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Paediatrics > Respiratory Infection in Children > Flashcards

Respiratory Infection in Children Flashcards

1
Q

How are respiratory infections classified by their location in children?

A
  • URTI
  • Laryngeal/Tracheal
  • Bronchitis
  • Bronchiolitis
  • Pneumonia
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2
Q

What are the most common cause of respiratory infeciton in children?

A

Viruses (80-90%)

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3
Q

What viruses are most commonly implicated in respiratory infection in children?

A
  • RSV
  • Rhinovirus
  • Parainfluenza
  • Influenza
  • Adenovirus
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4
Q

What are the most commonly implicated bacteria in respiratory infection?

A
  • Strep. pneumoniae
  • H. influenzae
  • Moraxella catarrhalis
  • Bortadella pertussis
  • Mycoplasma Pneumoniae
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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

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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
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7
Q

What are the common UTRI’s?

A
  • Common cold (coryza)
  • Sinusitis
  • Acute otitis media
  • Pharyngitis/Tonsilitis
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8
Q

How do children with URTI’s present?

A
  • Nasal discharge/blockage
  • Sore throat
  • Fever
  • Earache
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9
Q

How does coryza present?

A
  • Clear/mucopurulent nasal discharge/blockage
  • Fever
  • Pain
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10
Q

What organisms commonly cause coryza?

A
  • Rhinovirus
  • Coronavirus
  • RSV
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11
Q

How would you treat a child with coryza?

A

NO ANTIBIOTICS

Paracetamol and ibuprofen - for fever or pain

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12
Q

What is pharyngitis?

A

Inflammation of pharynx and soft palate with local lymph node enlargement

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13
Q

What organisms are responsible for pharyngitic infection?

A
  • Adenovirus
  • Enterovirus
  • Rhinovirus
  • Group A streptoccus - s. pyogenes; more common in older children
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14
Q

What is tonsilitis?

A

A form of pharyngitis where there is inflammation of the tonsils, often with a purulent exudate

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15
Q

What are common causes of tonsilitis?

A
  • Group A streptococcus
  • Epstein Barr Virus
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16
Q

What proportion of pharyngitis/tonsilitis cases are caused by bacteria?

A

1/3rd

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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
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18
Q

How would you initially manage suspected pharyngitis/tonsilitis?

A
  • Do nothing
  • Advise paracetamol/ibuprofen for fever/pain
  • Throat swab
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19
Q

Under what circumstances would you treat pharyngitis/tonsilitis with antibiotics?

A

Suspected bacterial infection - prolonged course

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20
Q

If you decided it was appropriate, what antibiotics would you use to treat pharyngitis/tonsilitis?

A

Penicillin

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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

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22
Q

What is acute otitis media?

A

Acute infection of the middle ear

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23
Q

At what age does acute otitis media most commonly occur?

A

6-12 months

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24
Q

Why are infants and young children prone to AOM?

A

Eustachian tubes short, horizontal and function poorly

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25
Q

How does AOM present?

A
  • Ear pain
  • Fever
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26
Q

What organisms are often implicated in AOM?

A
  • RSV
  • Rhinovirus
  • Pneumococcus
  • H. flu
  • M. catarrhalis
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27
Q

How would you manage AOM?

A

Most resolve spontaneously

  • Regular Analgesia - Paracetamol and ibuprofen
  • No antibiotics - risk outweigh the benefits
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28
Q

What can occur as a complication of recurrent infections of the ear?

A

Otitis media with effusions (glue ear)

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29
Q

If you suspected AOM, what would you do to confirm your diagnosis?

A

Auriscope examination

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30
Q

On otoscopic examination, what would you suspect if you saw the following?

A

Acute otitis media

Bright red (hyperaemic) bulging tympanic membrane with loss of light reflection

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31
Q

What can be a complication of otitis media with effusion in terms child development?

A

Speech and learning difficulties from hearing loss

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32
Q

What is sinusitis?

A

Infection of the paranasal sinuses

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33
Q

How does sinusitis present?

A

Pain, swelling and tenderness - over cheeks

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34
Q

How is sinusitis managed?

A
  • Antibiotics
  • Analgesia
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35
Q

What is laryngotracheobronchitis (Croup)?

A

Mucosal inflammation and increased secretion

Subglottic oedema -> critical narrowing of the airway

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36
Q

What is croup caused by?

A
  • Para-influenza I, II, III
  • RSV
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37
Q

What age range does croup normally occur in?

A

6 months - 6 years

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38
Q

How does croup present?

A

Coryza (++) + Fever, Followed by

  • Barking cough
  • Harsh stridor
  • Hoarse voice
  • Signs - chest recession, signs of difficulty breathing
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39
Q

How would you manage mild croup?

A

Oral dexamethasone

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40
Q

What presention would indicate that a child is suffering from mild croup?

A
  • Minimal recession/stridor
  • No cyanosis
  • Alert child
  • Good air entry
41
Q

What presentation would indicate a child is suffering from severe croup?

A
  • Restlessness/tiredness/Altered consciousness
  • Cyanosis
  • Recession
  • Stridor at rest
  • Rising pulse/resp rate
42
Q

How would you treat severe croup?

A
  • Call for help
  • Nebulised adrenaline with oxygen
  • Consider ITU
43
Q

What is acute epiglottitis?

A

Intense swelling of the epiglottis and surrounding tissues associated with septicaemia

44
Q

How quickly does epiglottitis present?

A

Over hours

45
Q

What causes acute epiglottitis?

A

Haemophilus influenza B

46
Q

How does acute epiglottitis present?

A
  • High fever
  • Toxic looking child
  • Intensely painful throat - can’t speak or swallow
  • Drooling
  • Soft stridor
  • Rapidly increasing resp effort - over hours
47
Q

How does epiglottitis differ from croup?

A
  • Quicker onset
  • No preceding coryza
  • Absent or light cough
  • Not able to swallow
  • Toxic
  • Temp > 38.5oC
  • Soft stridor
48
Q

What must you not do in suspected epiglottitis?

A

Examine the throat or Lie the child down

49
Q

Hoiw would you manage acute epiglottitis?

A
  • Transfer to ITU
  • Intubate under GA - remove after 24 hrs
  • Blood cultures
  • IV Antibiotics - cefotaxime (3-5 days)
50
Q

If you had complete airway obstruction from acute epiglottitis, what could be done to prevent death?

A

Tracheostomy

51
Q

What is bacterial tracheitis?

A

Defined by thick mucopurulent exudate and tracheal mucosal sloughing that is not cleared by coughing -> risks occluding airways

52
Q

How does bacterial tracheitis present?

A
  • High fever
  • Toxic child
  • Loud, harsh, biphasic stridor
53
Q

If a child had inspiratory stridor, where would that suggest the lesion is in the airway?

A

Supraglottic/Pharynx

54
Q

If a child had biphasic stridor, where would the lesion potentially be in the respiratory tract?

A

Glottis, subglottis

55
Q

If a child had expiratory stridor, where would the lesion be in the respiratory tract?

A

Thoracic trachea and bronchi

56
Q

How would you treat Tracheitis?

A

Augmentin

Early intubation?

57
Q

What is bronchitis?

A

Endobronchial infection which results in dysfunction of the mucociliary escalator

58
Q

What can cause bronchitis in children?

A
  • Haemophilus
  • Pneumococcus
59
Q

How does bronchitis present in a child?

A
  • Cough - rattly
  • Fever
  • URTI
  • Post tussive vomit (glut)
60
Q

How would you manage a child with bronchitis?

A
  • Reassure
  • Do not treat with Abx
61
Q

How long does bronchitis last?

A

2-4 weeks

62
Q

When does bronchitis most commonly occur?

A

After a UTRI

63
Q

How does the severity of bronchitis episodes change with age?

A

Become less severe

64
Q

What is bronchiolitis?

A

Inflammation of the bronchioles

65
Q

What are the pathogens that can cause bronchiolitis?

A
  • RSV
  • Metapneumovirus
  • Parainfluenza
  • Rhinovirus
  • Adenovirus
  • Influenza
  • M. pneumonia
66
Q

What is the most common cause of bronchiolitis?

A

RSV

67
Q

What symptoms would suggest bronchiolitis?

A
  • Coryza
  • Sharp Dry cough
  • Poor feeding
  • Fever
68
Q

What signs would indicate the need for admission in suspected bronchiolitis?

A
  • Poor feeding
  • Respiratory Distress
  • Hypoxia
69
Q

What signs would indicate bronchiolitis?

A
  • Tachypnoea
  • Fine end Crackles +/- wheeze
  • Cyanosis - if severe
  • Subcostal/intercostal recession
  • Tachycardia
70
Q

What signs on examination would you assess for in a child presenting with stridor?

A
  • Fever/Toxic/ill
  • Cyanosis
  • Barking cough
  • Drooling
  • Chest recession
71
Q

What investigations would you do for a child with suspected bronchiolitis?

A

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
Q

How would you manage a child with non-severe bronchiolitis?

A

Admit to the ward

  • Monitor for apnoea
  • Humidified Oxygen
  • Monitor feeding with Pre-feed suction
  • Senior review
  • NO ANTIBIOTICS
73
Q

What would you do if a child with bronchiolitis began to deteriorate?

A

Seek senior advice and move to HDU

  • Increase oxygen
  • Saline Bolus (20ml/kg 0.9% NaCl)
  • Check bloods (FBC/CRP/Cap/VBG)
  • CXR
74
Q

How long does it take to recover from bronchiolitis?

A

2 weeks

75
Q

What can be a severe complication of bronchiolitis (particularly when caused by adenovirus)?

A

Bronchiolitis obliterans

76
Q

What is whooping cough (pertussis) caused by?

A

Bordetella pertussis

77
Q

How does pertussis present?

A

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
Q

How long do children suffer from symptoms of pertussis?

A

3-6 weeks

79
Q

What investigations would you do in suspected pertussis?

A
  • Nasal swab - PCR
  • Bloods - FBC - lymphocytosis
80
Q

What are children under the age of 6 months at risk of in pertussis infection?

A

Apnoea - need to admit

81
Q

How would you manage a child with pertussis?

A
  • Admit them
  • Macrolide Abx - only effective in cattarhal phase
  • Isolate from other children
82
Q

What are the most common causative organisms of pneumonia in the newborn?

A
  • Group B strep
  • Enterococcus
83
Q

What organisms most commonly cause pneumonia in infants and young children?

A
  • RSV
  • S. pneumoniae
  • H. influenzae
  • B. pertussis
  • C. trachomatis
  • S. aureus - this is serious
84
Q

What are the most common organisms to cause pneumonia in children over the age of 5?

A
  • M .pneumoniae
  • S. pneumoniae
  • C. pneumoniae
85
Q

What symptoms can children with pneumonia have?

A

Ususally preced by URTI

  • Fever/Generally unwell
  • Difficulty breathing
  • Cough
  • Lethargy
  • Poor feeding
86
Q

What signs can children with pneumonia have?

A
  • 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
Q

How would you investigate pneumonia?

A

Only if severe/staying in hospital

  • CXR
  • Bloods
  • Sputum cultures
88
Q

Hwo would you treat pneumonia in a child

A
  • Nothing if symptoms are mild - SAFETY NET!!!
  • First line - Oral Amoxycillin
  • Second line - Oral Macrolide
  • Paracetamol/ibuprofen
89
Q

When would you admit a child with suspected pneumonia?

A
  • SpO2 < 92%
  • Respiratory distress - difficulty breathing, grunting, not feeding, apnoea, severe tachypnoea
90
Q

How would you manage a child admitted to hospital with pneumonia?

A
  • Antibiotics - amoxicillin/co-amoxiclav/macroliade
  • Oxygen therapy
  • Paracetamol/ibuprofen
  • IV fluids - if dehydrated
91
Q

What complications can occur in the context of pneumonia?

A
  • Empyema
  • Parapneumonic Effusions
92
Q

How would you treat an empyema in a child?

A
  • Antibiotics +/- drainage
  • Oxygenation
  • Hydration
  • Nutrition
93
Q

What signs would indicate severe bronchiolitis?

A

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
Q

What is viral induced wheeze?

A

Wheeze caused by inflammation of the airways due to viral infection

95
Q

How does VIW differ from asthma?

A

VIW is episodic, whereas asthma is sinusoidal, and varies on a daily basis, becoming worse in the evening

96
Q

What signs would you see in a child with bronchiolitis?

A
  • Hyperinflation
  • Chest recession
  • Fine crackles
  • Hyper-resonant
  • Laboured breathing
97
Q

What signs would you see in a child with pneumonia?

A
  • Reduced chest movement on the affected side
  • Rapid, shallow breaths
  • Dull percussion
  • Bronchial breathing
  • Crackles
98
Q

When would you consider admitting a child with bronchiolitis?

A

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.

Paediatrics (27 decks)

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