Major early childhood risk factors for persistent asthma
Parental asthma
Atopic dermatitis (eczema)
Inhalant allergen sensitization
strongest identifiable factor for the persistence of childhood asthma
allergy in young children with recurrent cough and/or wheeze
most common chronic symptoms of asthma
Intermittent dry coughing
Expiratory wheezing
lung function abnormalities in asthma
Define Bronchodilator response, exercise challenge, daily PEF or FEV1 monitoring
Bronchodilator response: increase in FEV1 >12% or predicted FEV1 >10% after inhalation of SABA
Exercise challenge: worsening in FEV1 >15%
Daily PEF or FEV1 monitoring: day-to-day and/or AM-to-PM variation >20%
