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Paediatrics > LRTI > Flashcards

LRTI Flashcards

1
Q

Is the trachea upper or lower respiratory tract?

A

Lower

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2
Q

What is tracheitis?

A

Uncommon

“croup which does not get better”

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3
Q

How does tracheitis present?

A

Fever

Sick child

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4
Q

What causes tracheitis?

A

BACTERIA

Staph or strep invasive infection

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5
Q

How does tracheitis present on endoscopy?

A

Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris

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6
Q

How is tracheitis treated?

A

Augmentin

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7
Q

What is bronchitis?

A

Common ++++

Endobronchial infection

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8
Q

How does bronchitis present?

A

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

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9
Q

What causes bronchitis?

A

Haemophilus/Pneumococcus

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10
Q

How is bronchitis treated?

A

Mostly self-limiting

Child VERY well, parent worried

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11
Q

What is the mechanism of bacterial bronchitis?

A

Disturbed mucociliary clearance

  • Minor airway malacia
  • RSV/adenovirus

Bacterial infection/overgrowth is secondary

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12
Q

What is the cycle associated with child LRTI?

A

Respiratory virus -> Clearance stops for <4 weeks -> Cough and rattle -> Clearance almost recover ->

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13
Q

What is the natural history of bacterial bronchitis?

A

Following URTI (e.g. rhinovirus infection)
Lasts 4 weeks
60-80% respond to antibiotic (must consider side-effects)
First winter bad
Second winter better
Third winter fine
Pneumococcus/H flu

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14
Q

How do you manage persistent bacterial bronchitis?

A

Make the diagnosis
Reassure
Do not treat

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15
Q

What is bronchiolitis and how does it present?

A

LRTI of infants
Affects 30-40% of all infants

Nasal stuffiness!!
Tachypnoea
Poor feeding
Crackles +/- wheeze

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16
Q

What is the causative organism in bronchiolitis?

A

Usually RSV (respiratory syncynctial virus)

Others include:
Paraflu III
HMPV - Human metapneumovirus

17
Q

What are the diagnosing factors of bronchiolitis?

A

12 months old
One off (NOT recurrent)
Typical history

18
Q

How is bronchiolitis managed?

A

Maximal observation

Minimal intervention

19
Q

How is bronchiolitis investigated?

A 
NPA - nasopharyngeal aspirate (nursing in same ward)
Oxygen saturations (severity)

No routine need for

  • CXR
  • Bloods
  • Bacterial cultures
20
Q

Which medications are not proven to work in bronchiolitis?

A 
NO MEDICATIONS WORK!!
Salbutamol
Ipratropium bromide
Adrenalin
Steroids
Antibiotics
Nebulised hypertonic saline
21
Q

What are the markers of a LRTI?

A

48 hrs, fever (>38.5oC), SOB, cough, grunting
Wheeze makes bacterial cause unlikely
Reduced or bronchial breath sounds
“Infective agents” - Virus+commensal bacteria/bacterium

22
Q

What is the timeline of bronchiolitis?

A

Days 2-5: gets worse
Days 5-7: stabilises
Days 7-14: recovery

23
Q

How do you decide if it’s pneumonia?

A

Totally academic! (does the child care??)

Word causes great anxiety

You might call it pneumonia if:

  • Signs are focal, ie in one area (LLZ)
  • Creps
  • High fever

Otherwise call it LRTI

24
Q

What can an x-ray do in LRTI?

A

Confirm diagnosis BUT DOESN’T CHANGE WHAT YOU DO

25
Q

What are the BTS guidelines for investigating community-acquired pneumonia?

A

CXR and inflammatory markers not routine

26
Q

What are the BTS guidelines for managing community-acquired pneumonia?

A

Nothing if symptoms are mild
(always offer to review if things get worse!)

1) Oral Amoxycillin first line
2) Oral Macrolide second choice
3) Only for iv if vomiting

PNEUMOINIA - IV AMOXCILLIN

27
Q

Why use oral antibiotics over IV?

A

Shorter hospital stay
Cheaper

When:

  • antibiotics are indicated (48 hours, etc, etc)
  • in non-severe LRTI
  • when child is not vomiting
28
Q

Why use IV antibiotics over oral?

A

Fever for a few more hours

When:

  • antibiotics are indicated (48 hours, etc, etc)
  • in non-severe LRTI
  • when child is not vomiting
29
Q

What are the differences between LRTI and bronchiolitis?

A

Technically same thing

LRTI:

  • In all ages
  • More rapid onset of symptoms
  • Fever

BRONCHIOLITIS:

  • Aged <12 months
  • 3 days before reach peak
  • Fever rarely >38oC

LRTI GUIDANCE

30
Q

What is pertussis?

A

Whooping cough
This is common!
Vaccination reduces risk
Vaccination reduces severity

31
Q

What are the signs of pertussis?

A

“Coughing fits”

Vomiting and colour change

32
Q

What is empyema?

A

Complication of pneumonia

Extension of infection into pleural space

33
Q

What are the signs of empyema?

A

Chest pain and very unwell

34
Q

What is the management of empyema?

A 
Antibiotics+/- drainage
Good prognosis (in contrast with adults)
35
Q

What do you do first in all LRTIs?

A

Oxygenation, hydration and nutrition

36
Q

Summary

A

LRTI SUMMARY

Paediatrics (37 decks)

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