Paediatric respiratory

Question 1

DDx of respiratory distress

Answer 1

Bronchiolitis
Pneumonia
Viral induced wheeze
Asthma
Foreign body inhalation
Epiglottitis
Croup
Tonsillitis/pharyngitis
TB
Laryngomalacia

Question 2

What is bronchiolitis caused by

Answer 2

RSV in most case

Question 3

Bronchiolitis presentation

Answer 3

up to 2 yrs of age usually

coryzal prodrome last 1-3 days
peristent cough
tachypnoea
chest recession
wheeze / crackles on auscultation

Question 4

Bronchiolitis treatment

Answer 4

Self resolve
If moderate - admit for oxygen

Question 5

Croup presentation

Answer 5

SEAL LIKE BARKING COUGH
fever
stridor
6 months - 6 yrs age

Question 6

Croup treatment

Answer 6

Steroid - dexamethasone single dose

Question 7

What causes pertussis

Answer 7

bordatella pertussis

notifiable disease!

Question 8

Pertussis presentation

Answer 8

cough - paroxysms
whoops
post cough vomiting
may last 2-3 months

Question 9

Petussis tx

Answer 9

Clarithromycin 5-7 days
Off skl for 21 days following onset or 48 hrs post abx
Abx prophylaxis and vaccine for close relatives

Question 10

Acute epiglottis symptoms

Answer 10

drooling
fever
muffled voice
tripod stance

Question 11

Acute epiglottis treatment

Answer 11

SEVERE AIRWAY OBSTRUCTION - EMERGENCY - DON’T EXAMINE

ENT anaesthetist
Secure airway
Adrenaline
Nasoendoscopy
Intubation
IV abx
IV steroid

Question 12

What is cystic fibrosis and what can it lead to

Answer 12

autosomal recessive disease mutation in CFTR gene causing build up of mucus in multi0ple organs

predisposes to infection
poor digestion
infertility
diabetes
osteoporosis
pulmonary hypertension

Question 13

Cystic fibrosis presentation

Answer 13

Neonatal blood spot
Meconium ileus
Recurrent chest infections
Family history

Question 14

Cystic fibrosis investigations

Answer 14

Sweat test
Lung function test
Genetic testing
REFER TO CF CENTRE

Question 15

Cystic fibrosis treatment

Answer 15

Chest physio
Prophylactic abx
Mucolytics
Pancreatic enzymes

Question 16

Why does CHRONIC LUNG DISEASE OF
PREMATURITY (BRONCHOPULMONARY
DYSPLASIA) cause resp distress

Answer 16

 Surfactant produced from 23 weeks
 Makes lungs less ‘stiff’
 Without it, alveoli collapse = resp distress

Question 17

Chronic lung disease of prematurity - bronchopulmonary dysplasia treatment

Answer 17

 Corticosteroids promote production
 Surfactant therapy given +/- mechanical ventilation
 However prolonged mechanical ventilation- causes alveolar injury
 Many improve by 2 years
 Tx: CPAP + steroids + + diuretics + RSV monoclonal antibody injections
 Prognosis: increased frequency and severity of chest infections, reduced lung function

Question 18

Laryngomalacia presentation

Answer 18

in first 2 weeks neonate
- floppy larynx
- stridor
- inward collapse of airway during inspiration
- worse when feeding, crying or sleeping (OSA)
- harsh cough
- feeding difficulties
- sleeping difficulties

Question 19

Laryngomalacia treatment

Answer 19

ENT or MLB referral

Question 20

OSA presentation

Answer 20

snoring
mouth breathing
daytime sleepiness

Question 21

OSA investigations and treatment

Answer 21

Sleep study

Tx
- CPAP
- weightloss
- ent referral

Question 22

Signs of foreign body inhalation and tx

Answer 22

persistent wheeze
cough
resp distress

Tx - CXR and refer to ENT for MLB