acutely ill child - respiratory

Question 1

what is bronchiolitis

Answer 1

acute viral inflammatory injury of the bronchioles

Question 2

most common cause of bronchiolitis

Answer 2

RSV

Question 3

who gets bronchiolitis

Answer 3

children under one, most common in children under 6 months

Question 4

symptoms of bronchiolitis

Answer 4

viral URTI infection
dyspnoea, tachypnoea, apnoea
poor feeding
mild fever (<39)

Question 5

clinical signs of bronchiolitis

Answer 5

respiratory distress
wheeze and crackles on auscultation

Question 6

management of bronchiolitis

Answer 6

supportive

Question 7

what is croup

Answer 7

URTI causing oedema in the larynx

Question 8

what classically causes croup

Answer 8

parainfluenza virus

Question 9

name 3 other common causes of croup

Answer 9

influenza
adenovirus
RSV

Question 10

classic sign of croup

Answer 10

barking cough

Question 11

management of mild croup

Answer 11

usually self limiting but could benefit a single dose of dexamethasone orally

Question 12

management of croup that requires hospital admission

Answer 12

1. Oraldexamethasone - if too unwell to receive oral medication can give IM dexamethasone or nebulised budesonide
2. Oxygen
3. Nebulised adrenaline
4. Intubation and ventilation

Question 13

symptoms of acute asthma

Answer 13

progressively worsening SOB
tachypnoea

Question 14

clinical signs of acute asthma

Answer 14

respiratory distress
expiratory wheeze
chest sounds tight with reduced air entry

Question 15

severity of acute asthma in terms of peak flow

Answer 15

moderate >50% of expected
severe <50% of expected
life threatening <33% of expected

Question 16

management of mild acute asthma

Answer 16

regular salbutamol via a spacer

Question 17

management of moderate-severe acute asthma

Answer 17

OSHITMA

Question 18

what does OSHITMA stand for

Answer 18

oxygen
salbutamol (neb)
oral prednisolone/ IV hydrocortisone
ipratropium (neb)
theophylline
magnesium sulphate
an anaesthetist to intubate

Question 19

what is the most common cause of bacterial pneumonia

Answer 19

strep pneumo

Question 20

what is the most common cause of viral pneumonia

Answer 20

RSV

Question 21

symptoms of pneumonia

Answer 21

wet/productive cough
high fever
increased work of breathing
lethargy
delirium

Question 22

clinical signs of pneumonia

Answer 22

bronchial breath sounds
focal coarse crackles
dullness to percussion

Question 23

what causes bronchial breath sounds in pneumonia

Answer 23

consolidation of the lung tissue around the airway

Question 24

what causes coarse crackles in pneumonia

Answer 24

air passing through sputum

Question 25

what causes dullness to percussion in pneumonia

Answer 25

lung tissue collapse and/or consolidation

Question 26

investigations in pneumonia

Answer 26

CXR and blood cultures

Question 27

first line management of pneumonia

Answer 27

amoxicillin

Question 28

management of pneumonia in a patient with a penicillin allergy

Answer 28

erythromycin