Pediatrics
PPT
Terms
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- What are 2 categories of bacterial infections?
- Pneumonia, pertussis
- What are the most common bacterial agents that cause pneumonia in kids?
- S. pneumoniae H. influenzae C. pneumoniae M. pneumoniae Pseudomonas
- What is a common viral infection in children?
- Bronchiolitis
- What 4 other disease fall in the category of bronchiolitis?
- RSV Croup/Parainfluenzae Adenovirus Influenza
- What is the main cause of pneumonia?
- Viral
- What are 5 common pediatric pulmonary problems?
- Asthma CF Foreign body aspiration Obstructive sleep apnea Premature lung disease
- What is the single best way to protect both yourself and your child from getting sick?
- hand washing
- Many newborn infections are transmitted by the ____ in a process called _____ transmission
- mother/vertical
- What are the most common causes of CAP in children from birth to 20 days old?
- Escherichia coli Group B streptococci Listeria monocytogenes
- What are the most common causes of CAP in children age 3 weeks to 3 months?
- Bacteria- Chlamydia trachomatis S. pneumoniae Viruses- Adenovirus Influenza virus Parainfluenza virus 1, 2, and 3 Respiratory syncytial virus
- What are the most common causes of CAP in children age 4 months to 5 years
- Bacteria- Chlamydia pneumoniae Mycoplasma pneumoniae S. pneumoniae Viruses- Adenovirus Influenza virus Parainfluenza virus Rhinovirus
- What are the most common causes of CAP in children age 5 years to adolescence?
- C. pneumoniae M. pneumoniae S. pneumoniae
- What are the symptoms of community acquired pneumonia?
- worsening productive cough, SOB, chest pain, fever, sweats/shaking chills/"rigor". May begin suddenly.
- CAP is most often in what age group?
- <2 and >65
- What bug most frequently causes CAP?
- S. pneumoniae (50% of cases)
- What are the symptoms of atypical pneumonia (walking pneumonia)?
- Low-grade fever, non-productive cough, insidious onset. May see myalgias, fatigue, skin rash
- What bugs most commonly cause walking pneumonia?
- Mycoplasma & chlamydophila
- What are the symptoms of nosocomial (hospital acquired) pneumonia?
- Be suspicious if new fever develops with or without cough
- What bug most commonly causes nosocomial pneumonia?
- Pseudomonas
- Why are we seeing an increase in atypical or walking pneumonias?
- Because of prevnar or pneumovax, there is less strep pneumo going around, which increases the prevalence of atypical pneumonia.
- What will you see on the PE for a child with pneumonia?
- Altered/decreased breath sounds, +/- crackles (rales), bronchial breath sounds
- What lab tests should you order to test for pneumonia?
- WBC (CBC), CRP, No sputum culture, consider viral or FA panel
- What will CBC values show?
- WBC may be elevated, with potential left shift
- What will CRP values show?
- elevation
- What imaging should you order?
- CXR
- What will CXR show for CAP?
- lobar consolidation +/- effusion in CAP
- What will CXR show for atypical?
- segmental/unilateral/lower lobe more common in mycoplasma.
- What will CXR show for viral pneumonia?
- Streaky/patchy pattern more common in viral
- Why should you not do a sputum culture in kids?
- Kids have so much oral bacteria that it can skew the results
- What bug is a gram positive diplococci?
- Streptococcus Pneumoniae
- How many different serotypes does strep pneumo have?
- 90
- How is strep pneumo transmitted?
- Through the air from respiratory droplets
- What are the most common seasons for strep pneumo?
- winter & early spring
- What is the incubation period for strep pneumo?
- 1-3 days
- What are the vaccines that are available to treat strep pneumo?
- Prevnar, pneumovax
- How many strains does prevnar cover vs. pneumovax?
- 13/20
- Who is eligible for pneumovax?
- Kids with chronic illnesses- this one is better, but you have to be indicated for it
- What diseases is strep pneumo associated with?
- meningitis, pneumonia, OM, sinusitis
- What is penicillin resistance for strep pneumo?
- 10-60%
- What should you treat strep pneumo with?
- can start with amox and add a clindamycin if no improvement, or can start with a macrolide (azith)
- What is a gram negative obligate intracellular bacteria?
- Chlamydia (chlamydophila) pneumoniae
- How is chlamydia pneumoniae transmitted?
- respiratory droplets
- What are symptoms of chlamydia pneumoniae infection?
- insidious onset of cough, can start with pharyngitis, may/may not have fever
- What diseases can chlamydia pneumoniae cause?
- laryngitis, OM, sinusitis
- Chlamydia is _____ to test for and can have possible ____ sequelae
- difficult/neurological
- What is a gram-negative rod/bacilli that is an obligate parasite present on mucous membranes?
- Haemophilus Influenzae
- How many known serotypes are there of haemophilus influenzae?
- 6 (a thru f)
- What type of haemophilus influenzae is associated with meningitis, pneumonia, and epiglotitis?
- Type B, encapsulated
- What is the vaccine available for h. influenzae type B?
- Hib
- What diseases are the unencapsulated h. influenzae bacteria associated with?
- OM, sinusitis, pneumonia
- What bug does not react to a gram stain?
- Mycoplasma pneumoniae
- Mycoplasma lack a cell wall and so are resistant to...
- PCNs and beta-lactams
- Mycoplasma inhibit ___ function which causes ______ ______
- ciliary/paroxsysmal cough
- What is the most common age group for mycoplasma infection?
- 5-20 yrs
- What is the treatment of choice for mycoplasma?
- Macrolides (azith)
- What is a gram-negative, rod-shaped & polar flagella bacteria?
- pseudomonas
- Pseudomonas is an ______ pathogen
- opportunistic
- Pseudomonas tends to smell...
- fruity
- How does pseudomonas resist abx?
- They have efflux pumps that "pump" out abx before they can act
- On CXR, a blurred mass with no visible heart border would indicate consolidation of what lobe?
- right middle lobe
- What is the proper pneumonia treatment for someone from birth to 20 days?
- Admit- amp and gent with or without cefotaxime (claforan)
- What is the proper pneumonia treatment for someone 3 weeks to 3 months?
- Afebrile: macrolide, amoxil/clavulanate, 3rd gen cephalosporin Febrile: admit. Macrolide + 3rd gen cephalosporin
- What is the proper pneumonia treatment for someone 4 months to adolescence?
- High dose amoxil, amoxil/clavulanate, macrolide or 3rd gen cephalosporin
- 3rd Generation cephalosporins cover what?
- gram+, gram-, and mycoplasma
- Define bronchiolitis
- The swelling/mucous buildup in the smallest airways (bronchioles), usually due to a viral infection
- What age group is bronchiolitis in?
- <2 yo
- What are the symptoms of bronchiolitis?
- nasal congestion, cough (wet), wheezing, cyanosis, decreased apetite, fever
- What is the granddaddy of all viruses?
- Respiratory synctial virus (RSV)
- What is the #1 cause of hospitalizations in children <1 year
- RSV
- T/F: almost all children will be infected with RSV by their 2nd birthday
- T
- What does RSV cause?
- A thick mucous build up in the lungs and nasal passages making air exchange difficult
- How is RSV spread?
- VERY CONTAGIOUS- spread mostly through hand contact, exposure to other children.
- Who is more susceptible to RSV?
- males, those who are not breastfed, and those living in crowded conditions
- What is the biology of RSV?
- negative-sense, enveloped RNA virus
- What is the contagious period for RSV?
- 3-8 days, but as long as 4 weeks- can live on desk surfaces for hours
- What is the seasonal cycle for RSV?
- ramps up mid-october, hits the peak in dec-jan, then tapers down and is gone by mid-april
- What will a baby with RSV look like?
- Skin retraction sucking into chest Wet cough Wheezing Not eating Apnea spells
- What diagnostic tests are available for RSV?
- Nasal rinse for antigen detection, +/- cell culture in young kids, PCR assays (esp for older kids), typically no other labs
- What will CXR imaging show for RSV?
- scattered areas of atelectasis/mucus plugging/inflammation "c/w bronchiolitis"
- When would a chest x-ray be indicated?
- If you are also worried about pneumonia
- What is treatment for RSV?
- Tylenol, saline/bulb suction, etc
- There is a potential link between RSV and ...
- asthma
- In more severe cases, treatment is:
- oxygen, apnea monitoring, IVF, mechanical ventilation, +/- bronchodilators, steroids (unknown effects)
- What are ways to prevent the spread of RSV?
- handwashing wipe down surfaces cover nose/mouth when sneezing try to avoid childcare in the winter avoid kissing the child avoid sharing items avoid exposure to congested areas/children breastfeed
- A very expensive RSV preventive medicine is...
- Palivizumab (synagis)
- What are the 2 factors that a child <2 must meet to qualify for synagis (never given to kids >2)?
- 1. some kind of hemodynamically significant disease 2. premature birth
- What are risk factors for RSV?
- prematurity, congenital HD, chronic lung disease, neuro disease, daycare attendance, exposure to smoke or poor air quality, older school-age kids
- What is the presentation of croup?
- Mild URI that leads to barking cough (seal bark), stridor- caused by swelling around the vocal cords and windpipe
- More severe cases of croup can include...
- retractions, cyanosis, air hunger
- What causes croup?
- Mainly human parainfluenza virus (type-1 and less often type 2). Type 3 associated with bronchiolitis/pneumonia. Others- adenovirus, RSV, Influenza
- What is the most common age group for croup?
- children between 3 months and 5 years old (severe cases mostly in kids <3)
- What is the seasonal progression of croup?
- begins during the last week of august, and ends in mid-late december
- Type 1 parainfluenza causes ____, type 3 causes ____.
- croup, pneumonia
- Type 3 pneumonia is typically during what seasons?
- spring-early summer
- What is the typical duration for croup?
- peaks 2-3 days after onset and lasts less than a week
- What lab tests would you order for croup?
- can test for antigen on nasal secretions by ordering a viral FA panel, rarely can do a lateral neck film
- What is the sign that could be present on lateral neck film?
- Steeple sign- swelling inside the larynx
- What is treatment for croup?
- Palliative therapy: Rest, Hydration, Calm your child Steroids- single dose Dexamethasone IM or oral (0.6mg/kg). Effects can last for up to 4 days. (can shorten the virus) Nebulized epinephrine- quick relief
- How can you prevent croup?
- Infection-control practices Pearl: Researchers are developing vaccines against HPIV-1 and -3 infections. Passively acquired maternal antibodies may play a role in protection from HPIV types 1 and 2 in the first few months of life, highlighting the importance of breast-feeding.
- A child with epiglottitis will present with...
- profuse drooling, respiratory distress, and fever
- Is epiglottitis a medical emergency?
- YES
- What test is used to confirm epiglottitis?
- Lateral neck x-ray
- Why should you not instrument an airway in a potential epiglottitis case?
- It may cause spasm and throat closing
- What is the primary causative agent for epiglottitis?
- H. Flu type b (prevented by the Hib vaccine)
- What is the most common cause of the common cold?
- Picornaviruses (200+ can cause it)
- What are other examples of viruses that cause colds?
- (rhinovirus- 100 serotypes) and coronaviruses, Also- parainfluenza virus, RSV, Adenovirus and Influenza.
- What are symptoms of a cold?
- scratchy throat, runny nose/congestion, cough, HA
- How long does a cold typically last?
- 1-2 weeks
- The common cold typically occurs in what seasons?
- usually fall/winter
- How may colds do adults get? Children? Children in daycare?
- 2-3/yr 6-10/yr Up to 14/yr
- What is treatment for the common cold?
- palliative: saline for the nose, steamy bathroom, elevate mattress, fluids, tylenol PRN, OTC not recommended for children <6 yo
- What is prevention for a cold?
- Hand washing, perhaps zinc, echinacea, vit C
- When is influenza season?
- Begins in late winter
- How is flu spread?
- coughing/sneezing
- What is the hallmark for the fl?
- Sudden onset with high fever
- What are the symptoms of the flu?
- Sudden onset high fever (>102), fatigue, HA, sore throat, runny nose, body aches +/- diarrhea and vomiting
- What labs should be ordered for flu?
- Rapid flu test (for A & B), or viral FA panel
- What is the flu shot?
- IM. Inactivated virus. Covers type A and B strains AND H1N1- ideally the ones that will be prevalent each winter. Indicated for people 6mos and up. Contraindicated in egg allergy.
- What is fluMist?
- live attenuated vaccine (type A&B&H1N1). Nasal spray. Indicated for people 2-49yrs without asthma. Contraindicated in people who have had allergic rxn to eggs, gentamycin, gelatin and those who are using aspirin therapy.
- Relenza and Tamiflu need to be started within what time frame of symptom onset?
- 48 hours
- Relenza and tamiflu work against what strains of the flu?
- A & B
- What is relenza? Who is it contraindicated in?
- Relenza is an inhaled powder-given 2 inhalations BID x 5 days / people with lung problems
- What is tamiflu?
- an oral medication (pill or liquid)