Cough and wheeze

Question 1

Assessment of airway and breathing

Answer 1

Effort
Efficacy
Effects on other organs

Question 2

Signs of increased effort of breathing

Answer 2

Recessions
Accessory muscle use
Grunting

Question 3

Grunting

Answer 3

• Maintains
  Positive End Expiratory Pressure
• expiration against closed glottis
• sx of pneumonia/oedema

Question 4

Types of recession

Answer 4

Subcostal recession
Sternal recession
Intercostal recession
Tracheal tug

Question 5

Accessory muscle use in babies

Answer 5

Head bobbing
Abdo muscle use - see saw breathing
Nostril flaring

Question 6

Common viral repiratory tract infection pathogens

Answer 6

RSV
Influenza
Parainfluenza

Question 7

Admission criteria for pneumonia

Answer 7

Need O2
Septic
Can’t tolerate oral abx

Question 8

Indication for CXR in children with pneumonia

Answer 8

If suspect complications

Eg. empyema

Question 9

Pneumonia pathogens on newborns

Answer 9

Group B strep
Listeria
Klebsiella
Staph aureus

Question 10

Pneumonia pathogens of all ages

Answer 10

Strep pneumonia
H. influenza
TB

Question 11

Pneumonia pathogens for susceptible groups

Answer 11

Staph aureus

Pneomocystis

Question 12

Non infective causes of cough

Answer 12

Asthma
Foreign body
Irritant cough
Habit cough/psychogenic cough - diagnosis of exclusion

Question 13

Causes of stridor

Answer 13

Viral croup
Epiglottitis
Foreign body
Vascular ring
Laryngomalacia
Stenosis

Question 14

Laryngomalacia

Answer 14

Floppy larynx

Question 15

Causes of wheeze

Answer 15

Viral associated wheeze
Infection - eg. bronchiolitis
Asthma
Aspiration pneumonitis

Question 16

Chronic cough definition

Answer 16

6-8 weeks

Question 17

Severe asthma criteria

Answer 17

Unable to complete sentences
Use of accessory muscles
SpO2 < 92%
PEF < 50% predicted/best

Question 18

Life threatening asthma criteria

Answer 18

Unable to speak
PEF < 33%

Cyanosis
Hypotension
Exhaustion
Silent chest
Tachy/brady/arrhythmias

Question 19

Rx of asthma

Answer 19

O2
Bronchodilator
Steroids
Re-evaluate

Question 20

Chronic Mx of asthma

Answer 20

1) SABA
2) Inhaled steroid
3) LABA
4) Increase inhaled steroid / theophylline / leukotrine receptor antagonist
5) Daily oral steroid

Question 21

Mx of CF

Answer 21

Mucolytics
Abx
Bronchodilators

Question 22

Causes of unilateral monophasic wheeze

Answer 22

Foreign body

Lymphoma

Question 23

Cause of epiglottitis

Answer 23

HiB

Question 24

Mx of viral croup

Answer 24

Steroids - single dose dexamethasone

Adrenaline - if severe

Question 25

Cause of bronchiolitis

Answer 25

RSV

Question 26

Age of bronchiolitis

Answer 26

Most < 6 months

Maximum age for bronchiolitis = 2 yrs

Question 27

Ix for bronchiolitis

Answer 27

Clinical diagnosis
Nasopharyngeal aspirate - to group pts with same pathogen only
SpO2

Question 28

Mx of bronchiolitis

Answer 28

Supportive

Question 29

Outcomes of bronchiolitis

Answer 29

Self resolving
Post bronchiolitic wheeze - common
Apnoea

Question 30

CF genetics

Answer 30

• autosomal recessive

- CFTR mutations: commonest dF508

Question 31

Muscle in tripod

Answer 31

pec major

Question 32

Why use accessory muscle

Answer 32

creates negative pressure

Question 33

Effect of hypoxia on RR, HR and BP

Answer 33

HR up
RR up
BP low

Question 34

Harrisons sulcus

Answer 34

lumps on ribs

hypertrophic bone due to prolonged accessory muscle use

Question 35

Cause of viral croup

Answer 35

Parainfluenza virus

Question 36

Pertussis abx

Answer 36

< 1mo: clarithromycin
>1 mo: azithromycin or clarithromycin
pregnant: erythromycin