Resp - chest infections 2

Question 1

What investigation is helpful in bronchiolitis?

Answer 1

immunofluorescence of sputum may show RSV

Question 2

Treatment of acute bronchiolitis

Answer 2

Usually supportive

humidified oxygen, if O2 sats persistently <92%
NG feed
Suction if excessive upper airway secretions

Question 3

What is atelectesis?

Answer 3

Feature on CXR - air trapping eg in bronchiolitis leads to dense areas

Question 4

Give advise on how to manage bronchiolitis at home

Answer 4

Don't go to johannesburg (i mean school)
Keep head upright - easier breathing
Smaller feeds but more frequently
Air humidifier may help the cough
Saline drops from pharmacy for nose
Avoid smoke

Paracetamol can be given for fever if >2 months old
Ibuprofen can be given if over 3 months old and >5kg

Question 5

Know the common pathogens causing pneumonia

Answer 5

Streptococcus pneumonia (80% of all, typical pneumonia)
Haemophilus influenza (typical pneumonia)

Mycoplasma pneumonia (atypical pneumonia)
Legionella pneumophila (legionellosis)

Staph aureus (after viral infection)

Question 6

What are the characteristic features of typical pneumonia

Answer 6

Sudden onset malaise, fever and productive cough (purulent sputum - yellow-green)

Crackles and bronchial breath sounds
Dull on percussion

Tachypnoea and dyspnoea
Pleuritic pain, which may project to epigastric region
Manifests as lobar pneumonia or bronchopneumonia

Question 7

How may atypical pneumonia present? (seen more in elderly though)

Answer 7

gradual onset of unproductive cough
dyspnea
extrapulmonary manifestations

Auscultation is typically unremarkable

Question 8

Routes of infection for pneumonia

Answer 8

Airborne droplets or pathogens

Aspiration of gastric acid, food or liquids

Question 9

What is the antibiotic management of pneumonia in children?

Answer 9

Antibiotics unlikely to be needed in simple pneumonia if <2 years old

First line - oral amoxicillin
Macrolides can be added (erythromycin)

IV is indicated if child cannot tolerate oral, has septicaemia or complications

Question 10

Oxygen and physio management of pneumonia

Answer 10

Oxygen via face mask, nasal cannula or head box (babies) if O2 sats below 92% (ideally >95%).
All methods equally effective

Physio has been shown to have no effect on radiological resolution, hospital stay and symptom improvement… may not be true in CF etc

Question 11

Pneumonia treatment at home

Answer 11

Rest
Hydrate with regular small drinks (see if wet nappies)
Paracetamol or ibuprofen for tummy ache
Avoid smoking
Do not try to reduce temperature with sponging you ding dong

Question 12

Safety netting for pneumonia (to go to hospital)

Answer 12

If has an underlying lung condition
Dyspnoea or tachypnoea
Nappies dry
Won’t feed

Question 13

Aetiology of pertussis

Answer 13

Airborne droplets through coughing (contact with nasal or oral mucosa)
Gram -ve bacterium: Bordetella pertussis

Question 14

Natural history of pertussis

Answer 14

Catarrhal stage (1-2 weeks)
Nonspecific, like URTI and possibly conjunctivitis

Paroxysmal stage (2-6 weeks)
Intense paroxysmal coughing, often at night. Followed by a high-pitched whooping inhalation.
May be followed by phlegm or posttussive vomiting!
With tongue protrusion, gagging and struggling for breath

Convalescent stage (weeks to months)
Progressive reduction of symptoms

Question 15

Presentation of pertussis in <6 months old

Answer 15

Only develop apnoea without the whooping cough

Can have seizures

Question 16

When are children immunised for pertussis? What is the immunisation and its effect

Answer 16

DTAP (diphtheria, tetanus, acellular pertussis)
There is antenatal vaccination (to protect in first month)

2,4, 6, 18 months
3-5years

> 90% effect
It is not lifelong, so adults and adolescents can still get it.
If given post-exposure, it can lessen the symptoms

Question 17

When should a parent take their child to the hospital (suspected case of pertussis)

Answer 17

This applies, even if child has received vaccination

Cough followed by:
vomiting
whooping sound
breathing problems

makes lips turn blue or purple

Question 18

What are the symptoms of TB in children

Answer 18

90% asymptomatic

Fever
Night sweats
Swollen glands
Weight loss/ Poor growth if not treated

Persistent cough
Irritability and fatigue

TB meningitis often in <3 year olds
Infants at risk of miliary TB

Question 19

Clinical features of TB in children (other than symptoms)

Answer 19

Pre-disposing factors:
Endemic areas
Close contact to someone with TB

HIV and other immunosuppression

Question 20

Which test is used to diagnose TB?

Answer 20

Mantoux test

Question 21

What is the treatment of TB in children?

Answer 21

Triple or quadruple antibiotic therapy:
Rifampicin
Isoniazid
Pyrazynamide
Ethambutol

Decreased to rifampicin and isoniazid after 2 months

Dexamethasone given for 1 month if TB meningitis (decreases risk of long-term sequelae)

Question 22

What is a problem with treating TB in children

Answer 22

Adherence is an issue

Resistence can emerge as a result