LRTI in children

Question 1

Describe the clinical presentations of common lower respiratory tract infections including bronchitis, pneumonia and bronchiolitis

Question 2

Define the common organisms causing lower respiratory infection including bacteria, and common viruses.

Question 3

Define the role of supportive therapy in addition to specific antimicrobial therapy.

Question 4

common bacterial infective agents

Answer 4

strep pneumonia, haemophiliac influenza, moraxella catarrhalis, mycoplasma pneumonia

Question 5

common viral infective agents

Answer 5

RSV, parainfluenza, adenovirus, influenza A+B

Question 6

tracheitis

Answer 6

inflamed pus laden trachea. Barking cough, temperature, fever and miserable. caused by staph or strep and treatment is augmentin.

Question 7

Bronchitis

Answer 7

Affects the large airways. (endobronchial). Loose, rough cough.no crackles or wheeze and cough so much may vomit at the end. caused by haemophilia/pneumococcus and child can be very well but parents worried. don’t treat just watch

Question 8

bacterial bronchitis

Answer 8

disturbance of the mucociliary clearance so no where for the secretion to go so pull on airways and needs to be coughed up. follows rhinovirus infection. takes 3 winters to stop being affected

Question 9

how do you treat persistent bacterial bronchitis

Answer 9

1. make the diagnosis. 2. reassure. 3. don’t treat

Question 10

bronchiolitis

Answer 10

affects the small airways. presents with a blocked nose so can’t feed very well. can have a crackly cough and may or may not have a wheeze. very predictable disease.
you get worse then stabilise at day 5 and then recover.
occurs in infants and peaks around 3 months

Question 11

key features of LRTI

Answer 11

Occurs for 48 hours, fever (>38.5), SOB, cough, grunting to keep airways open. unlikely to be a bacterial infection. using stethoscope hear fluid in the large airways

Question 12

when does something become pneumonia

Answer 12

signs are in one area e.g lower, left zone.
Crepitus in the lungs refers to the sound and sensation associated with subcutaneous emphysema, a condition in which air is trapped under the skin
High fever

Question 13

management of pneumonia

Answer 13

only if has a fever for more than 2 days, cough and focal signs- oral amoxycillin, oral macrolide, IV if vomiting

Question 14

differences between LRTI and bronchiolitis

Answer 14

LRTI= all ages, rapid onset of symptoms and a fever
Bronchiolitis= occurs before 12 months, 3 days before peak symptoms, fever rarely greater then 38

Question 15

pertussis- whooping cough

Answer 15

vaccination reduces risk. coughing fits and vomiting with colour changes

Question 16

empyema

Answer 16

extension of infection from lung tissue into pleural space. Causes chest pain and tend to be very unwell and can occur as a complication of pneumonia.

give antibiotics and drain fluid

Question 17

take home messages from LRTI

Answer 17

very common in children, focus on hydration, oxygenation and nutrition and then look to antibiotics and always review if needed