Asthma, Cough and Wheeze in Children

Question 1

What is the commonest cause of acute LRTI in infancy?

Answer 1

Bronchiolitis

Question 2

What are common causes of bronchiolitis?

Answer 2

Respiratory Syncytial Virus (80%)

Adenovirus

Influenze and parainfluenza virus in winter months

Question 3

What happens in the pathophysiology of bronchiolitis?

Answer 3

Necrosis of ciliated cells and proliferation of non-ciliated cells

→ Bronchiolar obstruction, Atelectasis (collapsed lung), Hyperinflation

→ hypoxia, hypercapnea, VQ mismatch

Question 4

How would bronchiolitis present in an examination?

Answer 4

Hyperinflation with palpable liver edge

Widespread crepitations throughout respiratory cycle

Prolonged expiratory phase with wheeze

Subcostal and intercostal recession

Tracheal tug

Nasal flaring

Fever

Question 5

What is the first choice pre-school asthma device?

Answer 5

Metered dose inhaler + spacer

Question 6

What is the first choice primary school asthma device?

Answer 6

Bronchodilators: MDI + spacer

Dry powder

Steroids: MDI + large volume spacer