LRTI in Children

Question 1

What are 5 bacterial infective agents?

Answer 1

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 2

What are 4 viral infective agents?

Answer 2

RSV
Parainfluenza III
Influenza A and B
Adenovirus

Question 3

What is tracheitis?

Answer 3

Croup which does not get better - obstructed airways due to narrowing

Question 4

Features of tracheitis

Answer 4

Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris

Question 5

What can tracheitis present with?

Answer 5

Fever

Inspiratory stridor

Question 6

What bacteria causes tracheitis?

Answer 6

Staph or strep

Question 7

What can be used to treat tracheitis?

Answer 7

Augmentin

Question 8

What is bronchitis?

Answer 8

Common endobronchial infection

Question 9

What are the symptoms of bronchitis?

Answer 9

Loose rattly cough with URTI
Post-tussive vomit
No wheeze/creps

Question 10

What bacteria can cause bronchitis?

Answer 10

Haemophilus

Pneumococcus

Question 11

How is bronchitis treated?

Answer 11

It is self-limiting, no antibiotics

Question 12

What is the mechanisms of bronchitis?

Answer 12

It disturbs the mucociliary clearance from UTRI causing difficulty to remove bacteria
Causes minor airway malacia
Can last up to 4 weeks

Question 13

What usually precedes bronchitis?

Answer 13

URTI

Question 14

What is the criteria for persistent bacterial bronchitis?

Answer 14

Wet cough
More than 1 months
Remission occurs with antibiotics

Question 15

What are the 3 steps to be taken with persistent bacterial bronchitis?

Answer 15

Diagnosis should be made
Parents reassured
No treatment given

Question 16

What percentage of children does bronchiolitis affect?

Answer 16

30-40%

Question 17

What is the causative bacteria in bronchiolitis?

Answer 17

RSV

Others include:
Paraflu III
HMPV

Question 18

What is the clinical presentation of bronchiolitis?

Answer 18

Nasal stiffness
Tachypnoea
Poor feeding
Crackles +/- wheeze

Question 19

Who does bronchiolitis usually affect?

Answer 19

< 12 months old

Question 20

Is bronchiolitis a recurrent infection?

Answer 20

No, it is a one off

Question 21

What is the management of bronchiolitis?

Answer 21

maximal observation
Minimal intervention
Oxygen saturations according to severity

Question 22

Investigation for bronchiolitis?

Answer 22

NPA (cohering)

O2 saturations

Question 23

What are the general signs for LRTI in children?

Answer 23

Pyrexia (> 38.5C)
SOB 
Cough 
Grunting 
Wheeze makes bacterial cause unlikely 
Reduced or bronchial breath sounds

Question 24

Infective agents in LRTIs

Answer 24

Viruses in <35%
Bacteria: pneumococcus, mycoplasma, chlamydia
Mixed infection in <40%

Question 25

When is it pneumonia and not a LRTI?

Answer 25

Signs are focal Crepitations High fever Otherwise call it LRTI

Question 26

Investigation for community acquired pneumonia

Answer 26

CXR and inflammatory markers not routine

Question 27

Management of community acquired pneumonia

Answer 27

Nothing is symptoms are mild 1st: oral amoxycillin 2nd: oral macrolide Only administered through IV if vomiting

Question 28

When to use oral over IV antibiotics

Answer 28

Antibiotics are indicated In non-severe LTRI When child not vomiting

Question 29

What are the benefits of oral antibiotics over IV?

Answer 29

Shorter hospital stay Cheaper Fewer for a few more hours

Question 30

What is pertussis?

Answer 30

Whooping cough - coughing fits lasting over two weeks, vomiting and colour change

Question 31

What can reduce the risk and severity of pertussis?

Answer 31

Vaccinations

Question 32

What is empyaema a complication of?

Answer 32

Pneumonia - spread of infection into pleural space causing pus formation

Question 33

Symptoms of empyaema?

Answer 33

Chest pain and very unwell

Question 34

What is the management of empyaema?

Answer 34

IV Antibiotics +/- drainage

Question 35

What is the prognosis on empyaema in children?

Answer 35

Good prognosis (in contract with adults)

Question 36

Can bronchitis be treated with antibiotics?

Answer 36

No

Question 37

What antibiotic is used to treat pneumonia and first antibiotic given in for general LTRIs?

Answer 37

Oral amoxycillin

Question 38

Is there an antibiotic for bronchiolitis?

Answer 38

No

Question 39

What is the first step in management in LTRIs before administering antibiotics (if appropriate)?

Answer 39

Oxygenation Hydration Nutrition Then think about antibiotics