URTI & LRTI In Children (pathology)

Question 1

What is rhinitis?

Answer 1

Seasonal allergies - e.g. dust irritating nose causing cold like symptoms

Question 2

Rhinitis: how common? When in year? Management?

Answer 2

• Very common, 5-10/year
• Winter months
• Self-limiting (10-15 days)
• Review if prone to other illnesses (pneumonia, bronchiolitis, meningitis, septicaemia)

Question 3

What is otitis?

Answer 3

Media-inflammation of middle ear infection

Question 4

What is the cause of otitis

Answer 4

• Erythema

- Bulging drum/spontaneous rupture

Question 5

What infections may cause otitis?

Answer 5

• 1st viral infection (rhinovirus)

- 2nd infection with pneumococcus/Hemophilus influenza

Question 6

Management of otitis?

Answer 6

Self-limiting

Analgesia

Question 7

What is cause of tonsillitis/pharyngitis? Investigation? Management?

Answer 7

• Viral or bacterial
• Throat swab-48 h for results
• Viral= nothing
• Bacterial= 10 days penicillin
• Do NOT give amoxycillin= rush if patient has EBV

Question 8

What causes Croup- Laryngotracheobronchitis? What are the symptoms? What is the management?

Answer 8

• Parainfluenza virus I
• Common
• Child is well
• Coryza
• Stridor
• Hoarse voice
• Barking cough
• One off oral DEXAMETHASONE

Question 9

What causes acute epiglottitis? What are the symptoms? What is the management?

Answer 9

• H. influenza type B
• Group A strep and parainfluenza virus type 4
• Cherry swollen epiglottis
• Rare
• Stridor, drooling
• Intubation+ antibiotics

Question 10

What are some common UTRI in children (5)?

Answer 10

Rhinitis
Otitis
Tonsillitis/pharyngitis
Croup
Acute epiglottitis

Question 11

What are some LRTI in children?

Answer 11

Tracheitis 
Bronchitis 
Pneumonia 
Pertussis (whooping cough)
Bronchiolitis

Question 12

What is traceitis? What causes is? What are the symptoms? What is the management?

Answer 12

• Uncommon
• Croup that doesn’t get better= fever, sick child+ barking cough
• Staph or strep infection
• Augmentin (amoxicillin/clavulanic acid)

Question 13

What is bronchitis? What causes it? What are the symptoms? What is the management?

Answer 13

• Common
• Disturbed mucociliary escalator clearance -> due to minor airway malacia/RSV/adenovirus-> 2nd bacterial infection Pneumococcus/ H. influenza
• Loose rattly cough
• Post-tussive vomit- glut
  Mostly self-limiting

Question 14

What are the symptoms of pneumonia? What is the management?

Answer 14

• 48 hrs, fever (> 38.5)
• SOB
• Cough
• Grunting
• Wheeze= likely viral
• Reduced or bronchial breath sounds
• Crepitations
• Virus+ commensal bacteria

•	Mild= nothing 
•	2 days fever, cough + focal signs 
-	First line= amoxycillin 
-	Second line= erythromycin (macrolide) 
IV ONLY if vomiting

Question 15

What is pertussis? What are the symptoms?

Answer 15

• Vaccination reduces risk and severity
• Still common
• Vomiting and colour change
• Paroxysmal cough

Question 16

What is empyema? What is the management?

Answer 16

• Complication of pneumonia
• Infection into pleural space
• Chest pain + very unwell
• Antibiotics +/- drainage
• Good prognosis in children

Question 17

What is bronchiolitis? What are the symptoms? What is the management?

Answer 17

• Disease of infancy – peak at 3 months
• RSV/ parainfluenza virus
• Nasal stiffness
• Tachypnoea
• Poor feeding
• Crackles +/- wheeze
• Fever rarely > 38
• Stable after day 5
• If unwell before day 5= admit
• One off- NOT recurrent
• Maximal obs (O2 sats) -minimal intervention
  Nasopharyngeal aspirate

Question 18

What is the initial treatment of LTRI in children?

Answer 18

O2, H2O & food first

Then antibiotics if needed