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PEDS > TBL #1 > Flashcards

TBL #1 Flashcards

1
Q

what is the clinical presentation of bronchiolitis

A

rhinitis, cough, tachypnea, use of accessory respiratory muscles, hypoxia and variable wheezing/crackles on auscultation, nasal flaring, grunting, retractions

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2
Q

Diagnosis of bronchiolitis

A

AAP recommendations: should be clinical diagnosis without routine lab/radiographic findings, clinicians should assess for risk factors (LVLB)

  • common CXR findings hyperinflation, areas of atelectasis, infiltrates that do not correlate with severity of disease and do not guide management
  • viral studies not recommended
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3
Q

management of bronchiolitis

A

bronchodilators should not be used routinely (LVLB) monitored trial of alpha-adrenergic (epi) or beta adrenergic (albuterol) is an option with continuation only if response documented (LVL B) corticosteroids should not be used routinely (LVLB) Ribavarin should not be used routinely (LVLB) abx only if SBI (LVLB)

  • chest physiotherapy should not be used (LVLB)
  • Supplemental O2 if SPO2 <90
  • antivirals not recommended for treatment
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4
Q

what is the role of laboratory testing in the diagnosis of bronchiolitis

A

viral isolation, blood serology, chest radiograph have little impact on diagnosis

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5
Q

what are the efficacies of current therapeutic interventions of treating bronchiolitis

A

most clinical interventions have no significant impact on length of hospital stay, or subsequent outcomes like recurrent wheezing

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6
Q

what is the prognosis of recurrent wheezing with bronchiolitis

A

maybe they have an underlying predisposition to the original RSV infection an dsubsequent recurrent episodes of wheezing

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7
Q

what is the risk of recurrent wheezing with bronchiolitis

A

40% of infants with bronchiolitis have subsequent wheezing though age 5, 10% after age 5

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8
Q

what is the most common lower respiratory tract infection in infants and children aged 2 and younger

A

bronchiolitis

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9
Q

what is bronchiolitis most commonly caused by

A

RSV

others: adenovirus, HMPV, influenza, parainfluenza

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10
Q

pathophys of bronchiolitis

A

acute infection of the epithelial cells lining the small airway of the lungs resulting in edema increased mucus production necrosis and regeneration of these cells

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11
Q

recommendation regarding palivizumab

A

recommended for infants with a hx of prematurity, chronic lung disease or congenital heart disease
-is antiviral against RSV
LVL A rec
-in 5 monthly doses beginning in Nov or Dec 15mg/kg IM

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12
Q

what is the most important step in preventing nosocomial spread of RSV?

A

hand decontamination-alcohol rubs preferred

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13
Q

what is recommended to decrease a childs risk of lower resp infection?

A

breastfeeding

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14
Q

what is the most common risk factor for hospitalization?

A

age-most under 1

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15
Q

RSV associated deaths more common in children with no pre-existing medical conditions true or false

A

true

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16
Q

what is the earliest and most sensitive vital sign change in bronchiolitis?

A

elevated RR

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17
Q

what are the most clinically significant parameters in assessing severity of illness?

A

RR, work of breathing and hypoxia

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18
Q

when do bronchiolitis symptoms peak?

A

illness days 3-4

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19
Q

what should be the basis for isolation procedures?

A

clinical signs

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20
Q

what is the most commonly diagnosed SBI with bronchiolitis?

A

urinary tract infection

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21
Q

what is the recommended management for bronchiolitis?

A

supportive care with oxygenation and hydration status monitoring
-give isotonic fluids NOT hypotonic-increases risk for hyponatremia bc bronchilitis causes release of ADH

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22
Q

when should oxygen be discontinued?

A

when pulse ox saturations rise between 90-92% for most of the time and the pt is demonstrating overall clinical improvement

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23
Q

strategies for minimizing unwanted consequences of prolonged monitoring in the hospital

A

1: scheduled spot checks with measurement of vitals and unscheduled checks when clinically indicated
2: scheduled spot checks after a fixed period of monitoring

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24
Q

should corticosteroids be used in the treatment of bronchiolitis?

A

no-no proven significant decreased length of stay or decreased severity of disease

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25
Q

when is ribavirin considered for treatment for bronchiolitis?

A

pts with pre-exisiting medical conditions like organ transplantation, malignancy or congenital immunodeficiencies or patients who remain critically ill despite maximal support

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26
Q

what treatment is recommended for influenza caused bronchiolitis?

A

oseltamivir for kids older than 1 year

and zanamivir for kids older than 5 years-neuraminidase inhibitors

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27
Q

what concurrent bacterial infection is diagnosed most commonly with bronchiolitis?

A

acute otitis media-treat for sure if less than 6 months with amoxicillin, if older only if certain about diagnosis

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28
Q

what can excessive suctioning lead to ?

A

nasal edema and additional obstruction

  • most beneficial before feeding an din response to copious secretions
  • no evidence for deep suctioning of the lower pharynx
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29
Q

are nasal decongestant drops supported? cough suppressants?

A

no

30
Q

what is palivizumab?

A

a monoclonal antibody against RSV

31
Q

when is palivizumab indicated?

A

in infants who have chronic lung disease, and infants born with hemodynamically significant congenital heart disease
-if born at 28 weeks or less should get it whenever theres a bronchiolitis outbreak in the community
-if born at 29 weeks through 32 weeks should get it during the first 6 postnatal months
should receive for the remainder of the bronchiolitis season
-pts born at 32-35 weeks should get it if younger than 6 months by the start of bronchiolitis season and either 2of these -at child care, school age sibs, exposure to envt air pollutants, congenital airway anomalies, severe neuromuscular disease
-pts 2 and younger with chronic lung disease, diuretic use, bronchodilator or corticosteroid therapy within 6 months before bronchiolitis season

32
Q

what is the primary benefit of bronchiolitis prophylaxis?

A

decrease in RSV associated hospitalization

33
Q

is pavilizumab effective at treating RSV?

A

no

34
Q

besides hand hygeine what are other ways to prevent bronchiolitis?

A

avoidance of tobacco, encouraging breast feeding

35
Q

unresolved bacteriuria

A

inadequate microbial therapy consider noncompliance, inadequate absorption, resistant uropathogens

36
Q

bacterial persistence

A

occurs after sterilization of the urine has been documented

-same pathogen documented again

37
Q

reinfection

A

different pathogens documented on urine cultures with each new UTI

38
Q

uti occurence in kids

A

2.4-2.8% of children each year

39
Q

uncircumsized boys in first year of life

A

have 10-12 fold increased risk for UTI, males have higher risk than females in first year of life for UTI

40
Q

what is the most frequent UTI pathogen documented

A

E coli

41
Q

what pathogen is more common in neonates than in older populations?

A

GBS

42
Q

what pathogen can be documented in pts with UTI and catheter?

A

Candida

43
Q

what are common types of nosocomiual UTIs

A

E coli, candidia, enterococcus, enterobacter, pseudomonas

44
Q

what is the main defense mechanism against UTI?

A

constant anterograde flow or urine from the kidneys to the bladder with emptying via the urethra

45
Q

what properties of the urine are protective against UTI?

A

low pH, polymorphonuclear cells, tammHorsfallglycoprotein (inhibits bacterial adherence to the bladder mucosal wall)

46
Q

when does UTI occur

A

when introduction of pathogens adhere to the mucosa of the urinary tract

47
Q

how does E coli cause UTI

A

adhesins bind specific receptors of the uroepithelium-fimbriae and mucosal receptors trigger internalization of the bacteria in the cell–> apoptosis, hyperinfection and invasion

48
Q

what toxins have been identified in uropathogenic E coli?

A

cytolethal distending toxin, alpha hemolysin, cytotoxic necrotizing factor, secreted autotransporter toxin

49
Q

what are the risk factors for pediatric UTI?

A

-prematurity: incomplete immune system (breastfeeding helps iwth IgA)
foreskin: harbor higher concentrations of pathogenic microbes
gender
fecal and perianal colonization: most UTI fecal to perianal flow
urinary tract anomalies: generally seen in children younger than 5, may serve as reservoir for bacterial persistence or may decrease washout , higher incidence of multidrug resistant organisms like pseudomonas and enterococcus
functional anomalies: ie neurogenic bladder-clean cath occasionally
immunocompormised states
sexual activity: risk factor in women not men esp with diaphragm and spermicide use

50
Q

clinical presentation of UTI

A

vague and non specific, CVA and suprapubic tenderness not helpful
may see
(in kids 60-90 days)
FTT< diarrhea, irritability, letharfy, malodorous odor, fever, asymptomatic jaundice, oliguria, polyuria,
in kids younger than 2 most common fever, vomiting, anorexia, and FTT
after 5 classic UTI symptoms dysuria, urgency, urinary frequency and CVA tenderness more common

51
Q

signs associated with neurogenic bladder:

A

dimples, pits or sacral fat pad

52
Q

all boys with suspected UTI should be evaluated for

A

epididymitis or epididymo-orchitis

53
Q

definitive diagnosis of UTI

A

requires isolation of at least one uropathogen from a urine culture-should be obtained before the initiation of antimicrobial therapy

54
Q

how is urine most commonly collected in kids for uti dx

A

urtehral catheterization -reliable but unfortunately is invasice
-suprapubic aspiration is the gold standar for accurately identifying bacteria within the baldder

55
Q

what does the AAP recommend in collecting urine from kids?

A

suprapubic aspiration (most reliable) or urethral catheterization (easier to accomplish)

56
Q

diagnosis of UTI

A

quantitative culture of urine obtained (from suprapubic asp or cath) and demonstrated 105 CFU colony forming units of a single uropathogen

57
Q

evidence of UTI (chemical markers)

A

leukocyte esterase (produced by WBCs) and nitrites (reduced from nitrates by gram - bacteria)

58
Q

when should a renal us be considered

A

if symptoms persist after 2 days of antimicrobial therapy can use reanl US or CT to rule out disease that would require invasive testing like renal abscesss, pyonephrosis, urinary calculi or surgically correctable anatomic abnormalities

59
Q

should infants and young children be evaluated after proper response to antimicrobial therapy?

A

yes to rule out urinary tract anomalies

60
Q

what increases a childs risk for renal scarring

A

high grade vesicouretral reflux

61
Q

uncomplicated nontoxic child with UTI treatment

A

amoxicillin, trimethoprimsulfamethoxazole, nitrofurantoin and cephalosporins
-children younger than 2=short course
-

62
Q

treatment for immunocompromised pt, younger than 2, or a complicated UTI

A

hospital admission, rehydration, parenteral brough specturm antmicrobial therapy

  • amp and gent or ceph
  • usually 48-72 hrs and then changed to PO to complete 7-14 day course
63
Q

what is the criterion for therapy for fungal UTI

A

10^4 colonies on suprapubic aspiration or catheterization

64
Q

when should prophylaxis for UTI be considered

A

-in neonates or infants once they complete their therapy course until they have proper imaging done and urinary tract evaluation
-history of VUR
-immunosuppression
-partial urinary obstruction
-recurrent UTI with normal anatomy
-

65
Q

what is recommended for asymptomatic bacteriuria?

A

follow up with pts periodically without concurrent antimicrobial therapy bc asymptomatic bacteriuria is not associated with renal damage and the incidence of actual symptoms is low

66
Q

how often is renal scarring seen?

A

20-30% after UTI

67
Q

what are the three likely mechanisms for PCV7 asociated decrease in disease

A

individual risk decline, decline in antibiotic resistant bacteria, and herd immunity

68
Q

can a response to antipyretics give you a clue as to whether the illness is bacterial or viral?

A

no

69
Q

neonate

A

0-28 days

70
Q

young infant

A

1-3 months

71
Q

older infant/toddler

A

3-36 months

PEDS (3 decks)

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