Cases- Asthma/Peds (3)- Melissa Flashcards Preview

DT3- EXAM 2 > Cases- Asthma/Peds (3)- Melissa > Flashcards

Flashcards in Cases- Asthma/Peds (3)- Melissa Deck (39):
1

All day cough
Fever 101
Runny nose

Common cold; rhino or coronavirus

2

Coughing until you vomit for weeks

Pertussis

3

Coughing at night***
Wheezing
Nasal discharge

Asthma

4

Conjunctivitis
Pharyngitis
Fever 103+

Adenovirus

5

Coughing, loss of appetite, retractions, nasal flaring

RSV; bronchiolitis

6

Barking cough + stridor at night

Croup;#1 parainfluenza virus (the seals!!!)

7

Resp diseases that kills kiddos (3)

Pertussis
Pneumonia
Flu

8

High fever
Aches
Fatigue
Kid looks SICK

Influenza. DONT GIVE ASPIRIN BECAUSE REYES!!!!

9

Isolated crackles and all day cough

Mycoplasma; walking pneumonia

10

-Isolated dullness to percussion, rhonchi, adventitial sounds

-Look "sick"; 103+ fever

-sudden onset all day cough

Bacterial pneumonia
--> strep pneumo

11

Empiric therapy for pneumonia

Ceftriaxone for strep pneumo + azithromycin for mycoplasma

12

Three modes of transmission for respiratory infection

- airborne (not face to face i.e .legionella, TB)
- droplet (face to face)
- contact (touching fomites)

13

#1 place to get resp. infection for kiddos under 5

DAYCARE

14

What are 4 symptoms of asthma (* = dead giveaway)?
When do these kids typically present?
What are some common triggers for asthma aggravation?

Kids typically present UNDER 5 yoa
1. chest tightness
2. DRY COUGH AT NIGHT
3. SOB
4. wheezes (may not be audible on kids with REALLY bad obstructive disease)
*Be on the lookout for family hx**

Triggers: exercise, pollen/ weather, tobacco smoke, RI, etc.

15

What are some common PE findings indicative of asthma in kiddos? (2)

- "Allergic shiners"--kids have dark circles under eyes due to pooling of venous blood that cant drain into nares
- LOW insp/exp (I/E) ratio due to decreased air entering into obstructed airway (normal= 1/4, asthma= 1/7)

16

when you see nasal polyps in a peds patient, what is the knee jerk reaction?

CF!!!! (may also be seen in asthmatic kiddos too)

17

What do you see on an asthmatic's CXR? CBC? methacholine challege?
When do we test these kids for allergies?

- CXR will be normal; MAYBE see flattened diaphragm due to air trapping
- CBC = ^ EOS (Type 1 hypersensitivity...)
- Methacholine challenge = LOWER threshold for bronchoconstriction
- Test for allergies in older kids whose asthma is not controlled

18

Meds to treat asthma: first line and others...

#1: Albuterol rescue inhaler to use only when needeed
2. Long term managment w montelukast, steroid inhalers, combo meds

*Kids need to wait 1 min between puffs**

19

***What vaccine do we ALWAYS make sure our asthmatic kiddo patients have?

INFLUENZA

20

Three sx/ PE findings associated with the common cold:
Which virus is typically the culprit?
How long are these kids usually sick? How can we differentiate this from asthma?

1. Cough
2. Fever 101-102
3. Rhinorrha/ Coryza with erythematous nasal passages

Typically caused by RHINOVIRUS; kids will be sick 7-10 days; asthma is NOT self limiting, whereas common cold is...

21

How are we gonna treat our kids with the common cold?

ALL THE NORMAL SHIT EXCEPT ASN!!!
(antihistamines/ antipyretics/ analgesics/ antitussives/etc.)

22

Coronavirus: what are the TWO REALLY BAD DISEASES caused by this type of virus?

How do we differentiate patients with severe disease from those with common cold like symptoms? (3)

SARS and MERS
Seriously ill patients will have common cold sx. +:
- *BODY ACHE*, ARD, and HYPOXIA

23

List the 3 most common symptoms of resp illness caused by adenovirus + one other?
What do we see on PE? (3)

"Pharyngioconjunctival Fever"
1. fever 103+
2. red eyes (erythematous sclera bilaterally)
3. sore throat
4. Bloody pees (hemorrhagic cysturia) + runny poops

PE: Look for the red sclera, cervical lymphadenopathy, fever, weight loss

24

Places you'll see adenovirus outbreak (2)

- military groups
- SUMMER CAMP***

25

#1 cause of bronchiolitis in infants (under 12 mos)

RSV

26

5 symptoms of RSV infection?

1. cough
2. decreased wet diapers
3. poor feeding
4. fever
4. dyspnea

27

Common high yielf finding on RSV physical exam?

Prolonged capillary refill

28

fevers always cause what in kiddos ?

tachypnea!

29

What are some possible high yieldCXR findings associated with RSV (2)

- air bronchogram (inflammation around bronchioles will light up lining of airway)
- atelectasis (assocaited with the syncitia formation?)

30

What do we administer to little guys at high risk for RSV infection? Who ALWAYS gets this?

Palivizumab (anti F protein Ab)--give for 5 consecutive mos in all kiddos born *before 35 weeks* no matter what

31

That virus that is not RSV but likes to pretend it is?

Human Metapneumovirus

32

What is the #1 bacterial cause of pneumonia?
What KIND of pneumonia is this typically?
How does it present and how would you differentiate this from other common bacterial pneumonias?

#1 Strep pneumo
- KIDS LOOK SICK***
- sudden onset fever 100+
- cough
- Adventitial sounds/ ronchi
- pneumonia is typically lobar; rusty sputum more common in adults

33

Mycoplasma pneumonia:
What age group typically gets this?
How do we differentiate this from strep penumo?
What do you hear on exam?
Treatment?

Typically kids 4+yoa
- walking pneumonia: KIDS DONT LOOK SICK SICK but will COUGH ALL DAY!
- will hear ISOLATED CRACKLES
- possible fever fever ~100.4

*Treat with azithromycin

34

When is a CXR warranted?

ANYTIME you can not hear breath sounds

35

Is sputum stain useful in meds practice

not typically useful; kids spit up mostly spit

36

How are most meds pneumonia cases managed?

Most kiddos are managed on home ABX regimen
strep pneumo = amox
mycoplasma = macrolide (azithro)

37

Pediatric Influenza:
Clinical findings
CXR
Management

- MYALGIA/ FATIGUE/ KID IS WIPED OUT
- Fever and other nonspecific sx.
- CXR with diffuse infiltrate
- Treat with oseltamivir or Zanamivir if present within first 48
- NEVER USE ASN***

38

Croup
#1 cause
What do you see on PE?
CXR?
Management?

#1 Cause Parainfluenza virus (also RSV)
PE: Seal-like barking cough, inspiratory stridor, tachypnea (fever)
CXR: Steeple sign (narrow trachea)
Tx: Humidification only

39

Pertussis:
Clinical presentation
Important lab finding***
Tx

- WHOOPING COUGH; violent coughing spells with whoops of inspiration; infants will have apnea in lieu of whoop
- Kids cough until they VOMIT
- rhinorrhea, fever especially early on

***KNOW THAT THESE KIDS HAVE REALLY BAD LYMPHOCYTOSIS!!
Tx: macrolide