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Systems: Resp. WK > 27. LRTIs Children > Flashcards

27. LRTIs Children Flashcards

1
Q

What are 5 most common LRTIs?

A
  1. tracheitis
  2. pneumonia
  3. bronchitis
  4. empyaema
  5. bronchiolitis
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2
Q

How many children born will end up going to hospital for bronchiolitis?

A

1 in 5 children

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3
Q

What is the most common LRTIs with the highest number of hospital admissions?

A

bronchiolitis

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4
Q

What are common BACTERIAL infective agents causing bronchiolitis? (5)

A
  • strep penumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
  • mycoplasma pneumoniae
  • chlamydia pneumoniae
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5
Q

What are common VIRAL infective agents causing bronchiolitis? (4)

A
  • RSV
  • parainfluenza III
  • influenza A and B
  • adenovirus
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6
Q

What are common symptoms for tracheatis?

A
  • barking cough and stridor that doesn’t go away

- fever

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7
Q

Why are children at risk of tracheatis?

A

because they have small airways

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8
Q

Describe the trachea in tracheatis.

A
  • swollen tracheal wall
  • narrowed tracheal lumen
  • luminal debris
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9
Q

What are symptoms of bronchiolitis? (6)

A

At first like common cold (cough and runny nose):

  • fever
  • crackles and wheeze
  • dry and persistent cough
  • rapid and noisy breathing (wheezing)
  • tachypnoea
  • difficulty feeding
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10
Q

What are common symptoms for bronchitis?

A
  • loose rattly cough with URTI
  • post-tussive vomit (glut)
  • chest free of wheeze/ creps
  • mostly self-limiting
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11
Q

What does the child present as with bronchitis?

A

Completely well ( but parent worried)

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12
Q

What 2 main pathogens cause bronchitis?

A
  1. haemophilus

2. pneumococcus

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13
Q

What type of infection is bacterial bronchitis?

A

secondary infection (so therefore antibiotics not needed)

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14
Q

What does bacterial bronchitis disturb? What does it cause?

A
  • mucociliary clearance (no clearance)

- causes minor airway malacia (softening/ floppy tissue)

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15
Q

What are 2 most common co-infections in children which can lead to bacterial bronchitis?

A
  • RSV (respiratory syncytial virus)

- adenovirus

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16
Q

How long can cough last for in bacterial bronchitis?

A

around 4 weeks

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17
Q

What does bacterial bronchitis usually follow? ( it’s a secondary infection)

A

It follows URTIs

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18
Q

What bacteria cause bacterial bronchitis? (2)

A
  1. pneumococcus

2. H flu

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19
Q

What is the general trend in bacterial bronchitis cough?

A

It gets better every winter (cough morbidities decrease)

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20
Q

What is the criteria for the very common PERSISTENT bacterial bronchitis? (3)

A
  1. wet cough
  2. more than 1 month
  3. remission with antibiotics (gives relief)
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21
Q

What is persistent bacterial bronchitis often misdiagnosed as?

A

asthma

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22
Q

What are the 3 main steps for addressing persistent bacterial bronchitis?

A
  1. make the diagnosis
  2. reassure
  3. do NOT treat
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23
Q

Why should bacterial bronchitis not be treated?

A

Because side effects of antibiotics do more harm than good

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24
Q

How many infants does bronchiolitis affect?

A

30-40% of all infants

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25
Q

What virus mainly causes bronchiolitis?

A

RSV (but others include; paraflu III and HMPV; human metapneumovirus)

26
Q

What time period is usually the worst for RSV infections?

A

week before Christmas

27
Q

At how many months is there a bronchiolitis peak in infants?

A

At around 3 months (but is the commonest LRTI in infants<12 months )

28
Q

How long does bronchiolitis last for?

A

Around 2 weeks

29
Q

Is bronchiolitis a one off or recurrent?

A

Only a one off

30
Q

Describe the trend in symptoms in bronchiolitis in an infant. Doctors can predict bronchiolitis very well.

A

day 1-5: getting worse symptoms (cough+snot)
day 5-7: stabilising of bronchiolitis
day 7-14: recovery

31
Q

What analogy is used to describe a child suffering from bronchiolitis?

A

Similar to child having a golf ball in its mouth and only being able to breathe through the nose which eventually also gets blocked.

32
Q

What is the course of action for a child who presents with bronchiolitis at day 5?

A

can be sent home for recovery as condition is stabilising

33
Q

What are the 2 rules for management for bronchiolitis/

A
  1. maximal observation

2. minimal intervention

34
Q

What investigations are done for a clinical diagnosis of bronchiolitis? (2)

A
  1. NPA (cohorting

2. Oxygen Saturations (severity)

35
Q

What is NPA (cohorting of patients)

A

group of patients experiencing same symptoms and monitored over time, biological samples obtained from all patients and analysed

36
Q

What is there NO routine need for in bronchiolitis?(3)

A
  • chest x ray
  • bloods
  • bacterial culture
37
Q

Is there medication that has been proven to work for treating bronchiolitis?

A

no; BUT evidence changes all the time

38
Q

What medications are NOT proven to work for treating bronchiolitis?

A
  • salbutamol
  • ipratropium broimde
  • adenaline
    -steroids
  • antibiotics
  • nebulised saline
    GRADE A EVIDENCE FOR THESE
39
Q

What are indicators of a LRTI?

A
  • fever (for 48hrs >38.5 degrees)
  • reduced bronchial breath sounds
  • several infective agents
40
Q

What are some of the infective agents of LRTIs and what’s their distribution? (3)

A
  1. Viruses (<35% and higher in younger)
  2. Bacteria: pneumococcus, mycoplasma, chlamydia
  3. mixed infection
    (<40%)
41
Q

What does wheeze indicate about the LRTI?

A

bacterial cause unlikely

42
Q

Does bronchiolitis give us fever?

A

No

43
Q

When to call an LRTI pneumonia? (3)

A
  1. if signs are focal (centred)
  2. creps/ crackles
  3. high fever
44
Q

In LRTIS, what should chest x rays only confirm?

A

they should only confirm clinical findings, not change management

45
Q

What investigations can sometimes be done for community acquired pneumonia but aren’t “routine”? (2)

A
  • chest x ray

- inflammatory makers

46
Q

What is the first line treated for community acquired pneumonia if symptoms are severe?

A

Oral amoxycillin (antibiotic)

47
Q

What is the second choice treatment for community acquired pneumonia if symptoms are very severe?

A

Oral macrolide (antibiotic)

48
Q

What is the treatment option for mild community acquired pneumonia?

A

nothing if symptoms mild

49
Q

When should IV drugs be given to children with community acquired pneumonia?

A

Only if they are vomiting

50
Q

What is the effect of vaccine on petussis/ whooping cough? (2)

A
  • reduces risk of getting it

- reduces severity

51
Q

What are pertussis/ whooping cough symptoms? (very common!) (4)

A
  1. coughing fits
  2. vomiting
  3. fever
  4. colour change under skin or eyes
52
Q

Is empyema a complication of pneumonia?

A

Yes; should be suspected if patient with a resolving pneumonia develops recurrent fever but has good prognosis for children (not for elderly)

53
Q

What is empyema treated with?

A

antibiotics and postural drainage

54
Q

What should ALWAYS be maintained in children with LRTIs? (3)

A
  1. oxygenation
  2. hydration
  3. nutrition
55
Q

Is tracheatis treated with antibiotics? If so, which ones?

A

Yes; Augmentin

56
Q

Is bronchitis treated with antibiotics? If so, which ones?

A

No

57
Q

Is LRTI/pneumonia treated with antibiotics? If so, which ones?

A

Usually if 2 days of fever, cough and focal signs on one side ; Oral amoxycillin

58
Q

Is bronchiolitis treated with antibiotics? If so, which ones?

A

No

59
Q

Is empyema treated with antibiotics? If so, which ones?

A

Yes; IV antibiotics

60
Q

What do you always do when symptoms get worse?

A

REVIEW

Systems: Resp. WK (40 decks)

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