Lower Respiratory Tract Infections in Children

Question 1

What are common bacterial agents that cause infections?

Answer 1

strep pneumoniae, Haemophilus influenzae, Moraxella catrrhalis, Mycoplasma pneumoniae, chlamydia pneumoniae,

Question 2

What are comon viral agents that cause infection?

Answer 2

RSV, parainfleunza III, influenze A and B, adenovirus

Question 3

What are the principles of management of a LRTI?

Answer 3

Make a diagnosis, Asess the patient (oxygenation, hydration, nutrition), to treat or not to treat

Question 4

What is tracheitis?

Answer 4

it is croup which doesnt get better, inflammation of the trachea.

Question 5

What are the symptoms of tracheitis?

Answer 5

Barking cough, stridor, fever and sickness
Fever, sick child
Swollen tracheal wall, narrowed tracheal lumen, luminal debris

Question 6

What bacteria causes tracheitis?

Answer 6

Staph or strep

Question 7

What is an endobronchial infection?

Answer 7

An infection inside the airway

Question 8

What are the symptoms of bronchitis?

Answer 8

loose rattly cough started off with an URTI with an end of the cough there is vomit (post tussive vomit)

Question 9

What bacteria cause bronchitis?

Answer 9

Pneumococcus and Haemophilus

Question 10

What is the mechanism of bacterial bronchitis?

Answer 10

Distrubed mucociliary clearance, lack of social inhibition, bacterial overgrowth is secondary.

Question 11

How are bacterial infections transmitted during winter?

Answer 11

The respiratory virus is picked up, mucociliary escalator switches off for up to 4 weeks, cough and rattle, mucociliary escalator slowly recovers.

Question 12

What is the natural history of bacterial bronchitis?

Answer 12

It follows URTI, lasts 4 weeks, 60-80% respond to antibiotics.

Question 13

What URTI does bronchitis follow?

Answer 13

Rhinovirus

Question 14

How does the cough morbidity vary with each winter?

Answer 14

First winter - bad, second winter better, Third winter - fine

Question 15

What is the diagnosis for bacterial bronchitis?

Answer 15

Make a diagnosis, Reassure (parents and grandparents), Do not treat

Question 16

How does bronchitis differ from bronchiolitis?

Answer 16

Bronchitis is the infection of the large airways and bronchiolitis is the infection of the small airways

Question 17

What is bronchiolitis?

Answer 17

It is a LTRI of infants

Question 18

What percentage of infants does bronchiolitis affect?

Answer 18

30 - 40%

Question 19

What are the common viruses that cause bronchiolitis?

Answer 19

Respiratory syncytial virus, parainfluenza, human metanuma virus

Question 20

What are the symptoms of bronchiolitis?

Answer 20

Stiuffy nose, tachypnoae, poor feeding

Question 21

Why do infants feed poorly when they have bronchiolits?

Answer 21

They’ve only got one orifice through which they feed and breath with a nose block and that is their mouth.

Question 22

What might you hear during an examination of a infant that has bronchiolitis?

Answer 22

Crackles +/- wheezes

Question 23

What are the management techniques of bronchiolitis?

Answer 23

Maximal observation, minimal intervention

Question 24

What are the investigations carried out during bronchiolitis?

Answer 24

NPA

Oxygen saturation

Question 25

What is a lower respiratory tract infection often characterised by?

Answer 25

48-hour history of fever, SOB, cough and often grunting

Question 26

What does wheeze rule out in LRTIS?

Answer 26

Wheeze makes the bacterial cause unlikely.

Question 27

What are the infective agents of LRTIs

Answer 27

Virus and commensal bacteria/bacterium, mycoplasma, Chlamydia.

Question 28

When are you allowed to call in pneumonia?

Answer 28

Signs are focal in one area (Left lower zone) Craputations High Fever (otherwise call it a LRTI)

Question 29

What are the management methods for pneumonia?

Answer 29

Nothing if the symptoms are mild Oral Amoxycillin first line Oral Macrolide second choice Only for iv if vomiting

Question 30

What are the benefits of oral antibiotics?

Answer 30

Shorter hospital stay, Cheaper

Question 31

What vaccination do to the risk and severity of pertussis?

Answer 31

It reduces the risk and severity

Question 32

What is pertussis characterised by?

Answer 32

• Coughing fits, vomiting and color change

Question 33

What is empyema?

Answer 33

• The complication of pneumonia, extension of the infection into pleural space.

Question 34

What are the treatments for empyaema?

Answer 34

• Antibiotics +/- drainage

Question 35

What is the treatment for tracheitis?

Answer 35

Augmentin

Question 36

What the most common cause of LRTI in infancy?

Answer 36

Bronchiolitis

Question 37

What is the peak incidence of bronchiolitis?

Answer 37

3 months

Question 38

What separates bronchiolitis from asthma?

Answer 38

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

Question 39

What are the relevant investigations for bronchiolitis?

Answer 39

Nasopharyngel aspiration, Oxygen saturasion to determine severity

Question 40

What does NPA involve?

Answer 40

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 41

How can you confirm a lower respiratory tract infection?

Answer 41

Reduced or bronchial breath sounds

Question 42

What are the possible investigations for community acquired pneumonia?

Answer 42

CXR and inflammatory makers NOT routine

Question 43

What is the management for community acquired pneumonia?

Answer 43

``` –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 44

When would you consider antibiotics for an LRTI?

Answer 44

After 48 hour history exist

Question 45

What is the treatment for empyema?

Answer 45

Antibiotics and drainage