week 10 Flashcards
pharengitis
inflammation of the throat mucousa
GABHS
most comomon cause of acute threp throat that is bacteria (35%) ages 5-11 years
viral vs bacteria pharengitis symtptoms
same except viral includes : diarrea, rhinitis, stridor, rash, cough etc.
look of bacterial vs viral pharyngitis
bacterial gahs: swollen uvula, swollen tonsils, petichia, gray furry tongue
viral: red twollen tonsils, throat redness,
CENTOR criteria to determine what?
GAHS only for ADULTS, but there is a modified version for kids
looking at
-fever
- swollen lymphs,
-tonsillar exudate,
-absence of cough
RADT criteria
not under 3
need culture confirmation
negative should be cultured
ASO titer
rises one week after infection, peaks 3-5 weeks
- for determining phumatic fever and acute glomularnephritis
-detects GAHS in the system from a previous infection
treatment for strep throat
Amoxacillin or penicillin
Amox: more easily taken by the kids, 50mg/kg/day
Penicillin: low cost, 250mg 2-3 times per day for 10 days
alternative therpies for pen. allergy
- cephalexin (NOT for kids with immediate-type hypersensitivity to penicillin)
- clindamycin
-azithromycin
-clarithromycin
school rule for antibiotics
at least 12-24 hours of abx and no fever
retropharengeal absess and peritonsillar absess
retropharengeal absess: <6 years of age
pertonsilar absess: peaks ar age 13.5 years
suppurative complications og GAHS VS nonsuppurative complication
suppurative: cervical adenitis, mastoiditis, AOM, rhinosinusitis, absesses
nonsuppurative: rheumatic fever, post-streptococcal reactive arthritis
actute glomularnephritis
T and A removal indication
infection:
-7 infections in last year,
-5 in the last 2 years,
-or three or more per year in the past 3 years
-Infections have to meet GAHS test, have fever and lymph involvment
noninfection:
-recurrent tonsilitis
-sleep apnea
-peritoneal abscess
-periodic fever with aphthous -ulcers
-adenopathy
Adenoid removal:
- severe nasal obstruction for > 1 year
- hyponasal speech
- chronic mouth breathing
Croup is also known as
laryngotracheobronchitis
croup symtoms
- barky cough
-inspirtorytridor
-resp distress
cause of croup
human para influenze virus
peak age croup
5 mo-5 years
tx for croup
typically self limiting but sometimes require supportive tx
physical exam croup findings
- irritability
- audible inspiratory stridor
- brassy barky cough
- restrictions
- prolonged inspiration
xray findings croup
- steeple sign (subglottal narrowing)
diff diagnosis for croup
- acute epiglotits
- bacterial tracheitis
- forign body aspiration
- abscesses
- extrinsic compression
- angioedema
- infectious monoculcosis
- psychogenic stridor
how to rule out absess? when trying to detemine croup or absess?
CT scan
mild, moderate and severe croup
mild: no retractions, no stridor at rest
moderate, retractions and stridor at rest
severe: respirtory distress
TX croup
single dose .15 mg/kg oral dexamethasone
OTHERS
nebulized budesonide
IM dexamethasone
oral prednisolone
epiglottis
MEDICAL EMERGENCY
rapid inflammation of the epiglottis
epiglottitis HX
increasing resp distress, toxic looking, horse muffled voice, abrupt fever, drooling, insp and expiratory stridor, sniffing posture
tx abx for epiglottis
- bs ABX
ampicillin
cefotaxime
ceftriaxone
clindamycin
10 days post extubation
household contacts abx for epiglotitis
refampin 20mg/kg 4 days
if there are young children or unimmunized children in house
chronic rhinosinusitis
12 weeks or longer of sx
uri vs acute sinusitis
uri: 3-6 days (improve by 7-10 days)
Sinusitis: >10 days of symptoms
abx choice for acute sinusitis
mild-moderate >2 years: amox
mod-severe <2 years: amox/clavulanate
acute sinusitis with eye involvment
hospitalization and IV abx
pots puffy tumor
frontal sinus swelling- ent consult, surgical consult and infectious disease
bronchiolitis
most common LOWER resp illness. 80% are due to RSV.
inital sx of RSV
cough, conjestion, rhinitis
progression of RSV
worse cough, apnea, resp distress, copious mucous, poor feeding
duration RSV
2-3 weeks
peak 3-5 days of illlness
RSV vs bac pnumonia
symmetric vs asymmetric breathe sounds
rsv immunization for infant
1 st week of life oct-march
rsv immunization for infant
32-36 weeks
bacterial indicators pnumonia
abrupt high fever temp >103, chest pain, lethargy and dyspnea
