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252 Cards in this Set
- Front
- Back
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Tylenol and NSAID's act on the ___ pathway
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arachiodonic
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ToF: there is an advantage to alternating Advil and Tylenol between doses.
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False
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ToF: when you have an infection, the prostaglandin level goes up?
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True
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ToF: a fever is not beneficial and should be treated.
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False: it is beneficial, treated after a certain point
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ToF: treatment of fevers in infants will prevent febrile seizures.
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false
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At what temperature does WBC function reach its highest level?
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102.5
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At what temperature does the WBC function begin to fail after reaching its highest poing?
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104
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What is FUO?
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documented fever for more than 3 weeks
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For which type of seizures is the postictal period long? which are short>
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Long in generalized seizures
Short in febrile seizures |
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How many febrile seizures should occur before a referral to neurology is made?
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3
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What is the name of the disorder that can have febrile seizures to age 7
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ectodermal dysplasia
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What is the # 1 cause of headache in children?
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fever
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if a child presets with headache and fever, what must be documented in the chart?
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Must document that the neck is not stiff, that there are negative Kernig's and Bruznicks sign. Checking for meningitis
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What is the major cause of febrile seizures?
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Human herpes viruses 6 and 7 that cause roseola
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What type of work-up is done on a child under 30 days of age with fever?
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Full septic work-up
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What is involved in a full septic work-up?
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-Check for signs of meningitis
-CBC with diff, CRP, blood culture -urine culture and UA -spinal tap -CXR if respiratory symptoms |
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what is the hallmark sign of roseola?
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occipital nodes!
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What are the classic symptoms of roseola?
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high fever for 2-3 days then get a rash
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what % of children will get roseola in childhood?
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100%
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___ % of infants with fever have UTI
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7
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ToF: a child with febrile seizures will be well appearing and running around shortly after.
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true
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What is the common sign of hyperglycemia in a baby.
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Jitteriness
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What is a risk factor for febrile neutropenia?
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child on immunosuppression
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What are the examples of serious bacterial infections SBIs>
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-UTI
-Bacteremia/sepsis -pneumonia -meningitis -osteomyelitis |
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What type of fever is common in SCD kids and how are they treated?
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Febrile neutropenia and hospitalized with antibiotics
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What is the normal range of URIs that young children get per year?
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6-10
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Why should parents be told to avoid using sudafed/ cold syrup for their children with a cold?
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It can cause Stroke, tachy and HTN
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50% of URI's result from infection by the more than 100 serotypes of ___
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rhinovirus
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What is the #2 virus for bronchiolitis?
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human metapneumo virus
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What are the common agents causing URI's?
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RSV, HUMAN metapneumoviurs, coronavirus, parainflueza virus, adenovirus, enterovirus, influezna reoviruses and human bocavirus
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What environment causes the most amount of transmission of URIs?
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Daycare and Preschools
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How are URIs spread?
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by inoculation of the nose and possibly the conjuctiva. Direct inhalation of virus, from a sneeze, nasal blowing or inoculation via fingers from nasal secretions or fomites
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What causes the green mucus secretion during an URI?
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polymorphonucleocytes
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What type of cells are increased in the nasal submucoas and epithelium of children with URI?
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polymorphonuclear cells
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THe ___ activity of PMN changes the nasam mucus to green and yellow mucus is caused by the simple presence of ___
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enzymatic; PMN
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With rhinovirus there is an increase in the ___ and ___ in the nasal secretions; but there is no increase in ___
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bradykinins; albumin; histamines
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ToF: rhinovirus and coronoviruses cause destruction to the nasal epithelium.
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False
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ToF: adenovirus and influenza do have cause significant destruction on the respiratory epithelium
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False; they do cause sig destruction
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If a child has marked red ciliary injection, what 2 viruses would be considered?
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adenovirus and flu
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What is the key finding of URIs?
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prominent nasal symptoms of rhinorrhea
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About how many days of symptoms of rhinorrea does the nasal secretions thicker and more purulent leading to nasal excoriation?
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1-3
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What are the history findings of an URI?
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-Gradual onset
-prominant nasal symptoms -sore throat and dysphagia -mild cough -low-grade fever |
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ToF: URI are associated with mild injection of the conjunctiva?
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True
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ToF: adventitious breath sounds are associated with a URI
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False
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What supportive care for URIs generally should NOT be given to children under 4 and with caution under 6
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decongestants and cough medications
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What are the supportive care that can help children with URI and fever, pain and nasal congestion?
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-normal saline
-antipyretic -fluid intake -controlled trials have not found sufficient evidence to recommend zinc lozenges, vitamin C, heated humidified air |
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What type of microorganisms make up the oral cavity normal flora?
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Anaerobic and aerobic
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What do the microorganisms of the oral cavity do?
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They protect against colonization or subsequent invasion by potentially virulent organisms
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What are the two most frequently involved sinuses in URIs?
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maxillary and anterior ethmoid sinuses
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ToF: the maxillary and anterior ethmoid sinuses are not present at birth, but develop?
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False; present at birth
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When does the frontal sinus develop?
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develops at 7 years old and finishes in adolescents
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What are the key elements that keep the sinuses patent?
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-Ostia patency
-normally functioning cilia -quality of secretions |
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What is involved in rhinosinusitis?
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inflammation and secondary infection of the paranasal sinsues an the adjacent nasal mucosa
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ToF: rhinosinusitis causes facial pain, pressure and fullness lasting up to 2 weeks.
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False; up to 4 weeks!
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5-10% of URIs are complicated by ___
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rhinosinusitis
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What are the 3 general clinical presentation of rhinosinusitis?
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1. Persistence of URI symtpoms
2. Severe sinusitis 3. Worsening |
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What is involved in the persistence of URI symptoms of rhinosinusitis?
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-longer than 10 days and less than 30 without improvement
-nasal discharge -daytime cough, worse at night -variable fever -headache and facial pain |
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What are the symptoms of severe sinusitis?
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-high fever (>39 degrees)
-purulent rhinitis at the onset and lasting at least 3-4 days -may have intense headache |
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What are the symptoms of worsening sinusitis?
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-worsening on day 6-7 of a common cold which the patient develops an increase in respiratory symptoms
-nasal congestion -a new onset or recurrence of a fever |
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What are the common causes of rhinosinusitis?
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-Viral infection (40%)
-allergic and nonallergic rhinitis -anatomical problems -cigarette smoking -swimming and diving -high altitude -dental infections |
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WHat can 2 or more rhinosinusitis infections in 1 year be indicative of?
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immunodeficiency
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What are the predisposing conditions for rhinosinusitis?
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-allergies
0nasal deformitis -CF -nasal polyps -HIV |
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What are the risk factors for rhinosinusitis?
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-Reflux
-anatomical damage -irritant and allergen exposure -defects in mucocilliary function, immune deficiency -chronic infection 3 distinct syndromes: -chronic rhinosinusitis without polyps -chronic rhinosinusitis with polyps -allergic fungal rhinosinusitis |
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ToF: an acute rhinosinusitis can occur at the same time as having chronic rhinosinusitis.
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True
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what is the name of a patient that develops new symptoms of rhinosinusitis while having chronic rhinosinusitis?
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acute-on-chronic rhinosinusitis
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ToF: radiologic studies are a standard protocol in the initial management of patients suspected ABS
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False; CT abnormalities with the common cold may last up to 2 weeks after symptomatic improvement
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What are the 2 cardinal symptoms that must be present to dx rinosinusitis?
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1. purulent rhinorrhea for > 14 days
2. either facial pressure or nasal obstruction |
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what are the suggestive signs and symptoms of rhinosinusitis?
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-headache
-fever -fatigue -maxillary denatal pain, cough, decreased smell (hyposmia) -no smell (anisopia), and ear pressure or fullness |
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What is a sign of ethmoid sinusitis in children?
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periorbital cellulitis
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ToF: rhinosinusitis can cause malodorous breath or abnormal middle ear findings
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True
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What are the main organisms causing sinusitis?
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-S. pneumo (25-30)
-H. flu(25-30) -M. catarrhalis (10-15) -Sterile (25%) meaning viral |
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If no resolution after 10 days of sinusitis what type of bacteria is the likely culprit?
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anaerobic
-F. nucleatum -Prevotelia -Prophyromonas -Peptostrptococcus spp |
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What is the first line treatment for sinusitis? what are the others that can be used?
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High dose amox
-augmentum -cefpodoxime proxetil -cefuroxime axetil -if allergic to amox give a macrolide or bactrim |
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ToF: day care attendance makes children at risk for resistant bacterial infections?
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True
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failure to respond to Abx therapy within __ hours makes a child susceptible to resistant bacterial infection.
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72
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what are considered the adjuvent therapies of sinusitis?
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-antihistamines
-intranasal steroids -mucolytics -intranasal saline -decongestants |
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ToF: antihistamines should be used for atopic children.
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True
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What do topical corticosteroids do for sinusitis?
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they are intranasal and may decrease the mean symptoms inpatients with uncomplicated sinusitis
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if a decongestant is used on a child with sinusitis it should be limited to ___ days to avoid rebound __
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5; edema
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what children have been found to have moderate improvement with decongestants and sinusitis?
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adolescents
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what are the Side effects of decongestants?
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Tachycardia and HTN
in the very young ---> Stroke! |
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What are the SxS of orbital cellullitis?
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-Fever
-Lid edema/erythema -conjunctivitis -chemosis -altered acuity -proptosis -ophthalmoplegia (pain when your move the eye) -tenderness to palpation |
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what are the treatment options for orbital cellullitis?
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IV antibiotics
consult: otolaryngology and/or ophthalmology -imaging: decision to image made in collaboration with consulting specialist, usually CT scan |
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What is the common CC of a child with orbital cellullitis?
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inability to move the eye
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what are the SxS of orbital Abscess?
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-same as cellullitis with proptosis and chemosis prominent features; severe impairment of vision
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what are the SxS of Cavernous sinus thrombosis and or intracranial infection, complicated from sinusitis?
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-same as orbital cellullitis plus spiking fevers, cranial neuropathy, mental status change
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What is the name of the sinusitis complication that has a +/- globe displacement laterally or superiorly?
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subperiosteal abscess
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ToF: school aged children have the highest incidence of epistaxis?
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false: adolescents
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epistaxis is higher for families living in __ climated or during the __ months
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dry; winter
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what is the number 1 cause of epistaxis?
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nose picking
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95% of all nose bleeds in children occur at ...
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anterior portion of the septum called kiesselbach's area
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where does the blood from kiesselbach's area come from?
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external carotid through the external maxillary artery
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Which population often gets posterior nosebleeds?
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adult
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ToF: nasal sprays have been found to be addicting
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true
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Neo-Synephrine on a cotton swab has been found to decrease __ __
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nose bleeds
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ToF: children with frequent nose bleeds may have tarry stools
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true from swallowing the blood
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What is the most common blood clotting disorder?
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Van Willabrends; will have an abnormal Prothrombin TIme
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what lab tests do you want to get on a child with frequent nose bleeds?
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CBC with diff and PT and PTT
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ToF: once a child's nose has stopped bleeding from an nose bleed event, you want to be sure to have them blow their nose in order to expel any excess blood.
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False! do want to them to blow out the clot
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What signs indicate a posterior nose bleed?
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bilateral epistaxis, blood in the oropharynx difficult to control bleeding
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What is the management of a nose bleed?
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-have kid sit upright and lean forward to prevent swallowing
-apply direct pressure to the at the nasal ala (pinch the nares together at the bony structure) for 5-15 mintues |
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What type of air is good to use at home and in the hospital to prevent nose bleeds?
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humidified and moistened air
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What is Rita's favorite product to stop nose bleeds?
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Nasal QR
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What can be used to help prevent nose bleeds?
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nasal saline nose sprays
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After a nose bleed, you should apply a topical antibiotic to the site of the septal scab for __ to __ days to keep moist, reduce itching and assist healing.
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5-7
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What does nosebleed QR do to stop the bleed?
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It forms an artificial scab when it comes in contact with blood
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ToF: NPs should use silver nitrate sticks on nosebleeds that have not stopped bleeding because they can cauterize the exposed vessels
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FALSE!! only ENTs do this
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What is the number 1 sign of nasal foreign body? What are the less commonly reported symptoms?
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persistent or recurrent unilateral purulent nasal discharge;
Foul odor, epistaxis, nasal obstruction and mouth breathing are less common |
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where do nasal foreign bodies specific embed?
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in the granulation tissue or mucosa, it may take on the appearance of a nasal mass
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What is the etiology of otitis externa?
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Frequent, prolonged H2O immersion (swimmer's ear), trauma, unerlying dermatitis; eczema
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What exactly does swimming do that causes otitis externa?
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it changes the pH in the canal and can alternate the epithelial lining
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What are the pathogens that are commonly linked to otitis externa?
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pseudomonas and staph aureaus
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what are the physical assessment finding of otitis externa?
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-ear pain
-ear discharge (otorrhea) -otoscopy: exudate, erythema, edema in ear CANAL |
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what is the preferred and second line treatments for otitis externa?
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antibiotic/steroid gtt:
Cortisporin is drug of choice floxin also used |
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what are the prophylactic treatments for otitis externa?
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ETOH, boric acid, acetic acid to restore pH and sterilize canal
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What must the clinician remember when prescribing antibiotic drops for otitis externa?
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must right for the suspension! not the solution, the suspension will stay in the canal and not go into the middle ear
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What is acute otitis media?
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-fluid in middle ear with s/s of infection
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what is the pathogenesis of AOM?
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E. tube occluded; fluid accumulation; infected with bacteria
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what are the common organisms responsible for AOM?
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strep. pneumo, H. flu, Moraxella
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What is the eustatian tube like under age 3
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wider, shorter and straighter
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Which populations have increased risk of AOM?
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African american, alaskan and indian
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What are the diagnostic features of AOM?
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Middle ear effusion:
-abnormal color: white, yellow, blue -opacity -decreased/absent mobility -visible fluid bubbles behind TM -Otalgia -TM appearance --redness, fullness, bulging |
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What are the 3 criteria needed for a AOM dx?
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-rapid onset
-presence of MEE -signs and symptoms of middle ear inflammation: distinct erythema and otalgia |
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What is the treatment of AOM with temp less than 39.
|
high dose amox
Alternative for pen non-type 1 allergy --Cefuroxime --Cefpodoxime if type 1 allergic rxn give azith or clarith |
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what is the treatment of AOM with temp > 39?
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augmentum with amox at 90mg/kg/day and with 6.4 mg/kg/day clavulanate
ceftriaxone 1 or 3 days. But only if the child is vomiting! really hurts! |
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what are the mainstay drugs to give for pain associated with AOM?
|
-acetaminophen
-ibuprofen -topical acetaminophen for >5 yrs |
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what are the anticipatory guidance factors for AOM?
|
-reasons for using abx
-adhering to regimen -household smoking -avoiding large group day care |
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What are the recommendations for feeding position with OM?
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-semi-upright position for feeding
-angled-neck bottles -no propping of bottle -upright position for 15 mins pc |
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___ is an inflammation fo the mucosa lining the structure of the throat including the tonsils, pharynx, uvula, soft palate and nasopharynx
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pharyngitis
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What is the name of the pharyngitis without nasal symptoms
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plain pharyngitis or tonsillopharyngitis
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What is the classic sign of pharyngoconjunctival fever?
|
preauricular nodes
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what is the clinical presentation of HSV induced pharyngitis?
|
gingivitis and anterior tongue ulcers
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coxsackie virus has what pharyngitis symptoms?
|
back of mouth ulcers on tonsillor pillars
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which pharyngitis virus can lead to hemorrhagic conjunctivitis?
|
adenovirus
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What age group do you see children in urban areas getting mono? what are the organisms? which is worse
|
preschool children
either CMV or EBV CMV is worse |
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what is the pharyngitis clinical manifestation of GAS?
|
scarlet fever
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what pharyngitis causing bacteria has clinical presentation in adolescents that mimics scarlet fever
|
arcanobacterium haemolyticum: cases scarletinotform rash
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What are the key symptoms pointing to GAS?
|
-Fever
-no cough -swollen, tender anterior cervical lymph nodes -tonsillar enlargement with exudate -stomach pain -vomiting -actue onset |
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if a child presents with symptoms similar to GAS, but has a persistent cough, what is the cause? which groups have more severe symptoms?
|
Mycoplasma; adolescents have more severe case
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which virus leading to pharyngitis causes vesicles or ulcers on the tonsillar pillars and posterior fauces; coryza, vomiting or diarrhea.
|
Enterovirus
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What pharyngitis symptoms are seen with EBV infection?
|
-edxudate on the tonsils,
-soft palate petechiae -diffuse adenopathy |
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How long should you wait from the start of symptoms to conduct an EBV antibody titer and why?
|
1 week, it takes that long to take effect
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What are 2 disorders that are rarely indicated for tonsillectomy?
|
OSA
airway or digestive tract obstruction |
|
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What are group does strep pharyngitis most effect?
|
5-15
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What is Group A beta-hemolytic Strep?
|
Tonsillopharyngitis: 35% contagious, shorten duration, signs, symptoms and period of contagion.
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ToF: a child on antibiotics for GABHS should be out of school for 3 days of after the start of abx?
|
false; not contagious after 24hours of abx
|
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What disorder is characterized by tonsillopharyngeal exudate that is yellow, blood tinged and accompanied by bad breath?
|
GABHS
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does GABHS have a rash? what is it like?
|
Yes, scarlatiniform with strawberry tongue.
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what are the differential dx for GABHS?
|
viral: other bacteria
adolescents: N. gonorrheaa or mono |
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What are the complications of GABHS that are trying to be prevented with abx?
|
-Rheumatic fever
-post strep glomerularnephritis |
|
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What are the 3 recommended abx for GABHS
|
-PVK for 10 days
-Amox for 10 days (more palatable) -Benzanthine Pen G IM: the more you give the more chance for increase allergic rxn |
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What is the likely cause of continued symptoms of GABHS with abx therapy?
|
actual treatment failure or the child may have a new infection with a different serologic type of strep
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which abx therapy for GABHS is recommended if there is noncompliance to medication?
|
Benzanthine penicillin is recommended IM
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What things in the household should be cleaned or discarded following a GABHS infection?
|
toothbrushes, bathroom cups, orthodontic devices
|
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What does erythema marginatum cause?
|
rare presentatio of rheumatic fever causing a wiggly worm rash
|
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What lab value will be high for 6 months to 1 year following acute rheumatic fever?
|
ASO
|
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WHat are the major criteria for acute rheumatic fever?
|
-carditis
-polyarthritis -chorea -erythema marginatum -subcutaneous nodules -new onset murmur |
|
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ToF: in acute rheumatic fever the ASO and DNA B tests will be normal?
|
false, they will be elevated
|
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What are the tonsillectomy guidelines in terms of number of infections needed to be indicated?
|
7 episodes in the past year or 5 episodes per year for 2 years or at least 3 episodes per year for the past 3 years with documentation of sore throat
|
|
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What are the modifying factors under guideline 3 for a tonsillectomy?
|
-Abx allergy/intolerance
-periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) -history of peritonsillar abscess (just one episode!) |
|
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What do guidelines 4-6 concern for a tonsillectomy indication?
|
Sleep disordered breathing
improve health with abnormal sleep study sleep disordered breathing may reoccur even after tonsillectomy |
|
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ToF: hypertrophic tonsils contribute to SDB
|
true
|
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Tonsillectomy only resolves SDB in __ to __ % of obese children and may not be ___
|
10-25; curative
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What are the 2011 guidelines for tonsillectomy in terms of steroids?
|
give intraoperative steroids (dexamthasone) to decrease time to resume oral liquids and decrease throat pain
|
|
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ToF: perioperative abx are given to children having tonsillectomies to prevent infection
|
false: not needed
|
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What is the most critical aspect of post tonsillectomy management
|
pain management
|
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Most aspirated material into the lung is immediately expelled with __
|
coughing
|
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What is the tale-tell sign of FB aspiration?
|
onset of sudden episode of coughing without a prodrome or signs of respiratory infection
|
|
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What are the physical exam findings of foreign body in the lung?
|
-Hemoptysis
-unequal breath sounds -dyspnea, wheezing and cyanosis |
|
|
what are the diagnostic tests for a foreign body in the lungs?
|
-expiratory and lateral decubitius chest radiograph
-bronchoscopy or direct laryngoscopy; presence of foreign body |
|
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Radiograph of a suspected foreign body in the lungs may not reaveal a FB but shows local ___, and area that does not inflate or deflate- suspect __ __
|
emphysema; FB aspiration
|
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What is the organism that causes pertussis?
|
bordetella pertussis
|
|
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How long does the classic cough of pertussis last?
|
6-10 weeks, but in 50% of patients last longer than 10 weeks
|
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ToF: pertussis is limited to the very young
|
false: 72-100% of adolescent cases with post tussive vomiting noted in 5- to 70% of adolescent cases
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What are the lab values that change with pertussis?
|
increase in WBC and a shift to the left
|
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What is the treatment for pertussis? what is unique about this treatment?
|
macrolide: azithromycin. Only shortens the contagiability. NOT THE COURSE OF THE DISEASE
|
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What are the specific findings of infants younger than 6 months old with pertussis?
|
-apnea
-NO inspiratory whoop -severe pneumonia and pulmonary hypertension is common |
|
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What are the findings in older children with pertussis?
|
-persistent, irritating, nonproductive cough that may last for months; resembles a prolonged bronchitic illness
-may also have severe paroxysms of coughing but generlly no whopping sound -low grade fever |
|
|
what are some of the ways in which a culture for pertussis could be negative even when they have the illness?
|
-the person has been sick for 3 weeks or more
-previously been vaccinated -if antibiotics have been started. The organism is found most frequently during the catarrhal or early paroxysmal stage |
|
|
What can be used to test for pertussis if the culture comes back negative?
|
PCR
|
|
|
ToF: erythromycin can be a form of tx for pertussis for children under 1 month
|
false; not under 1 month
|
|
|
ToF: corticosteroids, albuterol and other beta 2s can be used for pertussis adjunctive therapy
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False! none should be used
|
|
|
ToF: chemoprophylaxis is given to all members of the household of children with pertussis using azithromycin as first line.
|
True: but erythromycin in young children
|
|
|
When should chemoprophylaxis be started after exposure to pertussis?
|
immediately
|
|
|
What is involved in croup?
|
swelling and erythema of the lateral walls of trachea below the vocal cords in an area called the subglottis
|
|
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What is the result of croup?
|
rapid, acute, upper airway obstruction of varying degress at the larynx
|
|
|
What are the characteristics of croup
|
harsh, barking cough and inspiratory stridor
|
|
|
What are the 2 main viruses that can cause croup
|
metapneumovirus and RSV
|
|
|
if staph is the cause of croup, what are the characteristics
|
exudate on the trachea and lower airways
|
|
|
what is another name for bacterial croup?
|
bacterial tracheitis
|
|
|
What is the most common viral agent causing croup?
|
parainfluenza type 1, occurs in the fall and spring
|
|
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which virus is associated with severe croup?
|
parainfluenza type 3
|
|
|
which sex has a greater incidence of croup>
|
males
|
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viral croup is most common in children between __ and ___ months old (60 % are young than 24 months) and occurs most often in the __ season of the year.
|
6-36; cold
|
|
|
ToF: croup is a rapid onset of symptoms
|
false: gradual
|
|
|
what does Laryngotracheitis look like on an xray
|
steeple sign
|
|
|
How long does croup tend to last?
|
about 5 days
|
|
|
ToF: most children with croup are admitted
|
false; they get dexamethasone and are sent home after observations
|
|
|
When are the symptoms of croup worse, day or night>
|
night
|
|
|
How does the epiglottis appear with laryngotracheitits?
|
normal
|
|
|
Are fevers associated with croup?
|
yes low grade
|
|
|
where do retractions occur with croup?
|
substernal and chest wall
|
|
|
How is croup measured?
|
croup score based on LOC, cyanosis, stridor, air entry and retractions. the higher the number the worse the croup
|
|
|
What are the differential dx to croup?
|
-epiglottis
-bacterial tracheitis -foreign body -abcesses --peritonsilor --retroparyngeal -smoke inhalation |
|
|
ToF: humidified air has been found to improve the croup scores of children with mild to moderate croup
|
false
|
|
|
What type of air is helpful in croup?
|
cold air
|
|
|
What are the nebulizers used for croup?
|
-raecemic epinephrine
-corticosteroids |
|
|
why are corticosteroids used in croup?
|
-decrease inflammation and cell damage without prolonging the viral shedding duration
-can be oral, IM or nebulized |
|
|
ToF: antibiotics are commonly prescribed in croup
|
false
|
|
|
ToF: cold medications have been found to help with croup
|
false
|
|
|
what type of O2 support is used in croup?
|
Blow by O2 if O2 sat falls below 92%
|
|
|
What is heliox? when is it used?
|
used in severe croup and is a helium-O2 mixture
|
|
|
what are the indications for hospitalization with croup?
|
-epiglottitis
-cyanosis -pallor -altered LOC -progressive stridor -restlessness -Toxic appearance |
|
|
what is spasmotic croup?
|
-recurrent episodes of acute LTB
-etiolgoci agents are similar to those in Laryngotracheitis -minimal coryza and acute onset of nightime croup in well child or with mild symptoms -no fever, pharyngitis or epiglottitis -episode is milder -responds well to cold air |
|
|
ToF; spasmodic croup responds to cold air
|
true
|
|
|
What season does bronchiolitis predominate?
|
Winter! october to april
|
|
|
what is the most common lower respiratory tract infection in children less than 2?
|
Bronchiolitis cause by RSV
|
|
|
what are the other organisms to cause bronchiolitis other than RSV?
|
-adenovirus
-human metapneumovirus -influenza -parainfluenza |
|
|
what are the risk factors for severe case of bronchiolitis?
|
-age < 12 weeks (apnea)
-prematurity -cardiopulmonary disease -immune deficiency -smoke exposure -day care attendance -older child in home |
|
|
what is the pathophysiology of bronchiolitis?
|
acute infection of the epithelia cells lining the small airways
-edema -increase mucus production -necrosis and regeneration of cells |
|
|
what is the clinical presentation of bronchiolitis?
|
-rhinitis
-cough -tachypnea -use of accessory muscles -hypoxia -variable wheezing and crackles on ausculation -tests: viral isolation, blood serology (chest xray not used often) |
|
|
what are levels A-X on the evidence in AAP guidelines?
|
A: well designed randomized clinical trials or dx studies on relevant pops
B: randomized clinical trials or dx studies with minor limitations; overwhelmingly consistent evidence from observational studies C: observational studies (case control and cohort) D: expert opinion, case reports reasoning from first principles X: exceptional situation where validating studies cannot be performed and there is clear preponderance of benefit or harm |
|
|
20% of kids with bronchiolitis will also get ___ by day 3.
|
AOM
|
|
|
ToF: chest PT is used in bronchiolitis?
|
false
|
|
|
what is synergis? how is it given?
|
prophylactic treatment to prevent RSV in the very at risk populations. Given 5 doses in 6 months between Nov and April
|
|
|
What si the earliest and most sensitive vital signs to change with RSV?
|
respiratory rate
|
|
|
what are the peak symptoms of RSV?
|
-rhinorrhea, congestion
-cough -fever ? -change in breathing -tachycardia -decreased appetite -vomiting -irritability |
|
|
List the reasons to hospitalize a child with RSV.
|
-expiratory wheezing
-tachypnea >70 -grunting, nasal flaring, retractions -moderate fever -inability to feed -hypoxemia (no cyanosis) |
|
|
What are the xray findings for bronchiolitis?
|
-hyperinflation
-areas of atelectasis -infiltrates -do not correlate with disease severity -does not guide management -may prompt use of Abx when not needed |
|
|
what is the management of RSV?
|
-O2 and Hydrations
-bronchodilators -epinephrine -steroids -riboviran (last measure; only those at high risk of the disease) -prevention: synagis IM (at risk infants under 2 years ) |
|
|
ToF: infants born before 32 weeks usually do not benefit from synagis unless they have CLD
|
false they do benefit even without CLD
|
|
|
how long to infants born at 28 weeks or ealier benefit from synagis?
|
up to 12 months of life
|
|
|
how long do infants born between 28 and 32 weeks benefit from synagis?
|
up to 6 months
|
|
|
for children born 32-35 weeks during RSV season, what can they get to help protect them?
|
max of 3 doses of synagis until they reach 9 days
|
|
|
which infants are eligible for 3 doses of synagis?
|
preemie infants with GA of 32 weeks 0 days to 34 weeks and 6 days with at least 1 risk factor born 3 months before or during RSV season
|
|
|
which groups of infants are eligible for 5 doses of synagis?
|
-infants with CLD less than 24 months requiring medical therapy
-premature infants born at < or = 31 weeks and 6 days -certina infants with neuromuscular disease or congenital anomalies of the airways |
|
|
what is the transmission of TB?
|
respiratory
|
|
|
what is latent TB infection?
|
positive TST, no physical finding and normal chest
|
|
|
what is the disease of TB
|
infection in which symptoms, signs or radiographic manifestation caused by M tuberculosis complex are apparent: pulmonary or extra-pulmonary or both
|
|
|
who is at risk for TB?
|
infants and post pubertal teens
|
|
|
ToF; children with TB are infectious?
|
false: adults are
|
|
|
What are the TB signs and symptoms?
|
-asymptomatic
-lymphadenopathy -cough -weight loss -night sweats |
|
|
who are the individuals needing an immediate TST?
|
-contacts of confirmed or suspected contagious TB
-radiogarphic or clinical findings -immigrating or traveling from countries that are endemic |
|
|
what are you looking for on a PPD?
|
induration
|
|
|
who are the groups that would be PPD + if a degree of induration at > 5mm but less than 10
|
-HIV +, household contacts, suspicion of TB
|
|
|
a child greater than 4 years old needs a ppd with ___ mm of induration to be considered + result
|
15
|
|
|
what is the incubation period of infection to positive PPD for TB?
|
2-10 weeks
|
|
|
which is preferred for TB testing for patients under 5 years; TST or IGRA?
|
TST, but IGRA can be used under 5 years
|
|
|
What is the preferred testing to TB over 5 years of age?
|
IGRA, but TST acceptable in children > 5 who have recived BCG vaccine and children >/= 5 who are unlikely to return for TST reading
|
|
|
according to the red book, when are TST and IGRA both used?
|
-the initial and repeat IGRA are indeterminate
-the initial test (TST or IGRA) is negative and: there is moderate to high clinical suspision, risk of pregression and poor outcome is high |
|
|
what are the treatment options for TB?
|
INH, rifampin, macrolides if atypical. usually 6-9 months of therapy
|
|
|
if a child or adult has a resistant form of TB what is the abx therapy?
|
combination of 4 drugs and 2 should include and injectable aminoglycoside and floroquinoline
|
