Flashcards in Cases- Asthma/Peds (3)- Melissa Deck (39):
All day cough
Common cold; rhino or coronavirus
Coughing until you vomit for weeks
Coughing at night***
Coughing, loss of appetite, retractions, nasal flaring
Barking cough + stridor at night
Croup;#1 parainfluenza virus (the seals!!!)
Resp diseases that kills kiddos (3)
Kid looks SICK
Influenza. DONT GIVE ASPIRIN BECAUSE REYES!!!!
Isolated crackles and all day cough
Mycoplasma; walking pneumonia
-Isolated dullness to percussion, rhonchi, adventitial sounds
-Look "sick"; 103+ fever
-sudden onset all day cough
--> strep pneumo
Empiric therapy for pneumonia
Ceftriaxone for strep pneumo + azithromycin for mycoplasma
Three modes of transmission for respiratory infection
- airborne (not face to face i.e .legionella, TB)
- droplet (face to face)
- contact (touching fomites)
#1 place to get resp. infection for kiddos under 5
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
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.
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)
when you see nasal polyps in a peds patient, what is the knee jerk reaction?
CF!!!! (may also be seen in asthmatic kiddos too)
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
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**
***What vaccine do we ALWAYS make sure our asthmatic kiddo patients have?
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?
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...
How are we gonna treat our kids with the common cold?
ALL THE NORMAL SHIT EXCEPT ASN!!!
(antihistamines/ antipyretics/ analgesics/ antitussives/etc.)
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
List the 3 most common symptoms of resp illness caused by adenovirus + one other?
What do we see on PE? (3)
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
Places you'll see adenovirus outbreak (2)
- military groups
- SUMMER CAMP***
#1 cause of bronchiolitis in infants (under 12 mos)
5 symptoms of RSV infection?
2. decreased wet diapers
3. poor feeding
Common high yielf finding on RSV physical exam?
Prolonged capillary refill
fevers always cause what in kiddos ?
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?)
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
That virus that is not RSV but likes to pretend it is?
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+
- Adventitial sounds/ ronchi
- pneumonia is typically lobar; rusty sputum more common in adults
What age group typically gets this?
How do we differentiate this from strep penumo?
What do you hear on exam?
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
When is a CXR warranted?
ANYTIME you can not hear breath sounds
Is sputum stain useful in meds practice
not typically useful; kids spit up mostly spit
How are most meds pneumonia cases managed?
Most kiddos are managed on home ABX regimen
strep pneumo = amox
mycoplasma = macrolide (azithro)
- 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***
What do you see on PE?
#1 Cause Parainfluenza virus (also RSV)
PE: Seal-like barking cough, inspiratory stridor, tachypnea (fever)
CXR: Steeple sign (narrow trachea)
Tx: Humidification only