LRTI

Question 1

What is whooping cough?

Answer 1

An upper respiratory tract infection.

Question 2

What are the signs of whooping cough?

Answer 2

Low grade fever 
Coughing fits - with periods of no coughing between (paroxysmal coughing)
Loud inspiratory whoop
Rhinorrhoea 
Post cough vomiting

Question 3

What can happen in severe coughing, especially in children?

Answer 3

Pneumothorax
Faint
Vomit

Question 4

What is a common presentation in infants?

Answer 4

Apnoea (temporary cessation of breathing) - instead of cough

Question 5

Who gets the whooping cough vaccine?

Answer 5

Pregnant women
Infant
Children
Pre teens

Question 6

What is the tests done to diagnose whooping cough>

Answer 6

Nasal swab culture - takes 2-3 weeks

If infection > 2 weeks - can test for anti pertussis immunoglobulin G

Question 7

How is anti pertussis immunoglobulin G tested for?

Answer 7

5-16 yrs - in mouth saliva

>17 yrs - in blood

Question 8

What is the management of whooping cough?

Answer 8

Notify public health
Macrolide antibiotics - clarithromycin, azithromycin or erythromycin - if cough begun within 21 days

Co-trimoxazole (alternative)
Prophylaxis antibiotics to vulnerable close contacts

Question 9

What is the main complication from whooping cough?

Answer 9

Bronchiectasis

Question 10

How long does whooping cough take to resolve?

Answer 10

8 weeks - can take longer

Question 11

What are examples of macrolide antibiotics?

Answer 11

Clarithromycin
Erythromycin
Azithromycin
Roxithromycin

Question 12

What is the cause of whooping cough?

Answer 12

Bordetella pertussis

Question 13

What is the 1st line antibiotic for >1 month?

Answer 13

Azithromycin

Question 14

What is the 2nd line antibiotic for >1 month?

Answer 14

Trimethoprim + sulfamethoxazole

Question 15

What is bronchiolitis?

Answer 15

Infection and inflammation of the bronchioles, only seen in children <1yr.

Question 16

When is bronchiolitis common?

Answer 16

In the winter
As a ONE OFF (not recurrent).
Most common before 6 months (average = 3 months).

Question 17

How does bronchiolitis present?

Answer 17

runny nose
sneezing
poor feeding
mild fever
dyspnoea 
wheeze
crackles 
tachypnoea

Question 18

How many infants get bronchiolitis?

Answer 18

30-40%

Question 19

What investigation is done for children with bronchiolitis?

Answer 19

Nasopharyngeal aspirate

Question 20

What is the difference between bronchiolitis and bronchitis?

Answer 20

Bronchiolitis is an infection of the smaller airways whereas bronchitis is an infection of the larger airways.

Question 21

What is the usual cycle of bronchiolitis?

Answer 21

• starts as URTI (1/2 get better and 1/2 develop chest symptoms)
• chest symptoms start 1-2 days after URTI symptoms
• symptoms are at their worst on days 3-4
• symptoms usually last 7-10 days total
  Full recovery occurs within 2-3 weeks

Question 22

When should you admit someone with bronchiolitis to hospital?

Answer 22

<3 months or any pre-existing condition ( prematurity, Downs syndrome or cystic fibrosis)
50 – 75% or less of their normal intake of milk
Clinical dehydration
RR 70
O2 sats 92%
deep recessions or head bobbing
Apnoeas
Parents not confident in their ability to manage at home or difficulty accessing medical help from home

Question 23

What is the treatment for tracheitis, bronchitis, pneumonia/LRTI, bronchiolitis and empyema?

Answer 23

tracheitis = augmentin
bronchitis = nothing 
bronchiolitis = nothing 
empyema = IV antibiotics 
LRTI/pneumonia = nothing OR oral amoxycillin

Question 24

What is tracheitis?

Answer 24

A very rare disease which presents like croup.

Question 25

How does tracheitis present?

Answer 25

Like croup but it doesn’t get better
Fever
Sick
High fever and rapidly progressing airway obstruction with thick airway secretions.

Most children with croup are otherwise well but children with tracheitis are very unwell

Question 26

What is the main cause of tracheitis?

Answer 26

Staphylococcus aureus

Question 27

what is the treatment for tracheitis?

Answer 27

Augmentin

usually IV

Question 28

in bronchiolitis, how high is the fever?

Answer 28

the fever rarely reaches >38 degrees

Question 29

What are the main features of bronchitis?

Answer 29

Its an infection of the larger airways, causes sputum production and does NOT require antibiotics.
Usually viral infection.

Question 30

What is the most common cause of bronchitis?

Answer 30

Strep pneumoniae

haemophilus influenza

Question 31

What are negative signs in bronchitis?

Answer 31

there is NO crackles or wheeze

Question 32

What is the typical cycle of bronchitis?

Answer 32

child has a cough that’s nearly gone then it reoccurs.

Question 33

How long does bronchitis last for?

Answer 33

usually up to 4 weeks

Question 34

how does a bacterial infection occur after bronchitis?

Answer 34

When the mucociliary tract stops working then a bacterial infection can occur secondary to the bronchitis

Question 35

what is the treatment for bronchitis?

Answer 35

NOTHING

Question 36

What are the main signs of pneumonia?

Answer 36

Focal signs (in one part of the chest)
crepitations
High fever
Productive cough
Fever >38.5
tachycardia
tachypnoea 
lethargy
delirium
dullness to percussion
coarse crackles
bronchial breathing

Question 37

What are the most common causes of pneumonia?

Answer 37

Strep pneumonia

Most common virus: respiratory syncytial virus

Question 38

How is pneumonia managed?

Answer 38

Amoxycillin (+ a macrolyde - erythromycin, clarithromycin and azithromycin)

Macrolide are used as monotherapy in patients with a penicillin injury

Question 39

when should IV antibiotics be used?

Answer 39

Only if the child is vomiting