Paediatric Respiratory

Question 1

What are signs of respiratory distress in children?

Answer 1

Raised RR

Use of accessory muscles

Intercostal/subcostal recessions

Nasal flaring

Head bobbing

Tracheal tugging

Question 2

What are causes of stridor?

Answer 2

Croup - stridor + barking cough

Acute epiglottitis - stridor, drooling, acutely unwell

Inhaled foreign body - choking

Laryngomalacia

Question 3

What is the cause of bronchiolitis?

Answer 3

RSV (Respiratory syncytial virus)

Question 4

How does bronchiolitis present?

Answer 4

Coryzal symptoms - runny nose, watery eyes, sneezing

Dry cough

Mild fever

Wheeze

Dyspnoea

Tachypnoea

Question 5

When should a child with bronchiolitis be admitted?

Answer 5

Under 3 months

Pre-existing health condition

Clinical dehydration

RR > 70

Oxygen sats <92%

Apnoeas

Deep recessions

Head bobbing

Question 6

How is bronchiolitis managed?

Answer 6

Supportive

Supplementary oxygen if required

Question 7

Which children are at risk of severe bronchiolitis?

Answer 7

Bronchopulmonary dysplasia

Congenital heart disease

Cystic fibrosis

Question 8

How to differentiate Asthma vs. Viral induced wheeze?

Answer 8

Viral induced wheeze..

Features of viral illness e.g. coryza, fever

Presents prior to 3 years

No atopy history

Only occurs during infections

Question 9

How is viral induced wheeze managed?

Answer 9

1st line = Salbutamol

Question 10

What is the stepwise management of Asthma in under 5’s?

Answer 10

1. SABA (e.g. Salbutamol)
2. Low dose ICS or Montelukast
3. Add other option
4. Refer to specialist

Question 11

What is the most common bacterial and viral cause of pneumonia in children?

Answer 11

Strep pneumoniae

RSV

Question 12

How does pneumonia present?

Answer 12

Productive cough

Fever

Tachypnoea

Tachycardia

Hypotension

Question 13

How is pneumonia managed in children?

Answer 13

1st line = Amoxicillin

2nd line = Macrolide (Clarithromycin, Erythromycin, Azithromycin)

Question 14

What is croup? What is the most common causative organism?

Answer 14

Upper respiratory tract infection which causes laryngeal oedema, leading to stridor

Most common = Parainfluenza virus

Question 15

How does croup present?

Answer 15

Stridor

Barking cough

Low grade fever

Coryza

Increased work of breathing

Question 16

When should a child with croup be admitted?

Answer 16

Stridor at rest

Recessions

Any significant distress

Tachycardia

Question 17

How is croup treated?

Answer 17

Single dose oral Dexamethasone

Oxygen if required

Question 18

What organism causes epiglottitis?

Answer 18

Haemophilus influenza type B

Question 19

How does epiglottitis present?

Answer 19

Acute onset

Sore throat

Stridor

Tripod position

High fever

Drooling of saliva

Question 20

What is seen on neck XR in epiglottitis?

Answer 20

Thumb sign

Question 21

How is epiglottitis managed?

Answer 21

IV Ceftriaxone

Oxygen

Question 22

What is Laryngomalacia?

Answer 22

Soft larynx

Larynx causes partial airway obstruction

Causes chronic stridor on inhalation

Question 23

How is Laryngomalacia managed?

Answer 23

Problem usually resolves as the larynx matures and grows

Question 24

What is whooping cough?

Answer 24

URTI caused by Bordatella pertussis

Question 25

How does whooping cough present?

Answer 25

Sats with coryza symptoms Then - Severe coughing fits, worse at night Inspiratory whoop at end of coughing fit May be vomiting May be apnoea attacks

Question 26

How is whooping cough treated?

Answer 26

Supportive care In first 21 days - can use oral macrolide

Question 27

What do infants with bronchopulmonary dysplasia receive to reduce infections?

Answer 27

Monthly injection of Palivizumab

Question 28

What type of inheritance pattern does cystic fibrosis have?

Answer 28

Autosomal recessive

Question 29

What are the first signs of CF?

Answer 29

Meconium ileus Prolonged jaundice

Question 30

What are features of CF?

Answer 30

Chronic cough Thick sputum Recurrent infections Greasy stools Finger clubbing Pancreatic enzyme deficiency

Question 31

What are common colonisers in CF?

Answer 31

Staph aureus Pseudomonas

Question 32

What is the gold standard diagnostic investigation for CF? What does it show?

Answer 32

Sweat test showing increased chloride levels

Question 33

How is CF managed?

Answer 33

Chest physio High calorie idet Pancreatic enzyme supplementation Prophylactic flucloxacilin

Question 34

What are complications of CF?

Answer 34

Diabetes Delayed puberty Male infertility Nasal polyps

Question 35

Why are males with CF often infertile?

Answer 35

Absence of the vas deferens

Question 36

What is primary ciliary dyskinesia?

Answer 36

Autosomal recessive condition TRIA Paranasal sinusitis Bronchiectasis Situs invertus