LGA age baby born to a mother with gestational diabetes has issues with breathing and and decreased tone in his arm. What is the cause of the breathing and arm issue
LGA babies are at risk for birth trauma i.e. shoulder dystocia leading to damaged
- brachial plexus–>Erbs/Duchenne’s palsy
- phrenic nerve–>hemidiaphragm–>trouble breathing
- ->Dx: Ultrasound of chest/diaphragm
kid <2 years old with fever, runny nose, cough (URI symptoms) followed by respiratory distress (cyanosis, retractions, nasal flaring, tachypnea wheezing, crackles)
Bronchiolitis
<2 years of age
cause: RSV>parinfluenza, influenza
mech:inflamm of lower airways (bronchioles)
Bronchiolitis
- how to diagnose
- treatment
diagnose
- clinical signs (URI signs cough, sneezing, runny nose, then resp distress)
- chest xray: interstitial infiltrates, hyperinflation, atelectasis
lung empyema are usually in the setting of
Bacterial pneumonia
- xray: whiteout of the lung with loss of costophrenic angle
- def:accum of pus in the pleural space
- causes
1. bacterial pneumonia>rupture of lung abscess, extension of mediastinits,
child with recurrent hemoptysis, anemia, pneumonia, rapidly clearing chest x-ray
idiopathic pulmonary hemosiderosis
hemoptysis-due to alveolar hemorrhage–>crackles
dyspnea-
anemia-due to loss of blood
occult blood stool loss-blood is swallowed and enters the GI tract
A child with pulmonary hemosiderosis with a hypersensitivity to _______has this disease______
hypersensitiv. to cow’s milk
Heiner syndrome
RX: dairy free diet
Dx for pulmonary hemosiderosis
bronchoscopy to obtain a bronchioalveolar lavage
findings-hemosiderin laden macrophages
croup like symptoms followed by toxic appearance, high fever
Bacterial tracheitis
Tx: Intubation+IV antibiotics
Croup vs Bacterial Tracheitis
Croup
- viral symptoms: low fever, inspir. stridor, seal like cough
- Rx: mild-cool mist, moderate-racemic epi+steroids
Bacterial tracheitis
- viral like symptoms of croup (or no viral like symptoms) then a high fever, toxic appearance
- or croup like symptoms that don’t respond to epi+steroids
- RX: intubate+IV antibiotics
cold for >10 days+fever+facial pain
rhinosinusitis
what is the first step in treating anaphylaxis
Airway intubation (not epi treatment)
Rule of 2s for asthma
Determines whether asthma is intermittent or persistent
- asthma attacks >2x per week
- use of rescue inhaler>2x per week
- nightime symptoms>2x per month
Rule of 2s for asthma
Determines whether asthma is intermittent or persistent
- asthma attacks >2x per week
- use of rescue inhaler>2x per week
- nighttime symptoms>2x per month
Neonatal conjunctivitis caused by: Neisseria vs Chlamydia
Neisseria gonorrhea
- purulent discharge, occurs 1st days of life
- toxic baby: septic, febrile
- RX: IM ceftriaxone
Chlamydia
- watery eye discharge, occurs usually after 1st week of life
- nontoxic baby, nonfebrile
- RX: oral macrolide (for active infection), topical macrolide for prophylaxis
recurrent unilateral pneumonia in a healthy child
-foreign body aspiration
-on xray inspiration film normal, expiration film will see air trapping (blacker) distal to the obstruction
Dx: bronchoscopy
kartegeners vs cf
kartegeners: dynein arm defect, bronhiectesis (recurrent pneumonias), situs inversus, infertility
CF: (+) sweat test, diabetes (pancreatic insuff), infertility, malabsorption (failure to thrive) recurrent pneumonias
cause of infertility in kartegeners vs cf
Kartegeners-dynein arm of cilia abnormal
men-sperm immotile
women-cilia in fallopian tubes abnormal, can’t move egg normally
CF-male infertility: bc absence of vas deferens to due inspissated mucous blocking vas deferens development–>obstructive azoospermia (sperm have normal motility though)
acetaminophen or ibuprofen should be given to pts who experience febrile seizures after taking antibiotics. T or F?
False
- antipyretics can reduce the antibody response to vaccinations
- antipyretics have not been shown to reduce fever or prevent febrile seizures
boy is at a picnic and develops wheezing and inc work of breathing
- diagnosis
- treatment
anaphylaxis-type 1 hypersensitivity rxn
symptoms: wheezing, +/-hives, pruritis
treatment-IM epinephrine
point of maximum impulse is displaced to the right…..disease
Kartegeners (primary ciliary dyskinesia)
- PMI displaced to the right–>situs inversus
- sinusitis/pneumonias
- bronchiectasis
stress, trauma, dental procedures followed by facial swelling, colicky pain
hereditary angioedema=c1 inhibitor deficiency
- kallekrien–>bradykinin->angioedema
- C1–>angioedema
- Ci inhibitor inhibits both C1 and kallekrein
- without C1 inhibitor, increased bradykinin, dec C4 (C1 cleaves C4), dec C1 inhibitor
CF mediated pneumonia
- in adults
- in kids
adults-pseudomonas–>RX: fluoroquinolones
peds-staph aureus–>for MSSA, strep cover with nafcillin, for MRSA cover with vancomycin
complication of bacterial pneumonia
pleural inflammation->pleural effusions
- signs: loss of costophrenic angle
- fluid layering on lateral decubitus film
Name the B cell deficiencies and unique characteristics
Brutons x linked agammaglobulinemia
- tyrosine kinase deficiency->failure of pre B cell maturation into B cells
- dec B cells, dec in all Igs
- baby>6 months: bc for 1st 6 months there’s maternal IgG protection
CVID
- milder version of brutons, recurrent sinopulm infections in teenager
- -dec in all Igs, but normal B cells
IgA deficiency
- dec Iga, inc IgG and IgM which compensate so pt often asymptomatic
- after blood transfusion–>anaphylaxis
hyper IgM syndrome
- can’t convert IgM to IgG
- inc IgM, dec IgG, IgA, IgE
