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Pediatric NRP 613 > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

The common cold (AKA: URI) will occur how many times per year for the average young child?

A

Young children will have 6-10 URIs per year.

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2
Q

what is the most common cause of the common cold?

A

Rhinovirus (over 100 serotypes)

…and there are over 200 viruses that can cause the common cold

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3
Q

A key finding of the common cold is ____.

A

Rhinorrhea

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4
Q

T/F: If a runny nose turns color (i.e. from clear to green) it means that the cause is bacterial

A

FALSE! The common cold is caused by a virus. The color of mucous drainage has no indication of bacteria.

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5
Q

Symptoms of a viral URI include:

A

Malaise, sneezing, watery nasal drainage, mild sore throat, possible fever.

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6
Q

Management of a viral URI includes:

A

NO ANTIBIOTICS! saline nose drops, bulb syringe, humidifier

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7
Q

Symptoms of an Acute Bacterial Rhinosinusitis include:

A

Acute presentation with high fever. purulent rhinitis

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8
Q

Management of Acute Bacterial Rhinosinusitis includes:

A

Amox 45-90mg/kg/day BID
or Amox-clavulanic acid (Augmentin) 45mg/kg/day BID
or 2nd generation cephalosprin

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9
Q

Decongestants, antihistamines and cough medicines are not indicated for children under ___ years old

A

There is no evidence to support the use of these medications for children under 4 years old in the treatment of URI.

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10
Q

What are the 4 paranasal sinus cavities that can become inflamed/infected as a consequence of an URI?

A

Maxillary: Most commonly infected
Ethmoid: 3-5 air filled cells, with paper-thin bone to orbit.
Frontal: only develop after age 10. IMPORTANT…infection can rarely spread to the intracranium!
Sephnoid: Anterior to pituitary fossa.

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11
Q

4 common types of Bacteria which commonly cause sinusitis

A
  1. Streptococcus pneumoniae (most common)
  2. Hemophilus influenza
  3. Moraxella Catarrhalis
  4. GABHS
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12
Q

When to Rx antibiotics to a child with a URI/Sinusitis

A

toxic appearing/severe onset/worsening symptoms
URI with persistent nasal d/c or cough >10 days
URI with a worsening fever, cough or nasal d/c
Fever >102.2 with purulent nasal d/c x 3 days.

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13
Q

Which virus is most responsible for mononucleosis?

A

Epstein-Barr virus

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14
Q

One of the key findings of VIRAL pharyngitis is:

A

Gradual onset

Also mild cough, sore throat and low grade fever.

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15
Q

What are the virus-specific physical exam findings in viral pharyngitis: Epstein-Barr

A

Tonsillar exudate, soft palate patechiae, diffuse and impressive adenopathy.

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16
Q

What are the virus-specific physical exam findings in viral pharyngitis: Adenovirus

A

Tonsillar exudate, cervical adenopathy

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17
Q

What are the virus-specific physical exam findings in viral pharyngitis: Enterovirus

A

Vesicles or ulcerations on tonsillar pillars, coryza, vomiting, possible diarrhea

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18
Q

What are the virus-specific physical exam findings in viral pharyngitis: Herpes virus

A

Ulcers on the anterior oropharynx, marked adenopathy.

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19
Q

Gianotti-Crosti Syndrome

A

A benign condition which presents as a skin-colored-to-pink vessicular eruptions on the extremities and head, but spares the torso. Caused by the Epstein-Barr virus. Can last 2-6 weeks. Symptomatic care only. These kids will rarely appear sick.

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20
Q

Roseola Infantum

A

Benign herpetic condition common among 6-24 months. 3-5 days of Fever of >101. Rash appears upon defervesence. Starts centrally with a discrete, non-puretic, macular-papular rash

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21
Q

Ertythma Infectiosum

aka: 5th disease, slapped-cheek syndrome

A

When the rash appears on the cheek, the infectous period is already over. Lacy, faint rash starts centrally, and moves distally. Can last for one month.

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22
Q

Herpangina

A

sudden onset of fever, last 1-4 days. s/s are very similar to strep pharyngitis, BUT… herpangina has tiny vesicles which progress into 1-5mm ulcers on tonsils, uvula, palate, etc.

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23
Q

Remember this rule: If the oral cavity has signs which include vesicles or ulcerations…it must be ____.

A

Viral !!

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24
Q

Hand-Foot-Mouth Disease

A

Caused by the cocsackie virus. Benign. LARGE ulcerations (1-10mm) to the mouth. If the ulcerations are also on the hands and/or feet, then its Hand/foot/mouth.

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25
Q

Epstein-Barr virus (viral Pharyngitis)

A

Most common in adolescents. It is a host response to the antigenic changes in the B-Lymphocytes. This causes a strong T-Lymphocyte response.

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26
Q

What is the incubation period for the Epstein-Barr virus

(aka infectious mononucleosis)?

A

25-50 days

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27
Q

What are the typical points found in the history which may indicate Epstein-Barr virus (infectious mono)?

A

Fever (sometimes severe), severe fatigue & malaise.
“worst sore throat ever,” white/gray tonsillar exudate.
Mostly non-tender, Lymphadenitis, but…POSTERIOR CERVICAL ADENOPATHY
Speenomegaly (organomegaly) RUQ tenderness

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28
Q

One of the most useful lab results to confirm infectious mono (Epstein-Barr Virus) is:

A

CBC with diff.
Look for >10% atypical lymphocytes.
(Also a monospot test…95% specific)

29
Q

Management of a patient with Infectious mononucleosis should include:

A

School note

Avoid strenous exercise and NO CONTACT SPORTS for 3-4 weeks due to splenic rupture.

30
Q

The most frequent bacterial cause of pharyngitis is:

A

GABHS
“Group A Beta hemolytic streptococcus”
Antibiotics are ALWAYS indicated!!

31
Q

Bacterial pharyngitis is associated with: (5)

A
  1. Peritonsillar abscess
  2. Retro-pharyngeal abscess
  3. Cervical Lymphadenitis
  4. Rheumatic Fever
  5. Glomerulnephritis
32
Q

Only ___% of patients with sore throat have strep throat

A

20%

33
Q

Scarlintena rash looks like

A

fine sandpaper

34
Q

GABHS antimicrobial management:

A

Benzathine PCN-G IM 600,000 u (if <60lbs.), 1.2m u (if > 60lbs.) or
Pen V-K PO 250mg BID (<27kgs) 500 mgs BID (>27 kgs) x ten days.
if PCN allergy:
Erythro 20-40 mgs/kg BID-QID x 10 days

35
Q

In order to recommend a child for tonsillectomy 1 of 3 criteria must be met:

A
  1. 7 or more episodes of throat infection in past year.
  2. More than 5 episodes in the past 2 years
  3. At least 3 episodes per year x 3 years.
    * (Throat infections must be correctly diagnosed to be considered)
36
Q

Tonsillectomy decreases throat infections for ___ years

A

two years

-also decreases the recurrence of peritonsillar abscesses and helps with sleep apnea.

37
Q

Croup is be caused by a virus or bacteria

A 
Most of the time Viral (Parainfluenza type 1,2,or 3, adenovirus, rubeola)
Sometimes bacterial (M. pneumoniae, H. flu, GABHS, pneumococcus, staph)
38
Q

The classic symptoms of croup is

A

Gradual onset over 1-2 days. symptoms worse at night, barky “seal-like” cough.

39
Q

What is a “steeple sign?”

A

Subglotic narrowing seen on soft tissue XR of neck

40
Q

DDx for croup? (7)

A

Acute epiglottitis, Acute spasmodic croup, foreign body aspiration, retropharyngeal abscess, compression by tumors, trauma or congenital malformation, early asthma

41
Q

Antibiotics used to cover Staph aureus and H. Influenza include:

A

Amoxicillin
Amoxicillin+Clavulanic acid (Augmentin)
-OR- if PCN allergy-
Macrolide (Azithromycin or Clarithromycin)

42
Q

Is Dexamethasone indicated for croup?

A

Yes ! (0.6mg/kg x 1 IM or PO)

43
Q

Management of epiglottitis includes:

A

Pediatric emergency. (call 911) Do not examine pharynx, possible need for intubation. IV Ceftriaxone

44
Q

Bacterial Tracheitis

A

Usually follows a viral respiratory infection
Caused by: S. Aurerus/H. Flu/M. Caterrhalis.
Lots of purulent sputum.
Kiddo looks sick and will usually require hospitalization and possible intubation

45
Q

Bronchitis

A

Dry, hacking cough which starts 3-4 days after runny nose. clear to course breath sounds. If “productive” cough, its probably coming from nasopharynx and not the lungs.

46
Q

Bronchitis managment

A

Supportive care. (remember to inquire about smoking and marijuana use in teens.)

47
Q

Bronchiolitis

A

Caused by RSV in 50% of cases. Usually occurs in children under two years old. Typically starts as a URI. High respiratory rate (60-80/min)

48
Q

Bronchiolitis management

A

adequate hydration, anti-pyretics, small frequent feedings, educate parents about increasing distress. pulse oximetry.

49
Q

The best diagnostic test to determine foreign body aspiration is

A

Clinical Suspicion

“History history history” :)

50
Q

Define Pneumonia:

A

A disease marked by the inflammation of the parenchyma of the lungs. Could be caused by: viral, bacterial, mycoplasmic, chlamydial or aspiration

51
Q

What two items will determine the management of antibiotic treatment for bacterial pneumonia?

A

antibiotic treatment is dependent upon the AGE and SUSPECTED ORGANISM

52
Q

Mycoplasmal pneumonia is the most common form of pneumonia in children over ____.

A

Mycoplasmal pneumonia is the most common form of pneumonia in children over 5 years of age. It is transmitted via droplets and has an incubation period of 2-3 weeks

53
Q

Mycoplasmal pneumonia management:

A

if under 9 years: Erythromycin 20-50mg/kg/day BID/QID x 14 days

54
Q

Chlamydial pneumonia

A

Appears between 2 & 19 weeks of age. transmitted from the infected vaginal canal during delivery. Presents as a repetitive, staccato cough with tachypnea.

55
Q

By history, viral pneumonia differs from bacterial pneumonia how?

A

Viral pneumonia has a slower progression of symptoms than bacterial

56
Q

The biggest complication of viral pneumonia is ___?

A

Bacterial pneumonia

57
Q

The most common cause of pleural effusion is ___?

A

Bacterial pneumonia

58
Q

Pleurisy is divided into several types

A

Dry / Plastic
Serofibrinous / serosanguinous
Purulent / empyema (fluid sac)

59
Q

What is Dry or Plastic pleurisy associated with?

A

Acute bacterial pulmonary infections or URI, mafan’s syndrome

60
Q

What is serofibrinous/serosanguinous pleurisy associated with?

A

A complication of dry pleurisy and associated with lung, mediastinal or abdominal inflammatory conditions

61
Q

What is purulent pleurisy (empyema) associated with?

A

Accumulation of pus, needs to be drained with thoracentesis and systemic Abx.
(under/improperly treated empyema can lead to “extensive fibrinous changes”

62
Q

How is pleurisy treated?

A

Treat the underlying cause.
Systemic Abx if bacterial
thoracentesis if purulent/empyema

63
Q

How would you describe TB to a microbiologist?

A

Mycobacterium tuberculosis is a “Aerobic, non-motile, non-sporulating with pleomorphic rods”
TB is droplet spread and takes 21 days to culture due to its slow growth.
2-10 weeks incubation period

64
Q

The majority of TB cases are____.

A

Latent

65
Q

The main treatment method for TB is ____.

A

Isoniazid.

Although resistance worldwide is increasing.

66
Q

High risk children should be tested for TB annually. A positive TB test is indicated by?

A

Induration >15mm if older than 4 years old without risk factors
Induration >10mm if younger than 4 years old or with risk factors
Induration > 5mm in any child in a TB household or previous active TB

67
Q

Allergic Rhinitis (aka: A/R, hay fever)

A

“Cobblestone” appearance of pharynx/conjuctiva
Nasal smears are the “Gold standard” of diagnostic testing.
Skin tests for specific IgE antibodies

68
Q

Allergic Rhinitis drug therapies include:

A

Loratadine, Cetirizine, Fexofenadine.
Leukotriene receptor antagonist (Singulair)
Decongestants, nasal antihistamines or intranasal steroids.
Use non-sedating antihistamines first

Pediatric NRP 613 (4 decks)

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