Paediatric Respiratory

Question 1

What causes the common cold?

Answer 1

Rhinovirus

Question 2

What can the common cold be a prodrome to?

Answer 2

Bronchitis
Bronchiolitis
Meningitis
Sepsis

Question 3

What bacteria causes Otitis media?

Answer 3

Pneumococcus

H. Influenzae

Question 4

What is the pathology of otitis media?

Answer 4

Rhinovirus infection causing blockage of eustacian tube

Then bacterial infection

Question 5

Signs of otitis media?

Answer 5

Erythema
Bulging drum
Loss of light reflex
Pain

Question 6

When should antibiotics be given in otitis media?

Answer 6

<2 y/o

Bilateral

Question 7

What other treatment should be given?

Answer 7

analgesia

Question 8

What causes pharyngitis/tonsilitis?

Answer 8

EBV

Group A strep

Question 9

What are the signs of pharyngitis/tonsilitis?

Answer 9

Pain on swallowing
Swollen tonsils 
Headache
Voice changes
Pus on tonsils

Question 10

Ix pharyngitis?

Answer 10

Throat swab and culture

Question 11

Treatment for bacterial pharyngitis?

Answer 11

Antibiotics

Question 12

What antibiotics are good in group A strep?

Answer 12

Penicillins

Question 13

What should not be given in pharyngitis before swab results?

Answer 13

Amoxicillin

causes rash in EBV infection

Question 14

What is croup?

Answer 14

Laryngotracheobronchiolitis

Question 15

What causes croup?

Answer 15

Parainfluenza type 1

Question 16

What are the symptoms of croup?

Answer 16

Systemically well
Cold like symptoms
BARKING COUGH

Question 17

What breath sound might be heard with croup?

Answer 17

Stridor

Question 18

Tx for croup?

Answer 18

Dexamethasone

Question 19

What causes Epiglottitis?

Answer 19

H. Influenzae type B

Question 20

What is the presentation of epiglottitis?

Answer 20

Fever
Tachycardia
Stridor (red flag)
Drooling

Question 21

Treatment of epiglottitis?

Answer 21

Must intubate

Antibiotics

Question 22

What antibiotic should be used in epiglottitis?

Answer 22

Cefotaxime IV

Question 23

What causes Tracheitis?

Answer 23

Staph/strep

Essentially same as croup but doesn’t get better

Question 24

What is the presentation of tracheitis

Answer 24

Swollen trachea
Narrowed trachea

Fever
Can be septic

Question 25

What is the treatment of tracheitis?

Answer 25

Oxygen Hydration Antibiotics

Question 26

Antibiotic for tracheitis?

Answer 26

Amoxicillin

Question 27

What causes bronchitis?

Answer 27

H. Influenza

Question 28

Presentation of bronchitis?

Answer 28

Long term cough in very young child

Question 29

Pathology of bronchitis?

Answer 29

Infection of RSV/adenovirus leading to ciliary dysfunction H influenza then moves in and infects

Question 30

What are the symptoms of bronchitis?

Answer 30

Cough URTI/previous URTI NO WHEEZE NO CRACKLES

Question 31

Treatment of bronchitis?

Answer 31

No treatment - should recover

Question 32

What does RSV cause?

Answer 32

Bronchiolitis VERY COMMON IN INFANTS

Question 33

Typical presentation of bronchiolitis?

Answer 33

Not recurrent Nasal stuffiness Poor feeding Starts coughing day 1, gets worse then doctors day 5, stabilises and recovers up to 14 days CRACKLES +/- WHEEZE

Question 34

Bronchitis vs Bronchiolitis?

Answer 34

Bronchitis no crackles or wheeze cause by H. influ Bronchiolitis crackles and wheeze caused by RSV

Question 35

Investigation of bronchiolitis?

Answer 35

Nasopharyngeal swab SATS

Question 36

Management of bronchiolitis?

Answer 36

No treatment MAXIMUM OBSERVATION MINIMAL INTERVENTION

Question 37

What are the most common causes of pneumonia in kids?

Answer 37

Pneumococcus Neisseria meningitidis Mycoplasma Chlamydia

Question 38

Symptoms of pneumonia?

Answer 38

48hr history - Fever - Productive cough - Wheeze - Reduced breath sounds - Focal signs

Question 39

What is a wheeze more likely to indicate in pneumonia?

Answer 39

Viral cause

Question 40

What are focal signs of pneumonia?

Answer 40

Creps | Bronchial breathing

Question 41

Investigations of pneumonia?

Answer 41

Can do sputum culture Rarely CxR

Question 42

What indicates antibiotic use in pneumonia in kids?

Answer 42

- Longer than 2 days - Neonates - Sepsis

Question 43

What antibiotics should be used in neonates?

Answer 43

Broad spectrum

Question 44

What antibiotics are first line in kids?

Answer 44

Amoxicillin | Macrolides

Question 45

What is a complication of pneumonia that requires immediate treatment?

Answer 45

Empyema thoracis

Question 46

What is treatment of empyema thoracis?

Answer 46

Drain | IV antibiotics

Question 47

When would asthma cause SOB at rest?

Answer 47

If lung function is reduced by >30%

Question 48

What trial can be done to diagnose asthma?

Answer 48

If true wheeze Then 2 month trial of corticosteroid If it gets better - asthma

Question 49

What is the treatment protocol of asthma for >5yrs?

Answer 49

1. SABA +/- ICS 2. Add LABA if symptomatic 3x per week 3. Stop LABA, increase ICS to medium 4. Increase ICS to max. Consider theophylline 5. Contiuous/frequent ora steroid.

Question 50

What shouldn't be used in <5yrs in asthma

Answer 50

LRTA instead of ICS and LABA

Question 51

Example of LRTA?

Answer 51

Monteklast

Question 52

When can dry powder inhalers be used?

Answer 52

>8 yrs

Question 53

What shouldn't be used without ICS?

Answer 53

LABA

Question 54

Side effects of ICS?

Answer 54

Height suppression | Adrenocortical suppression

Question 55

Define moderate acute asthma?

Answer 55

Sats >92% | PEF > = 50% pred.

Question 56

Treat moderate acute asthma?

Answer 56

SABA with spacer Oral pred

Question 57

Define severe acute asthma?

Answer 57

Sats <92% PEF 33-50% Unable to talk HR and RR very high

Question 58

Treatment severe acute asthma?

Answer 58

Nebulised ipratropium

Question 59

Define life threatening asthma?

Answer 59

``` SILENT CHEST POOR RESP EFFORT AGITATION/CONFUSION REDUCED GCS CYANOSIS ```

Question 60

Treatment of life threatening asthma?

Answer 60

Nebulised SABA and ipratropium If unable to nebulised - IV theophylline, SABA, ICS - Intubation

Question 61

DDx wheeze?

Answer 61

Virus Asthma CF Aspiration