paediatric resp - infections (upper + lower)

Question 1

side effects of antibiotics

Answer 1

diarrhoea
oral thrush 
nappy rash
allergic reaction 
multi-resistance

more harm than benefit?

Question 2

what can advise when see child with URTI

Answer 2

anti-pyrexials e.g. paracetamol, ibuprofen
sugary fluids
time

Question 3

rhinitis

Answer 3

winter months
self-limiting

prodrome to other illnesses: pneumonia, bronchiolitis, meningitis, septicaemia

review if not sure

Question 4

otoscope findings otitis media

Answer 4

erythema

bulging drums

Question 5

otitis media

Answer 5

common, self-limiting
primary viral infection
secondary infection with pneumococcus/h’flu

spontaneous rupture of drum

antib usually dont help

Question 6

treating URTIs

Answer 6

analgesia works

jury is out for antibiotics - may work after 24hrs

Question 7

tonsiliis/pharyngitis treatment

Answer 7

viral? no treatment

bacterial? 10 days penicillin

Question 8

croup

Answer 8

parainfluenzae
common
coryza++, stridor, hoarse cough, barking cough
oral dexamethesone

Question 9

epiglottitis

Answer 9

h.influenzae type b
rare, toxic
stridor, drooling
intubation and antibiotics

Question 10

LRTI: common infective agents

Answer 10

bac: strep pneumoniae, haemophilus influenzae, moraxella catarrhalis, mycoplasma pneumoniae, chlamydia pneumoniae
viral: RSV, influenzae A and B, adenovirus

Question 11

principles of management of LRTI

Answer 11

make diagnosis
assess patient: oxygenation, hydration, nutrition

to treat or not to treat?

Question 12

tracheitis

Answer 12

uncommon
‘croup which doesn’t get better’
fever, sick child
staph or strep

treatment = augmentin

Question 13

tracheitis pathophys

Answer 13

swollen tracheal wall
narrowed tracheal lumen
luminal debris

Question 14

bronchitis

Answer 14

common
endobronchial infection
loose rattly cough w URTI
post-tussive vomit

heamophilus/pneumococcus
mostly self limiting

Question 15

mechanism of bacterial bronchitis

Answer 15

• disturbed mucociliary clearance
• lack of social inhibition - why it spreads toddler age
• bacterial infection/overgrowth is secondary

Question 16

persistent bacterial bronchitis

Answer 16

make diagnosis
reassure
don’t treat

Question 17

bronchiolitis

Answer 17

LRTI of infants
usually RSV, can be paraflu III, HMPB

nasal stuffiness, tachypnoea, poor feeding

crackles +/- wheeze

Question 18

management of bronchiolitis

Answer 18

maximal observation

minimal intervention

Question 19

bronchiolotis

Answer 19

NPA - to nurse RSV+ kids in same place

oxygen sats

Question 20

LRTI characteristics

Answer 20

48hrs fever, SOB, cough, grunting

wheeze makes bacterial cause unlikely

reduced or bronchial breath sounds

Question 21

is it pneumonia or not/

Answer 21

might call in pneumonia if

• signs focal - one area (e.g. left lower zone)
• crepitation
• high fever

otherwise - LRTI or chest infection

Question 22

management of community acquired pneumonia

Answer 22

-CXR and inflammatory markers not routine

nothing if mild

1st line - oral amoxycillin
2nd line - oral macrolide

IV if vomiting

Question 23

LRTI vs bronchilotis

Answer 23

LRTI - all ages, rapid onset syptoms, fever

b: <12mo, 3 days before peak, fever rarely >38

Question 24

empyaema

Answer 24

complication of pneumonia
extension of infection into pleural space

chest pain + very unwell
antibiotics +/- drainage

Question 25

CXR sign epiglottitis

Answer 25

thumb sign seen on lateral view

Question 26

most common cause epiglottitis

Answer 26

H influenzae B

Question 27

epiglottitis Mx

Answer 27

senior assistance airway protection IV antib do not examine throat

Question 28

classic cause of croup

Answer 28

parainfluenze virus

Question 29

croup Mx

Answer 29

dexamethasone