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N827 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Recurrent Respiratory Infections Warrant:

A
  • Investigations:
  • Immunodeficiency: SCID, IgG or IgA deficiencies (look at immunoglobulins)
  • Ciliary dyskinesia: familial disorder
  • Cystic fibrosis
  • Alpha-1 Antitrypsin deficiency: lung (kids) & liver (adults)
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2
Q

Keys to look at immunodeficiency

A
  • 8+ new severe ear infections
  • 2+ serious sinus infections
  • Persistent oral candidiasis
  • 2+ months on ABX without improvement and/or need for IV ABX to clear infection
  • Recurrent PNA
  • Failure to thrive
  • Family Hx of immunodeficiency
  • 2+ deep skin infections
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3
Q

Respiratory: Physical Exam

A
  • Rate, Rhythm, Effort
  • Grunting: NEVER normal
  • Accessory muscles
  • Level of anxiety (is child speaking)
  • Nasal flaring
  • Nose: rhinorrhea, color, mucoid, etc.
  • Sinuses
  • Throat: (If epiglottitis is suspected do NOT elicit gag reflex)
  • Chest: If decreased sounds on one side, think PNA)
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4
Q

Respiratory: Dx

A
  • SpO2, Imaging; soft tissue of neck (croup, epiglottitis); CXR; CBC-diff; sweat chloride; bronchoscopy, lavage, biopsy, genetic testing
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5
Q

Respiratory: Meds (general)

A
  • Decongestants: generally avoid, not under 4yr; caution under 6yr
  • Expectorants: not under 4yr
  • Suppressants: use rarely
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6
Q

Common Cold: Basics

A
  • ~10-12/yr
  • Most common viral etiology: parainfluenza; RSV; coronavirus; adenovirus; influenza; enterovirus
  • An increase in polymorphonuclear leukocytes causes changes in color of nasal mucous to yellow
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7
Q

Common Cold: S/S

A
  • Rhinorrhea
  • Sore throat
  • Mild cough
  • Low grade fever
  • After variable period, nasal secretions get thicker, more purulent
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8
Q

Common Cold: PE

A
  • Mild injected conjunctiva
  • Red nasal mucosa with secretions of varying colors; Anterior cervical adenopathy with freely moveable nodes <2cm
  • CTAB
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9
Q

Common Cold: Dx

A
  • Throat culture

- Nasal culture

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10
Q

Common Cold: Mgmt.

A
  • No ABX
  • Saline/suction
  • Cool mist/hydration
  • Educate parents on potential for secondary infections such as ear and sinuses
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11
Q

Pharyngitis/Tonsillitis: Basics

A
  • Pharyngitis: inflammation of the mucosa lining of the structures of the throat including tonsils, pharynx, uvula, soft palate, and nasopharynx
  • Nasopharyngitis: nasal symptoms present
  • Pharyngitis/Tonsillitis: without nasal symptoms
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12
Q

Pharyngitis/Tonsillitis: Etiology

A
  • Usually viral: same as cold + EBV, coxsackie, HSV

- Bacterial: Strep group A, C, or G; mycoplasma PNA

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13
Q

Pharyngitis/Tonsillitis: Hx

A
  • Sore throat
  • dysphagia
  • fever
  • myalgia
  • arthralgia
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14
Q

Pharyngitis/Tonsillitis: Viral PE

A
  • reactive lymphadenopathy common
  • EBV: Exudate on tonsils; soft palate petechiae; diffuse adenopathy (***posterior)
  • Adenovirus: cobblestoning of pharynx
  • Enterovirus: vesicles or ulcers onn tonsillar pillars assoc. w/coryza, vomit, diarrhea
  • Herpesvirus: ulcers, adenopathy
  • Parainfluenza and RSV: Croup (stridor), rales (PNA), Bronchiolitis (wheezing)
  • Influenza: more systemic symptoms
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15
Q

Pharyngitis/Tonsillitis: Viral PE & Mgmt.

A
  • Throat culture
  • CBC-diff
  • Monospot
  • EBV panel
  • Supportive
  • NO Abx
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16
Q

Pharyngitis/Tonsillitis: Bacterial (Facts)

A
  • Most common: GABHS
  • IF throat culture is positive for other bacteria (staph, strep PNA, or GBHS or GGBHS, treatment not neccessary)
  • Sexually active: consider gonorrhea
  • Chlamydia: possible in newborns (cough, conjunctivitis)
17
Q

Pharyngitis/Tonsillitis:Bacterial Hx

A
  • Rare <2yr
  • Abrupt onset without nasal Sx or coughing
  • Constitutional: arthralgia, myalgia, HA
  • Mod-to-high fever
  • malaise
  • prominent sore throat
  • dysphagia
  • ABD pain, N/V (esp. children)
  • HA
  • tonsillar exudate
  • Rash (**Scarlet Fever)
18
Q

Pharyngitis/Tonsillitis: Bacterial PE

A
  • Soft palate/pharynx petechiae
  • Swollen beefy red tonsils or uvula
  • Exudate, maybe yellow/blood-tinged
  • Tender lymphadenopathy
  • bad breath
  • Scarlatinoform rash (can be confused with Kawasaki Dz)
  • peeling hands and feet: delay in Dx
  • Strawberry Tongue: (can be confused with Kawasaki Dz)
  • May have mild Sx without exudate
19
Q

Pharyngitis/Tonsillitis: Bacterial Dx

A
  • Throat culture
  • Antistreptolysin titers (ASLO): antibody titer; peaks 3-6wk after infection
  • Anti-deoxyribose B tests (anti-Dnase B): peaks 8wk after infection
20
Q

Pharyngitis/Tonsillitis: Bacterial ABX

A
  • PCN: any kind; Amoxicillin; IM LA Bicillin; Augmentin
  • Cephalosporins (any gen.): Keflex, omnicef, ceftin, cedax
  • Azithromycin
  • Clarithromycin
  • Clindamycin (SAVE for resistant cases)
  • Sulfa: NOT effective
21
Q

Pharyngitis/Tonsillitis: Bacterial Mgmt.

A
  • May return to school after 24hr fever free and on ABX >24hr
22
Q

Pharyngitis/Tonsillitis: Complications

A
  • Rheumatic fever
  • Post-streptococcal reactive arthritis and acute glomerulnephritis
  • Secondary PNA, mastoiditis, otitis media
23
Q

Rhinosinusitis: Basics

A
  • Inflammation and secondary infection of the paranasal sinuses
  • 3 Sx required for Dx:
    1) purulent nasal discharge
    2) nasal obstruction
    3) facial pain, pressure, fullness lasting b/n 10d and 4wk
24
Q

Rhinosinusitis: 3 Clinical Presentations

A

1) Persistence of URI for >10d and <30d without improvement
2) Severe sx with high fever and purulent rhinitis at the onset and lasting at least 3-4d
3) Biphasic illness with worsening on day 6/7 of a common cold, wen patient develops an increase in respiratory Sx, nasal congestion, or new onset of fever

N827 (19 decks)

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