1 - Paeds - Resp - Chest infections - Pneumonia

Question 1

when does incidence peak?

% of cases with no ID’d pathogen? most common causes in older and younger kids?

Answer 1

in infancy and old age - also high in kids
50% have no id pathogen
younger - viruses more common
older - bacteria more common

Question 2

newborn causes

Answer 2

organisms in mothers genital tract - GBS, Gram -ve enterococci

Question 3

Infants and young kids causes

Answer 3

resp viruses
RSV most common
bact infections include strep pneum or h influenzae
S Aureus is rare but serious case

Question 4

Childern >5 causes

Answer 4

mycoplasma pneumoniae, strep pneumoniae, chlamydia pneumoniae

Question 5

all ages causes

Answer 5

mycobacterium TB should be considered

Question 6

what immunisations are available

Answer 6

conjugate vaccine (prevenar) vs. 13 most common serotypes of Strep pneum responsible for invasive disease. Hib vs H Influenzae type B

Question 7

common presentation -

Answer 7

fever Hx and difficulty breathing - usually preceded by URTI

Question 8

other sx

Answer 8

cough, lethargy, poor feeding, unwell child, localised chest, abdo or neck pain > pleural irritation > bacterial cause

Question 9

O/E -

Answer 9

tachypnoea (best, always measure in febrile kid > ‘silent pneumonia), nasal flaring, chest indrawing
end inspiratory coarse crackles over affected area. classical signs of consolidation eg dullness to percussion often absent in infants. O2 sat decreased (admit)

Question 10

Ix - to confirm? which cause can CXR ID? whats useful in younger kids?

Answer 10

CXR to confirm
can only look for strep pneumoniae lobar pneumonia appearance.
NP aspirate to ID viral causes

Question 11

What else may be seen on CXR? what can this progress to? to confirm this?

Answer 11

pleural effusion (blunting of CPA on CXR) - may go to empyema and fibrin strands form > septations > difficult drainage. Use USS to confirm

Question 12

mgmt of pneumonia in kids - indications for admission?

Answer 12

generally mged at home,

indications for admission…. O2 <93% and difficulty breathing, grunting, apnoea, not feeding, unable to manage at home

Question 13

General supportive care given?

Answer 13

O2 for hypoxia, analgesia for pain, IV fluids for dehydration and fluid balance

Question 14

Antibiotics - determined by?

newborns? older infants? >5’s

Answer 14

age, severity and CXR appearance
newborn - broad spec AB IV
older infants - oral amox, broader spec
>5 amox or oral macrolide (erythromycin)

Question 15

If empyema develops?

Answer 15

drain
either
1 - surgical decortication
2 - place chest drain with/without fibrinolytic agent in intrapleural space to break down septations

Question 16

prognosis - follow up needed?

Answer 16

virtually all make full recovery
CXR 4-6 weeks after
follow up if lobar collapse, atelectasis or empyema