Lower respiratory tract infections-children

Question 1

name some examples of LRTIs?

Answer 1

tracheitis
pneumonia
bronchitis
empyaema
bronchiolitis

Question 2

what are the common bacterial bacterial infectious agents for LRTIs?

Answer 2

strep. pneumoniae
H. influenzae
Moraxella catarrhalis
mycoplasma pneumoniae
chlamydia pneumoniae

Question 3

what are the viral infectious agents of LRTIs

Answer 3

RSV
parainfluenza III
influenza A and B
adenovirus

Question 4

what is tracheitis?

Answer 4

an inflammation of the trachea, basically “croup which does not get better”

Question 5

what are the infectious agents for tracheitis?

Answer 5

staphylococci or streptococci

Question 6

what is the drug used to treat tracheitis?

Answer 6

augmentin

Question 7

what are the symptoms of tracheitis?

Answer 7

fever, deep cough, wheeze, difficulty breathing, often biphasic stridor

Question 8

what are the symptoms of bronchitis?

Answer 8

loose rattly cough with urti
post-tussive vomitting
chest free of wheeze and creps

Question 9

what are the bacteria responsible for causing bacterial bronchitis?

Answer 9

haemophilus/ pneumococcus

Question 10

what is the mechanism for bacterial bronchitis (secondary infection)?

Answer 10

disturbed mucociliary clearance from URTI (eg. RSV or adenovirus) means that there is difficulty in clearing bacteria.

Question 11

who does bronchiolitis usually affect?

Answer 11

infants, <12months

Question 12

what are the infective agents of bronchiolitis?

Answer 12

RSV, parainfluenza III, HMPV (human metapneumovirus)

Question 13

what are the symptoms of bronvhiolitis?

Answer 13

nasal stuffiness, tachypnoea, poor feeding, crackles or wheeze +/-

Question 14

is bronchiolitis recurrent?

Answer 14

no, it is a one off infection

Question 15

what is the typical history of bronchiolitis?

Answer 15

1. child normal for first 2 days
2. gradual worsening over days 2-5
3. stabilises in days 5 to 7
4. recovers after 7 days

Question 16

what is the management of bronchiolitis?

Answer 16

maximal observation
minimal intervention
- cohorting
oxygen saturations according to severity

Question 17

what are the general signs of a LRTI?

Answer 17

fever (>38.5 degrees Celsius), SOB, cough, grunting for 48 hours. reduced or bronchial breath sounds.

Question 18

if there is wheeze with a LRTI is it likely to be bacterial or viral?

Answer 18

viral

Question 19

when is it pneumonia and not a LRTI?

Answer 19

when signs are focal, there are creps, high fever

Question 20

what are the investigations for community acquired pneumonia?

Answer 20

just go by clinical signs, CXR and inflammatory markers are not routine.

Question 21

what is the management of community acquired pneumonia in children?

Answer 21

nothing if symptoms are mild
1st line- oral amoxycilllin
2nd line- oral macrolide
iv if vomiting

Question 22

what does vaccination to pertussis do?

Answer 22

reduces risk

reduces severity

Question 23

what sort of coughing comes with perussis?

Answer 23

coughing fits

Question 24

what is are the symptoms of pertussis?

Answer 24

coughing fits

vomiting and colour change

Question 25

what does empyaema come as a complication of?

Answer 25

pneumonia it is an extension of the infection into the pleural space

Question 26

what are the symptoms of empyaema?

Answer 26

chest pain

Question 27

what are the treatment options for empyaemia?

Answer 27

antibiotics

drainage

Question 28

before antobiotics are given for LRTIs what first needs to be sorted out?

Answer 28

oxygenation, hydration, nutrition

Question 29

are antibiotics given for tracheitis?

Answer 29

yes, augmentin

Question 30

are antibiotics given for bronchitis?

Answer 30

no

Question 31

are antibiotics given for pneumonia?

Answer 31

usually, when there has been a 2 day fever and focal signs.

Question 32

are antibiotics given for bronchiolitis?

Answer 32

no

Question 33

are antibiotics given for empyema?

Answer 33

yes, IV antibiotics