LRTI in children

Question 1

name 5 LRTI

Answer 1

pneumonia
tracheitis
bronchitis
emyaema
bronchiolitis

Question 2

common bacterial infective agents for LRTI

Answer 2

Strep pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Mycoplasma pneumoniae

Chlamydia pneumoniae

Question 3

common viral infective agents for LRTI

Answer 3

RSV
parainfluenza III
influenza A and B
adenovirus

Question 4

principles of management of LRTI

Answer 4

diagnosis
assess patient - oxygenation, hydration, nutrition
treat or not treat?

Question 5

tracheitis disease profile

Answer 5

swollen tracheal wall with narrowed tracheal lumen and luminal debris

uncommon
a child will present with a fever
it’s a staph or strep invasive infection

Question 6

what antibiotic is used to treat tracheitis?

Answer 6

augmentin

Question 7

bronchitis disease profile

Answer 7

common
endobronchial infection
loose rattly cough with URTI 
post cough vomit - 'glut'
no wheeze
haemophilus/pneumococcus
mostly self-limiting

Question 8

bacterial bronchitis mechanism of infection in children

Answer 8

disturbs mucociliary clearance
lack of social inhibition- child doesn't cover mouth etc
infection secondary (due to treatment of something else or changes in immune system)

Question 9

natural history of bacterial bronchitis

Answer 9

following a URTI
lasts 4 weeks
cough morbidity gets better in repeated infection

Question 10

what should happen with persistent bacterial bronchitis?

Answer 10

make the diagnosis
reassure patient
but don’t treat

Question 11

bronchiolitis

Answer 11

LRTI of infants
30-40% of all infants affected
usually RSV (Respiratory syncytial virus)
nasal stuffiness, tachypnoea - rapid breathing
poor feeding
crackles but no wheeze

Question 12

how many days after the start of a cough should you seek medical attention for an infant

Answer 12

5 days after start of cough

Question 13

bronchiolitis diagnosis

Answer 13

under 12 months
one off (NOT recurrent)

Question 14

management of bronchiolitis

Answer 14

maximal observation

minimal intervention

Question 15

investigations done for bronchiolitis

Answer 15

NPA - nasopharyngeal aspirate- collects specimen using nasal tube

oxygen saturations

Question 16

which medications have been proven not to work at treating bronchiolitis

Answer 16

salbutamol
adrenalin
steroids
ipratropium bromide
antibiotics

Question 17

LRTI

Answer 17

48 hours, fever, SOB, cough, grunting
wheeze means bacterial cause unlikely

reduced or bronchial breath sounds

Question 18

when would you call it pneumonia and not a LRTI?

Answer 18

if signs are focal
creps
high fever

Question 19

British thoracic society guidelines for community acquired pneumonia

Answer 19

nothing if symptoms are mild
Oral Amoxycillin first line
Oral Macrolide second choice
Only for iv if vomiting

Question 20

what are not routinely used investigations for community acquired pneumonia

Answer 20

CXR and inflammatory markers are NOT routine

Question 21

why are oral antibiotics preferred choice for treatment of pneumonia over IV

Answer 21

shorter hospital stay
cheaper
although you may have fever for longer

Question 22

pertussis (whooping cough)

Answer 22

common!
vaccination reduces risk and severity
coughing fits
vomiting and colour change

Question 23

empyaema

Answer 23

complication of pneumonia
extension of infection into pleural space
chest pain and very unwell
IV antibiotics used to treat