FPC: peds clinical cases II

Question 1

What are symptoms of hand, foot, mouth disease (HFMD)?

Answer 1

Erythematous macules or vesicles with thin erythematous halos on the tongue and inner cheeks as well as vesicular skin rash that is not painful and nonpruritic of limbs, hands, feet, butt.

Question 2

What is the pathogen associated with HFMD?

Answer 2

Coxsackievirus A.

Question 3

Where are frequent HFMD outbreak areas?

Answer 3

Daycare, schools, summer camps.

Question 4

What is the usual age for HFMD?

Answer 4

Kids less than 5-7.

Question 5

What is the timing of HFMD?

Answer 5

Summer/fall.

Question 6

How do we treat HFMD?

Answer 6

Just Tylenol or Motrin for fever if the child seems uncomfortable. Potentially a special mouthwash if kid is in lots of pain.

Question 7

How do we counsel for HFMD?

Answer 7

Make sure to handwash!!! Can return to school when the child feels better and is afebrile.

Question 8

What is herpangina?

Answer 8

A benign clinical syndrome caused by coxsackievirus A with painful vesicles/ulcers in the back of the mouth and sudden high fever.

Question 9

What is bronchiolitis?

Answer 9

Disease of small bronchioles with significant mucus production, maybe bronchospasm, and possibly airway obstruction.

Question 10

What is the most common cause of bronchiolitis?

Answer 10

RSV.

Question 11

What is the timing of bronchiolitis?

Answer 11

Later winter, December-March.

Question 12

What are clinical features of bronchiolitis?

Answer 12

Common cold symptoms over 4-6 days, audible wheezing that moves locations, noisy breathing, low-grade fever, increased WOB, hyperresonance with percussion, possibly cyanosis.

Question 13

How might really young infants present with bronchiolitis?

Answer 13

Apnea.

Question 14

How do we diagnose bronchiolitis?

Answer 14

Clinical diagnosis, no lab testing is needed! Get a pulse ox.

Question 15

How do we treat bronchiolitis?

Answer 15

Supportive care and oxygen/hydration if they need to be hospitalized.

Question 16

What is associated with children hospitalized for bronchiolitis?

Answer 16

They’re more likely to end up having asthma.

Question 17

How can we prevent bronchiolitis?

Answer 17

RSV vaccines.

Question 18

What is laryngotracheobronchitis?

Answer 18

Croup; middle respiratory infection that classically follows a common cold.

Question 19

What is the pathogen associated with croup?

Answer 19

Parainfluenza.

Question 20

What is the pathogenicity of croup?

Answer 20

Airway inflammation leads to increased resistance, WOB, and stridor heard in the neck.

Question 21

What is the timing of croup?

Answer 21

Fall and early winter.

Question 22

What are symptoms of croup?

Answer 22

Barking ‘seal-like cough’, hoarseness, respiratory distress, fever.

Question 23

What exacerbates croup symptoms?

Answer 23

Nighttime, crying, agitation.

Question 24

What is an imaging sign of croup?

Answer 24

‘Steeple-sign’.

Question 25

What is bacterial tracheitis?

Answer 25

Complication of croup that is a bacterial superinfection following croup and is associated with staph aureus.

Question 26

What is the presentation of bacterial tracheitis?

Answer 26

A kid who had croup, got better for a few days, and came back several days later decompensated with fever, return of symptoms, high fever.

Question 27

How do we treat croup?

Answer 27

Steroids, racemic (inhaled) epinephrine if stridor at rest to reduce subglottic edema. The epi is usually given in the ED for monitoring after as sometimes it can cause worsening symptoms as the drug fades.

Question 28

What is epiglottitis?

Answer 28

Cellulitis of the epiglottis and adjacent structures.

Question 29

What is the pathogen associated with epiglottitis?

Answer 29

Hflu type B.

Question 30

What is the presentation of epiglottitis?

Answer 30

Sore throat, fever, muffled voice, tripod posture with hyper extended neck ('sniffing position').

Question 31

How do we treat epiglottitis?

Answer 31

Emergent establishment of an airway and antibiotics.

Question 32

Who is most at risk for pertussis?

Answer 32

Kids under 6.

Question 33

What is the catarrhal stage?

Answer 33

Stage of pertussis lasting about 2 weeks in which there are nonspecific symptoms.

Question 34

What is the paroxysmal stage?

Answer 34

Stage of pertussis where classic whooping cough symptoms emerge; coughing during expiration that causes forceful inhalation against a narrowed glottis that causes the 'whoop' sound. Stage can last 2-4 weeks.

Question 35

What is the convalescent stage?

Answer 35

Stage of pertussis in which symptoms resolve.

Question 36

How do we treat pertussis?

Answer 36

Supportive care, macrolides, macrolides for prophylaxis in close contacts!!!

Question 37

How do we prevent pertussis?

Answer 37

Vaccination.

Question 38

What is radial head subluxation?

Answer 38

Traction on distal radius causes the annular ligament to slip over the radial head and the joint becomes trapped.

Question 39

Who does radial head subluxation usually occur in?

Answer 39

Kids 1-4.

Question 40

What causes radial head subluxation?

Answer 40

Swinging kids by the hands or pulling their arm.

Question 41

How do we diagnose radial head subluxation?

Answer 41

Clinical diagnosis! Xray isn’t needed unless there is bony tenderness or swelling.

Question 42

How do we treat radial head subluxation?

Answer 42

Reduce with forearm supination, leave the room, and return with something of interest so they extend their arm.