Pediatric Study Notes: Viral and Bacterial Rhinosinusitis

Exam 2 Peds Study Notes

Viral Rhinosinusitis (Common Cold): Treatment involves supportive care (saline nose drops, humidifier). Common viruses include rhinovirus, influenza, parainfluenza, RSV, adeno, corona, and enteroviruses.
Bacterial Rhinosinusitis: First-line treatment is amoxicillin or amoxicillin clavulanate. Alternatives include levofloxacin or clindamycin plus cefixime if allergic to penicillin. Symptoms include periorbital edema, sinus pain, clear/mucoid/purulent discharge, halitosis, and erythematous oropharynx. Bacterial organisms include S. pneumoniae, Haemophilus influenzae, and S. aureus.
Croup (Laryngotracheobronchitis): An inflammatory condition causing laryngeal and subglottic swelling. Common cause is parainfluenza virus. Symptoms include hoarseness, barking cough, inspiratory stridor, and substernal/suprasternal/supraclavicular retractions. Treatment involves supportive care, racemic epinephrine, and prednisolone (in moderate to severe cases).
Epiglottitis: A life-threatening infection caused by Haemophilus influenzae type B. Symptoms include tripod sitting, muffled voice/cry, trismus (difficulty opening the mouth), dysphagia (difficulty swallowing), drooling, cyanosis, and retractions. Treatment involves 100% oxygen, intubation, ceftriaxone or amoxicillin/clavulanate. Do not attempt to inspect the oropharynx.
Pertussis (Whooping Cough): Treatment is largely supportive, including oxygen, suctioning, hydration, and avoiding respiratory irritants. Parenteral nutrition may be needed.
Pharyngitis/Tonsillitis: Physical exam findings include fever, erythema of the mouth/tongue/tonsils, petechiae, enlarged tonsils, and cervical lymphadenopathy. The cause is often group A beta-hemolytic streptococcus (GABHS). Treatment for GABHS is penicillin; alternatives for PCN allergy include cephalexin, cefadroxil, clindamycin, or azithromycin.
Mononucleosis: Caused by Epstein-Barr virus (EBV). Symptoms include fever, eyelid edema, injected pharynx/tonsils, tender posterior/cervical lymphadenopathy, hepatomegaly, and splenomegaly. Treatment is supportive care.
Infectious Respiratory Disorders vs. Non-Infectious: Non-infectious examples include asthma, cystic fibrosis, bronchiolitis, and sleep apnea. Infectious examples include pertussis, pneumonia, bronchiolitis, and common cold.
Foreign Body Aspiration (Lungs): Symptoms include drooling, gagging/vomiting, refusal to eat, cough, wheeze, reduced/abnormal breath sounds. Treat with bronchoscopy. First-line treatment for removal is the Heimlich maneuver or chest thrusts, depending on age.
Cystic Fibrosis: Symptoms include tenacious mucus in airways, pancreas, liver, and sweat chloride test positive at 60mmol/L or higher.
Normal Respiratory Rates: Vary by age (infant 30-60 breaths/min, adolescent 12-16 breaths/min).
Respiratory Distress: Signs include general appearance changes, altered position (e.g., tripod), increased respiratory effort (e.g., flaring nares, retractions), altered breathing rate/depth/pattern, and level of consciousness, and restlessness/anxiety.
Red Flag Signs of Asthma: Using accessory muscles, significant distress.
Foreign Body Aspirations: Highest prevalence in children under 5. Symptoms include choking, coughing, respiratory distress, unilateral wheezing, altered breath sounds, history of playing with small objects, or eating certain foods (e.g., hard candies, nuts).
Asthma Attack: Symptoms include troublesome cough (especially at night), cough/wheezing after physical activity, shortness of breath, chest tightness, and/or chest tightness/tightness after exposure to allergens. Examination findings can include hyperexpansion of the thorax, increased nasal secretions, and allergic skin conditions.
Bronchiolitis: Caused primarily by RSV and parainfluenza viruses, presents as inflammation and obstruction of small bronchioles. Common in infants/toddlers, and can be life-threatening in those under 6 months.
Pertussis (Whooping cough): Symptoms include choking, coughing, abrupt onset of respiratory distress, unilateral wheezing/decreased breath sounds. History of playing with small objects or eating certain foods (e.g., hard candies, nuts) may be present.
Pneumonia: First-line treatment for community-acquired pneumonia in young children if bacterial is suspected is amoxicillin/clavulanate, and macrolides if atypical (e.g., mycoplasma pneumonia) is suspected.
Obstructive Sleep Apnea (OSA): Symptoms include prolonged partial/intermittent/complete airway obstruction during sleep; prolonged daytime fatigue/somnolence, morning headaches, snoring, nocturnal enuresis, mouth breathing, hyperactivity.
Spontaneous Pneumothorax: Symptoms include chest pain, shortness of breath, diminished breath sounds, chest tightness, subcutaneous emphysema(crepitus).
Lung Function Measurement: Spirometry is the gold standard for measuring lung function in children aged 6 years and older.
Hypertension (HTN) in Children: Defined as a systolic blood pressure (SBP) and/or diastolic blood pressure (DBP)≥95th percentile for age, gender, and height, measured in two or three visits.
Secondary HTN: Causes can include sleep disorders, renal issues, cardiac issues, endocrine disorders, and environmental factors.
Dyslipidemia/Hyperlipidemia: Lifestyle modifications (diet, exercise) are first-line treatment. Second line/pharmacologic treatment for adolescents with dyslipidemia includes HMG Coenzyme A reductase inhibitors.
Patent Ductus Arteriosus (PDA): If the duct doesn't close naturally, pharmacological therapy (e.g., prostaglandin synthesis inhibitors) is used.
Acyanotic Heart Disease (CoA): Coarctation of the aorta is a narrowing of the aorta, usually at the origin of the left subclavian artery.
Innocent Murmurs: These are common in children and usually don't require any treatment.
Genetic Information Carrier: DNA.
Allele: One variant of a gene.
Genetic Testing: Can identify changes in genes/chromosomes to check for genetic conditions or determine the possibility of a child inheriting a condition.
Infant Genetics: Humans inherit one set of chromosomes from each parent; mitochondria DNA is only inherited from the mother.
Pertussis (Whooping Cough): This is a serious illness and immediate medical attention is needed. Supportive care (e.g. oxygen) and hydration is essential, especially in very young patients.
Pneumonia: Pneumonia commonly follows a viral infection of the respiratory system, but in severe cases, hospitalization will be required to manage the illness and any complications.

Pediatric Study Notes: Viral and Bacterial Rhinosinusitis

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Questions and Answers

Which of the following are potential causes of epiglottitis in children?

The Heimlich maneuver is the recommended treatment for a foreign body lodged in a child's lung.

What is the leading cause of death in children under 5 years old worldwide?

What are the two most common types of familial hypercholesterolemia (FH)?

What is the best prevention for pertussis infection in a neonate?

The most common pathogen associated with laryngotracheobronchitis in children is parainfluenza virus.

Which of the following are signs and symptoms of respiratory distress in a child? (Select all that apply)

What is the name of the most common type of bacteria that causes pharyngitis in children?

What are two signs and symptoms that might indicate a bacterial sinus infection in a child?

What are the two most common medications used to treat bacterial pneumonia in a child?

Most cases of coarctation of the aorta occur at the origin of the left subclavian artery.

What are the first line treatments for hyperlipidemia in children?

Which of the following conditions can be considered a risk factor for obstructive sleep apnea (OSA) in children?

The "Tripod" position is considered a sign of respiratory distress in children.

What is the most common type of viral respiratory infection that causes bronchiolitis in children?

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Exam 2 Peds Study Notes

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