Pulmo Flashcards by Alyzah Masorong

most common agent causing HFMD

Coxsackie A16

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What is Lemierre syndrome?

Internal jugular vein septic thrombophlebitis
- caused by F. necrophorum

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gold standard for diagnosing streptococcal pharyngitis

throat culture plated on blood agar

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suppurative complications of GAS pharyngitis

peritonsillar abscess
cervical adenitis

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primary benefit and intent of antibiotic treatment of GAS pharyngitis

prevention of acute rheumatic fever (ARF)

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this is a diagnostic physical finding in peritonsillar cellulitis/abscess

asymmetric tonsillar bulge with displacement of the uvula

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best known clinical syndrome caused by Epstein-Barr virus (EBV)

Infectious mononucleosis

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Primary EBV infections in adolescents manifests in 30-50% cases as the classic triad of?

Fatigue, Pharyngitis and generalized lymphadenopathy

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three mechanisms by which viruses cause common cold spread

-direct hand contact
-inhalation of small-particle aerosols
-deposition of large-particle aerosols and land on nasal or conjunctival mucosa

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most common pathogens associated with the common cold

human rhinoviruses

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Young children have an average of ___ colds per year

6-8 colds

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most common complication of colds

Acute otitis media

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most common bacterial pathogen in children 3 weeks to 4 years of age in PCAP

Streptococcus pneumoniae

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most frequent bacterial pathogen in children 5 years and older seen in PCAP

Mycoplasma pneumoniae
Chlamydophila pneumoniae

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most common causes of lower respiratory tract infections in infants and children older than 1 month but younger than 5 yr of age

Viral pathogens
— most common are RSV and rhinoviruses

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definition of recurrent pneumonia

2 or more episodes in a single year or
3 or more episodes ever
with radiographic clearing between occurences

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most consistent clinical manifestation of pneumonia

Tachypnea

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recommended antibiotic for mildy ill children with PCAP who do not require hospitalization

Amoxicillin, usually high dose (90 mkday)

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According to PPS guidelines, PCAP is considered in patients when these symptoms are present

Cough or fever + any of the ff:
1. tachypnea
2. retractions or chest indrawing
3. nasal flaring
4. O2 saturation <95% at room air
5. grunting

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based on the PPS guidelines, what antibiotics should be given for patients with nonsevere PCAP?

Amoxicillin (40-50 mkday) q8 x 7 days or 80-90 mkday q12 x 5-7 days or
Co-amox (80-90 mkday) q12 x 5-7 days or Cefuroxime (20-30 mkday) q12 x 7 days if with penicillin-resistance pneumococci or beta lactamase h. influenzae

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According to PPS guidelines, patients with PCAP severe should be given with what antibiotics?

Pen G (200,000 IU/kg/day) q6 if complete Hib, Ampicillin (200 mkday) q6 if no or incomplete or unknown HIb vaccine OR
Cefuroxime (100-150 mkday) q8 or Ceftriaxone (75-100 mkday) q12-q24 or Ampi-Sulbactam (200 mkday) q6 if with documented high level penicillin-resistance

add Clindamycin (20-40 mkday) q6-q8 if Staphylococcal pneumonia is highly suspected
if sepsis and shock, add Vancomycin (40-60 mkday) q6-q8

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if viral etiology is considered for PCAP, according to PSS, what should be given

Oseltamivir, to be started immediately within 36 hours of laboratory confirmed influenza infection

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good response to therapy in PCAP non severe is presented by

improvement of cough or normalization of core body temperature in the absence of antipyretics within 24-72 hours after initiation of treatment

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what is strongly recommended as adjunctive treatment for measles pneumonia

Vitamin A

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a child with suspected asthma is placed on low dose ICS and as needed SABA over how many weeks?

8-12 weeks

2 diagnostic features in diagnosing asthma in older children and adolescents (6-18 yo)

history of variable respiratory symptoms confirmed variable expiratory airflow limitation

most serious complication of foreign body aspiration

complete obstruction of the airway

narrowest portion of the upper airway in children <10 yo

cricoid cartilage encircling the airway

Stridor is a sign of ______ airway obstruction

upper

75% of cases of croup is caused by this organism

Parainfluenza virus

most common form of acute upper respiratory obstruction

Croup/Laryngotracheobronchitis

The child has barking cough, hoarseness and inspiratory stridor. What condition is this?

Croup

Chest xray will reveal typical subglottic narrowing or steeple sign on the posteroanterior view

Croup

This virus is associated with severe laryngeotracheobronchitis

Influenza A

This condition is characterized by an acute rapidly progressive and potentially fulminating course of high fever, sore throat, dyspnea and rapidly progressing respiratory obstruction

Acute epiglottitis

classic radiograph of this condition: thumb sign

Epiglottitis

established treatment for moderate or severe croup

Nebulized racemic epinephrine

Aside from racemic epi for croup, what other medication should be given as part of the treatment?

Oral corticosteroids

most commonly isolated pathogen of bacterial tracheitis

S. aureus

this condition typically present in child with “brassy” cough

Bacterial tracheitis

this etiologic agent is responsible for more than 50% of cases of bronchiolitis

Respiratory Syncytial Virus (RSV)

This condition presents initially as rhinitis then 3-4 days later, a frequent dry hacking cough develops, which may or may not be productive

Acute bronchitis

walking pneumonia

M. pneumoniae

sinuses that are present at birth

Ethmoidal Maxillary

3 bacterial pathogens causing acute bacterial sinusitis in children

S. pneumoniae nontypeable H. influenzae Moraxella catarrhalis

Definition of sinusitus according to duration

ACUTE: <30 days SUBACUTE: 1-3 months CHRONIC: >3 months

Diagnosis of sinusitis

2 major or 1 major and >=2 minor symptoms MAJOR: Purulent anterior nasal discharge Purulent or discolored posterior nasal discharge Nasal congestion/obstruction Facial congestion/fullness Facial pain/pressure Hyposmia/anosmia Fever MINOR: Headache Ear pain, pressure or fullness Halitosis Dental pain Cough Fever Fatigue

the only accurate method of diagnosis in sinusitis

Sinus aspirate culture

initial therapy given to children with uncomplicated mild to moderate severity acute bacterial sinusitis

Amoxicillin (45 mkday) BID

duration of therapy for acute sinusitus

minimum of 7 to 10 days

orbital complications such as periorbital and orbital cellulitis are most often secondary to acute bacterial infection of what sinus?

Ethmoid sinus

Osteomyelitis of the frontal bone

Pott Puffy tumor

whooping cough

Pertussis

Describe the stages of Pertussis

1. Catarrhal stage (1-2 wks): nondistinctive symptoms of congestion and rhinorrhea with low grade fever, sneezing, lacrimation and conjunctival suffusion 2. Paroxysmal stage (2-6 wks): cough begins as a dry, intermittent, irritative hack and evolves into inexorable paroxysms — hallmark 3. Convalescent stage

characteristic lab finding in the catarrhal stage of pertussis

Leukocytosis (15,000-100,000 cells/uL)

drug of choice in all age groups for patients with Pertussis, as well as for postexposure prophylaxis

Azithromycin

most common esophageal disorder in children of all ages

Gastroesophageal reflux disease

infant reflux peaks at what age and when does it resolve

peaks at 4 months, resolves by 12 months in 88% of infants, nearly all by 24 months

positions that can be used to minimize reflux in infants

prone position upright carried position

most common congenital anomaly of the esophagus

Esophageal atresia

suggestive of this condition is the inability to pass a NGT or OGT in the newborn

Esophageal atresia

what is the gap between atretic ends of the esophagus in EA that is not operable thru primary repair

>3 to 4 cm (>3 vertebral bodies)

complication of surgery in EA

anastomotic leak refistulization anastomotic stricture

current standard surgical approach in EA with TEF

Primary end-to-end anastomosis of the esophagus and surgical ligation of the TEF

definitive diagnoses of tracheomalacia and bronchomalacia

flexible or rigid bronchoscopy

low pitched inspiratory snoring sound typically produced by nasal or nasopharyngeal obstruction

Stertor

inspiratory, low-pitched sound produced when there is upper airway obstruction

Stridor

diagnostic confirmation of laryngomalacia

flexible laryngoscopy

Infection from oropharynx which extends to cause septic thrombophlebitis of the IJV and embolic abscesses in the lungs

Lemierre disease

etiologic agent for Lemierre disease

Fusobacterium necrophorum

how many cc of fluid is present in the pleural space

10 mL

rapid removal of >1L of pleural fluid may be associated with the development of ???

Reexpansion pulmonary edema

predominant source of the organisms causing abscesses

Aspiration of infected materials or a foreign body

duration of treatment for primary lung abscess

2-3 weeks of IV antibiotics to complete with oral antibiotics for a total of 4-6 weeks

most often involved lobe in children with atelectasis

right upper lobe

accumulation of extrapulmonary air within the chest

Pneumothorax

this happens occasionally in teenagers and young adults who are male, tall, thin without trauma or underlying lung disease

Primary spontaneous pneumothorax

accumulation of extrapulmonary air within the chest

Pneumothorax

principal features of pneumomediastinum

dyspnea transient stabbing chest pain that may radiate to the neck

“spinnaker sail sign” or “angel wing sign”

Pneumomediastinum — occurs when air deviates the thymus upward and outward

pathognomic for pneumomediastinum

mediastinal “crunch”/Hamman sign

pathognomic for pneumomediastinum

mediastinal “crunch”/Hamman sign

targeted oxygen saturation in patients with BPD outside of the NICU

=>92%

Wheezing at rest caused by Tracheomalacia usually resolves by what age?

3 years old

Most common bacterial agents of PCAP in children 5 yr and older (give top 3)

Mycoplasma pneumonia - S. pneumoniae - Chlamydophylia pneumonia

What are included in the McIsaac criteria

1 point for each - history of temp >38 C - absence of cough - tender anterior cervical adenopathy - tonsillar swelling or exudates - age 3-14 yo subtracts 1 point for age >45 yo

Major early childhood risk factors for persistent asthma

Parental asthma Atopic dermatitis (eczema) Inhalant allergen sensitization

strongest identifiable factor for the persistence of childhood asthma

allergy in young children with recurrent cough and/or wheeze

most common chronic symptoms of asthma

Intermittent dry coughing Expiratory wheezing

lung function abnormalities in asthma Define Bronchodilator response, exercise challenge, daily PEF or FEV1 monitoring

Bronchodilator response: increase in FEV1 >12% or predicted FEV1 >10% after inhalation of SABA Exercise challenge: worsening in FEV1 >15% Daily PEF or FEV1 monitoring: day-to-day and/or AM-to-PM variation >20%

Pulmo Flashcards

(90 cards)