Lower Respiratory Tract Infections in Children

Question 1

List some common bacterial ‘infections’ which are common in health.

Answer 1

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 2

Name two bacteria which are not common in health and what they cause/.

Answer 2

Pertussis - whooping cough
Mycobacterium - tuberculosis.

Question 3

List some viruses which cause LRTI.

Answer 3

RSV
Parainfluenza III
Influenza A and B
Adenovirus

Question 4

What are the principles of management in children with LRTI’s?

Answer 4

Make a diagnosis (easy)
Assess the patient (easy)->oxygenation, hydration, nutrition

To treat or not to treat (grey)

Question 5

What is tracheitis?

Answer 5

Infection of the trachea

Question 6

Name some symptoms of children with tracheitis.

Answer 6

‘Croup which didn’t get better’

-Barking cough
-Fever
-Feeling sick

Question 7

What is the tracheitis caused by?

Answer 7

Staph or strep over colonisation of the airways.

Question 8

What is the treatment for tracheitis?

Answer 8

Augmentin

Question 9

How is bronchitis charcaterized?

Answer 9

Child very well, parent very worried

Question 10

What is bronchitis?

Answer 10

Infection of the inside of the airways
Endobronchial infection

Question 11

What are the presenting symptoms of bronchitis?

Answer 11

Loose rattly cough started with URTI
Post-tussive vomit - “glut” -> vomiting after coughing for a long period of time

Question 12

What’s the mechanism of bacterial bronchitis?

Answer 12

Disturbed mucociliary clearance-> cilia don’t work

Question 13

How long can bacterial bronchitis last for?

Answer 13

Up to four weeks

Question 14

Describe briefly the cycle of bacterial bronchitis.

Answer 14

Continuous cycle through winter- 4 or 5 cycles.
Child’s first winter- bad
Second- better
Third-fine

Question 15

What is the management for persistent bacterial bronchitis?

Answer 15

1. Make the diagnosis
2. Reassure
3. Do not treat

Question 16

What is bronchiolitis?

Answer 16

Infection of the smaller airways

Question 17

How common is bronchiolitis?

Answer 17

Very common

Question 18

Which forms of viruses/bronchiolitis may an infant get soon after being born?

Answer 18

Usually RSV (respiratory sensitive virus), others include paraflu III, HMPV

Question 19

What are the presenting symptoms of bronchiolitis?

Answer 19

Nasal stuffiness, tachypnoea, poor feeding
Crackles and sometimes wheeze in chest

Question 20

How many days after the start of bronchiolitis does the child stabilise?

Answer 20

Five days

Question 21

How long does the child remain at this stabilised worst period?

Answer 21

Two days

Question 22

At what age does bronchiolitis occur?

Answer 22

<12months

Question 23

Is bronchiolitis recurrent or one off?

Answer 23

One off

Question 24

What is the management of bronchiolitis?

Answer 24

Maximum observation
Minimum intervention

Question 25

What investigations take place for a clinical diagnosis of bronchiolitis?

Answer 25

NPA (nasal pharyngeal aspirin) to identify virus Oxygen saturation

Question 26

Name some medication which can help bronchiolitis.

Answer 26

Hehe none ...wait not hehe that makes me sound mean

Question 27

If there is a wheeze in someone presenting w a LRTI, what kind of infection is it unlikely to be?

Answer 27

Bacterial

Question 28

Name some characterisations of LRTI's.

Answer 28

48 hrs, fever (>38.5oC), SOB, cough, grunting

Question 29

What symptoms are common in pneumonia? btw, if they have these symptoms, you are allowed to call it pneumonia. If they don't, call it URTI as parents get terrified when they hear pneumonia.

Answer 29

Signs are focal, ie in one area (LLZ) Creps High fever

Question 30

What are the treatment options for children w pneumonia?

Answer 30

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

Question 31

When might you use IV antibiotics/medications?

Answer 31

If the child is vomiting

Question 32

Name some advantages of oral medication compared to IV.

Answer 32

Shorter hospital stay Cheaper

Question 33

Name a disadvantage of oral medication compared to IV

Answer 33

Child might have a fever for a couple of hours longer

Question 34

What are the differences between LRTI and bronciolitis?

Answer 34

LRTI- In all ages More rapid onset of symptoms Fever Bronchiolitis- Aged <12 months 3 days before reach peak Fever rarely >38oC

Question 35

What is the medical term for whooping cough?

Answer 35

Pertussis

Question 36

Pertussis is still common despite being vaccinated. However, what does the vaccine do?

Answer 36

Reduces risk and severity of whooping cough

Question 37

Name some symptoms of pertussis.

Answer 37

Coughing fits Vomiting after coughing fit

Question 38

What condition can be a complication of pneumonia?

Answer 38

Empyaema

Question 39

In Empyaema, where does the infection spread?

Answer 39

Spreads to the pleural space

Question 40

What may children with Empyaema expereince?

Answer 40

Chest pain and feeling generally unwell

Question 41

What is the treatment for Empyaema?

Answer 41

Antibiotics with drainage of the fluid

Question 42

What are the three most important things to sort when deciding if to give a child w a LRTI antibiotics or not?

Answer 42

Nutrition Hydration Oxygenation

Question 43

Which LRTI's should you give antibiotics to treat?

Answer 43

Tracheitis and Empyaema

Question 44

What LRTI may you need to give antibiotics for and when?

Answer 44

Pneumonia if two days of fever, cough, focal signs