Respiratory

Question 1

is a common lower respiratory tract infection that occurs
during the first 2 years of life, with peak incidence at 6 months of age.

Answer 1

Acute bronchiolitis

Question 2

how many URTI of children in first few years per year

Answer 2

5 times

Question 3

how many URTI of toddlers and primary school aged per year

Answer 3

10-12 per year

Question 4

the most common URTI

Answer 4

Acute nasopharyngitis (common cold) is the most common.

Question 5

is the most common cause of respiratory distress and wheezing in infants.

Answer 5

Acute bronchiolitis

Question 6

Def of Acute bronchiolitis

Answer 6

= Acute bronchiolitis is a common lower respiratory tract infection that occurs during the first 2 years of life, with peak incidence at 6 months of age.

= It is the most common cause of respiratory distress and wheezing in infants.

= It causes inflammatory obstruction of the small airways, leading to bronchiolar
obstruction, air trapping and hyperinflation.

Question 7

Causative organisms of Acute bronchiolitis

Answer 7

mostly caused by respiratory syncytial virus (RSV).
Parainfleunza virus and adenoviruses

Question 8

Clinical picture of acute brochiolitis

Answer 8

1. Prodromal stage: Mild URI with nasal discharge and sneezing for few days.
2. Respiratory distress and expiratory wheezing: Manifestations of respiratory
   distress (Tachypnea, retractions) with paroxysmal wheezy cough.
   Chest auscultation reveals expiratory wheezing. This stage
   usually lasts for few days.
3. Rapid recovery usually occurs within few days.
   The case fatality rate is less than 1%.

Question 9

Investigations of Acute bronchiloitis

Answer 9

1. Chest X-ray: hyperinflation of the lungs with focal atelectasis.
2. Blood gas analysis; hypoxia- CO2 retention.
3. RSV antigen detection from nasopharyngeal secretions.

Question 10

TTT of Acute bronchiloitis

Answer 10

1. Infants with minimal or mild respiratory distress (at home)
   a) Close observation: Increasing distress is an indication for hospitalization.
   c) Careful feeding to avoid aspiration.
2. Infants with moderate to severe respiratory distress (at hospital)
   a. Oxygen therapy to correct hypoxemia.
   b. I.V maintenance fluid therapy to prevent dehydration.
   c. Nebulized salbutamol
   d. No Corticosteroids or antiviral agents. (are not beneficial)
   e. Mechanical ventilation used in those with severe respiratory failure

Question 11

RSV antigen detection inv for

Answer 11

Acute bronchiolitis

Question 12

Def of pneumonia

Answer 12

serious lower respiratory tract infection characterized by an acute inflammatory consolidation of alveoli, infiltration of interstitial tissue with inflammatory cells or a combination of both.

Question 13

Etiology of pneumonia

Answer 13

1. Bacterial:
   - Gram +ve: pneumococci, streptococci, staphylococci.
   - Gram -ve: H. influenza, klebsiella, pseudomonas
   - TB
2. Parasitic: Loffler’s pneumonia
3. Viral:
   - RSV (most common)
   - Adenovirus
4. Mycotic:
   - Aspergillosis
   - Candidiasis
5. Other microorganisms:
   - Actinomyces - Pneumocystis carnii-
   - Chlamydia and Mycoplasma

• Non infectious pneumonia
  1. Aspiration and chemical (amniotic contents, vomitus, or kerosine or foreign body).
  2. Hypostatic pneumonia

Question 14

Pathological types of Pneumonia

Answer 14

Pathological types
1. Lobar
= Unilateral affection of one or more lobes.
Etiology: It is mostly bacterial
= Xray: Chest x-ray shows lobar consolidation
2. Bronchopneumonia
« Bilateral affection of both lungs with small foci.
= Etiology: bacterial or viral.
= Chest x-ray shows fine nodular or patchy infiltration.
3. Interstitial
“ Bilateral affection of interstitial lung tissues.
= Etiology: mostly viral.
“ Chest x-ray: parahilar shadow with radiating streaks

Question 15

Clinical picture of pneumonia

Answer 15

o Symptoms
1. Pneumonia should be suspected in every case of respiratory distress, fever and cough
2. Difficult feeding and referred pain (neck or abdomen)
© Signs
1. Manifestations of respiratory distress include:
Grade I: Tachypnea (rapid respiration).
Grade Il: Intercostal and subcostal retractions
Grade III: Expiratory grunting.
Grade IV: Cyanosis appears.
2. According to pathological types
a. Lobar pneumonia
3. Bronchial breathing over the involved lobe is the main finding.
4. Some dullness to percussion over the involved lobe
b. Bronchopneumonia
5. Fine bilateral consonating crepitations are the main finding.
c. Interstitial pneumonia
=Severe spasmodic cough and tendency to expiratory wheezing are the main findings.

Question 16

difference between bacterial pneumonia and viral pneumonia

Answer 16

Bacterial pneumonia
High grade fever and severe course
Elevated ESR, CRP, leukocytosis
X ray: lobar pneumonia
Common complications

//////Viral pneumonia
///// Low grade fever
/////Mild or no elevation of laboratory tests
//////X ray Interstitial pneumonia
//////Less common complications

Question 17

complications of pneumonia

Answer 17

Pneumothorax and pneumatoceles
Lung abscess and Embyema
Respiratory failure and Heart failure

2 Hawa 2 sadeeed 2 failure

Question 20

TTT of pneumonia

Answer 20

A. Hospital management (7-10 days):
1. Indications
= Severe pneumonia (severe RD) or complicated pneumonia
= Small infants (Less than 6 months)
2. Supportive measures:
- Humidified oxygen - IV fluid (NPO) — suction — mechanical ventilation
3. Specific treatment:
Broad spectrum combined parenteral antibiotics to cover G+/-
(Ampicillin 50- 100 mg/kg/day + gentamycin 4-6 mg/kg/day).
4. Treatment of complication:
Drainage of empyema.
Mechanical ventilation (in respiratory failure)
B. Home management for most cases:
1. In Older children with mild pneumonia without distress.
2. Oral or better intramuscular antibiotics.
3. Amoxicillin 50 mg/kg/day or better broader-spectrum antibiotics such as amoxicillin-clavulanic acid for 7-10 days.