lower respiratory tract infections - children

Question 1

what are common bacterial infective agents

Answer 1

strep pneumoniae, haemo flu, mira ella catarrhalis

Question 2

what are common viral infective agents

Answer 2

RSV, paraflu, flu a

Question 3

what are the principles of management

Answer 3

make a diagnosis
assess the patient - oxygenation, hydration, nutrition
to treat or not to treat

Question 4

what is tracheitis

Answer 4

uncommon 
croup that’s hasn’t gotten better 
fever, sick child 
staph or strep invasive infection 
augmentin 
narrowed tracheal lumen

Question 5

what is bronchitis

Answer 5

endobronchial infection 
loose rattle cough with URTI
post tussive vomit 
chest free of wheeze/crepes 
haemophilus/ pneumococcus 
most self limiting

Question 6

what is bacterial bronchitis

Answer 6

disturbed mucociliary clearance 
- minor airway malacia 
- RSV/adenovirus 
lack of social inhibition 
bactera infection/ overgrowth is secondary

Question 7

what is the natural history of bacterial bronchitis

Answer 7

following URTI 
lost 4 weeks 
60-89% respond 
first winter bad 
second winter better 
third winter fine
pneumococcus/ H flu

Question 8

what are symptoms of bronchiolitis

Answer 8

nasal stiffness
tachypnoea
poor feeding

Question 9

what age groups get bronchiolitis

Answer 9

infants under 12 months

Question 10

what investigations are used

Answer 10

NOA

Oxygen saturations

Question 11

what are features of a lower respiratory tract infection

Answer 11

48hrs, SOV, cough, grunting 
wheeze makes bacterial cause unlikely 
rescued or bronchial breath sounds 
infective agents 
virus +commensal bacteria/bacterium

Question 12

when may you call it pneumonia

Answer 12

creps
high fever
signs are focal

Question 13

what are the BTS guidelines for community acquired pneumonia

Answer 13

investigations - CXR and inflammatory makers not “routine”
management - notjing of symptoms of mild
oral amoxicillin first line
oral macrolide second choice
only for iv if vomiting

Question 14

when do u use oral rather than iv

Answer 14

when antibiotics are indicated
in non severe LTRI
when child is not vomiting
oral are cheaper, require less hospital stay

Question 15

what’s the difference between LRTI

and bronchiolitis

Answer 15

LRTI - in all ages, more rapid onset of symptoms, fever

bronchiolitis - ages <12 months, 3 days before reach peak, feber rarely>38°c

Question 16

what is pertussis

Answer 16

common !
vacc reduces risk and severity
coughing fits
vomiting and colour change

Question 17

what is empyaema

Answer 17

complication of pneumonia 
extension of infection into pleural space 
chest pain and very u well 
antibiotics +/-drainage 
good prognosis