Paediatric Lower Airway Issues

Question 1

Where is an aspirated foreign body most likely to end uo?

Answer 1

In the right main bronchus or further- this is because the right main bronchus is more vertical than the left

Question 2

What are some signs of foreign body aspiration?

Answer 2

Decreased air entry of the affected side
Reduced chest wall expansion of the affected side
Cyanosis/ Low oxygen saturations
Note- silence on the affected side is more concerning as this can indicate a complete obstruction

Question 3

Describe the difference in airway narrowing location between stridor and expiratory wheeze?

Answer 3

Stridor is due to airway obstruction below the larynx but in the extrathoracic upper airway, it is an inspiratory sound

Expiratory wheeze are heard when there is narrowing of the smaller airways within the thorax

Question 4

What investigations should be done for foreign body aspiration?

Answer 4

CXR
Neck Radiograph
Bronchoscopy
Sometimes CT

Question 5

What are some indirect signs of obstruction?

Answer 5

Consolidation distal to the obstruction
Atelectasis if complete obstruction
Air trapping can cause a mediastinal shift

Question 6

What is the most common cause of acute bronchitis in children?

Answer 6

Influenza Type A and B
Parainfluenza
Adenovirus
RSV
Rhinovirus
Coronavirus

(Most common causes are therefore viral)

Question 7

What is the most common lung infection in children?

Answer 7

Acute Bronchiolitis

Question 8

What are some bacteria that can cause acute bronchitis in children?

Answer 8

Bordetella pertussis (whooping cough)
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 9

What are some symptoms of whooping cough?

Answer 9

Features of URTI- Congestion, Dysphagia
Bouts of coughing that may end with vomiting and cyanosis
Fever

Question 10

What age group is whooping cough common in?

Answer 10

Infants but there is a second peak around 14 years of age

Question 11

When are vaccines for whooping cough given?

Answer 11

During pregnancy

At 8, 12 and 16 weeks as it is included in the 6 in 1 vaccine

Question 12

What causes the whoop of whooping cough?

Answer 12

The whoop occurs after breathing in when trying to inspire against a closed glottis

Question 13

What antibiotic is used for pertussis?

Answer 13

A macrolide such as clarithromycin

Admit if less than 6 months old- may need ventilation or ECMO

Question 14

What is the most common cause of acute bronchiolitis?

Answer 14

RSV

Acute bronchiolitis is the most common lung infection in infants

Question 15

What are some of the symptoms of acute bronchiolitis?

Answer 15

Coryzal symptoms often precede- rhinorrhoea, sneezing, cough, congestion

Question 16

What are some signs of acute bronchiolitis and associated respiratory distress?

Answer 16

Tachypnea
Tachycardia
Cyanosis
IC , SC or Sternal Recession
Tracheal Tug
Wheeze (small intrathoracic airway obstruction)
Inspiratory crackles

Question 17

What are some signs that should prompt admission?

Answer 17

Altered mental status
Hypoxia
Difficulty feeding
Signs of respiratory distress

Question 18

In which group of patients is the risk of death from acute bronchiolitis greatest?

Answer 18

Patients with symptomatic congenital heart defects

Other risks include- prematurity, low birth weight, non breast feeding, chronic pulmonary disease, immunodeficiency

Question 19

What is included in the treatment for acute bronchiolitis?

Answer 19

Oxygen keeping sats >92 %
NG feeding if struggling to maintain nutritional intake
Steroids and nebulised salbutamol sometimes used
Respiratory support where needed
Fluids

Question 20

How might acute bronchiolitis be prevented in at risk groups?

Answer 20

Ribavirin can be used which is anti-RSV retroviral medication can be used.

Prophylaxis with monthly injections of Palivizumab which is Ab against RSV can be given

Question 21

At what age does acute bronchiolitis typically occur?

Answer 21

Children under two years of age most often between 3 and 6 months

Question 22

What typically precedes acute bronchiolitis?

Answer 22

Coryzal prodrome- cough, congestion, rhinorrhea, low grade fever

Followed by tachypnoea, signs of respiratory distress, wheeze or crackles on auscultation

Question 23

How does the cause of LRTI/Pneumonia differ between children and adults?

Answer 23

The cause is more likely to be viral in young children

Question 24

What are some of the symptoms of pneumonia in a child?

Answer 24

Features of respiratory distress
Poor feeding
Fever (higher if bacterial)
Malaise
Pleuritic chest pain if near the pleural surface
Productive cough
Tachypnoea

Question 25

How might the features of a viral and bacterial pneumonia differ?

Answer 25

Bacterial- start suddenly, more sever, high grade fever unlikely to have upper airway symptoms, larger rises in inflammatory markers

Viral- begin gradually, milder and less severe, more likely to have upper airway symptoms

Question 26

What are some features of severe pneumonia in children?

Answer 26

Poor feeding
High grade fever
Lethargy/Malaise/Altered Mental Status
Failure to maintain oxygen sats above 92%
Features of respiratory distress including SC/IC/Sternal Recession, Tracheal Tug, Pallor/Cyanosis