surfactant production begins
b/w 22-24 weeks, survival possible at 27-28 weeks
adult lung function is achieved by age
8
how does a decrease in airway diameter affect an infant?
a decrease of 50% results in a 16x increase in resistance, since their airway is so small it’s bad
common cold is aka
rhinosinusitis, symptoms of rhinorrhea and nasal obstruction w/o systemic fever or myalgia
rhinosinusitis treatment
- first gen antihistamines may help bc of the anticholinergics in them
- symptomatic
peritonsilar abscess is commonly seen in
- adolescents and young adults w/history of pharyngotonsilitis caused by group a strep
- presents w/fever, sore throat, trismus, dysphagia
- tx antibiotics and drainage
retropharyngeal abscess
- emergency!!! infection of retropharnygeal space down into superior mediastinum in kids age 3-4, doesn’t occur after 5 bc these nodes involute
- treat w/IV antibiotics and possible drainage
absolute indications for tonsilectomy
- airway obstruction
- partial obstruction w/chronic alveolar hypoventilation and possible cor pulmonale
probably indications for tonsilectomy
- S/P peritonsilar abscess
- tonsil hypertrophy interfering w/swallowing
- dysphagia leading to poor weight gain
possible indications for tonsilectomy
- 7 bacterial infections in one year
- 5 per year for 2 years
- 3 per year for 3 years plus history of fever, lymphadenopathy >2 cm, + strep culture + adequate antibiotic coverage to ensure it is not a l=prolonged initial illness
probable vs
possible adenoidectomy
- obstruction leading to mouth breathing, snoring, SA or adenoid facies leading to deformity of oral cavity
- recurrent serous otitis media w/hearing loss
mild sore throat progressing to acute respiratory obstruction/distress in hours, pt has neck extended and is in tripod position
epiglottitis
barking or brassy cough
croup
sudden onset cough in the middle of the night, afebrile, age 1-3
acute spasmodic croup, treat by increasing humidity
MC form of croup, preceeded by viral illness, barking cough and inspiratory stridor, agitation and crying worsen the symptoms
laryngotracheitis, treat w/steroids
a bacterial superinfection after having croup
laryngotracheobronchitis, may need anbx
presents w/purulent airway secretions, no drooling or dysphagia (unlike epiglottitis), MCC staph aureus
bacterial tracheitis
croup tx
- racemic epi
- 2-3 hr observation mandatory after tx
viral disease of lower airway resulting in edema, increased mucus
bronchiolitis, caused by RSV
how to prevent RSV?
- synagis (palivizumab) in high risk infants <2 such as premies/chronic lung disease
- Tell pts to take a big bath towel and put over crib, take a cold air humidifier and let it run
infants to 3 months of age MCC of non-bacterial and bacterial pneumo
RSV
group B strep
4 month-5 year old MCC of non-bacterial and bacterial pneumo
RSV
strep pneumo
infants vs older children presentation of pneumonia?
no cough, minimal systemic signs
cough, fever
nonbacterial vs
bacterial presentation of pneumo
gradual progression of symptoms over -10 days
sudden change
how to treat mycoplasma pneumo
erythromycin (doesn’t work on cell wall)
signs of pneumo
rales (crackling) on inspiration, wheezing initially expiration, rhonchi on inspiration and expiration (coarse breath sounds)
when to do a CXR for pneumo?
if breath sounds are unequal, palpate above suprasternal notch for tracheal deviation
TB spreads to the regional lymph nodes, this is known as
primary complex, t-cells respond leading to an immunologic response
PPD >5mm
>10
>15
- immunocompromised, xray evidence of TB, close contact of known TB case
- infants and children <4 years, DM/renal/hematological diseases
- pts w/o any risk factors
how to treat TB
Latent TB you should still treat with 4 months of rifampin
INH + Rifapentin once/week for 3 months
MC complication of TB in kids
meningitis
MC chronic illness of childhood
asthma
asthma presentation
Wheeze on expiration at beginning (alveoli get smaller when you breathe out), then air trapping begins causing inspiratory and expiratory wheezing
mild intermittent asthma tx
mild persistent tx
moderate persistent
severe persistent
SABA
short burst of ICS
montelukast as young as 6
everything
rules of 2 for asthma
pts require an ICS if….
- using SABA >2x per week
- awaken at night >2x per month
- refill SABA rx more than 2x per year
what should you do is you suspect a FBA?
bronchoscopy
upper (extrathoracic) vs
lower (intrathoracic) FB presentation
inspiratory stridor
expiratory wheeze
if pt has expiratory wheezing, lesion is….
if pt has inspiratory wheezing, lesion is…
within the chest, below the vocal chords
outside of the chest, above the vocal chords
cough stimulus
can be stimulated from cough receptors in the nose, sinuses, ear canals, etc
MC lethal genetic disease of white people
cystic fibrosis, F508 deletion is MC
abnormal CFTR gene results in decreased Cl ion transport results in activation of Epitheal Na channel
hwo to dx cystic fibrosis
chloride sweat test >60 mEq
CF treatment options
- ivacaftor
- lumacaftor + ivacaftor