Respiratory Infection in Children Flashcards
1
Q
How are respiratory infections classified by their location in children?
A
- URTI
- Laryngeal/Tracheal
- Bronchitis
- Bronchiolitis
- Pneumonia
2
Q
What are the most common cause of respiratory infeciton in children?
A
Viruses (80-90%)
3
Q
What viruses are most commonly implicated in respiratory infection in children?
A
- RSV
- Rhinovirus
- Parainfluenza
- Influenza
- Adenovirus
4
Q
What are the most commonly implicated bacteria in respiratory infection?
A
- Strep. pneumoniae
- H. influenzae
- Moraxella catarrhalis
- Bortadella pertussis
- Mycoplasma Pneumoniae
5
Q
What is an important pathogen globally that can cause respiratory infection in children, with symptoms of fever and night sweats?
A
M. Tuberculosis
6
Q
What risk factors can increase risk of respiratory infection?
A
- Parental smoking
- Poor socioeconomic status
- Poor nutrition
- Underlying lung disease - e.g. CF
- Male
- Haemodynamically significant heart disease
- Immunocompromise
7
Q
What are the common UTRI’s?
A
- Common cold (coryza)
- Sinusitis
- Acute otitis media
- Pharyngitis/Tonsilitis
8
Q
How do children with URTI’s present?
A
- Nasal discharge/blockage
- Sore throat
- Fever
- Earache
9
Q
How does coryza present?
A
- Clear/mucopurulent nasal discharge/blockage
- Fever
- Pain
10
Q
What organisms commonly cause coryza?
A
- Rhinovirus
- Coronavirus
- RSV
11
Q
How would you treat a child with coryza?
A
NO ANTIBIOTICS
Paracetamol and ibuprofen - for fever or pain
12
Q
What is pharyngitis?
A
Inflammation of pharynx and soft palate with local lymph node enlargement
13
Q
What organisms are responsible for pharyngitic infection?
A
- Adenovirus
- Enterovirus
- Rhinovirus
- Group A streptoccus - s. pyogenes; more common in older children
14
Q
What is tonsilitis?
A
A form of pharyngitis where there is inflammation of the tonsils, often with a purulent exudate
15
Q
What are common causes of tonsilitis?
A
- Group A streptococcus
- Epstein Barr Virus
16
Q
What proportion of pharyngitis/tonsilitis cases are caused by bacteria?
A
1/3rd
17
Q
In suspected tonsilitis, what symptoms are more consistent with bacterial infection than viral?
A
- Headache
- Apathy and abdominal pain
- White tonsillar exudate
- Cervical lymphadenopathy
18
Q
How would you initially manage suspected pharyngitis/tonsilitis?
A
- Do nothing
- Advise paracetamol/ibuprofen for fever/pain
- Throat swab
19
Q
Under what circumstances would you treat pharyngitis/tonsilitis with antibiotics?
A
Suspected bacterial infection - prolonged course
20
Q
If you decided it was appropriate, what antibiotics would you use to treat pharyngitis/tonsilitis?
A
Penicillin
21
Q
In the context of tonsilitis/pharyngitis, what antibiotic would you avoid using, and why?
A
Amoxicillin
Could potentially erupt in maculo-papular rash if the cause of tonsilitis/pharyngitis is EBV
22
Q
What is acute otitis media?
A
Acute infection of the middle ear
23
Q
At what age does acute otitis media most commonly occur?
A
6-12 months
24
Q
Why are infants and young children prone to AOM?
A
Eustachian tubes short, horizontal and function poorly
25
How does AOM present?
* Ear pain
* Fever
26
What organisms are often implicated in AOM?
* **RSV**
* **Rhinovirus**
* **Pneumococcus**
* **H. flu**
* **M. catarrhalis**
27
How would you manage AOM?
Most resolve spontaneously
* **Regular Analgesia** - Paracetamol and ibuprofen
* **No antibiotics** - risk outweigh the benefits
28
What can occur as a complication of recurrent infections of the ear?
Otitis media with effusions (glue ear)
29
If you suspected AOM, what would you do to confirm your diagnosis?
**Auriscope examination**
30
On otoscopic examination, what would you suspect if you saw the following?
***_Acute otitis media_***
Bright red (hyperaemic) bulging tympanic membrane with loss of light reflection
31
What can be a complication of otitis media with effusion in terms child development?
Speech and learning difficulties from hearing loss
32
What is sinusitis?
Infection of the paranasal sinuses
33
How does sinusitis present?
**Pain, swelling and tenderness** - over cheeks
34
How is sinusitis managed?
* **Antibiotics**
* **Analgesia**
35
What is laryngotracheobronchitis (Croup)?
Mucosal inflammation and increased secretion
Subglottic oedema -\> critical narrowing of the airway
36
What is croup caused by?
* Para-influenza I, II, III
* RSV
37
What age range does croup normally occur in?
6 months - 6 years
38
How does croup present?
Coryza (++) + Fever, Followed by
* **Barking cough**
* **Harsh stridor**
* **Hoarse voice**
* **Signs** - chest recession, signs of difficulty breathing
39
How would you manage mild croup?
Oral dexamethasone
40
What presention would indicate that a child is suffering from mild croup?
* **Minimal recession/stridor**
* **No cyanosis**
* **Alert child**
* **Good air entry**
41
What presentation would indicate a child is suffering from severe croup?
* **Restlessness/tiredness/Altered consciousness**
* **Cyanosis**
* **Recession**
* **Stridor at rest**
* **Rising pulse/resp rate**
42
How would you treat severe croup?
* **Call for help**
* **Nebulised adrenaline with oxygen**
* **Consider ITU**
43
What is acute epiglottitis?
Intense swelling of the epiglottis and surrounding tissues associated with septicaemia
44
How quickly does epiglottitis present?
Over hours
45
What causes acute epiglottitis?
Haemophilus influenza B
46
How does acute epiglottitis present?
* **High fever**
* **Toxic looking child**
* **Intensely painful throat** - can't speak or swallow
* **Drooling**
* **Soft stridor**
* **Rapidly increasing resp effort** - over hours
47
How does epiglottitis differ from croup?
* **Quicker onset**
* **No preceding coryza**
* **Absent or light cough**
* **Not able to swallow**
* **Toxic**
* **Temp \> 38.5oC**
* **Soft stridor**
48
What must you not do in suspected epiglottitis?
Examine the throat or Lie the child down
49
Hoiw would you manage acute epiglottitis?
* **Transfer to ITU**
* **Intubate under GA** - remove after 24 hrs
* **Blood cultures**
* **IV Antibiotics** - cefotaxime (3-5 days)
50
If you had complete airway obstruction from acute epiglottitis, what could be done to prevent death?
Tracheostomy
51
What is bacterial tracheitis?
Defined by thick mucopurulent exudate and tracheal mucosal sloughing that is not cleared by coughing -\> risks occluding airways
52
How does bacterial tracheitis present?
* **High fever**
* **Toxic child**
* **Loud, harsh, biphasic stridor**
53
If a child had inspiratory stridor, where would that suggest the lesion is in the airway?
Supraglottic/Pharynx
54
If a child had biphasic stridor, where would the lesion potentially be in the respiratory tract?
Glottis, subglottis
55
If a child had expiratory stridor, where would the lesion be in the respiratory tract?
Thoracic trachea and bronchi
56
How would you treat Tracheitis?
Augmentin
Early intubation?
57
What is bronchitis?
Endobronchial infection which results in dysfunction of the mucociliary escalator
58
What can cause bronchitis in children?
* **Haemophilus**
* **Pneumococcus**
59
How does bronchitis present in a child?
* **Cough** - rattly
* **Fever**
* **URTI**
* **Post tussive vomit (glut)**
60
How would you manage a child with bronchitis?
* Reassure
* Do not treat with Abx
61
How long does bronchitis last?
2-4 weeks
62
When does bronchitis most commonly occur?
After a UTRI
63
How does the severity of bronchitis episodes change with age?
Become less severe
64
What is bronchiolitis?
Inflammation of the bronchioles
65
What are the pathogens that can cause bronchiolitis?
* **RSV**
* **Metapneumovirus**
* **Parainfluenza**
* **Rhinovirus**
* **Adenovirus**
* **Influenza**
* **M. pneumonia**
66
What is the most common cause of bronchiolitis?
RSV
67
What symptoms would suggest bronchiolitis?
* **Coryza**
* **Sharp Dry cough**
* **Poor feeding**
* **Fever**
68
What signs would indicate the need for admission in suspected bronchiolitis?
* **Poor feeding**
* **Respiratory Distress**
* **Hypoxia**
69
What signs would indicate bronchiolitis?
* **Tachypnoea**
* **Fine end Crackles +/- wheeze**
* **Cyanosis** - if severe
* **Subcostal/intercostal recession**
* **Tachycardia**
70
What signs on examination would you assess for in a child presenting with stridor?
* **Fever/Toxic/ill**
* **Cyanosis**
* **Barking cough**
* **Drooling**
* **Chest recession**
71
What investigations would you do for a child with suspected bronchiolitis?
General
* **NPA** - PCR identification
* **Continuous O2 Monitoring** - sats monitor
Severe
* **CXR** - only in severe cases to look for pneumothorax/atelectasis/hyperinflation
* **Capillary Blood gas** - hypercapnia
72
How would you manage a child with non-severe bronchiolitis?
Admit to the ward
* **Monitor for apnoea**
* **Humidified Oxygen**
* **Monitor feeding with Pre-feed suction**
* **Senior review**
* **NO ANTIBIOTICS**
73
What would you do if a child with bronchiolitis began to deteriorate?
Seek senior advice and move to HDU
* **Increase oxygen**
* **Saline Bolus (20ml/kg 0.9% NaCl)**
* **Check bloods (FBC/CRP/Cap/VBG)**
* **CXR**
74
How long does it take to recover from bronchiolitis?
2 weeks
75
What can be a severe complication of bronchiolitis (particularly when caused by adenovirus)?
Bronchiolitis obliterans
76
What is whooping cough (pertussis) caused by?
**Bordetella pertussis**
77
How does pertussis present?
**Coryza, followed by Spasmodic/paroxysmal cough -\> inspiratory "whoop"**
* Worse at night
* May result in vomiting
* Go red/blue
* Mucus flows from mouth
* Can cause epistaxis/subconjunctival haemorrhaging from straining
78
How long do children suffer from symptoms of pertussis?
3-6 weeks
79
What investigations would you do in suspected pertussis?
* **Nasal swab** - PCR
* **Bloods** - FBC - lymphocytosis
80
What are children under the age of 6 months at risk of in pertussis infection?
Apnoea - need to admit
81
How would you manage a child with pertussis?
* **Admit them**
* **Macrolide Abx** - only effective in cattarhal phase
* **Isolate from other children**
82
What are the most common causative organisms of pneumonia in the newborn?
* **Group B strep**
* **Enterococcus**
83
What organisms most commonly cause pneumonia in infants and young children?
* **RSV**
* **S. pneumoniae**
* **H. influenzae**
* **B. pertussis**
* **C. trachomatis**
* **S. aureus** - this is serious
84
What are the most common organisms to cause pneumonia in children over the age of 5?
* **M .pneumoniae**
* **S. pneumoniae**
* **C. pneumoniae**
85
What symptoms can children with pneumonia have?
Ususally preced by URTI
* **Fever/Generally unwell**
* **Difficulty breathing**
* **Cough**
* **Lethargy**
* **Poor feeding**
86
What signs can children with pneumonia have?
* **Tachypnoea** - most important clinical sign
* **Chest wall recession**
* **Nasal flaring**
* **Classic pneumonic symptoms** - Coarse end crackles, Dull to percuss, Decreased breath sounds, Bronchial breathing
* **Decreased saturations**
87
How would you investigate pneumonia?
Only if severe/staying in hospital
* **CXR**
* **Bloods**
* **Sputum cultures**
88
Hwo would you treat pneumonia in a child
* **Nothing if symptoms are mild** - SAFETY NET!!!
* **First line** - Oral Amoxycillin
* **Second line** - Oral Macrolide
* **Paracetamol/ibuprofen**
89
When would you admit a child with suspected pneumonia?
* **SpO2 \< 92%**
* **Respiratory distress** - difficulty breathing, grunting, not feeding, apnoea, severe tachypnoea
90
How would you manage a child admitted to hospital with pneumonia?
* **Antibiotics** - amoxicillin/co-amoxiclav/macroliade
* **Oxygen therapy**
* **Paracetamol/ibuprofen**
* **IV fluids** - if dehydrated
91
What complications can occur in the context of pneumonia?
* **Empyema**
* **Parapneumonic Effusions**
92
How would you treat an empyema in a child?
* **Antibiotics +/- drainage**
* **Oxygenation**
* **Hydration**
* **Nutrition**
93
What signs would indicate severe bronchiolitis?
Combination of the following
* **Apnoea in \< 4 months**
* **Intercostal and subcostal recession**
* **Chest hyperinflation** - sternum prominent, liver displaced
* **Fine end inspiratory crackles**
* **Prolonged expiration**
94
What is viral induced wheeze?
Wheeze caused by inflammation of the airways due to viral infection
95
How does VIW differ from asthma?
VIW is episodic, whereas asthma is sinusoidal, and varies on a daily basis, becoming worse in the evening
96
What signs would you see in a child with bronchiolitis?
* **Hyperinflation**
* **Chest recession**
* **Fine crackles**
* **Hyper-resonant**
* **Laboured breathing**
97
What signs would you see in a child with pneumonia?
* **Reduced chest movement on the affected side**
* **Rapid, shallow breaths**
* **Dull percussion**
* **Bronchial breathing**
* **Crackles**
98
When would you consider admitting a child with bronchiolitis?
If any of the following:
* **Apnoea** - observed or reported
* **Persistent oxygen saturation of less than 92% when breathing air**
* **Inadequate oral fluid intake** - 50–75% of usual volume, taking account of risk factors and using clinical judgement
* **Persisting severe respiratory distress** - grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.
