Cameron's Paeds Respiratory Chapters

Question 1

What is the typical presentation of a patient with vocal cord dysfunction?

Answer 1

Sudden onset of stridor with marked respiratory distress in a adolescent female athlete with no response to asthma treatment

Question 2

What is the usual age range for a child with croup?

Answer 2

6-36 months

Question 3

Discuss the timing of croup.

Answer 3

Acute URTI followed by fever, inspiratory stridor, barking cough and dyspnoea

Question 4

Discuss bacteria tracheitis.

Answer 4

Children 4-6 years old; look toxic, marked swelling of the tracheal mucosa with purulent discharge. Common causes: staph aureus, strep pyogenes, strep pneumo

Question 5

Where should the diagnosis of epiglottitis be made?

Answer 5

In theatre with gas induction

Question 6

What is the age peak of presentations with anaphylaxis?

Answer 6

0-4 years old

Question 7

List three causes for chronic stridor in children.

Answer 7

Laryngomalacia, subglottic narrowing, vocal cord paralysis, subglottic haemangioma and congenital tracheomalacia

Question 8

In a 12 month old child who develops choking on solids and worsening stridor, what should be suspected?

Answer 8

External compression from a vascular ring (double aortic arch/R-sided aortic arch with abnormal L subclav artery) - secondary tracheomalacia

Question 9

How many URTIs do children typically have per year?

Answer 9

Up to 6-8 per year

Question 10

List features that would favour bacterial tonsillitis.

Answer 10

Age > 4 years, tender neck nodes, scarlatiniform rash/oedematous tonsils/exudates, absence of cough, strawberry tongue - all in keeping with streptococcal infection

Question 11

What is the use of strep swabs in acute pharyngitis?

Answer 11

20% of children are colonised with strep A; antibiotics only decrease duration of illness by 1 day

Question 12

What is the issue with a monospot test?

Answer 12

If done too early in disease course (particularly in younger children) then may be falsely negative

Question 13

What is croup?

Answer 13

Acute clinical syndrome of hoarse voice, barking cough and inspiratory stridor usual seen in young children

Question 14

What is the dose of steroids in croup?

Answer 14

0.15 mg/kg prednisolone or 1 mg/kg of prednisolone

Question 15

When can children who have received adrenaline for croup go home?

Answer 15

If they have also had steroids and been observed for several hours without stridor at rest.

Question 16

What are the common causes for croup?

Answer 16

Parainfluenza virus type 1 (50% during winter), type 2, influenza A, adenoviruses, RSV, eteroviruses

Question 17

Why is croup worse in older children?

Answer 17

Because of the small size of the larynx, loose submucosal tissues, tight encirclement of the area by the cricoid.

Question 18

What are features of life threatening asthma?

Answer 18

Silent chest, cyanosis, poor respiratory effort, exhaustion, altered mental state

Question 19

List a ddx for asthma.

Answer 19

Bronchiolitis, mycoplasma, allergy, aspiration, heart failure, foreign body.

Question 20

What are risk factors for mortality with asthma?

Answer 20

Severity of disease: prior near-fatal asthma, ICU, heavy use of beta-2 agonists, repeat attendances to ED.
Medical Mx: inadequate treatment, inadequate monitoring, delay in help-seeking
Psychological: non-adherence, poorly perceived symptoms, failure to attend clinic, family dysfunction