Paediatric Respiratory

Question 1

What are the main signs of respiratory distress in children?

Answer 1

1) Tachypnoea (RR40-60)
2) Stridor
3) Tracheal Tug
4) Subcostal/Intercostal recession
5) Cyanosis

Question 2

What 3 bacterial organisms cause pneumonia?

Answer 2

Group B strep in neonates.
S.pneumoniae.
H.influenzae.
K.pneumoniae.
M.pnuemoniae.

Question 3

What are the main signs of pneumonia?

Answer 3

1) Fever
2) Miserable
3) Rapid breathing
4) Cough
5) poor feeding
6) lethargy

Question 4

What investigations for suspected pneumonia?

Answer 4

1) CXR: Look for consolidation
2) Blood cultures
(Difficult for sputum sample)

Question 5

What is the treatment for child with pneumonia?

Answer 5

1) IV Benpen (Acutely unwell)
Stable: PO Amoxicillin

Question 6

How do wheezes and stridor differ?

Answer 6

wheeze: polyphonic noise on expiration
stridor: monophonic high pitched on inspiration

Question 7

What are causes of recurrent wheeze?

Answer 7

1) Asthma
2) Viral episodic wheeze
3) persistent infantile wheeze

Question 8

What is persistent infantile wheeze normally associated with/exacerbated by?

Answer 8

Persistent infantile wheeze tends to affect the small airways. It is associated with parental smoking or post-viral infection.

Question 9

Are inhalers likely to help a child with persistent infantile wheeze?

Answer 9

No. Inhalers are unlikely to help; symptoms will improve as the child gets older.

Question 10

What is viral episodic wheeze normally associated with/exacerbated by?

Answer 10

It normally follows a URTI. The child will have no interval symptoms.

Question 11

Are inhalers likely to help a child with viral episodic wheeze?

Answer 11

Bronchodilators may help but there is no benefit from inhaled steroids.
Symptoms are likely to improve with age.

Question 12

How would you manage an acute exacerbation of asthma in a child?

Answer 12

O2.
Beta agonist nebulised.
Prednisolone 1mg/kg.
If still not improving…
- IV salbutamol bolus.
- Aminophylline/ MgSO4/ salbutamol infusion.

Question 13

Inhalers: name 2 ‘preventers’.

Answer 13

ICS act as ‘preventers’ e.g. beclamethasone, budenoside

Question 14

Inhalers: name 2 ‘relievers’

Answer 14

1) Beta agonists e.g. salbutamol.
2) Muscarinic antagonists e.g. ipratropium bromide.

Question 15

Describe the step-wise approach to asthma management.

Answer 15

SABA -> SABA + ICS -> LABA + ICS -> LABA + increased dose of ICS -> LABA + daily PO steroids.

Question 16

Give 3 long term risks of systemic steroids

Answer 16

Adrenal suppression.
Growth suppression.
Osteoporosis.

Question 17

Why might asthma treatment fail in children?

Answer 17

Adherence.
Wrong diagnosis.
Environmental factors.
Choice of drug.
Bad disease.