Lower respiratory tract infection in children

Question 1

What are common infective agents ?

Answer 1

Bacterial:
    - strep pneumoniae
    - haemophilus influenzae
    - Moraxella catarrhalis
    - mycoplasma pneumoniae
    - chlamydia pneumoniae 
Viral:
    - RSV
    - parainfluenzae III
    - influenza A + B
    - adenovirus

Question 2

What is tracheitis ?

Answer 2

Inflammation of the trachea

Question 3

What is the description of tracheitis ?

Answer 3

Croup which doesn’t get better

Question 4

What are the symptoms of tracheitis ?

Answer 4

Fever
Swollen tracheal wall
Narrow tracheal lining
Luminal debris

Question 5

What are the common causative agents for tracheitis ?

Answer 5

Staph or strep infection

Question 6

What is the treatment of tracheitis ?

Answer 6

Augmentin

Question 7

How common is bronchitis ?

Answer 7

Very common

Question 8

What are the symptoms of bronchitis ?

Answer 8

Loose rattily cough with URTI
Post-tussive vomit - ‘glut’
Chest free of wheeze and creps

Question 9

Is bronchitis self-limiting ?

Answer 9

Yes

Question 10

What is the causative agents for bronchitis ?

Answer 10

Haemophilus/Pneumococcus

Question 11

What is the mechanism of bacterial bronchitis ?

Answer 11

Disturbed mucocilary clearance

- minor airway malacia
- RSV/adenovirus

Question 12

What does bacterial bronchitis usually follow on from ?

Answer 12

URTI

Question 13

What is Bronchiolitis defined as ?

Answer 13

A lower respiratory tract infection of infants

Question 14

What % of children are usually affected by bronchiolitis ?

Answer 14

30-40%

Question 15

What is the cause of bronchiolitis ?

Answer 15

RSV (Respiratory Syncytial Virus)

Parainfluenza 3, HMPV (human metapneumovirus)

Question 16

What are the symptoms of bronchiolitis ?

Answer 16

Nasal Stiffness
Tachypnoea
Poor feeding
Crackles +/- wheeze

Question 17

When is the peak incidence of Bronchiolitis ?

Answer 17

3 months

Question 18

What separates bronchiolitis from asthma ?

Answer 18

Bronchiolitis is a 2 week infection from start to finish, asthma is recurrent

Question 19

What are the differences between LRTIs and bronchiolitis ?

Answer 19

LTRI:

- in all ages
- more rapid onset of symptoms
- fever 

Bronchiolitis:

- ages <12 months
- 3 days before reach peak
- fever rarely >38°C

Question 20

Why does feeding have complications during the course of bronchiolitis ?

Answer 20

It is essentially exercise for the baby who is unused to the idea of breathing through the mouth, nose is blocked
Feeding the baby now has complications

Question 21

What is the management of bronchiolitis ?

Answer 21

Maximal observation

Minimal intervention

Question 22

What does an NPA involve ?

Answer 22

A catheter (or tube) is inserted a short distance into your child’s nose (this should occur with minimal discomfort to your child)
Gentle suction is used to collect some mucus
The mucus is then sent to the laboratory for
testing

Question 23

What tests are there no need for in bronchiolitis ?

Answer 23

CXR
Bloods
Bacterial cultures

Question 24

What are the relevant investigations for bronchiolitis ?

Answer 24

Nasopharyngeal aspirate

Oxygen saturation to determine severity

Question 25

Are there any medications proven to help bronchiolitis ?

Answer 25

No

Question 26

What is the definition of a LRTI ?

Answer 26

48 hours of fever (above 38.5 degrees) SOB cough and grunting

Question 27

What can you infer from wheeze ?

Answer 27

Bacterial cause is unlikely

Question 28

How do you confirm a lower respiratory tract infection ?

Answer 28

Reduced or bronchial breath sounds

Question 29

What are the infective agents for LRTI ?

Answer 29

Viruses in <35% (higher in younger) Bacteria Pneumococcus, Mycoplasma, Chlamydia Mixed infection in <40%

Question 30

How can you tell if the LRTI is pneumonia ?

Answer 30

Signs are focal (one side of the chest) Creps – fine crackles High fever

Question 31

What are the possible investigations for community acquired pneumonia ?

Answer 31

CXR -(rarely going to help) and inflammatory makers NOT “routine”

Question 32

What is the management for community acquired pneumonia ?

Answer 32

``` Nothing if symptoms are mild (always offer to review if things get worse!) Oral Amoxycillin first line Oral Macrolide second choice Only for iv if vomiting ```

Question 33

When would you consider antibiotics for an LRTI ?

Answer 33

After 48 hour history exists

Question 34

What is the only thing that causes coughing fits ?

Answer 34

Pertussis

Question 35

What is pertussis also known as ?

Answer 35

Whooping cough

Question 36

What are the symptoms of pertussis ?

Answer 36

Vomiting | Colour change

Question 37

Is pertussis common ?

Answer 37

Yes

Question 38

What reduces the risk and severity of pertussis ?

Answer 38

Vaccination

Question 39

What is empyema ?

Answer 39

Extension of infection into pleural space

Question 40

Where can empyema arise from ?

Answer 40

Complications of pneumonia

Question 41

What are the symptoms of empyema ?

Answer 41

Chest pain | Very unwell

Question 42

What is the treatment of empyema ?

Answer 42

Antibiotics | Drainage