LRTI

Question 1

Is the trachea upper or lower respiratory tract?

Answer 1

Lower

Question 2

What is tracheitis?

Answer 2

Uncommon

“croup which does not get better”

Question 3

How does tracheitis present?

Answer 3

Fever

Sick child

Question 4

What causes tracheitis?

Answer 4

BACTERIA

Staph or strep invasive infection

Question 5

How does tracheitis present on endoscopy?

Answer 5

Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris

Question 6

How is tracheitis treated?

Answer 6

Augmentin

Question 7

What is bronchitis?

Answer 7

Common ++++

Endobronchial infection

Question 8

How does bronchitis present?

Answer 8

Loose rattly cough with URTI
Post-tussive vomit - “glut”
Chest free of wheeze/creps

Question 9

What causes bronchitis?

Answer 9

Haemophilus/Pneumococcus

Question 10

How is bronchitis treated?

Answer 10

Mostly self-limiting

Child VERY well, parent worried

Question 11

What is the mechanism of bacterial bronchitis?

Answer 11

Disturbed mucociliary clearance

• Minor airway malacia
• RSV/adenovirus

Bacterial infection/overgrowth is secondary

Question 12

What is the cycle associated with child LRTI?

Answer 12

Respiratory virus -> Clearance stops for <4 weeks -> Cough and rattle -> Clearance almost recover ->

Question 13

What is the natural history of bacterial bronchitis?

Answer 13

Following URTI (e.g. rhinovirus infection)
Lasts 4 weeks
60-80% respond to antibiotic (must consider side-effects)
First winter bad
Second winter better
Third winter fine
Pneumococcus/H flu

Question 14

How do you manage persistent bacterial bronchitis?

Answer 14

Make the diagnosis
Reassure
Do not treat

Question 15

What is bronchiolitis and how does it present?

Answer 15

LRTI of infants
Affects 30-40% of all infants

Nasal stuffiness!!
Tachypnoea
Poor feeding
Crackles +/- wheeze

Question 16

What is the causative organism in bronchiolitis?

Answer 16

Usually RSV (respiratory syncynctial virus)

Others include:
Paraflu III
HMPV - Human metapneumovirus

Question 17

What are the diagnosing factors of bronchiolitis?

Answer 17

12 months old
One off (NOT recurrent)
Typical history

Question 18

How is bronchiolitis managed?

Answer 18

Maximal observation

Minimal intervention

Question 19

How is bronchiolitis investigated?

Answer 19

NPA - nasopharyngeal aspirate (nursing in same ward)
Oxygen saturations (severity)

No routine need for

• CXR
• Bloods
• Bacterial cultures

Question 20

Which medications are not proven to work in bronchiolitis?

Answer 20

NO MEDICATIONS WORK!!
Salbutamol
Ipratropium bromide
Adrenalin
Steroids
Antibiotics
Nebulised hypertonic saline

Question 21

What are the markers of a LRTI?

Answer 21

48 hrs, fever (>38.5oC), SOB, cough, grunting
Wheeze makes bacterial cause unlikely
Reduced or bronchial breath sounds
“Infective agents” - Virus+commensal bacteria/bacterium

Question 22

What is the timeline of bronchiolitis?

Answer 22

Days 2-5: gets worse
Days 5-7: stabilises
Days 7-14: recovery

Question 23

How do you decide if it’s pneumonia?

Answer 23

Totally academic! (does the child care??)

Word causes great anxiety

You might call it pneumonia if:

• Signs are focal, ie in one area (LLZ)
• Creps
• High fever

Otherwise call it LRTI

Question 24

What can an x-ray do in LRTI?

Answer 24

Confirm diagnosis BUT DOESN’T CHANGE WHAT YOU DO

Question 25

What are the BTS guidelines for investigating community-acquired pneumonia?

Answer 25

CXR and inflammatory markers not routine

Question 26

What are the BTS guidelines for managing community-acquired pneumonia?

Answer 26

Nothing if symptoms are mild (always offer to review if things get worse!) 1) Oral Amoxycillin first line 2) Oral Macrolide second choice 3) Only for iv if vomiting PNEUMOINIA - IV AMOXCILLIN

Question 27

Why use oral antibiotics over IV?

Answer 27

Shorter hospital stay Cheaper When: - antibiotics are indicated (48 hours, etc, etc) - in non-severe LRTI - when child is not vomiting

Question 28

Why use IV antibiotics over oral?

Answer 28

Fever for a few more hours When: - antibiotics are indicated (48 hours, etc, etc) - in non-severe LRTI - when child is not vomiting

Question 29

What are the differences between LRTI and bronchiolitis?

Answer 29

Technically same thing LRTI: - In all ages - More rapid onset of symptoms - Fever BRONCHIOLITIS: - Aged <12 months - 3 days before reach peak - Fever rarely >38oC LRTI GUIDANCE

Question 30

What is pertussis?

Answer 30

Whooping cough This is common! Vaccination reduces risk Vaccination reduces severity

Question 31

What are the signs of pertussis?

Answer 31

“Coughing fits” | Vomiting and colour change

Question 32

What is empyema?

Answer 32

Complication of pneumonia | Extension of infection into pleural space

Question 33

What are the signs of empyema?

Answer 33

Chest pain and very unwell

Question 34

What is the management of empyema?

Answer 34

``` Antibiotics+/- drainage Good prognosis (in contrast with adults) ```

Question 35

What do you do first in all LRTIs?

Answer 35

Oxygenation, hydration and nutrition

Question 36

Summary

Answer 36

LRTI SUMMARY