Peds Exam 3

Pharyngitis refers to a sore throat, and it is important to determine whether it is of viral or bacterial origin to manage it effectively.

Common Cold: Viral pharyngitis is often referred to as the common cold.
Onset: Typically has a gradual onset. Symptoms may arise over a few days.
Symptoms: Patients, particularly children, may report that “my spit tastes weird.” They commonly complain of a sore throat, which is not usually severe compared to bacterial pharyngitis.
Examination Findings:
- Edema and inflammation of the varix and tonsils may be present, but typically lack overwhelming symptoms.
- There is an absence of white patches, which differentiates it from a bacterial infection.
- Some children with enlarged (kissing) tonsils may develop ulcers due to inflammation and friction.
Fever: If present, it is usually low grade and may fluctuate.
Other Symptoms: Hoarseness, cough, runny nose, conjunctivitis (red eyes), malaise, and possible anorexia.
Duration: Usually lasts around three to four days.
Management: Focus on symptom management which includes:
1. Antipyretics (age-appropriate)
2. Hydration (encouraging fluid intake)
3. Rest

Common Suspect: Most often caused by Streptococcus bacteria, commonly referred to as strep throat. Other bacteria might be involved occasionally, such as Staphylococcus.
Onset: Abrupt onset is typical, especially in school-aged children.
Symptoms:
- Severe sore throat that children can specifically identify as the strep throat feeling.
- Erythema of the throat, with tonsils often inflamed.
- Presence of pustules or white patches on the tonsils, although not all patients will exhibit these features.
- Gastrointestinal symptoms such as abdominal pain and vomiting are more common in children than adults with strep throat.
Cervical Lymphadenopathy: Tender enlargement of cervical lymph nodes.
Duration: Lasts approximately three to five days.
Management: Requires an antibiotic treatment for recovery.
- Antibiotics: Oral penicillin is commonly administered two to three times a day for ten days.
- Symptom Management: Same as for viral pharyngitis including antipyretics and hydration.
Contagiousness: Strep throat is highly contagious, necessitating a return to school only 24 hours post antibiotic treatment commencement.
Reinfection Prevention: Educate parents on replacing the child's toothbrush after starting antibiotics to prevent reinfections.

Definition: Refers broadly to conditions like viral pharyngitis.
Over-the-Counter Products: Generally not recommended for children due to potential side effects, including excess alcohol content.
Antihistamines: Not effective in treating colds in kids; parents should be informed accordingly.
Cough Suppressants: Should be cautious due to alcohol content. Only consider for older children, under appropriate recommendation.

Definition: Surgical removal of the tonsils, typically only indicated in severe recurrent infections.
Contraindications: Active infections or anatomical abnormalities (e.g., cleft palate).
Post-operative Care:
- Positioning to prevent aspiration is crucial (side-lying or prone).
- Clear liquid diet until the gag reflex returns; avoid milk products due to their coating effects which increase bleeding risk.
- Watch for signs of bleeding, tachycardia as a possible indication of hemorrhage.
Counseling Points for Parents: Importance of replacing toothbrushes after tonsillectomy to prevent reinfections.

Definition: A respiratory infection often seen in children, characterized by a distinctive barking cough.
Symptoms: Harsh, metallic cough, inspiratory stridor, and hoarseness. Symptoms often exacerbate at night due to the child’s recumbent position.
Management:
- Positioning (sit upright)
- Exposure to cool air may provide immediate relief
- Steam inhalation may alleviate symptoms at home.
- Racemic epinephrine and corticosteroids may be used when symptoms are severe.
Emergency Protocol: Continuous monitoring for progression; observe for signs of distress or hypoxia.

Causes: Typically caused by Haemophilus influenzae (Hib); vaccination has decreased occurrence.
Contagiousness: Highly contagious and requires immediate isolation.
Presentation: Drooling, dysphagia, dyspnea, and “croaking” sound during respiration.
Intervention: Keep the child calm, upright and do not attempt to visualize the throat with a tongue depressor to prevent airway collapse.
- Be prepared for possible intubation.
Management: Potential use of racemic epinephrine and corticosteroids to reduce inflammation.

Description: Inflammatory condition affecting the bronchioles primarily due to RSV in infants.
Symptoms: Tachypnea (60-80 bpm), wheezing, retractions, nasal flaring, and possible cyanosis.
Management: Focus on hydration, oxygen supplementation, and monitoring.
- Avoid antibiotics unless secondary bacterial infections occur.

Management: Similar to bronchiolitis; consider antibiotics for bacterial forms but not for viral. Key interventions: fluids, oxygen therapy, and monitoring.

Overview: Affects multiple systems including respiratory, digestive, and reproductive systems.
Diagnosis: Based on sweat chloride test (greater than 60 mEq/L is diagnostic).
Management: High-calorie diet, pancreatic enzyme replacement, and airway clearance therapies including CPT (chest physiotherapy).

Definition: Characterized by airway hyper-responsiveness leading to Bronchospasm.
Symptoms: Wheezing, chest tightness, shortness of breath, cough, and increased work of breathing. Symptoms typically worsen at night.
Management: Bronchodilators as rescuers, corticosteroids for inflammation, and peak flow monitoring for management.
Emergency Signs: Identify worsening cough, breathlessness, ineffective responses to bronchodilators, and difficulty in walking or talking.

Each respiratory condition has its specific symptoms and management guidelines, focusing on symptom relief and prevention of complications.
Reinforce infection control measures in both acute and chronic cases.