164. Ped Lung Disease Flashcards by Tegan Turner

What causes up to 90% of all pneumonias and are common in yo children?

viruses

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Unique cause of pneumonia age 3 to 19 weeks

chlamydia trachomatis

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Atypical pneumonia bacteria kids?

chylamydia trach 3-19 weeks bordetella pertussis infants <1 mycoplasma >5 chlamydia pneumonia >5

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Pneumonia: neonates 2 mc (+ 2 less common) bacteria?

GBS gram neg bacilli listeria ureaplama

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Leading cause bacterial infection beyond newborn age (pneumonia)?

strep penumo then s aureus h influ later on

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Less common examples of bacteria in pneumonia

gas neisseria anaerobic bacteria legionella PJP rickettsial TB

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MC viral pneumonia causative agents <1y

rsv parainfluenza

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Neonatal uncommon viruses for pneumonia:

rubella cmv hsv influ adeno rhino entero measles varicella ebv

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Fungal bacteria in immunocompromised kiddos for pneumonia?

coccidiomyocosis

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How long do passive antibodies work from mum?

few months

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What structural changes might aid in increased risk pneumonia?

cleft palate TE fistula pulmonary sequestration congenital cystic adenmatoid malformation

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What neuro or genetic causes might increase risk pneumonia

coma, seizure, CP, general anesth CF

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What viruses transmit from hematogenous spead?

cmv ebv varicella hsv measles rubella

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Key hx factors for risk pneumonia from birth and immuniz hx?

-pneumococcal and hinflu b particularly -sickle cell -prior pneumonia or freq infection -underlying chronic disease

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Most sensitive indicator for children with pneumonia?

tachypnea

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**Pleural irrita-
tion can cause abdominal tenderness or meningismus, and pulmonary
hyperinflation may cause downward displacement of the liver and
spleen.

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Pneumonia: ___ (sx) can be seen with chlamydial pneumonia

conjunctivitis

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Pneumonia: ___ and ___(sx) can be seen with m pneumoniae

pharyngitis exanthems

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MC complication Pneumonia:

dehydration

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What 3 bacteria mc cause pleural effusion/empyema

s pneumoniae h influ s aureus

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Local complications of pneumonia, particularly with s aureus include (3):

-lung abscess pneumatocele ptx

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What children are particularly at risk for apneas from pneumonia?

<3 months viral infection with RSV, chlamydial, pertussis

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When to particularly consider a bacterial cause of pneumonia in kids? (signs)

temp >39 toxic lobar infiltate pleural effusion

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Which kids are at risk for s pneumonia infections?

immunodeficiency
chr renal disease
functional or anatomic asplenia
Indigenous

Children with foreign body aspiraton, immunosup or concomittent skin infection are at risk of which bacteria pneumonia?

s aureus

GAS can be a pneumonia complication of which viral cause of pneumonia?

varicella

Children do not require chest radiography or viral testing to make the diagnosis of viral ___, particularly in a child who presents during the winter months with fever, cough, congestion, and wheezing.

pneumonia

Complications of viral pneumonia

dehydration,

local progression of the disease,

bronchiolitis obliterans,

apnea (usually in the first 3 months of life).

Viral pneumonia: sx

Viral pneumonia is more common in the winter season and gener- ally has a gradual onset, often with associated cough, congestion, and low-grade fever. Tachypnea may be the only physical finding; however, retractions, rales, and wheezing are common. Grunting, cyanosis, lethargy, dehydration, and apnea are seen in more severely affected children.

Viral pneumonia findings?

hyperinflation
peribronchial thickening
diffuse increase interstitial findings

Do children with viral pneumonia need cxr or viral test?

no - winter mo, fever, cough, congestion and wheeze is enough

Mycoplasma pneumonia: age

5-18yoa

Mycoplasma pneumonia: onset andc sx

gradual insidious
prodrome: fever, headache, malaise
nonrproductive hacking cough then several days later
+/- hoarseness, sore throat, cp, coryza

Mycoplasma pneumonia: appearance of children?

nontoxic
rales or wheezing
+/- pharyngitis, cervical lymphadenopathy, conjunctivitis, otitis media

Mycoplasma pneumonia: what rash may form with this?

urticaria
erythema multiforme
maculopapules
vesicles

Mycoplasma pneumonia: can increase risk of ___ exacerbation, or chronic structural abnormalities

exacerbation of asthma and may cause chronic pul- monary structural abnormalities (e.g., pneumatocele, pleural effusion, pneumothorax, or bronchiectasis)

mycoplasma pneumonia: cxr and wbc findings

Radiographic findings typi- cally show lower lobar consolidation, but scattered segmental infiltrates and interstitial disease can also be seen (Fig. 164.7). Pleural effusions are uncommon. The white blood cell (WBC) count is usually normal.

Complica- tions of mycoplasma pneumonia are varied, but unusual, and include:

hemolytic anemia
hus
myopericarditis
neurologic dis: meningoenceph, GBS, transverse myelitis
rhabdo
arthritis
SJS

Chlamydia pneumonia: how does this get transferred? to who?

sti causing cerivcal infection in 2-30% pregnant women
from genital tract to infants resulting in conjunctivitis and pneumonia

Chlamydia pneumonia: age?

3-19 wks after colonization at birth

Chlamydia pneumonia: sx

nasal congestion then cough
cojunctivitis pre resp sx
afebrile and alert but tachypneic with rep staccato cough
mild retractions, inspiratory rales

Chlamydia pneumonia: middle ear abnormalities in what amount of cases?

36893

Chlamydia pneumonia: CXR findings

hyperinfl bilateral symm and diffuse infiltrates

Chlamydia pneumonia: what testing?

NAAT

Chlamydia pneumonia: complications x2

apnea
hypoxemia

Chlamydia pneumonia: what can shorten the course? (even if disease protracted by cough and tachypnea)

erythromycin

When is a CXR in immunocompromised children not required?

no fever, tachypnea, focal findings on ausculation

Chlamydia pneumonia: when to xray

only when dx unclear
if thought + based on + fever, focal consolidation + tachypnea, can dx as pneumonia

CXR immunocompromised: where is mc distribution?

lobar

CXR immunocompromised: viral and chlamydial infections tend to appear as ? infiltrates?

viral and chlamydial

with hyperinflamation and atelectasis

CXR immunocompromised: what testing?

pulse ox
vbg
cbc
bl cultures if ill appearing
cxr

CXR immunocompromised: when should children undergo thoracentesis?

pleural effusions enlarging or compromising resp function

CXR immunocompromised: parapneumonic effusion causes

bacteria
mycoplasma
occassionally viral

CXR immunocompromised: thoracentesis - send fluid for?

gram stain and culture anaerobic, aerobic bacteria
cell count and diff
total PRO
ph
glucose

CXR immunocompromised: refractory to tx - trial?

bronchoalveolar lavage

CXR immunocompromised: when to test for TB?

-lobar pneumonia
-pulmonary effusion
-hilar adenopathy

Management of pneumonia in infant <2mo

admission to hospital
pulse ox for signs of resp support (apnea, resp failure)
amp+ ceftazadine or gent (*gent in a premie)

Management of pneumonia in infant <2mo - infants 1-2mo abx?

ceftriaxone
amp

Management of pneumonia in infant <2mo if suspect c trachomatis or B pertussis, tx?

additionally azithromycin or erythromicin

Empiric abx tx of bacterial pneumonia: neonate

Ampicillin (150–200 mg/kg/day every 6 hours) + ceftazidime (100 mg/kg/day every 12 hours)

Gentamicin (2.5 mg/kg daily) Avoid ceftriaxone.a

Empiric abx tx of bacterial pneumonia: 4 weeks to 3mo

Ampicillin (150–200 mg/kg/day every 6 hours) + ceftriaxone (50 mg/kg daily)

Empiric abx tx of bacterial pneumonia: outpt tx

azithromcyin 10mg/kg on day 1, 5mg/kg daily d2-5

Empiric abx tx of bacterial pneumonia: 3mo - 4 years

Amoxicillin (75–90 mg/kg/day every 12 hours)

Amoxicillin–clavulanic acid (90 mg/kg/day of the amoxicillin component every 8 hours)

Cefuroxime (20-30 mg/kg/day every 12 hours)

Empiric abx tx of bacterial pneumonia: in pt treatment age 3mo - 4 years

azithro 10mg/kg day 1, 5mg per kg daily on d2-5
ceftr 50mg/kg daily or amp 150-200mg/kg/dayq6h or ill add: clindamycin 40mg/kg per day q6h
or vanco 10-20mg/kg IV q6-8h if need MRSA

for 3mo-4 years of age tx mycoplasma pneumoniae

3mo-4 of age tx for b pertussis if afebrile and prolonged cough

Pneumoniae: In an infant beyond the neonatal period or a preschool-age child, high-dose ___ is the first line agent and will treat susceptible pneumoniae

amox- icillin

second line agent for pneumoniae in children - infant beyond neonatal or preschool child outpt?

amox calv for gram negative and methicillin sens s aureus

Penicillin allergic children - infants/preschool age tx pneumonia?

oral cephalosporins

Atypical pneumonia tx in infants/preschool age children?

azithromycin

For children with neurologic or anatomic abnormalities who aspirate oral or gastric contents - tx?

pen 100 000 - 250 000 unit/kg/d q4-6h
clinda
+/- serious ill = metronidazole 40mg/kg/d q6h and cefoxitin 80-260mg/kg/d q4-6h

Pneumonia: when to d/c home

no resp distress
maintain hydration
reevaluate 24-48hrs

Pneumonia: when to admit

toxic appearance
emesis or dehydration
resp compromise - distress, hypoxia, inadequ ventil
multilobar dis
pleural effusions
impaired immune function
unreliable social enviroments
<6mo high consider

Pertussis: dx in children <__ mo

Pertussis: 3 stages named

catarrhal
paroxysmal
convalescent

Pertussis: catarrhal stage

1-2 weeks
URTI and cough

Pertussis: paroxysmal stage

severe paroxysms of staccato cough then posttussive emesis
possible apnea and cyanosis in infant <6mo

Pertussis: whoop in children older than?

2-3y

Pertussis: how long does paroxysmal stage last?

2-4 weeks

Pertussis: convalescent stage

sx gradually wane
6-10 weeks

Pertussis: WBC findings

usually elevated
marked lymphocytosis

Pertussis: cxr findings?

shaggy R sided heart border
or clear

Pertussis: best test?

PCR

Pertussis: first year of life biggest concern?

apnea

Pertussis: other complications other than apnea?

seizure
secondary bacterial pneumonia
encephalopathy
death

Risk of apnea: children <3-6mo with presume pertussis: tx?

observe hospital
tx azithro or erythromycin
+ vaccine all HC workers and adult pop tdap

CF: type of disease?

AR mutation CTFR
defect in chloride transport across epithelium result in reduced ciliary clearance of thick mucus decreased antimicrobial efect of airway surface, increased bacterial adherence and innate secretion inflamm cytokines

CF: CXR findings?

emphysema
peribronchial thickening
bronchiectasis
focal infiltation - linear/nodular

CF: early childhood pneumonia causes?

s aureus
h influenza

CF: antistaph prophylaxis - increased risk of what?

pseudomonas

CF: by age 18, most are colonized with?

pseudomonas

CF: for exacerbation what is best abx?

penicillin - piperacillin or ceftrazadime with aminoglycoside for synergistic effect

CF: R strain pneumonia infection, use?

imi or meropenem

CF: tx of secretions?

bronchodilator therapy to mucolytics
inhaled N acetylcysteine
chest physio

Bronchopulmonary dysplasia: defn

need for suppl o2 28 days postnatally

bronchopulmonary dysplasia: who gets this?

birth weight <1000g

bronchopulmonary dysplasia: RF

degree of premie
peripartum steriods
damage incurred by ventil in neonatal period
nutritional sttatus

bronchopulmonary dysplasia: immunization recommendations 6-23mo

influ
13 valent pneumoccocal
h influ type b
monthly prophylaxis rsv with palivizumab (monoclonal IG)

bronchopulmonary dysplasia: physiology - __ airway rR, __ lung compliance, __ lung disease

incr
decr
obstr

bronchopulmonary dysplasia: severe disease, what med for improved lung mechanics?

diuretics

1. A 5-month-old boy presents with a cough. His parents report that for the past several weeks he has had mild respiratory tract symp- toms and cough; however, during the past day, he has developed a severe paroxysm of staccato cough followed by posttussive emesis. What is the most appropriate antibiotic choice for this patient?

a. Amoxicillin
b. Ampicillin
c. Azithromycin
d. Trimethoprim-sulfamethoxazole

2. Which of the following findings is an indication for admission to

the hospital in children with a diagnosis of pneumonia?
a. Abnormal chest radiograph showing pulmonary infiltrates b. Decreased breath sounds in a lower lung field
c. Dehydration and vomiting
d. Diffuse rales and mild tachypnea

3. Which of the following statements best describes the epidemiology

of pneumonia in children?
a. Bordetella pertussis is the most common cause in infants.
b. Haemophilus influenzae type b is still an important pathogen.
c. Listeria monocytogenes may cause illness in children younger

than the age of 5 years.
d. Viral agents are the most common cause of pneumonia in chil-

dren overall.

4. Whatisthemostcommonviralagentcausingpneumoniaininfants

younger than 1 year?
a. Adenovirus
b. Enterovirus
c. Epstein-Barrvirus
d. Respiratory syncytial virus (RSV)

5. A 2-year-old presents with fever, cough, and rales. Chest radio- graph reveals right middle lobe pneumonia. Which of the following antibiotics would be recommended for outpatient treatment for this toddler who is not penicillin allergic?

a. Amoxicillin b. Azithromycin c. Ceftriaxone d. Cephalexin

164. Ped Lung Disease Flashcards

(116 cards)