Clinical Features of Asthma in Children

Question 1

Features of Asthma (5)

Answer 1

Wheeze
Panting
Cough 
SOB
Variable/Reversible

Question 2

Triggers of asthma (4)

Answer 2

URTI
Exercise
Allergen
Cold weather

Question 3

Histology of Asthma (4)

Answer 3

Mucosal oedema of the bronchi
Infiltration of the bronchial mucosa or submucosa with inflammatory cells
Shedding of epithelium
Obstruction of peripheral airways with mucousGe

Question 4

Aetiology of Asthma (4)

Answer 4

Genes
Inherently abnormal lungs
Early onset atopy
Later exposures (Rhinovirus, Exercise, Smoking)

Question 5

Mechanism of Wheeze

Answer 5

Bronchoconstriction
Airway wall thickening
Luminal secretions
Children’s airways are smaller and more likely to be mucosal

Question 6

What type of cough is observed in asthma

Answer 6

Dry
Nocturnal
Exertional

Question 7

Treatment of infrequent episodic wheeze with a cold

Answer 7

Salbutamol

Question 8

Symptoms of Bronchitis

Answer 8

Loose rattly cough
Vomit
Chest free of wheezes and crepitation
Self-limiting

Question 9

Symptoms of Bacterial Bronchitis

Answer 9

Distrubed mucociliary clearance
Haemophilus culture medium
Lack of social inhibition

Question 10

Symptoms of Pertussis

Answer 10

Cough more than 2 weeks
Coughing fits
Vomiting, colour change, Petechiae
Haematoma

Question 11

2 groups of genetic associations with asthma

Answer 11

Immune response IL-4, IL-5, IgE

Airway genes ADAM33

Question 12

What is the Grandmother Effect

Answer 12

If Maternal grandmother smoked there is an epigentic risk that the grandchild will develop asthma

Question 13

Why is obesity a risk factor of asthma

Answer 13

Adipose tissue release pro-inflammatory mediators

Question 14

Possible risk factors of asthma

Answer 14

Reduced exposure to microbes/microbial products
Indoor pollution, chemical household products
Diet

Question 15

Environmental Allergens to asthma

Answer 15

House dust mite
Cat
Grass pollen

Question 16

Its probably not asthma if:

Answer 16

Clubbing, cervical lymphadenopathy- Cancer
Stridor- foreign body or tumour
Asymmetrical expansion
Dull percussion note (lobar collapse, effusion)
Crepitation (bronchieactasis, CF, alveolitis, LVF)

Question 17

What tests can be done to exclude COPD

Answer 17

Lung volume
Carbon Monoxide gas transfer
Use bronchodilator to test for reversibility
Response to oral corticosteroids (anti-inflammatory)

Question 18

If spirometry is normal what is the next step?

Answer 18

Peak flow meter and chart twice daily for 2 weeks to monitor variability

Question 19

Useful investigation for asthma

Answer 19

CXR, Skin prick (atopic), total and specific (UgE), FBC (eosinophilia)

Question 20

How do you assess acute severe asthma

Answer 20

Ability to speak
Heart rate
Respiratory rate
PEF (peak expiratory flow)
Oxygen Saturation/arterial blood gas

Question 21

Moderate asthma attack

Answer 21

Heart and respiratory rate is not raised
Normal O2 levels
PEF is low

Question 22

Severe asthma attack

Answer 22

Raised heart and respiratory rate

Saturation and oxygen levels are maintained and normal

Question 23

Life threatening asthma attack

Answer 23

Slow heart rate
BP is low
Peak flow very low
Cyanosis
O2 levels and saturation low
Normal partial pressure
Raised PaCO2

Question 24

In emphysema
Lung compliance would be
Inspiration would be
Expiration would be

Answer 24

High- loss of elastic recoil
Increased (easier)
Reduced and difficult

Question 25

How would you calculate the amount of oxygen an individual can carry in their blood

Answer 25

g/l of Hb multiplied by how much O2 1g of Hb can carry