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Respiratory/Musculoskeletal > CM- Pediatric Respiratory Disorders > Flashcards

CM- Pediatric Respiratory Disorders Flashcards

1
Q

What 3 main factors determine the phenotype/presentation of URT and LRT infections in children?

A
  1. site of maximal inflammation (type of pathogen)
  2. age of child
  3. presence of co-morbidities (asthma, etc)
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2
Q

What is the inciting factor most commonly associated children with:

  1. croup
  2. brochiolitis
  3. exacerbations of asthma
A
  1. parainfluenza
  2. RSV
  3. rhinovirus
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3
Q

What is the peak incidence of age for laryngotracheobronchitis?
When does it usually occur seasonally?
What is the usual causative factor?

A

7 to 36 months (affects mainly toddlers)

It occurs in the fall and is due to parainfluenza virus 1.

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4
Q

A 2 year old presents with hoarseness, seal-like cough and stridor. You inspect their upper airway and notice erythema and swelling of the lateral walls of the trachea just below the vocal cords. The child does not appear toxic and has a low grade fever. You do a CXR and notice suglittic narrowing (steeple sign). What is the likely disease and causative organism?

A

Viral croup- parainfluenza

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5
Q

How does onset/prodrome differ for bacterial tracheitis and viral croup?

A

Viral- mimics a cold with nasal irritation, cough, coryza and fever within the first 24 hours. URI symptoms develop in 48 hours

Bacterial - URI followed by progression to high fever cough, respiratory distress and stridor

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6
Q

How do symptoms and presentation differ between viral croup and bacterial tracheitis?
Who LOOKS sicker?
Who has a higher fever?

A

Viral - hoarseness, barking cough, stridor (best heard over neck with clear lung fields). NON-TOXIC looking, low grade fever

Bacterial - hoarseness, barking cough, stridor (best heard on ascultation with clear lung fields. TOXIC appearing, high grade fever

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7
Q

How do the radiographic findings of viral croup and bacteria tracheitis differ?

A

Viral croup- narrowing subglottis -= steeple sign

Bacterial - subglottis narrowing, soft tissue densities in trachea (seen on lateral view)

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8
Q

What are the causative agents of viral croup? Bacterial tracheitis?
List from most to least common.

A

V = parainfluenza, influenza, RSV, adenovirus, rhinovirus

B = S. aureus, GABHS, S. pneumonia

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9
Q

A child comes in with a high fever looking very ill. The mother says he had a URI last week and now he is getting a fever, cough and sounds like he is sucking in air when he breaths in. On physical exam, you note a seal like cough and stridor. What is the most likely disease and what is the causative organism?

A

Bacterial tracheitis- s. aureus

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10
Q

A toddler presents with stridor but has had no prior URI or fever. The mother says it started when the babysitter was there. What is the most likely cause of stridor?

A

Aspiration of foreign object

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11
Q

A toddler presents with stridor. He does NOT have a cough. He is in a tripod position with his chin pushed out and he is drooling. The mother claims he hasn’t had any immunizations because she doesn’t want him to get autism. What is the likely disease and likely cause?

A

epiglottitis caused by H. infleunza type B

vaccine has decreased incidence of this by a lot, but the child is un-immunized

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12
Q

A child presents with occassional barking cough, no audible stridor at rest and minimal retractions. What is the severity of the croup? What is treatment?

A

Mild croup- treat with supportive care at home with the warning to get medical help if it worsens to stridor at rest or respiratory distress.

Treatment: humidified air, potentially corticosteroids to reduce inflammation and cell damage

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13
Q

A child presents with frequent barking cough, audible stridor at rest, and chest retractions but no aggitation. What is the severity of the croup?
What is treatment?

A

Moderate croup
Treatment:
1. dexamethasone (steroid) with 4 hour observation to make sure there is no rebound
2. racemic epinephrine nebulizer

If a second epi nebulizer is required or there is persistent respiratory distress, admit.

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14
Q

A child presents with frequent barking cougn, audible stridor at rest, retractions and irritation. What is the severity of the croup and what is treatment?

A 
Severe
Treatment:
1. admit to hospital 
2. steroids, racemic epi nebulizer every 2 hours 
3. oxygen as needed (hypoxemic)

If no improvement is noted, consider helium/o2 mix or intubation

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15
Q

A child presents with frequent barking cough, stridor at rest, retractions, agitation, and they have a lethargic, dusky appearance. What stage of croup is this?

A

impending respiratory failure

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16
Q

What is the cause of whooping cough?
What are the features of the causative agent?
What age group is most affected?
Who has the highest rate of severe complications?

A

Bordatella pertussis-
fimbriated G- rods that have pertussis toxin as a virulence factor.
It has variable contagiousness (isolated cases, daycare outbreaks, epidemics) and affects ALL AGES.
Infants have the highest rate of serious complications, hospitalization and death.

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17
Q

What does the CDC recommend to protect infants from developing whooping cough from caretakers/housemembers?

A

Cocooning- give Tdap vaccine to everyone in close contact with the baby

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18
Q

What are the 3 stages of a pertussis infection?
What symptoms present in each stage?
Which stage is the contagious stage?

A
  1. Catarrhal phase (most contagious) : rhinitis, mild cough
  2. paroxysmal phase: coughing spells (to RV then whoop to get air back in or if you are a baby, cough to RV then go apneic)
  3. convalescent stage - waning symptoms “100 day cough”
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19
Q

What are the complications of pertussis in infants?

A
  1. apnea
  2. pneumonia

Rarely

  1. respiratory distress syndrome
  2. seizures
  3. encephalopathy
20
Q

How is the diagnosis of pertussis made?

What are the 3 tests? Which is the gold standard?

A

Clinically: child with cough lasting 7-14 days

  1. nasopharyngeal swab for Pertussis PCR
  2. culture (gold standard)
  3. serology if over 2 week old infection
21
Q

What is the main goal of treatment for pertussis?

A

At the time of presentation, the best you can do is stop the spread of pertussis, NOT help the present patient.

  • macrolides (clarithromycin, azithromycin)
  • chemoprophylaxis for household contacts
22
Q

What is bronciolitis?
What is the most common causative agent?
Who is most at risk?

A

It is inflammation of the bronchioles usually caused by RSV (less commonly adeno, metapneumo, influenza, parainfluenza).

Most common in children under 2 years old with risks being :

  1. <3 months
  2. premature
  3. unrepaired heart defects
  4. chronic lung disease
23
Q

What is the pathology broncholitis?

A
  1. Acute viral infection of the epithelial cells lining the small airways
  2. edema, mucus secretion, necrosis
  3. obstucted bronchioles
24
Q

A 2 year old comes in with rhinitis, cough, tachypnea, wheezing and crackles. They are grunting and have nasal flaring with retractions. The symptoms are the worst after 3 days. What is the most likely cause of the presentation? How is diagnosis made?

A

It seems like bronchiolitis due to the, tachypnea crackles AND wheezing.
Diagnosis is made with history and physical- CXR is NOT useful because it doesn’t correlate to degree of illness or direct therapy.

25
Q

What is management and treatment for bronchiolitis?

A

Supportive care:
1. nasal suctioning to help them breath (can be done at home)
2. hydration/fluid therapy (IV or NG tube if necessary)
O2 if necessary (SaO2 <92%)

NO bronchodilators, corticosteroids, ribaviran, or antibiotics

26
Q

When would be the only acceptable time to use antibiotics if there is RSV caused bronchiolitis?

A

If there is also otitis media as well (freq, associated with RSV bronchiolitis)

27
Q

What are the 5 major predisposing factors to pneumonia in children?

A
  1. colder months, dryer air
  2. preceding URI
  3. smoke exposure
  4. sickle cell, bronchopulm dysplasia, GERD, CF, CHD, immunodificiency
  5. aspiration risk (seizures, neuromuscular)
28
Q

What are the clinical manifestations of pneumonia in children?

A
  1. cough and fever (hallmark)
  2. tachypnea (most sensitive/specific sign of LRT infection)
  3. grunting (expiration against a closed glottis to increase PEEP
  4. chest pain (due to inflammation and pleural irritation)
  5. nasal flaring/ retraction
  6. cyanosis
  7. dullness to percussion, crackles, decreased breath sounds, bronchial breath sounds
29
Q

Why do children with pneumonia/ LRT infections become tachypnic?

A

They have a fever and are blowing off heat so get the fever down before you check their HR.

30
Q

Why do children with pneumonia grunt?

A

They are doing forced expiration against a closed glottis to increase PEEP.
It is associated with impending respiratory failure

31
Q

What RR would make the following people tachypnic?

  1. infant under 2 months
  2. infant between 2 mon and 1 year
  3. children 1-5
  4. children over 5
A
  1. > 60
  2. > 50
  3. > 40
  4. > 20
32
Q

What causes a wheeze? Which type of pneumonia is it more common with?

A

It is caused by turbulent flow through narrow bronchioles.
Viral or atypical infection
NOT associated with bacterial pneumonia

33
Q

A child under 6 presents with an abrupt onset high fever. She looks toxic and says that her chest hurts. What is the most likely cause of the pneumonia?

A

Bacterial/supperative

34
Q

A 2 month old presents with tachypnea, hypoxemia, wheezing and interstitial infiltrates. What was most likely present when they were 7-10 days old? What is the cause of the pneumonia?

A

7-10 days–> conjunctivitis

They have atypical pneumonia caused by chlamydia trachomatis

35
Q

A 14 year old comes in to the office for a gradual onset cough. They have a very low fever and do not seem very sick. You do a chest X-ray and note diffuse infiltrate. What is the likely cause of the pneumonia?

A

Mycoplasma causing walking pneumonia

36
Q

A four year old comes in with URI symptoms, low fever, wheezes. A CXR shows diffuse infiltrates. What is the likely cause of the pneumonia?

A

Viral (RSV, influenza, parainfluenza, etc)

37
Q

For bacterial pneumonia, how long will the lung appear abnormal on the CXR?

A

6 weeks

38
Q

What is the treatment for most cases of childhood pneumonia? What is the criteria for hospital admission?

A

Most is treated outpatient. Hospital if:

  1. less than 3 months old
  2. hypoxemia requiring 02
  3. dehydration, vomiting, toxic
  4. chronic condition
39
Q

What is the cause of CF?

A

AR disorder caused by mutation on chromosome 7 (usually delta F508 deletion of phenylalanine) mutating the CFTR chloride channel.

1/3500, mostly whites

40
Q

What are the 4 major places in the body affected by CFTR Cl channel mutation?

A
  1. respiratory
  2. GI - pancreatic ducts, biliary trees, intestines
  3. upper airway
  4. other systemic
41
Q

What are the three presentations CF is classically associated with?

A
  1. elevated sweat chloride
  2. progressive obstructive lung disease
  3. pancreatic insufficiency (fat/protein malabsorption–> failure to thrive)
42
Q

CF should be suspected and tested for in a child if they have what 4 things?

A
  1. recurrent episodes of cough, pneumonia, sinusitis
  2. poor weight gain/failure to thrive
  3. nasal polyps, rectal prolapse, hypochloremic alkalosis
  4. Family Hx
43
Q

What would be findings on CXR for advanced CF?

A

Barrel chest, bronchiectasis, mucus plugging the airways

44
Q

How does CF lead to bronchiectasis?

A
  1. impaired mucus clearance
  2. recurrent tracheobronchial infections
  3. inflammation
  4. destruction of airway via neutrophils
  5. bronchiectasis
45
Q

What are the 3 tests for CF? Which is the gold standard? Which is used in newborn screening tests?

A
  1. Immunoreactive trypsinogen (IRT) measures fraction of pancreatic enzymes which are elevated in serum. Newborn Screening Test (90-95% sensitive)
  2. Sweat chloride test- gold standard. Cl>60 is positive
  3. DNA analysis for CFTR (too many mutations)
46
Q

What is treatment/management for thickening of the airways associated with CF?
Colonization of pathogenic bacteria (s. aureus, pseudomonas, H flu)?

A

Thickened airways:

  1. chest percussion
  2. nebulized hypertonic saline
  3. nebulized DNase

Infection:

  1. aminoglycosides- inhaled
  2. azithromycin- oral
47
Q

How is pancreatic insufficiency in CF patients managed?

A

Supplement pancreatic enzymes, calories and protein

Respiratory/Musculoskeletal (36 decks)

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