Paediatric Respiratory Flashcards
Q: What are the key differentiators between viral-induced wheeze and multiple trigger wheeze?
A:
Viral-induced wheeze: Occurs only during viral infections, usually resolves by age 5, and is associated with smaller airways and an aberrant immune response.
Multiple trigger wheeze: Triggered by multiple factors (e.g., cold air, exercise, allergens) and is more likely to progress to asthma over time.
Q: What is the most common cause of bronchiolitis, and when does it peak?
A:
Cause: Respiratory Syncytial Virus (RSV), responsible for ~80% of cases.
Peaks: Winter (October to March), with most cases in infants aged 1-9 months.
Q: What are the clinical features of severe bronchiolitis?
A:
Tachypnoea
Subcostal recession
Difficulty feeding
Polyphonic wheeze and bilateral crepitations
Cyanosis or oxygen saturation <92%
Q: How is viral-induced wheeze managed in primary care?
A:
1- Mild cases: 2-5 puffs of salbutamol every 4 hours with a spacer.
2- Provide parental education and safety netting.
3- Advise on symptom resolution within days and monitor for severe signs (e.g., dehydration, poor response to bronchodilators).
Q: What are the presenting features of paediatric asthma?
A:
1- Symptoms: Recurrent wheeze, cough, difficulty breathing, or chest tightness.
2- Pattern: Worse at night or early morning, after exercise, or triggered by allergens.
3- Improvement: Symptoms improve with bronchodilator or corticosteroid treatment.
Q: What are the key investigations for asthma in children?
1- Spirometry (if >5 years) with reversibility testing.
2- Fractional exhaled nitric oxide (FeNO) testing if aged 5-16 and diagnosis is uncertain.
3- Trial of treatment and reassessment in 2-3 months.
Q: What factors increase the risk of severe bronchiolitis?
A:
Prematurity (<37 weeks)
Chronic lung or neurological disease
Congenital heart defects
Age <12 weeks
Immunocompromise
