Lower Respiratory Tract Infections

Question 1

What are some LRTIs?

Answer 1

Question 2

What are some common infective agents?

Answer 2

• Bacterial
  
  • Strep pneumoniae
  • Hemophilus influenza
  • Moraxella catarrhalic
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
• Viral
  
  • RSV
  • Parainfluenza III
  • Influenza A and B
  • Adenovirus

Question 3

What are the principles of management for LRTIs?

Answer 3

• Make diagnosis
• Assess patient
  
  • Oxygenation, hydration, nutrition
• To treat or not to treat

Question 4

Tracheitis - aetiology

Answer 4

• Staph or strep invasion infection

Question 5

Tracheitis - epidemiology

Answer 5

Uncommon

Question 6

Tracheitis - presentation

Answer 6

• “Croup that does not get better”
• Fever, sick child

Question 7

Bronchitis - aetiology

Answer 7

Usually haemophilus/pneumococcus

Question 8

Bronchitis - epidemiology

Answer 8

• Very common

Question 9

Bronchitis - pathophysiology

Answer 9

• Normal virus disturbs mucocilliary clearance
• Allowing secondary infection with bacteria

Question 10

Bronchitis - presentation

Answer 10

• Mostly self limiting
• Loose rattly cough with URTI
• Post-tussive vomit
• Chest free of wheeze/creps

Question 11

Bronchitis - management

Answer 11

• Reassurance
• Do not treat

Question 12

Bronchiolitis - aetiology

Answer 12

• Usually viral, RSV
  
  • Others include paraflu III and HMPV

Question 13

Bronchiolitis - epidemiology

Answer 13

• Very common
• Usually infants (30-40% of them)
  
  • <12 months old

Question 14

Bronchiolitis - presentation

Answer 14

• Nasal stuffiness
• Tachypnoea
• Poor feeding
• Crackles +/- wheeze
• Usually lasts up to 12 days, sometimes 14

Question 15

Bronchiolitis - investigations

Answer 15

• NPA
• Oxygen saturations

Question 16

Bronchiolitis - management

Answer 16

• Maximal observation
• Minimal interference
• No medications proven to work

Question 17

Pneumonia - aetiology

Answer 17

• Virus and commensal bacteria
• Wheeze makes bacterial cause unlikely

Question 18

Pneumonia - presentation

Answer 18

• Fever
• Shortness of breath
• Cough
• Grunting
• Reduced or bronchial breath sounds

Question 19

Pneumonia - treatment

Answer 19

• Nothing if symptoms milkd
  
  • Always offer review
• Antibiotics
  
  • First line – oral amoxicillin
  • Second line – oral macrolide
  • Only IV if vomiting

Question 20

What are the 1st and 2nd line antibiotics for pneumonia in paediatrics?

Answer 20

• First line – oral amoxicillin
• Second line – oral macrolide
• Only IV if vomiting

Question 21

What are the main differences between pneumonia and bronchiolitis for:

• age
• progression of symptoms
• presence of fever

Answer 21

Question 22

What is pertussis also called?

Answer 22

Whooping cough

Question 23

Pertussis - epidemiology

Answer 23

Common

Question 24

Pertussis - presentation

Answer 24

• Coughing fit
• Vomiting and colour change

Question 25

Pertussis - treatment

Answer 25

• Part of vaccination which reduces risk and severity

Question 26

Empyaema - pathology

Answer 26

• Complication of pneumonia
• Extension of infection into pleural space

Question 27

Empyaema - presentation

Answer 27

• Chest pain and very unwell

Question 28

Empyaema - treatment

Answer 28

• Antibiotics +/- chest drainage

Question 29

Empyaema - prognosis

Answer 29

• Good in contrast with adults

Question 30

Are, and if so what, antibiotics are used for:

• tracheitis
• bronchitis
• pneumonia
• bronchiolitis
• empyema

Answer 30