Lower respiratory tract infections in children

Question 1

How common is bronchiolitis in children?

Answer 1

1 in 5

Question 2

What are some common bacterial infective agents in LRTIs in children?

Answer 2

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 3

What are some common viral infective agents in LRTIs in children?

Answer 3

RSV
Parainfluenza II
Influenza A and B
Adenovirus

Question 4

Describe tracheitis

Answer 4

Inflammation of the trachea, leading yo airway obstruction. “Croup which does not get better” - loud barking cough and stridor (croup), except child is unwell

Question 5

What are the common infections that cause tracheitis?

Answer 5

Staph or strep

Question 6

What is stridor?

Answer 6

Stridor is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree

Question 7

What are the symptoms of tracheitis?

Answer 7

Barking croup cough
Inspiratory stridor (crowing)
Scratchy throat
Chest pain
Fever
Earache
Headache
Dizziness
Laboured breathing

Question 8

How do you treat tracheitis?

Answer 8

IV antibiotics - amoxicillin and augmentin

Question 9

What is co-amoxiclav?

Answer 9

Amoxicillin and clavulanic acid combined

Question 10

What are the symptoms of bronchitis?

Answer 10

Coughing up mucus
Loose rattly cough
Post tussle vomit - "glut"
SOB
Wheezing
Chest discomfort
Chest free of crepitations

Question 11

How do you treat bronchitis?

Answer 11

You don’t - mostly self limiting, even if persistent

Question 12

What is bronchitis?

Answer 12

Inflammation of bronchi, and subsequent bacteria infections, often from disturbed mucociliary clearance

Question 13

What is bronchiolitis?

Answer 13

Inflammation of the bronchioles

Question 14

What infective agents cause bronchiolitis?

Answer 14

RSV
Parainfluenzae
HMPV (human metapneumovirus)

Question 15

How do patients with bronchiolitis presenT?

Answer 15

Coughing
Wheezing
SOB, can cause difficulty feeding
Blocked nose, difficulty breathing (tongue)
Ribs sucked in

Question 16

How long does bronchiolitis usually last?

Answer 16

2 weeks

Question 17

How do you manage bronchiolitis?

Answer 17

Maximum observation

Minimun intervention

Question 18

What are the symptoms and signs of LRTIs?

Answer 18

Fever >38.5c
SOB
Cough
Grunting
Reduced or bronchial breath sounds

Question 19

When is it pneumonia and not LRTI?

Answer 19

Signs are localised
Crepitations
High fever

Question 20

How do you manage pneumonia in the community?

Answer 20

Nothing if mild
IV antibiotics if vomiting
Oram amoxycillin or macrolides
Analgesia for otitis

Question 21

What is pertussis?

Answer 21

Whooping cough!

Highly contagious bacterial disease characterised by severe coughing fits, which can last for over 10 weeks

Vaccination reduces risk and severity

Question 22

What is the only disease that causes severe coughing fits i.e. break ribs, vomit?

Answer 22

Pertussis/whooping cough

Question 23

What organism is responsible for pertussis?

Answer 23

Bordetella pertussis

Question 24

When are those with pertussis infectious to others?

Answer 24

From onset of symptoms till 3 weeks later

Question 25

What are some complications of the coughing in pertussis?

Answer 25

Subconjunctival haemorrhages
Rib fractures
Urinary incontinence
Hernias
Vertebral artery dissection

Question 26

What are the symptoms of pertussis?

Answer 26

Severe coughing fits + high pitched “whoop”
Sneezing and runny nose
Gasping or cessation of breathing in babies

Question 27

What % of children with cough for over 2 weeks are found to be positive for pertussis?

Answer 27

40%

Question 28

What has increased since the introduction of two pneumococcal vaccinations in Scotland?

Answer 28

rates of empyema