lower respiratory tract infections in children

Question 1

what are common infective agents for bacterial?

Answer 1

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

Question 2

what are common infective agents for viral?

Answer 2

RSV, parainfluenza III, influenza A and B, adenovirus

Question 3

what are the principles of management?

Answer 3

Make a diagnosis (easy)
Assess the patient (easy)
Oxygenation, hydration, nutrition
To treat or not to treat (grey)

Question 4

what is tracheitis?

Answer 4

“croup which does not get better”
Fever, sick child
Staph or Strep invasive infection

Question 5

what are characteristics of bronchitis

Answer 5

Endobronchial infection
Loose rattly cough with URTI
Post-tussive vomit - “glut”
Chest free of wheeze/creps
Haemophilus/Pneumococcus

Question 6

what is a bacterial bronchitis a follow up from?

Answer 6

upper resp tract infection

Question 7

at what winter is the patient not having any symptoms for bacterial bronchitis

Answer 7

third winter

Question 8

what are the stages of persistent bacterial bronchitis

Answer 8

make the diagnosis
reassure
do not treat

Question 9

what percentage of infants get bronchiolitis?

Answer 9

30-40%

Question 10

what symptoms does bronchiolitis have?

Answer 10

crackles and wheeze
nasal stuffiness,
tachypnoea

Question 11

what is the management of bronchiolitis?

Answer 11

maximal observation

minimal intervention

Question 12

do you need cxr, bloods and bacterial cultures for investigations of bronchiolitis

Answer 12

no

Question 13

what are the symptoms of LRTI?

Answer 13

48 hrs, fever (>38.5oC), SOB, cough, grunting
Wheeze makes bacterial cause unlikely
Reduced or bronchial breath sounds

Question 14

when would you call it pneumonia and when would you call it LRTI

Answer 14

call it pneumonia when signs are focal, creps, high fever

otherwise call it LRTI

Question 15

how do you manage a mild pneumonia?

Answer 15

nothing

Question 16

whats the first line for treating pneumonia?

Answer 16

oral amoxycillin

Question 17

whats the second choice for treating pneumonia?

Answer 17

oral macrolide

Question 18

do you give antibiotics to bronchiolitis, croup, LRTI, otitis media, pharyngitis/tonsilitis

Answer 18

no

Question 19

what is empyaema a complication of?

Answer 19

pneumonia?

Question 20

what does it have to be to be bronchiolitis?

Answer 20

under 12 months

Question 21

whats the treatment of empyema?

Answer 21

stick needle in and let it drain