[05.47] Common Pediatric Respiratory Diseases V2.1.pdf

Common cold

What is acute rhinitis popularly called?

Inflammation and swelling of the mucous membrane of the nose

What is the pathological definition of acute rhinitis?

Direct contact, Infection from particles on surfaces, Inhaling viral particles

Name two modes of transmission for acute rhinitis (common cold)

Hands

What body part may carry the etiologic agent of the common cold for at least 2 hours?

Symptomatic management

What is the recommended treatment for the common cold?

Reduce swelling of inflamed nasal passages, Constrict blood vessels, Relieve stuffiness, Clear nasal airways

Name two effects of decongestants used for runny nose and nasal congestion.

Phenylpropanolamine, Phenylephrine

Name two oral decongestants.

Phenylephrine, Oxymetazoline

Name two nasal decongestants.

Brompheniramine, Chlorpheniramine

Name two antihistamines used to help dry up the mucosa.

Decongestant reduces drowsiness

What is the advantage of using a combination of decongestant + antihistamine?

Paracetamol or NSAIDs

Name one mild pain reliever used for sore throat and headache.

Saline gargles, Local anesthetics

Name two non-pain relief remedies for sore throat and headache.

Steam inhalation

What remedy relieves congestion by loosening mucus?

Antibiotics

What type of drug should NOT be given for acute rhinitis unless there is concomitant acute bacterial sinusitis?

Does NOT prevent colds

What effect does Vitamin C have on preventing colds?

Reduce duration of cold but not its symptom severity

What effect may Zinc have on the common cold?

Antiviral

What type of drug is not usually recommended for acute rhinitis and has not shown protective efficacy?

Pneumonia

What respiratory disease involves the inflammation of the lung parenchyma?

Viral, Bacterial, Tuberculous, Fungal

Name two infectious types of pneumonia.

Aspiration of gastric acid, Foreign bodies, Hydrocarbons, Drugs

Name two noninfectious types of pneumonia.

Lower respiratory tract

What anatomical region is normally sterile?

Mucociliary escalator, Secretory IgA, Clearing of the airway by coughing

Name two mechanisms that keep the lower respiratory tract sterile.

Direct injury to the respiratory epithelium

What usually causes viral pneumonias?

Inhibits ciliary action

What action of bacterial pneumonias leads to cellular destruction and inflammatory response causing airway obstruction?

2021 Clinical Practice Guidelines (CPG) in the Evaluation and Management of Pediatric Community-Acquired Pneumonia (PCAP)

What guidelines govern the management of PCAP?

Philippine Academy of Pediatric Pulmonologists, Inc.

What organization published the PCAP CPG in 2021?

Cough or fever

What are the two mandatory criteria for considering PCAP?

Tachypnea, Retractions or chest indrawing, Nasal flaring, O₂ saturation < 95% at room air, Grunting

Name two positive predictors of radiographically-confirmed pneumonia in PCAP.

≥50 breaths per minute

What is the tachypnea cutoff for infants 3 months to 12 months old in PCAP?

≥40 breaths per minute

What is the tachypnea cutoff for children >1 year old to 5 years old in PCAP?

≥30 breaths per minute

What is the tachypnea cutoff for children >5 years old to 12 years old in PCAP?

≥20 breaths per minute

What is the tachypnea cutoff for children >12 years old in PCAP?

PCAP A and PCAP B

Which PCAP classifications are defined as low risk or non-severe PCAP?

PCAP C and PCAP D

Which PCAP classifications are defined as high risk or severe PCAP?

Chest X-ray (CXR)

What diagnostic aid is strongly recommended as an initial aid for patients classified as having severe PCAP?

Point-of-care chest ultrasonography (POCUS)

What diagnostic aid, performed by a skilled expert, is strongly recommended for patients classified as having severe PCAP?

Procalcitonin (PCT)

What laboratory aid is recommended to be used in conjunction with clinical presentation, imaging, and other aids in diagnosing bacterial PCAP?

Not considered to be done routinely

How is Sputum Gram stain and culture generally regarded for severe PCAP patients?

Lobar consolidation

What opacity finding on the right upper lobe of the lung is suggestive of PCAP, shown in Figure 2?

Elevated white blood cell count (WBC), Elevated C-reactive protein (CRP), Elevated procalcitonin (PCT), Imaging findings

Name two parameters suggestive of bacterial etiology that warrant empiric antibiotic therapy in PCAP.

Alveolar infiltrates in chest radiograph OR Unilateral, solitary lung consolidation and/or air bronchograms and/or pleural effusion in lung ultrasound

Name one imaging finding suggestive of bacterial etiology in PCAP.

Amoxicillin trihydrate

What is the first-line oral antibiotic considered for non-severe PCAP (PCAP A and B)?

40-50 mg/kg/day Q8 for 7 days OR 80-90 mg/kg/day Q12 for 5 to 7 days

What are the two dosing options for Amoxicillin trihydrate in non-severe PCAP?

Amoxicillin-clavulanate or Cefuroxime

Name one alternative antibiotic considered for non-severe PCAP in settings with documented high-level penicillin resistance or beta-lactamase producing H. influenzae.

Penicillin G

What antibiotic is started for severe PCAP (PCAP C and D) if the patient has complete Hib vaccination?

Ampicillin

What antibiotic is started for severe PCAP (PCAP C and D) if the patient has no, incomplete, or unknown Hib vaccination?

Cefuroxime, Ceftriaxone, or Ampicillin-sulbactam

Name one alternative antibiotic for severe PCAP, regardless of Hib status, in penicillin-resistant settings.

Clindamycin

What drug is added to the regimen for severe PCAP when staphylococcal pneumonia is highly suspected?

Vancomycin

What drug is preferred over Clindamycin for staphylococcal pneumonia in cases of severe and life-threatening conditions such as sepsis and shock?

Cefuroxime or Ceftriaxone

Name one cephalosporin considered for PCAP patients with non-type 1 hypersensitivity to penicillin.

Azithromycin or Clarithromycin or Clindamycin

Name one antibiotic considered for PCAP patients with Type 1 hypersensitivity (immediate, anaphylactic-type) to penicillin.

Azithromycin

Which macrolide regimen for Type 1 penicillin hypersensitivity has a duration of 3 days?

Macrolide

What drug class is considered when an atypical pathogen is highly suspected in PCAP?

Infants less than 6 months old

In what age group is Azithromycin particularly considered when pertussis is entertained?

7 to 10 days

What is the considered treatment duration for uncomplicated bacterial PCAP?

Tuberculosis (TB)

What infectious disease is caused by Mycobacterium tuberculosis?

Coughing, Sneezing, Spitting

Name two modes of transmission for M. tuberculosis.

Curable and preventable

What are two key characteristics of TB disease?

Males aged 25-55 years old

In which demographic group is TB more prevalent?

TB Exposure

What term describes a person in close contact with an active adult TB case but with negative TST and CXR?

TB Infection or Latent TB

What term describes a person without signs and symptoms but with a positive TST?

TB Disease

What term describes a person with signs and symptoms, and X-ray and laboratory findings consistent with TB?

TB is active and grows in the body

What characteristic distinguishes TB Disease from Latent TB concerning bacterial growth?

Can spread from one person to person

What characteristic distinguishes TB Disease from Latent TB concerning transmissibility?

Bacteriology confirmed (Positive for smear, culture, or rapid diagnostic tests) or Clinically diagnosed

What are the two parameters for bacteriologic status classification of TB?

Pulmonary TB or Extrapulmonary TB

What are the two anatomical site classifications of TB?

New case

What status is assigned if a patient never had treatment or took anti-TB medicine for <1 month?

Retreatment case

What status is assigned if a patient was previously treated with at least 1 month of anti-TB medicine in the past?

Monoresistant TB

What classification is used for TB resistant to only one anti-TB drug?

Polydrug-resistant TB

What classification is used for TB resistant to anti-TB drugs other than INH and RIF?

Isoniazid (INH) and Rifampicin (RIF)

Which two drugs define Multidrug-resistant TB (MDRTB)?

Extensive drug-resistant TB

What classification is used for TB resistant to MDRTB plus 1 of the 2nd line drugs?

Cough of at least 2 weeks duration

What is the main clinical sign/symptom for TB in patients 15 years old and above?

Significant or unintentional weight loss, Fever, Hemoptysis, Chest/back pains, Easy fatigability or malaise, Night sweats, Shortness of breath or dyspnea

Name two accompanying symptoms of TB in patients 15 years old and above.

Close contact of known active TB disease

What factor warrants investigation for TB if a patient 15 years or older has an unexplained cough of any duration?

Coughing/wheezing of 2 weeks or more (unexplained), Unexplained fever of 2 weeks or more, Loss/failure to gain weight with anorexia

Name three clinical criteria that, if at least three are present, suggest TB in patients below 15 years old.

Failure to respond to 2 weeks of antibiotics for LRTI

What antibiotic-related criterion suggests TB in patients below 15 years old?

Tuberculin skin test (TST), Chest radiography, Direct sputum smear microscopy, Xpert MTB/Rifampicin (MTB/RIF) test

Name two diagnostic tests for TB.

Cavitary lesions

What type of lesion is shown on the left side of Figure 3 (Chest X-ray)?

Disseminated miliary TB

What type of TB is shown on the right side of Figure 3 (Chest X-ray)?

2HRZE/4HRE

What is the recommended treatment regimen for a new case of Pulmonary TB (Category I)?

Extrapulmonary TB (except CNS, bones, joints)

What is the second condition treated by the Category I regimen (2HRZE/4HR)?

2HRZE/10HR

What is the recommended treatment regimen for a new case of Extrapulmonary TB of the CNS, bones, or joints (Category Ia)?

2HRZES/1HRZE/5HRE

What is the recommended treatment regimen for Pulmonary or Extrapulmonary relapse (Category II)?

Pleurisy

What infectious disease involves the inflammation of the pleura, often accompanied by effusion?

Plastic or dry, Serofibrinous or serosanguinous, Purulent or Empyema

Name two types of Pleurisy.

Serofibrinous or serosanguinous

Which type of pleural effusion is frequently associated with lung infections?

Increase in permeability of the surface, Increase in protein fluid formation, Decrease in lymphatic absorption

Name two results of inflammation leading to serofibrinous pleural effusion.

Cough, Dyspnea, Retractions, Orthopnea

Name two signs and symptoms of serofibrinous pleural effusion.

Chest X-ray, Thoracentesis, Chest ultrasound (if loculated)

Name one diagnostic method for serofibrinous pleural effusion.

Layering of fluid from lateral to median wall

What finding is highly suggestive of pleural effusion on a Chest X-ray (Figure 4)?

Pleural Fluid Protein Level > 3.0 g/dL

What pleural fluid analysis parameter indicates an exudative effusion (High protein)?

Pleural Fluid/Serum Protein Ratio > 0.5

What ratio parameter in pleural fluid analysis indicates an exudative effusion?

Pleural Fluid LDH > 200 iu/L

What enzyme level parameter in pleural fluid analysis indicates an exudative effusion (High LDH)?

Addressing the underlying disease

How is serofibrinous pleural effusion primarily managed?

Reexpansion pulmonary edema

What is associated with the rapid removal of ≥1 L during thoracentesis?

Pleural fluid pH is < 7.2, Pleural fluid glucose level is < 50 mg/dL, Pleural fluid is clearly purulent

Name two criteria that warrant Chest Tube Thoracostomy (CTT) in serofibrinous pleural effusion.

Purulent Effusion or Empyema

What is the term for purulent pleural effusion?

Pneumonia, Rupture of lung abscess, Trauma or thoracic surgery, Extension of intra-abdominal abscess

Name two conditions associated with Empyema.

Exudative, Fibrinopurulent, Organization

Name the three stages of Empyema pathogenesis.