Child with difficulty breathing

Question 1

aspiration

Answer 1

children with cerebral palsy and muscular distrophy
usually children with impairment of swallowing
CXR, CT chest: often non-specific inflammation
difficult to treat
feeding gastrostomy, fundoplication in severe cases

Question 2

cystic fibrosis

Answer 2

most common serious genetic respiratory disease
1/25 hetero 1/2500 homozygote
most cases picked up by antenatal screening
presents with respiratory symptoms/infection or malabsorption
care is fully multi-disciplinary team

Question 3

immunodeficiency

Answer 3

oncology cases common
mild non-oncology cases common
severe non-oncology cases rare
HIV rare in aus, common in africa
treatment: physio, antibiotics, IV Ig, ART for HIV

Question 4

bronchiectasis

Answer 4

socially disadvantaged, indigenous, CF, immunodeficiency, aspiration PCD primary ciliary dyskinesia - kartagener syndrome

Question 5

kartagener syndrome

Answer 5

rare, dextrocardia
primary ciliary dyskinesia

Question 6

to diagnose bronchiectasis

Answer 6

CT required to detect, CXR will miss most cases

Question 7

treatment for bronchiectasis

Answer 7

physio, antibiotics

Question 8

general features of respiratory illness in children

Answer 8

• more susceptible to respiratory infections
• children’s airways have a smaller diameter
• thoracic cage more compliant in infants: increase in respiratory effort leads to decrease in efficiency of breathing
• infants compromised mechanics of breathing: muscle fibres have decrease in oxidative capacity, respiratory muscle fatigue can occur, rib cage decrease

Question 9

recession - work of breathing

Answer 9

more obvious in infants - (increase in chest wall compliance)
more worrying sign in older children

Question 10

use of accessory muscles - work of breathing

Answer 10

not able to see in infants
difficult to see in children

Question 11

grunting

Answer 11

an expiratory noise
more common in young infants
common in oneumonia
indicates severe respiratory distress

Question 12

grunting is caused by

Answer 12

expiration against a partially closed glottis

Question 13

an inspiratory obstruction is an obstruction

Answer 13

above the thoracic outlet

Question 14

a expiiratory obstruction is an obstruction

Answer 14

below the thoracic outlet

Question 15

inspiratory obstructions

Answer 15

vocal cord dysfunctiion
laryngomalacia
thachromalaciaa
foreign body

Question 16

expiratory obstructions

Answer 16

tracheobronchomalacia
foreign body
vascular ring
asthma