URTI & LRTI in Children

Question 1

What are the clinical signs of tonsilitis/pharyngitis?

Answer 1

Swollen tonsils
Sore throat
Difficulty swallowing
Tender lymph nodes

Question 2

What are the clinical sign of the common cold (rhinitis)?

Answer 2

Runny/blocked nose
General malaise
Cough
Sneezing
Itchy/red/watery eyes

Question 3

What can rhinitis lead onto?

Answer 3

Pneumonia
Bronchiolitis
Meningitis
Septicaemia

Question 4

What are the clinical signs of EB virus?

Answer 4

Fatigue
Malaise
Fever
Sore throat
Generalised lymphadenopathy

Question 5

What are the clinical signs of glandular fever?

Answer 5

High temp
Sore throat
Swollen lymph nodes
Fatigue
Other symptoms
- Muscle aches
- General unwell
- Chills/sweats
- Loss of appetite

Question 6

What are the clinical signs of otitis media (ear infection)?

Answer 6

Red/inflamed ear drum
Bulging drum
Common and self-limiting
Secondary infection with pneumococcus/H’ flu
Spontaneous rupture of drum

**Antibiotic treatment usually unhelpful

Question 7

What are the different types of organism that cause infection?

Answer 7

Primary
Facultative
Opportunistic

Question 8

Explain Primary microorganisms?

Answer 8

Highly invasive

Question 9

Explain facultative microorganisms?

Answer 9

Need assistance to cause infection but are mostly independent.

Question 10

Explain opportunistic microorganisms

Answer 10

Look for damage and take advantage of it
- Increase chance of ordinary infection
- Infection by organisms not normally capable of producing disease in patients with intact lung defences
- Low grade bacterial pathogens, CMV, pneumocystis jirovecii, other fungi and yeasts

Question 11

What organisms commonly cause pneumonia?

Answer 11

Strep. pneumonia
Chlamydophila pneumonia
Mycoplasma pneumonia
Legionella
Staph aureus
Moraxella catarrhalis
Chlamydophila psittaci
Coxiella burnetii
Viruses - influenza

Question 12

What are the side effects of antibiotics?

Answer 12

Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Multi resistance

Question 13

What are the supportive therapies used in tandem with antibiotics?

Answer 13

Adequate hydration
Bronchodilators - for dyspnoea
Ibuprofen/paracetamol - for fever control
Rest

Question 14

What is bronchitis?

Answer 14

Endobronchial infection causing inflammation of bronchi

Question 15

What are the symptoms of bronchitis?

Answer 15

Loose rattly cough
- Cycles of cough that almost resolve
Post tussive-vomit (glut = sputum)
Chest free of wheeze/creps
Children are generally well

Question 16

What is the mechanism for bronchitis?

Answer 16

Disturbed mucocilliary clearance (Secretions pool and need to be coughed up)
- Minor airway malacia
- RSV/adenovirus
Lack of social inhibition (child doesn’t care that they sound snotty/raspy)
Bacterial infection/overgrowth in secondary

Question 17

What is the natural history of bronchitis?

Answer 17

Following URTI
Lasts 4 weeks
60-80% respond
First winter is bad, second is better and third is fine

Question 18

What are the signs of pneumonia?

Answer 18

Creps
High fever
Signs are focal (in one area)
Otherwise call it LRTI as the word pneumonia causes great anxiety

Question 19

What investigations do you do for CAP?

Answer 19

Chest X-Ray
Inflammatory markers

Question 20

What are the management options for CAP?

Answer 20

Nothing if symptoms are mild
Oral amoxicillin first line
Oral macrolide second choice (if allergic)
Only IV if patient vomiting

Question 21

Explain a complication of pneumonia

Answer 21

Empyema
- Extension of infection into pleural space
- Chest pain and very unwell
- Management = Antibiotics +/- drainage
- Good prognosis

Question 22

What is bronchiolitis?

Answer 22

Inflammation and condensation of the small airways primarily affecting young children and babies.

Question 23

What are the symptoms of bronchiolitis?

Answer 23

Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze

Question 24

What is the predictability of bronchiolitis like?

Answer 24

Day 1-2 = well
Day 2-5 = getting worse
Day 5-7 = stabilised
Day 7+ = recovery

Question 25

Management of bronchiolitis?

Answer 25

Maximal observation
Minimal intervention
- No medicines have been proven to work

Question 26

Investigations of bronchiolitis?

Answer 26

NPA (nursing in same ward)
Oxygen saturations (measure severity)

Question 27

What’s the difference between LRTI and bronchiolitis?

Answer 27

LRTI in all ages, bronchiolitis in <12 months
LRTI rapid onset of symptoms, bronchiolitis 3 days before reaches peak
LRTI = fever, bronchiolitis = rarely fever

Question 28

Describe the whooping cough (pertussis)

Answer 28

Vaccination reduces risk and severity
Coughing fits
Vomiting and colour change

Question 29

What common organisms cause LRTI?

Answer 29

Bacterial
- Strep. pneumoniae
- Haemophilus influenza
- Moraxella catarrhalis
- Mycoplasma pneumoniae

Viral
- RVS
- Parainfluenza
- Influenza A&B
- Adenovirus