Respiratory Diseases (Peds) Flashcards
Croup:
Parainfluenza 1 or 3, influenza A or B
-Age 3mos-5yrs; URTI symptoms: Deep barking cough, Rhinorrhea, Sore throat, Hoarseness, inspiratory stridor, tachypnea - symptoms are worse at night
Croup: Dx (always suspect epiglottis)
Croup = hypoxia on presentation
Epiglottis = imminent/danger of
- Clinical diagnosis
- Confirmed by: Neck XR (steeple sign - narrowing of air column in trachea)
Croup: Tx
-spontaneous resolution in 1 week
1) Humidified Oxygen (cool mist)
2) Nebulized/racemic epinephrine (epinephrine, inhalation) 3) Oral corticosteroids (dexamethasone, oral)
Epiglottis:
(H. Influenzae type B; S. Pyogenes; S. pneumoniae;
S. aureus; Mycoplasma)
- Sudden onset ,muffled voice, drooling, dysphagia, high fever, inspiratory stridor
- Pt in tripod position, toxic appearance
Epiglottis: Dx
Med Emergency; Straight to tx based on clinical dx
Perform diagnostic workup after stabilization:
(1) Neck XR: thumb print sign (2) blood cultures (3)nasopharyngoscopy OR epiglottic swab culture
Epiglottis: Tx
1) Transfer to hospita/OR/call ambulance/send to ED
2) Consult ENT/Consult anesthesia 3) Intubate in OR
4) Give ceftriaxone IV 7-10 days 5) Give steroids
Epiglottis: Prophylaxis
IF H. influenza (+); give household contacts: Rifampin
Bacterial Tracheitis
S. Aureus
-Brassy cough, high fever, respiratory distress, but NO drooling or dysphagia; following URTI, usually < 3yo
Bacterial Tracheitis: Dx
Clinical + laryngoscopy:
CXR: subglottic narrowing, ragged tracheal air column
Blood cultures, Throat cultures
Bacterial Tracheitis: Tx
Antistaphylococcal antibiotics; may require intubation if severe - risk of airway obstruction
Bronchiolitis (inflammation of small airways)
-leads to obstruction; air trapping; overinflation
Cause: RSV (50%); Parainfluenza; Adneovirus
Classic: child < 2 yo in fall/winter months
Bronchiolitis: symptoms
P/E: wheezing + prolonged expirations + fever
+/- Mild URI; Paroxysmal wheezy cough;
Dyspnea; Tachypnea; Apena
Bronchiolitis: diagnosis
-Clinical diagnosis
best initial: CXR (hyperinflation with patchy atelectasis)
most specific: viral antigen testing (ELISA) of nasopharyngeal secretions
Bronchiolitis: treatment
Supportive only;
- Hospitalize, give bronchodilators, isolate if:
Hypoxic; Tachypnea > 60/min; Intercostal retractions
Prevention in high risk patients only:
MC complication of RSV bronchiolitis:
prevention: RSV IVIG; monocolonal ab to RSV F protein
complication: Asthma/reactive airway disease
Viral Pneumonia: MCC < 5 yo (RSV)
URI + low-grade fever + tachypnea
Tx: withhold antibiotics; give if deteriorating
(30% coexisting bacterial infection)
Bacterial Pneumonia: MCC > 5 yo
S. pneumoniae, M. pneumoniae, C. pneumoniae
Acute-onset + shaking chills + high fever + prominent cough + pleuritic chest pain + dullness to percussion
Bacterial Pneumonia Tx: S. pneumoniae
Outpatient/mild: Amoxicillin
Inpatient: IV Cefuroxime (+Vancomycin if S. aureus)
Bacterial Pneumonia Tx: Chlamydia or Mycoplasma
Oral Erythromycin or other macrolide
Pneumonia - Best initial test: CXR
Viral: bilateral interstitial infiltrates
Pneumococcal: confluent lobar consolidation
Mycoplasma/Chlamydia: unilateral lower lobe interstitial
Chlamydia Trachomatis: (different than c. pneumoniae)
- Infants 1-3 months old
- Insidious onset > 3 weeks
Distinguish from RSV: no fever, no wheezing
H/P: staccato cough, peripheral eosinophilia +/- conjunctivitis at birth Tx: Oral erythromycin
CF: Autosomal recessive;
CFTR1 gene mutation (codes for chloride transport)
First step: Sweat chloride test
-Chloride > 60mEq/L on at least 2 occasions
CF: presentation
MC: Meconium ileus (bilious vomiting, distention at birth);
- failure to thrive/diarrhea (malabsorption); rectal prolapse;
persistent cough (copious purulent mucous production)
infertility, allergic bronchopulmonary aspergillosis
CF: treatment
Supportive: Aerosol tx; albuterol/saline; chest physical therapy; postural drainage; pancrelipase
CF: G551D mutation (present in 5%)
- interferes with activation of CFTR chloride channel
- all pts should be tested (at least 1 copy for Ivacaftor)
Tx: Ivacaftor (VX-770) - first CF approved therapy that restores function of mutant CF protein
CF: Improves survival
- Ibuprofen (reduces inflammatory lung response)
- Azithromycin (slows decline of FEV1 in pts < 13 yo)
- Antibiotics (during exacerbations delay progression)
CF: (most common pathogens - S. aureus; P. Aeruginosa)
Empiric tx in severe exacerbation:
Tobramycin + Ticarcillin-Clavulanate + Vancomycin
CF: mild disease
-Tobramycin; TMP-SMX; or Ciprofloxacin
Resistant pathogens: Inhaled tobramycin
