LRTI Flashcards

1
Q

What is bronchitis?

A

inflammation of the lining of the bronchial tubes
- Rare in children
- Viral infection
- Antibiotics not effective
- Confused with asthma

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2
Q

What is asthma?

A

a condition in which a persons airways become inflamed, narrow and swell and produce extra mucus which makes it difficult to breathe

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3
Q

Characteristic features of asthma?

A
  1. Common in children
  2. Familial
  3. Associated with eczema
  4. Confused with bronchitis
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4
Q

When is asthma diagnosed?

A

> 3 years and nearly all by the age of 7 years

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5
Q

What is the true definition of asthma?

A

Recurrent and REVERSIBLE bronchospasms

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6
Q

Clinical features of asthma?

A
  1. Recurrent cough
  2. worse at night
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7
Q

Historical points that may suggest that the child’s asthma is triggered by allergens?

A
  1. Seasonal nature: pollen
  2. Worse when exposed to a pet: Animal dander
  3. Worse when bed is made or carpets/furnisher is dusted: house dust mites
  4. Worse in damp house holds: moulds
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8
Q

Pathophysiology of asthma?

A

Trigger > Exacerbations > bronchi mucus, oedema, spasms > Bronchiole obstruction > air trapping OR collapse

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9
Q

Classification of asthma?
How it is classified?

A

Mild, Moderate, and Severe
- classified on frequency and Impact on activity

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10
Q

What are acute asthma exacerbations?

A

episodes of worsening asthma symptoms and lung function
- can be the presenting manifestation of asthma or occur in patients with a known asthma diagnosis in response to a trigger e.g. viral upper respiratory infection, allergen, air pollution etc

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11
Q

Treatment of acute exacerbation of asthma?

A
  1. bronchodialators
  2. steroids
    - Goal is to stop the spasms and reduce inflammation
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12
Q

What bronchodialators are used in asthma?

A
  1. Mild: Salbutamol MDI 2-4 puffs
  2. Mod-Severe: Salbutamol nebuliser
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13
Q

What steroids are used in asthma?

A

Oral Prednisolone or IV Dexamethasone

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14
Q

If asthma is severe with impending death what do you use to treat?

A
  1. aminophyline
  2. magnesium
    Note: aminophyline has a narrow therapeutic window necessitating close monitoring
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15
Q

Why is inhaled salbutamol preferred?

A

because adverse effects—tremor, prolonged tachycardia, and irritability—are less

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16
Q

What is the natural progression of an asthma attack?

A

Cough > Wheezing > Tachpynea > ”silent chest” > Lethargy > Hypocapnia > “Normalizing” of respiratory rate > Respiratory failure > Death

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17
Q

Why should you beware of an asthmatic child that looks like they are getting better?

A

are they getting better or getting tired?

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18
Q

What is status asthmaticus?

A

is an acute exacerbation of asthma that does not respond adequately to therapeutic measures and may require hospitalization

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19
Q

Treatment of mild asthma?

A

Salbutamol rescue Inhaler as needed
- teach guardian to identify triggers

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20
Q

Treatment of moderate asthma?

A

Long acting bronchodilator (e.g., Salmeterol) and rescue inhaler

21
Q

Treatment of severe asthma?

A

Daily inhaled steroids, long acting bronchodilator, and rescue inhaler
- guardian needs “emergency plan”

22
Q

Management of asthma?

A

Control allergies
- dust, mold, cockroaches, etc
Note: Oral salbutamol is of little use and should NOT be prescribed for moderate or severe asthmatics

23
Q

What is bronchiolitis?

A
  • ARI primarily in infants (3-6 months)
  • Infection and inflammation of the bronchioles.
  • Highly contagious (contact)
24
Q

Epidemiology of bronchiolitis?

A

90% are aged 1–9 months

25
Q

Aetiology of bronchiolitis?

A
  1. RSV is the pathogen in 80%
  2. Parainfluenza virus
  3. Rhinovirus
  4. Adenovirus
  5. Influenza virus
  6. Human meta­pneumovirus
26
Q

Pathophysiology of bronchiolitis?

A
  1. Epithelial infection
  2. Oedema
  3. Sloughing of cells into airways
  4. Mucus production
  5. Obstruction
  6. Airway trapping
  7. Ciliary function impairment
  8. Polymorphonuclear and lymphocyte proliferation
27
Q

Clinical features of bronchiolitis?

A
  1. dry, wheezy cough
  2. cyanosis or pallor
  3. tachypnea and tachycardia
  4. subcostal and intercostal recession
  5. hyperinflation of the chest
    - sternum prominent
    - liver displaced downward
  6. auscultation
    - fine end-inspiratory crackles
    - prolonged expiration/wheeze
28
Q

Investigations in bronchiolitis?

A
  1. pulse oximetry
  2. Chest X-ray
  3. capillary blood gases
    - are only indicated if respiratory failure is suspected
29
Q

Indication for hospital admission in bronchiolitis?

A
  1. Apnoea (observed or reported)
  2. Persistent oxygen saturation of <92% when breathing air
  3. Inadequate oral fluid intake (<70% of usual volume)
  4. Severe respiratory distress – grunting, marked chest recession, or a respiratory rate over 70 breaths/minute
30
Q

Which infants are most at risk from severe bronchiolitis?

A
  1. Infants born prematurely who develop bronchopulmonary dysplasia
  2. those with other underlying lung disease, such as cystic fibrosis
  3. or those who have congenital heart disease
31
Q

Management in bronchiolitis?

A

Supportive
1. Oxygen
2. Monitoring for apnoea
3. Fluids (nasogastric or intravenously)
4. Continuous Positive Airway Pressure

32
Q

Etiology of pneumonia?

A
  1. Viruses are the most common cause in young children beyond the neonatal period
  2. bacteria are more common in neonates and older children
    - In clinical practice, it is difficult to distinguish between viral and bacterial pneumonia and in more than half of cases no causative pathogen is identified.
33
Q

Newborn causes of pneumonia?

A
  1. B streptococcus
  2. Gram-negative enterococci and bacilli
34
Q

Infant and young children causes of pneumonia?

A
  1. Viruses (mostly RSV)
  2. Bacterial infections
    - Streptococcus pneumonia
    - H. influenzae
    - Staphylococcus aureus
    - Bordetella pertussis
    - Chlamydia trachomatis
35
Q

Causes of pneumonia in children > 5 years?

A
  1. Mycoplasma pneumoniae
  2. Streptococcus pneumoniae
  3. Chlamydia pneumoniae
36
Q

What can cause pneumonia at all ages?

A

mycobacterium tuberculosis

37
Q

What reduces the incidence of pneumonia?

A

Immunization with Hib and pneumococcal vaccines has markedly reduced the incidence of pneumonia fromHaemophilus influenzaeand invasiveStreptococcus pneumoniae

38
Q

Clinical features of pneumonia?

A
  1. Usually preceding URTI
  2. Fever, cough and shortness (most common)
  3. Lethargy, poor feeding, and appearing ‘unwell’
  4. Pleural irritation (Localized chest, abdominal, or neck pain
39
Q

Physical examination findings of pneumonia?

A
  1. Tachypnoea ± increased work of breathing
  2. Raised respiratory rate (most sensitive marker)
  3. Signs of consolidation
  4. ‘Stony dull’ if effusion or empyema
  5. Oxygen saturation may be decreased
  6. RR also increased in febrile children
40
Q

What are the signs of consolidation in pneumonia?

A
  1. localized dullness
  2. ↓breath sounds
  3. bronchial breathing
  4. end-inspiratory coarse crackles
    - Signs of consolidation often absent in young children
41
Q

Investigations in pneumonia?

A
  1. Chest x-ray – only if diagnosis is in doubt.
  2. FCB
  3. Blood gas
  4. CXR
  5. Acute phase reactants cannot reliably differentiate viral from bacterial cause
42
Q

What is empyema?

A
  • Pleural effusion associated with pneumonia are initially sterile (para-pneumonic effusion in 1/3 cases) but can become infected (empyema)
  • When this happens, the fluid becomes increasingly viscous, and fibrin strands form, leading to septations.
43
Q

Indications for admission to hospital in pneumonia?

A
  1. Oxygen saturation <92%
  2. Recurrent apnoea
  3. Grunting and/or an inability to maintain adequate fluid/feed intake
44
Q

Management of pneumonia?

A

Supportive care
1. Oxygen
2. Analgesic for pain
3. Fluids to maintain hydration and sodium balance

45
Q

Newborn antibiotic treatment in pneumonia?

A

Broad-spectrum intravenous antibiotics

46
Q

Older infant antibiotic treatment of pneumonia?

A
  1. Oral amoxicillin
  2. Broader-spectrum
    e.g., co-amoxiclav reserved for complicated/unresponsive pneumonia
47
Q

> 5 years of age antibiotic treatment of pneumonia?

A

Amoxicillin or an oral macrolide e.g. clarithromycin

48
Q

Treatment of empyema?

A
  1. Small parapneumonic effusions resolve with pneumonia treatment
  2. Persistent fever after 48 hours of antibiotics suggest infected effusion
  3. Drainage required for empyema
    Regular instillation of a fibrinolytic agent
  4. Rarely: Thoracoscopic surgery or thoracotomy and decortication