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91 Cards in this Set
- Front
- Back
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what are some common causes of OSA in peds
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enlarged tonsils
chronic snoring and congestion GERD Cleft palate/lip Downs CP Obesity |
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How can you diagnose OSA
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report from parents
snoring periods of apnea FTT change in behavior High risk Refer to ENT for eval |
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what are some early treatments of OSA before surgery
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Nasal steriods - with increased congestion or tonsils, may outgrow
treat before send to ENT - if tonsils kissing healthy will occlude when sick |
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What organisms cause tonislitis
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GABHS
Mycoplasma Penumonia Viral - Mono, adeno, HSV, HIV |
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if chronic tonsilitis what is treatment
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surgery - T and A
usually will conitnue into adulthood chronic OM or tonsilitis |
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why do you get OM with enlarged adenoids
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closs off eustachian tubes, cause fluid in ears
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what are absolute indications for surgery of tonsils
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obstruction
adenotis OSA interfere with swallowing uncontrolled hemmorhage should be severe |
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what are some possible indicatiosn for surgery of tonsils and adenoids
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presistent chronic OM with effusion
PE tubes that dont work chronic congestion |
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what is a tonsil stone
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tonsils cryptic, when swallow tonsils squeeze and stone traps
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when do you refer to ENT with strep
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6x year
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what are some common sx of strep
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absent cough
anterior cervical nodes petichae mouth tonsil exudate fever >100.4 HA Maliase exposure |
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how sensitive is the strep culture
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99%; if negative still send for culture
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what is the treatment of confirmed strep
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First line PCN - Amox
Second - Macrolides with allergy or first generation cephalosporins IM PCN with compliance issue |
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What are complications of strep
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rheumatic fever
acute pyelonephritis OM if chronic carrier refer to I and D |
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what is PANDAS
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with strep - act wierd, outburst, simular to tourettes and chorea
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What are symptoms of scarlet fever
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strawberry tongue, sandpaper rash before ST
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what is the treatment of someone who carries strep
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PCN 10 days then follow up on day 11 and recheck culture
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why would you check an ESR with strep
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to check for joint involvement
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what is the most common organism causing pharygnitis
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strep pneumoniae
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what are causes of croup - viruses
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influenza a
parainfluenza |
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what season and age is croup
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late fall and early winter time
toddlers most common |
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what are the most common symptoms of croup
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stridor - retractions
worse the first or second night then gets better subsides in 6 days |
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what symptoms occur before croup
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URI symptoms and ST before stridor low grade fever
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what will you see on xray for croup
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steeple sign
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what is the wesley croup score
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score symtpoms
LOC stridor cyanosis retractions severe>6 |
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what is the treatment for croup
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mist tent - thin secretions improve air flow
steroids - better than racemic 0.6mg/kg/day once per day for 3-5 days Racemic if severe cold air, popcycles, cold fluid |
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what are complications of croup
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bacterial super infection, blood culture septic
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what are differentals for croup
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foriegn body
abcess enlarged lymph epiglotitis - thumb sign, make sure vaccined with HIB |
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when do the vocal cords open and close and what is it controlled by
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vagus nerve
close with expiration and open with inspiration - opposite with dysfunction |
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what are causes of vocal cord dysfunction
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laryngeal hyperresponsive - irritant, frequent URI, altered autonomic balance by vagus
history of trauma or emotional abuse |
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what are common diagnoses of vocal cord dysfunction
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exercise induced asthma
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who are more commonly diagnosed with vocal cord dysfunction
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females
neonates with GERD |
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what are symptoms of vocal cord dysfunction
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sob
wheeze with exercise or emotion choking sensation does not respond to treatments like asthma, more frequent visits, no sputum symptoms go away with distraction flexion of neck helps |
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how is vocal cord dysfunction diagnosed
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fluroscopy - diagnose visually
diamond shaped- paradoxal adduction on inspiration |
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what are treatments of vocal cord dysfunction
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soft 's' sound - distraction
antacid may help speech therapy - practice when asymptomatic *cornerstone of therapy usually goes away |
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what is the first stage of pertusis
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first 1-2 weeks, like a regular cold, mild cough
highly contagious |
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what is the second stage of pertusis
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lasts 1-6 weeks, worst - whooping cough from inflammation from adhesions in endothelial cells
worse at night and worse the first 2 weeks of stage, cough so hard they vomit dry cough |
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what is the third stage of pertusis
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convelescent stage, lasts a few weeks to a few months
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what are complications of pertusis
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apnea
pneumonia seizures first or secondary bacterial pneumonia increased risk for death |
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what are some differential diagnosis for pertusis
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rsv
pneumonia viral illness |
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how is pertusis diagnosed
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nasopharyngeal culture - best in the first 2 weeks but results can take up to 2 weeks
PCR test - check antibodies its rapid serology is best if its late WBCs - lymphocytosis |
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what is the treatment for pertusis
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supportive
steroids airway management abx - decrease infection and spread anyone in close contact should be given erythromycin x 5 days droplet precautions for first 5 days of treatment then not needed |
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what medication class is the choice for pertusis
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macrolides
erythromycin |
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this is caused by infection that prevents clearing of mucous
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bronchiectisis
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the sluggish mucus of bronchietitisis is caused by what
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eosinophils build up in latent phase
increased histamines and prostaglandins build up makes mucous sluggish |
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what are you at increased risk for with bronchiectisis
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infection and remodeling
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what history is long term in bronchiectisis
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asthma
chronic croup bronchitis every year |
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what are some differentials for bronchiectisis
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history FTT, asthma, RSV, CF
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what is the work up for bronciectisis
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PFTs - asthma
CBC - anemia CMP - CF CXR - should be normal - thick bronchials looks like emphysema CT BEST - because it adds consideration to small airways GOLD standard |
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what is treatment for bronchiectisis
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move mucous out - vest therapy
continuous airway clearance |
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what are symptoms of CF
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FTT
abd pain diarrhea** chronic URI pneumonia broncheictisis nasal polyps** asthma petite pastey color decreased growth - was growing normally |
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what age is CF diagnosed
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toddlers
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how do you diagnose CF
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sweat test
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how do you treat nasal polyps
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nasal decongestant and saline, F/U in one week
refer to ENT |
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this is an IgE mediated reaction to mucosa
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allergic rhinitis
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what are common allergies
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pollen
cochroaches dust pets feather pillows mattresses |
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what are symptoms of allergic rhinitis
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itching, eyes and nose
epistaxis rhinorrhea cough ST sinus pressure |
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what are causes if they are perinneal allergies
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indoor allergies
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what are common seasonal allergies
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trees and grasses - have to grow big enough to cause allergy - if cut all the time then does not develop allergies
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what are common allergies in:
spring summer august - frost winter |
spring - grass and trees
summer - weeds august - ragweed kills at first frost winter - dust animals |
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when do indoor vs outdoor allergies usually present
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indoor - <2 years
outdoor 4 years |
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what on PE will you see with allergic rhinitis
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allergic shiners
periorbital edema transverse crease dennies lines - under eyes eyes watey Ears - effusion, incrased chronic OM, pale turbinates clear drainage Polyps RARE increased tonsils, high palate, mouth breath |
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what labs should you get with allergic rhinitis
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nasal smear - + eosinophils
CBCD - + eosinophils serum IgE - antibody to allergen is high, could be one or multiple and may be normal RAST - serum increased with food allergies scratch - allergy specific |
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what is treatment for allergic rhinitis
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ID trigger and avoidance
oral antihistamines BEST nasal steroids Nasal antihistamines Nasal decongestants - short term |
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what would you give if runny nose vs congestion and sinus ha
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runny nose - antihistamine
congestion - steriods |
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what shouldyou do if an infant is congested
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change formula
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what is PFAPA
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periodic fevers
Aphthous stomatitis, Pharyngitis, and cervical Adenitis |
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what age is PFAPA most common
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2-5 years old
> males rare in families - not genetic cease by 10 years |
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what is the cure for PFAPA
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tonsils removed
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what will you see on CBCD
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increased monocytes and eosinophils do to fever
increased sed rate and IgE because of autoimmune component |
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how is PFAPA diagnosed
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by exclusion
must rule out malignancy have normal growth and developement no symptoms between episodes |
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what are differentials for PFAPA
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fever of unknown orgin
leukemia tonsilitis pagets disease cyclic hematopoesis |
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what is the treatment for PFAPA
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tylenol or motrin for fever
3 day prednisone burst - decreased fever to 10hrs from 7 days 0.1mg/kg/day - does not prevent them rapid strep |
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this is a condition in which damage to the airways causes them to widen and become flabby and scared
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bronchiectasis
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usually caused by an infection or other condition that injures the walls of the airways or prevents the airways from clearing mucous
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bronchiectasis
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how long does it take for bronchiectisis to form
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months to years of repeat scarring, starts in childhood; if part of the lung could be a blockage
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which type of bronchiectasis affects infants and children and a result of a problem with the development of the lunch
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congenital
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which type of bronchiectasis is a result of another condition and occurs later in life
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acquired
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what diagnostic testing should be done to diagnose bronchiectasis
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PFT
pulse ox EKG CMP CXR CT chest with and without for special consideration of small airways |
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what are the 3 types of treatments for bronchiectasis
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dialation medications, steriods and life vest
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RSV is contagious for how long
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3-8 days but up to 4 weeks
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what is the gold standard for diagnosing RSV
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nasal wash for rapid and culture which takes 48 hours
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what is differentials for RSV
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common cold, flu, or bacterial
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which RSV is asymptomatic
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B
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which RSV results in bronchiolitis, pneumonia and associated with small airway obstruction
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A
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when is RSV season
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late fall to early spring
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how is RSV typically diagnosed
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history and PE, in healthy kids you do not need to differential from a common cold
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how is RSV spread
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highly contagious, through droplet
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what is the prodromal phase of RSV
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mild symptoms
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what comes after the prodromal phase of RSV
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wheeze, cough, low grade fever, UAC, flaring, hyperexpansion, hyperresonance, CXR hyperinflated and air trapping
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when do symptoms typically resolve in RSV
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5-7 days
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