Lower RTI in adults + children 2

Question 1

Common infective agents in children

Answer 1

BACTERIAL
-S.pneumonae, H.influenzae, moraxella catarrhalis, Klebsiella pneumoniae

VIRAL
-RSV, parainfluenza 3, Influenza A/B, Adenovirus, human metapneumovirus

• Immunisation history
• secondary bacterial infection

Question 2

Laryngotracheobronchitis ( croup) symptoms and cause

Answer 2

• viral infection
• large airways(narrowing)
• inspiratory stridor, hoarseness, RD
• rhinorrhoaea, fever
• WORSE AT NIGHT!

Question 3

What age are you more likely to get Croup?

Answer 3

-6m-6yrs ( peak 2 yrs)

Question 4

Rating of Croup

Answer 4

see slide 9

Question 5

Management of Croup

Answer 5

• supportive, reassurance, worsening advice

- oral once off dose dexamethasone(0.15ml/kg) steroid

Question 6

Admission of croup + treatment

Answer 6

• Moderate/sever
• Oxygenation
• Nebulised adrenaline
• Supportive

Question 7

Epiglottitis symptoms + cause

Answer 7

• fever, difficulty swallowing/breathing
• drooling, sore throat
• H.influenzar vauses this

Question 8

Bacterial tracheitis symptoms

Answer 8

• ’’ croup that doesn’t get better’’

- differential diagnosis of croup

Question 9

Treatment of epiglottitits

Answer 9

-H.influenzae(vaccine)

Question 10

Treatment of bacterial tracheitis + Cause

Answer 10

co-amoxiclav

-straphylococcus/streptococcus invasive infection

Question 11

What is Bronchiolitis + the type of infection

Answer 11

• Inflammation of bronchioles + mucous acc in small airways

- type of RSV infection(respiratory syncytial virus)

Question 12

When is bronchiolitis common?

Answer 12

-winter peak period

Question 13

Symptoms of bronchiolitis

Answer 13

• cold symptoms( fever, congestion ) THEN cough.
• tachypnoea
• crackles +/-wheeze

Question 14

How is bronchiolitis spread? How long does it last

Answer 14

• droplet ( air borne)

- days-weeks

Question 15

Bronchiolitis management

Answer 15

• observe oxygenation, NPA?

- NO CXR, Bloods/cultures

Question 16

Safety net of bronchiolitis

Answer 16

-RD, (tachypnoea, indrawing, sternal recession, nasal flaring, grunting, cyanosis if severe, see-saw breathing, tripod positioning, subcostal recession), other risk factors, systemically unwell (not feeding, poor urine output)

Question 17

Whooping cough (bordetella pertussis) symptoms

Answer 17

• Cold like symptoms
• coughing fits(ALOT), vomiting due to cough
• red face
• inspiratory ‘‘whooping’’ sound

Question 18

Treatment of whooping cough

Answer 18

< 3 weeks: macrolide antibiotics (clatithromycin, erythromycin, azithromycin)

Question 19

Special considerations of whooping cough treatment

Answer 19

• pregnancy, immunisation 16-32wks, <6m
• post exposure prophylaxis
• vaccination

Question 20

When is whooping cough common?

Answer 20

2-5 yearly cycle

Question 21

What is Bronchitis

Answer 21

• inflammation of bronchi

- endobronchial infection

Question 22

Symptoms of bronchitis

Answer 22

• loose rattly cough with URTI
• post-tussive vomit - ‘‘glut’
• chest free of wheeze/creps
• child is well

Question 23

Causes of bronchitis

Answer 23

-haemophilus/pneumococcus

Question 24

Describe the mechanism/cause of bacterial bronchitis

Answer 24

• disturbed mucocilary-escalator system
• RSV/adenovirus
• minor airway malacia
• secondary infection

Question 25

Symptoms of LRTI/Pneumonia in neonates

Answer 25

-grunting, poor feeding, irratable, lethary, tachypnoea, cough (unusal)

Question 26

Symptoms of LRTI/Pneumonia in infants

Answer 26

-cough, tachynoea, grunting, respiratory disress, not feeding, irratbile, preceding URTI

Question 27

Complications of pneumonia in kids

Answer 27

empyema

-extension of infection in pleural space

Question 28

Viral induced wheeze symptoms + treatment

Answer 28

• 6m-5yrs associated with viral infection of airways
• infection that causes symptoms of asthma
• bronchodilators (B2 agonist)

Question 29

When is asthma diagnosed?

Answer 29

> 5yrs