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Respiratory 1 > LRT Infections in Kids > Flashcards

LRT Infections in Kids Flashcards

1
Q

Define lower respiratory infection?

A

any sublaryngeal airway infection is LRT

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2
Q

Define pneumonia:

A

-inflammation or infection of the lungs - especially the gas exchange units (terminal and respiratory bronchioles and interstitium)

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3
Q

most common cause of pneumonia (a LRT infection) in children (<1 year old?

A

viral

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4
Q

number 1 cause (organism) of bacterial/pyogenic pneumonia through childhood?

A

strep pneumo

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5
Q

How does pneumonia happen?

A

-deposition and replication of viral/bacterial agents on resp tract mucosa or the lung can be seeded hematogenously during bacteremia (from the blood to lungs)

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6
Q

How do bacteria often cause pneumonia?

A

-colonize the respiratory tract

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7
Q

how do viruses cause pneumonia?

A

-viral infections impair HOST DEFENSES = secondary bacterial pneumonias

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8
Q

Host defenses:

A

ALL MUST WORK

  • nasopharyngeal air filtration
  • laryngeal protection of the airway
  • mucociliary clearance
  • normal cough reflexes and strength
  • normal anatomy
  • unobstructed airway drainage
  • normal cellular and humoral immune function
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9
Q

-3 main findings of pneumonia??? -Which symptom is most specific for pneumonia?

A
  • fever
  • cough
  • tachypnea –> MOST SENSITIVE AND SPECIFIC SIGN OF PNEUMONIA IN INFANTS!
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10
Q

Clinical findings of pneumonia in children on physical exam?

A
  • refusal to eat
  • grunting
  • rales
  • rhonchi
  • dec breath sounds
  • normal breath sounds (less mass so the sounds distribute better throughout chest so may be normal sounding)
  • cyanosis
  • pallor
  • accessory muscle use/retractions
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11
Q

Global health standards for pneumonia if youre out in the world?

A

need to have tachypnea and retractions to diagnose pneumonia

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12
Q

Bordatella pertusis- info:

A

WHOOPING COUGH

  • pertussis=intense cough
  • gram NEG pleomorphic
  • humans only host
  • transmission=droplet from cough
  • very contagious
  • incubation 6 days
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13
Q

3 phases of whooping cough:

A

1) catarhal phase
- 1-2 weeks
- rhinorrhea
- conjunctival injection
- mild cough
- wheezing
- low grade fever
2) Paroxysmal phase
- 2-4 weeks coughing inc in frequency and intensity
- WHOOP** - uncommon in child <6mo
- POST TUSSIVE EMESIS***
- hypoxia and fatigue from constant cough
- apnea
3) Convalescent phase
- 1-2 weeks
- cough and vomit dec in frequency
- cough may continue for weeks

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14
Q

Pertusis testing/lab results

A
  • leukocytosis (HIGH ABS LYMPH COUNT –> DIFFERENT BC THIS ISNT VIRAL BUT LYMPHS ARE UP!!!)
  • CXR=perihilar infiltrates, atelectasis or emphysema
  • nasopharyngeal swabs for PCR
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15
Q

Pertusis TX in child:

A
  • hospitalize (if infant)
  • oxygen & IV fluids
  • erythromycin 40mg/kg divided q 6hrs for 14 days
  • isolate patient for 5 days to prevent spread
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16
Q

Antibiotic of choice for pertussis in child?

A

-erythrmycin

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17
Q

influenza - info

A

RNA orthomyxovirus

  • A, B, and C types - A and B causing epidemics
  • H1N1 predominated last year
  • H3N2 have greater mortality
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18
Q

Type A influenza surface antigens:

A

-surface antigens hemagglutinin (HA) and neuraminidase

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19
Q

3 types of hemagglutinin types:

A

H1 H2 and H3

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20
Q

2 types of neuramidase types:

A

N1 and N2`

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21
Q

Major changes of hemagglutinin type is called? Minor?

A
  • antigenic shift = major

- antigenic drift = minor

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22
Q

influenza - spread?

A

-large droplets

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23
Q

influenza - who gets? when?

A
  • school age children

- community outbreaks occur in winter and peak within 2 weeks of onset and last 4-8 weeks

24
Q

influenza - infectious?

A
  • infectious > 10 days after the onset of symptoms

- severely immunocomp patients shed virus for weeks to months

25
Q

influenza - symptoms

A
  • 1-4 days onset (ABRUPT)
  • mimics bacterial sepsis
  • fever
  • coryza (perfuse runny nose)
  • myalgia
  • headache
  • malaise
  • conjunctivitis
  • pharyngitis
  • dry cough
  • can localize anywhere in resp tract = URI, croup, bronchiolitis, pneumonia
26
Q

most common secondary bacterial infection due to influenza?

A
  • strep pneumo (MOST COMMON)

- staph aureus ( ALSO COMMON)

27
Q

What is Reye syndrome:

A

-affects brain and liver post viral (varicella) or influenza infection

28
Q

Stages of Reye syndrome:

A

0=vomiting
1=vomit, confusion, lethargy
2=agitation, delirium, DECORTICATE (elbows flexed) posturing, hyperventilation
3=coma and DECEREBRATE (elbows extended) posturing
4=flaccidity, apnea, and dilated fixed pupils

Progression from stage 1 to 4 can happen in 24 hours
-worse outcome if younger

29
Q

What inc risk of Reye syndrome during viral illness?

A

-salicylates (aspirin)

30
Q

Diagnosis of reye syndrome:

Definitive diagnosis with?

A
  • hypoglycemia
  • hyperammonemia
  • inc liver enzymes

Definitive with liver biopsy

31
Q

Reye syndrome tx?

A

limited tx

-correct hypoglycemia and inc ICP

32
Q

diagnosis of influenza:

A
  • based on clinical presentation, time of year, and community surveillance
  • rapid nasal swab tests of Influ A and B
  • blood count short normal WBC or mild dec in leukocytes
33
Q

Tx for influenza?

A
  • supportive most - fluids, fever control, rest

- neuraminidase inhibitors (zanamivir & oseltamivir) in children if bad

34
Q

Vaccination against influenza?

A

vaccinate everyone above 6mo

2 doses

35
Q

RSV epidemic when?

A

winter

36
Q

RSV transmission:

A

-resp droplets and fomites

37
Q

classic finding in RSV?

A
  • WHEEZING

- otitis media

38
Q

recovery from RSV how long?

A

7-12 days

39
Q

x-ray of RSV?

A
  • air trapping
  • segmental atelectasis
  • inc interstitial markings

-DO NOT ORDER X-RAY

40
Q

Tx for RSV bronchiolitis

A
  • maintain patency of nasal airway
  • maintain adequate hydration and nutrition
  • optimize ventilation and oxygenation
41
Q

Aim of tx of RSV bronchiolitis

A
  • releive resp distress
  • overcome airway obstruction
  • enhance mucociliary clearance
  • return child to normal resp status
42
Q

tachypnea + rales heard but no wheezing, no fever, 6 weeks old, conjunctivitis - organism?

A

-chlamydia trachomatis pneumonia

43
Q

presentation of chlamydia trachomatis?

A
  • 1-3 months (NONE OLDER THAN 4mo)**
  • repetitive staccato cough, tachypnea, and absence of fever, wheezing some nasal stuffiness
  • CXR no sig abnormalities or hyperinflation (shaggy heart sometimes)
  • WBC usually normal with peripheral eosinophilia
44
Q

chlamydia trachomatis - tx:

A
  • macrolides (*ORAL AZITHROMYCIN for 5 days or ORAL ERYTHROMYCIN for 14days)
  • tetracyclines
  • quinolones
  • sulfonamides
45
Q

If there is evidence of chlamydial conjunctivits without pneumonia tx how?**

A

-still give oral erythromycin**

46
Q 
9mo female
sudent onset fever  to 102.5
dec activity
cough
lethargy
hypoxemia?
hgih WBC count
left shift-inc bands

organisms?
what organism present similarly?

A

pneumonia - strep pneumo
(since its not viral strep pneumo is most common)

-influenza similar BUT RARELY has hypoxemia and doesnt have high WBC

47
Q

CXR of strep pneumo?

A

-lobar or segmental consolidation

48
Q

strep pneumo if child is untable symptoms?

What Tx?

A
  • hypoxic
  • resp distress
  • hemodynamically unstable
  • IV antibiotics - ampicillin / sulbactam, cefuroxime, ceftriaxone
  • continueuntil patient stable then give 10 day course of oral antibiotics
49
Q

strep pneumo if child is stable tx?

A
  • oral antibiotics

- ->amoxicillin/clavulanic acid, cefuroxime, or other 2nd gen ceph

50
Q

mycoplasma pneumonia - info

A
  • walking pneumonia
  • most common in school age child
  • RARE BEFORE AGE 3-4
51
Q

presumptive diagnosis of m pneumo with what test?

A

cold agglutinins

52
Q

definitive diagnosis of mycoplasma via?

A

-drawing mycoplasma titers

53
Q

clinical manifestation of mycoplasma

A
  • intractable nonproductive to mild cough ***
  • squeaky door breathing
  • chills
  • pharyngitis
  • rhinorrhea
  • ear pain
54
Q

Tx of choice for mycoplasma?

A

-macrolides

55
Q

mycoplasma vs chlamydia pneumophilia:

A

-chlam has more pharyngitis followed by cough and high fevers

Respiratory 1 (9 decks)

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