Lower respiratory tract infections - children

Question 1

What is tracheitis?

Answer 1

Inflammation of the trachea

Question 2

What is the incidence of bronchiolitis?

Answer 2

20% of children will get admitted to hospital with this

Question 3

Incidence of LRTI

Answer 3

Question 4

What are the common infective agents?

Answer 4

•Bacterial

–Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae

•Viral

–RSV, parainfluenza III, influenza A and B, adenovirus

Question 5

What is the description of tracheitis?

Answer 5

•“croup which does not get better”

Question 6

What are the symptoms of tracheitis?

Answer 6

•Fever, sick child

Question 7

What are the common causative agents for tracheitis?

Answer 7

Staoh or strep

Question 8

What is the treatment for tracheitis?

Answer 8

Augmentin

Question 9

Is bronchitis common?

Answer 9

Yes, very

Question 10

What are the symptoms of bronchitis?

Answer 10

Loose rattly cough with URTI

Post-tussive vomit - ‘glut’

Chest free of wheeze and creps

Mostly self - limiting

Question 11

What are the common causes of bronchitis?

Answer 11

Haemophilus/Pneumococcus

Question 12

What is the mechanism of bacterial bronchitis?

Answer 12

Disturbed mucociliary clearance

• minor airway malacia
• RSV/adenovirus

Question 13

Why do people get recurrent colds in winter?

Answer 13

Question 14

What does bacterial bronchitis usually follow on from?

Answer 14

URTI

Question 15

What is Bronchioloitis defined as?

Answer 15

A lower respiratory tract infection of infants

Question 16

What is usually the cause of Bronchiolitis?

Answer 16

RSV (Respiratory Syncytial Virus)

Parainfluenza 3, HMPV (human metapneumovirus)

Question 17

What are the symptoms of bronchiolitis?

Answer 17

Nasal Stiffness, tachypnoea, poor feeding

Crackles +/- wheeze

Question 18

What is the most common cause of LRTI in infancy?

Answer 18

Bronchiolitis

Question 19

When is the peak incidence of Bronchiolitis?

Answer 19

3 months

Question 20

What separates bronchiolitis from asthma?

Answer 20

Bronchiolitis is a 2 week infection from start to finish, asthma is recurrent

Question 21

Why does feeding have complications during the course of bronchiolitis?

Answer 21

It is essentially excersize for the baby who is unused to the idea of breathing through the mouth, nose is blocked. Feeding the baby now has complications.

Question 22

What is managent of bronchiolitis?

Answer 22

Maximal Observation

Minimal Intervention

Question 23

What are the relevant investigations for bronchiolitis?

Answer 23

Nasopharyngel aspirate

Oxygen saturasion to determine severity

Question 24

What does an NPA involve?

Answer 24

A catheter (or tube) is inserted a short distance into your child’s nose (this should occur with minimal discomfort to your child).
· Gentle suction is used to collect some mucus.
· The mucus is then sent to the laboratory for testing

Question 25

Is there any need for ## Footnote –CXR –Bloods –Bacterial cultures ?

Answer 25

NO

Question 26

Are there any medications proven to help bronchiolitis?

Answer 26

NO

Question 27

What is the definition of a LRTI?

Answer 27

48 hours of fever (above 38.5 degrees), SOB, cough and grunting

Question 28

What can you infer from wheeze?

Answer 28

Bacterial cause is unlikely

Question 29

How do you confirm a lower respiratory tract infection?

Answer 29

Reduced or bronchial breath sounds

Question 30

What are the infective agents for LRTI?

Answer 30

–Viruses in \<35% (higher in younger) –Bacteria Pneumococcus, Mycoplasma, Chlamydia –Mixed infection in \<40%

Question 31

How can you tell if the LRTI is pneumonia?

Answer 31

–Signs are focal (one side of the chest) –Creps – fine crackles –High fever

Question 32

What are the possible investigations for community acquired pneumonia?

Answer 32

CXR - –(rarely going to help) and inflammatory makers NOT “routine”

Question 33

What is the management for community acquired pneumonia?

Answer 33

–Nothing if symptoms are mild –(always offer to review if things get worse!) –Oral Amoxycillin first line –Oral Macrolide second choice –Only for iv if vomiting

Question 34

When woud you consider antibiotics for an LRTI?

Answer 34

After 48 hour history exists

Question 35

LOOK

Answer 35

Question 36

What is the only thing that causes coughing fits?

Answer 36

Pertussis

Question 37

What are the symptoms of pertussis?

Answer 37

Vomiting and colour change

Question 38

Is pertussis common?

Answer 38

Yes

Question 39

Where can empyema arise from?

Answer 39

Complications of pneumonia

Question 40

What is the treatment of empyema?

Answer 40

Antibiotics and drainage

Question 41

To treat or not to treat

Answer 41