Respiratory Disorders Flashcards
The common cold (AKA: URI) will occur how many times per year for the average young child?
Young children will have 6-10 URIs per year.
what is the most common cause of the common cold?
Rhinovirus (over 100 serotypes)
…and there are over 200 viruses that can cause the common cold
A key finding of the common cold is ____.
Rhinorrhea
T/F: If a runny nose turns color (i.e. from clear to green) it means that the cause is bacterial
FALSE! The common cold is caused by a virus. The color of mucous drainage has no indication of bacteria.
Symptoms of a viral URI include:
Malaise, sneezing, watery nasal drainage, mild sore throat, possible fever.
Management of a viral URI includes:
NO ANTIBIOTICS! saline nose drops, bulb syringe, humidifier
Symptoms of an Acute Bacterial Rhinosinusitis include:
Acute presentation with high fever. purulent rhinitis
Management of Acute Bacterial Rhinosinusitis includes:
Amox 45-90mg/kg/day BID
or Amox-clavulanic acid (Augmentin) 45mg/kg/day BID
or 2nd generation cephalosprin
Decongestants, antihistamines and cough medicines are not indicated for children under ___ years old
There is no evidence to support the use of these medications for children under 4 years old in the treatment of URI.
What are the 4 paranasal sinus cavities that can become inflamed/infected as a consequence of an URI?
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.
4 common types of Bacteria which commonly cause sinusitis
- Streptococcus pneumoniae (most common)
- Hemophilus influenza
- Moraxella Catarrhalis
- GABHS
When to Rx antibiotics to a child with a URI/Sinusitis
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.
Which virus is most responsible for mononucleosis?
Epstein-Barr virus
One of the key findings of VIRAL pharyngitis is:
Gradual onset
Also mild cough, sore throat and low grade fever.
What are the virus-specific physical exam findings in viral pharyngitis: Epstein-Barr
Tonsillar exudate, soft palate patechiae, diffuse and impressive adenopathy.
What are the virus-specific physical exam findings in viral pharyngitis: Adenovirus
Tonsillar exudate, cervical adenopathy
What are the virus-specific physical exam findings in viral pharyngitis: Enterovirus
Vesicles or ulcerations on tonsillar pillars, coryza, vomiting, possible diarrhea
What are the virus-specific physical exam findings in viral pharyngitis: Herpes virus
Ulcers on the anterior oropharynx, marked adenopathy.
Gianotti-Crosti Syndrome
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.
Roseola Infantum
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
Ertythma Infectiosum
aka: 5th disease, slapped-cheek syndrome
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.
Herpangina
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.
Remember this rule: If the oral cavity has signs which include vesicles or ulcerations…it must be ____.
Viral !!
Hand-Foot-Mouth Disease
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.
Epstein-Barr virus (viral Pharyngitis)
Most common in adolescents. It is a host response to the antigenic changes in the B-Lymphocytes. This causes a strong T-Lymphocyte response.
What is the incubation period for the Epstein-Barr virus
(aka infectious mononucleosis)?
25-50 days
What are the typical points found in the history which may indicate Epstein-Barr virus (infectious mono)?
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
One of the most useful lab results to confirm infectious mono (Epstein-Barr Virus) is:
CBC with diff.
Look for >10% atypical lymphocytes.
(Also a monospot test…95% specific)
Management of a patient with Infectious mononucleosis should include:
School note
Avoid strenous exercise and NO CONTACT SPORTS for 3-4 weeks due to splenic rupture.
The most frequent bacterial cause of pharyngitis is:
GABHS
“Group A Beta hemolytic streptococcus”
Antibiotics are ALWAYS indicated!!
Bacterial pharyngitis is associated with: (5)
- Peritonsillar abscess
- Retro-pharyngeal abscess
- Cervical Lymphadenitis
- Rheumatic Fever
- Glomerulnephritis
Only ___% of patients with sore throat have strep throat
20%
Scarlintena rash looks like
fine sandpaper
GABHS antimicrobial management:
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
In order to recommend a child for tonsillectomy 1 of 3 criteria must be met:
- 7 or more episodes of throat infection in past year.
- More than 5 episodes in the past 2 years
- At least 3 episodes per year x 3 years.
* (Throat infections must be correctly diagnosed to be considered)
Tonsillectomy decreases throat infections for ___ years
two years
-also decreases the recurrence of peritonsillar abscesses and helps with sleep apnea.
Croup is be caused by a virus or bacteria
Most of the time Viral (Parainfluenza type 1,2,or 3, adenovirus, rubeola) Sometimes bacterial (M. pneumoniae, H. flu, GABHS, pneumococcus, staph)
The classic symptoms of croup is
Gradual onset over 1-2 days. symptoms worse at night, barky “seal-like” cough.
What is a “steeple sign?”
Subglotic narrowing seen on soft tissue XR of neck
DDx for croup? (7)
Acute epiglottitis, Acute spasmodic croup, foreign body aspiration, retropharyngeal abscess, compression by tumors, trauma or congenital malformation, early asthma
Antibiotics used to cover Staph aureus and H. Influenza include:
Amoxicillin
Amoxicillin+Clavulanic acid (Augmentin)
-OR- if PCN allergy-
Macrolide (Azithromycin or Clarithromycin)
Is Dexamethasone indicated for croup?
Yes ! (0.6mg/kg x 1 IM or PO)
Management of epiglottitis includes:
Pediatric emergency. (call 911) Do not examine pharynx, possible need for intubation. IV Ceftriaxone
Bacterial Tracheitis
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
Bronchitis
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.
Bronchitis managment
Supportive care. (remember to inquire about smoking and marijuana use in teens.)
Bronchiolitis
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)
Bronchiolitis management
adequate hydration, anti-pyretics, small frequent feedings, educate parents about increasing distress. pulse oximetry.
The best diagnostic test to determine foreign body aspiration is
Clinical Suspicion
“History history history” :)
Define Pneumonia:
A disease marked by the inflammation of the parenchyma of the lungs. Could be caused by: viral, bacterial, mycoplasmic, chlamydial or aspiration
What two items will determine the management of antibiotic treatment for bacterial pneumonia?
antibiotic treatment is dependent upon the AGE and SUSPECTED ORGANISM
Mycoplasmal pneumonia is the most common form of pneumonia in children over ____.
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
Mycoplasmal pneumonia management:
if under 9 years: Erythromycin 20-50mg/kg/day BID/QID x 14 days
Chlamydial pneumonia
Appears between 2 & 19 weeks of age. transmitted from the infected vaginal canal during delivery. Presents as a repetitive, staccato cough with tachypnea.
By history, viral pneumonia differs from bacterial pneumonia how?
Viral pneumonia has a slower progression of symptoms than bacterial
The biggest complication of viral pneumonia is ___?
Bacterial pneumonia
The most common cause of pleural effusion is ___?
Bacterial pneumonia
Pleurisy is divided into several types
Dry / Plastic
Serofibrinous / serosanguinous
Purulent / empyema (fluid sac)
What is Dry or Plastic pleurisy associated with?
Acute bacterial pulmonary infections or URI, mafan’s syndrome
What is serofibrinous/serosanguinous pleurisy associated with?
A complication of dry pleurisy and associated with lung, mediastinal or abdominal inflammatory conditions
What is purulent pleurisy (empyema) associated with?
Accumulation of pus, needs to be drained with thoracentesis and systemic Abx.
(under/improperly treated empyema can lead to “extensive fibrinous changes”
How is pleurisy treated?
Treat the underlying cause.
Systemic Abx if bacterial
thoracentesis if purulent/empyema
How would you describe TB to a microbiologist?
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
The majority of TB cases are____.
Latent
The main treatment method for TB is ____.
Isoniazid.
Although resistance worldwide is increasing.
High risk children should be tested for TB annually. A positive TB test is indicated by?
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
Allergic Rhinitis (aka: A/R, hay fever)
“Cobblestone” appearance of pharynx/conjuctiva
Nasal smears are the “Gold standard” of diagnostic testing.
Skin tests for specific IgE antibodies
Allergic Rhinitis drug therapies include:
Loratadine, Cetirizine, Fexofenadine.
Leukotriene receptor antagonist (Singulair)
Decongestants, nasal antihistamines or intranasal steroids.
Use non-sedating antihistamines first
