問題一覧
1
Age range of epiglottitis
2-7 years old
2
Epiglottitis onset is
Rapid and toxic
3
Epiglottitis site
Supraglottis
4
Infection of all the tissues above the glottis, epiglottis, aryepiglottic folds, and arytenoid cartlages
Epiglottitis
5
Epiglottitis clinical manifestations
high fever, severe sore throat , drooling, dysphagia , minimal nonbarking cough, muffled voice, tripod position, AIR RAID
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Endoscopic finding in epiglottitis
Cherry red (H. influenzae) or pale and edematous epiglottis
7
Diagnosis of epiglottitis requires direct visualization
True
8
xray sign in epiglottitis
Thumb sign
9
Epiglottitis Management
No procedures until airway established because they can precipitate complete airway obstruction
10
Management of epiglottitis
Artificial airway placed under a controlled condition , IV antibiotics of 3rd Gen cephalosporin for 7-10 days, For prophylaxis, give Rifampicin, Average days of intubation: 1-3 days
11
The pathognomonic of this disease has an adherent grayish white membrane which bleeds on attempted removal
Diphtheria
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Clinical manifestations of diphtheria
Fever, Sore throat , Fetor Oris, Cervical LAD, bull neck appearance
13
Diphtheria site
tonsils, pharynx, larynx, skin, nose
14
Diphtheria affects all ages and its onset is insidious and it follows after a bout of LTB
True
15
Diphtheria management
Diphtheria antitoxin, IV penicillin or erythromycin for 14days, Penicillin or erythromycin for prophylaxis, For prevention: Diphtheria toxoid contaning vaccine for those not given in the preceding 5 years
16
This disease has a pathophysiology of: lymphatic spread of infection - most common, penetrating trauma to the oropharynx, dental infection, vertebral osteomyelitis
Retrophayngeal abscess
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Stages of retropharyngeal abcess
Cellulitis, phlegmon, abscess
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Retropharyngeal Abscess clinical manifestations
•age range: 3-4 years old since (not common after 5 yo), Gradual onset, nonspecific - fever, sore throat, neck pain and stiffness, dysphagia, drooling, retropharyngeal bulge
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the definitive diagnosis of retropharyngeal abscess
I and D of the affected node with culture
20
The xray of retropharyngeal abscess has
increased width or air fluid level in retropharyngeal space
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Complications of retropharyngeal abscess
Aspiration pneumonia, thrombophlebitis, Lemierre disease
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Retropharyngeal abscess management
IV antibiotics +/- surgical drainage, 3rd Gen Cephalosporin combined with Ampi-Sul or Clindamycin, Consider surgery for • Respiratory distress • Failure to respond to IV antibiotics
23
Most common deep-space head and neck infection (adults and children)
PERITONSILLAR ABSCESS (QUINSY)
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Etiology: • mixed flora - S. viridans and pyogenes, anaerobes
Peritonsillar Abscess (Quinsy)
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Clinical manifestations of peritonsillar abscess:
Age range: older children Mean: 12 years old • Onset: follows as complication acute tonsillitis • ATP become more febrile and ill with severe sore throat, neck pain, dysphagia, trismus
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Peritonsilar Abscess (Quinsy) Management:
IV antibiotics (Penicillin) with ANAEROBIC coverage, Surgery: • Needle aspiration • land D • Tonsillectomy for failure to improve after 24hr antibiotics and needle aspiration, has recurrent tonsillitis, peritonsillar abscess, (+) complications - aspiration pneumonitis
27
Bronchiolitis Risk Factos
Male gender, Never breastfed , Living in crowded condition, Mothers who smoked during pregnancy
28
Pathogenesis of bronchiolitis
RSV, Antibodies do not protect the child against RSV infection, Spread by contact of the oral or nasal mucosa with secretions in the respiratory tract
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Bronchiolitis pathophysiology
bronchiolar obstruction with edema and cellular debris, atelectasis, V/Q mismatch
30
How to diagnose bronchiolitis
Clinically Diagnosed, CBC (moderate lymphocytosis), Immunofluorescent antibody staining (RSV or adenovirus can be identified in nasopharyngeal secretions), Chest Xray (PA- lat), Viral Culture or RT PCR
31
Bronchiolitis management
Supportive, Fluid and hydration - breastfeeding, 02 - AAP recommendation O2sats <90%, Nebulized Epinephrine, Ribavirin for high risk patients in confirmed RSV
32
In bronchiolitis management, the following should be the set up in mechanical ventilation:
Low ventilator rates (IMV, 6 to 12 breaths/min), low CPAP (2 to 6 cm H,O), long expiratory times, high oxygen concentrations (more than 50%)
33
Indications for mechanical ventilation in infants with bronchiolitis:
PaCo2 >55 mmg, Pa02 <70 mmHg with 02 of 60% and above, Life threatening apnea
34
Bronchiolitis Clinical Manifestation:
A viral URTI prodome followed by increased respiratory effort and wheezing in children <2yo, Expiratory wheezing-critical airway obstruction, previously healthy infant presenting with a 1st-time wheezing episode during a community outbreak.
35
-Syndrome with cough as a prominent symptoms (2-3 weeks) -Nonspecific bronchial inflammation often following a viral infection
Bronchitis
36
Bronchitis is:
Usually viral in origin: influenza
37
Bronchitis pathophysiology
Tracheobronchial epithelium is invaded by the infectious agent, leads to activation of inflammatory cells and release of cytokines, Inflammation of the large and medium-sized airways of the lungs
38
Clinical manifestation of bronchitis
Cough is prominent followed by constitutional symptoms (fever and malaise), Protracted cough may last 1-3 weeks, Nonspecific URTI (rhinitis)→frequent, dry, hacking cough, Sputum becomes purulent due to leukocyte migration , Chest pain
39
Early signs of bronchitis
no or low-grade fever, upper respiratory signs - nasopharyngitis, conjunctivitis, rhinitis, clear BS
40
Later findings of bronchitis:
coarse and fine crackles, scattered high-pitched wheezing
41
In line with the diagnosis of bronchitis:
Mainly clinical, Rule out pneumonia: (-)tachycardia, tachypnea, Chest Xray
42
Bronchitis is self-limited and no antibiotics if Viral
True
43
Bronchitis management
1. Rest and increase oral fluid intake, 2.Humidifiers - shorten course, 3.Non-Rx cough and cold meds should not be used in <2yo, and cautioned in 2- 11 yo, 4.Dextromethorphan - antitussive, for dry cough >4yo., 5. Paracetamol, ibuprofen - for fever/pain
44
Characteristics of Asthma
airway obstruction that is reversible, airway inflammation, increased airway responsiveness to a variety of stimuli, Heterogeneous disease with chronic airway inflammation
45
Asthma etiology
triggered by exercise, allergen exposure, changes in weather, viral infection
46
Asthma clinical manifestations
• More than one symptom (wheeze, shortness of breath, cough, chest tightness) • often worse at night or in the early morning • vary over time and in intensity • triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter, or irritants
47
Diagnosis of Asthma in 5yo
1. Symptom patterns (wheeze, cough, breathlessness [activity limitation]) triggered by exercise, laughing, crying or exposure to smoke + nocturnal awakening/ symptoms 2. Past History (Atopic dermatitis, allergic rhinitis) or FMHx (asthma in 1st degree relatives) 3. Therapeutic trial with ICS and prn SABA (clinical improvement during 2-3 mos of controller treatment and worsening when treatment is stopped)
48
select all that applies for asthma management
Dilate the bronchi and bronchiole and to prevent hypoxemia., The severity of the asthmatic attack and the response to therapy are assessed by the use of a clinical exam, spirometry, and arterial blood gas analysis, The Pa02 is decreased early in an asthmatic attack, The PaCO2 reflects the severity of the asthmatic attack
49
Community Acquired Pneumonia clinical manifestations
Tachypnea - most consistent manifestations, Increased work of breathing, Auscultations: crackles, wheezing, rhonchi, decreased breath sounds, abdominal pain in lower lobe pneumonia
50
Community Acquired Pneumonia can be diagnosed by CBC and CXR, but what is the definitive diagnosis?
isolation of organism from the blood (10%), pleural fluid, lung
51
If pneumonia is nonsevere, what should be the management?
Drug of choice: Amoxicillin, OPD (5 - 7 days)
52
If pnemonia is severe, management should be:
Penicillin G • fully immunized against Hemophilus Influenza, Ampicillin • Not fully immunized
53
Prevention for CAP
Vaccinations: Influenza, PCV 13 or 15
54
inflammation of the pleura
pleurisy
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most common cause of pleural effusion in children
Bacterial pneumonia
56
Pathophysiology: Pleurisy, Pleural Effusions, Empyema • 3 process:
dry/plastic pleurisy (pleural effusion), Serobrinous/ Serosanguineous (pleural effusion), Purulent pleurisy (empyema) 1. Exudative 2. Fibrinopurulent 3. Organizing
57
Dignosis of Pleurisy, Pleural Effusions, Empyema
• CRXand lateral decubitus • Ultrasound - markings, quantification, identify septations, differentiate mass vs fluid • CT scan - helpful in assessing pulmonary abscess, surgical planning • Thoracentesis- diagnostic and therapeutic • Empyema • pH <7.2 • low glucose • (+) Gram stain • WBC >100,000 neutrophils
58
Pleurisy, Pleural Effusions, Empyema Management:
IV antibiotics - 1-4 weeks, thoracentesis, Chest Tube drainage with fibrinolytic agents, If still with no improvement - VATS, If no improvement on VATS - open thoracotomy and decortication
59
accumulation of extrapulmonary air within the chest, most commonly from leakage of air from within the lung
Pneumothorax
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Under pneumothorax: - without trauma or underlying lung disease - males who are tall, thin, and thought to have subpleural blebs.
Primary spontaneous pneumothorax
61
Under pneumothorax: occur during mechanical or noninvasive ventilation, high-flow nasal cannula therapy, acupuncture, and other diagnostic or therapeutic procedures.
Iatrogenic pneumothorax
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Pneumothorax- related to menses, is associated with diaphragmatic defects and pleural blebs.
Catamenial pneumothorax
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Pneumothorax clinical manifestations
abrupt, dyspnea, pain, cyanosis
64
Pneumothorax diagnosis
•CXR with Expiratory View
65
Pneumothorax management
Small (<5%) or even moderate-sized pneumothorax • 100% oxygen >5% collapse • Needle Aspiration and chest tube drainage is necessary.