Paediatric Respiratory

Question 1

What are some causes of stridor?

Answer 1

Croup
Epiglottitis
Laryngomalacia
Adenotonsillar hypertrophy
Subglottal stenosis
Vocal cord palsy
Quinsy
Anaphylaxis -> laryngeal oedema
Foreign body

Question 2

What are some signs of respiratory distress?

Answer 2

Recession (subcostal and intercostal)
Tracheal tug
Tachypnoea/ raised RR
Tachycardia
Grunting
Nasal flaring
Cyanosis

Question 3

What would spirometry show in a child with asthma?

Answer 3

Obstructive pattern
FEV1 reduced less than 80% predicted
FEV1:FVC ratio <0.7
Reversibility with use of bronchodilators

Question 4

Exhaled nitric oxide test is used for patients with which condition?

Answer 4

Asthma

Question 5

What conservative management measures can be implemented for a child with asthma?

Answer 5

Check their inhaler technique and that they are using a space
Written asthma management plan
Annual review

Question 6

How is monteleukast administered?

Answer 6

Orally

Question 7

For a 4 year old child whose asthma is not adequately controlled with SABA and regular ICS, what is the next step in their management?

Answer 7

Add a LTRA e.g. monteleukast

If they were over 5 years old, we would add a LABA instead

Question 8

How is cystic fibrosis inherited?

Answer 8

Autosomal recessively

Question 9

How may children with cystic fibrosis present?

Answer 9

Neonate: meconium ileus, prolonged jaundice
Infants/ Children: rectal prolapse, recurrent chest infections, diabetes, failure to thrive and vitamin deficiency, nasal polyps, hyperinflated chest, steatorrhea, clubbing

Question 10

How is CF managed?

Answer 10

Physio twice a day
Mucolytics
Pancreatic enzymes
Vitamin A, D, E supplements 
High calorie diet
Psychological support
Prophylactic abx for presumed viral infections
Twice yearly follow ups

Question 11

Abnormally raised immunoreactive trypsinogen is suggestive of which condition?

Answer 11

Cystic fibrosis 
(This is measured in newborns on day 5/6 as part of the Guthrie screen, samples with high IRT will then undo CFTR mutation screening)

Question 12

What is bronchiectasis?

Answer 12

Permanent dilation and thickening of the bronchi
Due to chronic inflammation of the airways, associated with CF, immunodeficiency, or may develop after lung infections, or aspiration

Question 13

How could a child with bronchiectasis present?

Answer 13

Cough
Dyspnoea
Haemoptysis
Coarse crackles 
Wheeze in one third of patients 
Respiratory failure

Question 14

What is the gold standard investigation for bronchiectasis?

Answer 14

HRCT
Will show bronchial wall thickening and signet ring sign where the diameter of the bronchus is wider than the bronchial artery

Question 15

How is bronchiectasis managed in children?

Answer 15

• physio for airway clearance
• longer course or prophylactic abx
• encourage healthy diet and exercise
• influenza vaccine

Question 16

What triad of symptoms are characteristic of croup?

Answer 16

Barking cough
Hoarse voice
Stridor

Question 17

Outline your management plan for a child presenting with croup.

Answer 17

Steroids
Nebulised adrenaline
Rest

Question 18

What is the typical presentation of Petussis?

Answer 18

Prolonged severe bouts of coughing often associated with vomiting

Question 19

What presentation would warrant hospital admission for an infant with bronchiolitis?

Answer 19

Apnoeic episodes
Feeding less than 50 to 75%
Raised RR
Low sats

Question 20

What is the investigation of choice for suspected bronchiolitis?

Answer 20

Nasal pharyngeal aspirate

Question 21

What causes epiglottitis?

Answer 21

Haemophilus influenza type B

Question 22

How would you manage a child with epiglottitis?

Answer 22

Don’t examine!

Send child for intubation and IV Abx

Question 23

What investigation would you want to perform in a child with suspected bronchiolitis?

Answer 23

Nasopharyngeal aspirate for rapid RSV testing

Question 24

What are some causes of acute wheezes, and of chronic wheezes?

Answer 24

Acute and chronic: asthma, viral episodic wheeze
Acute: FB, anaphylaxis, atypical pneumoniae
Chronic: bronchiectasis, FB, CF, recurrent aspiration, tracheobronchomalacia, tracheal web, cystic tumour

Question 25

What are some causes of cyanosis in a child?

Answer 25

Airway: choanal atresia, micrognathia, larnygeal web/ stenosis, hemangioma, laryngomalacia, vascular rings, Pierre Robin sequence

Breathing: hypoventilation, pulmonary hypoplasia, diaphragmatic hernia, pneumonia, phrenic nerve palsy

Circulation: anaemia, polycythaemia, pulmonary stenosis/ atresia, tetralogy, tricuspid atresia, transposition great arteries, persistent pulmonary hypertension of newborn

Question 26

When is stridor exacerbated for an infant with laryngomalacia?

Answer 26

When feeding, crying, lay on their back

Question 27

How would you treat an infant with suspected whooping cough?

Answer 27

If presenting within 21days, offer macrolide antibiotic e.g. azithromycin
Abx prophylaxis for household members
Notify public health England

Question 28

How do severe asthma attacks present compared to life threatening asthma attacks?

Answer 28

Severe:
PEF 33-50%, sats <92%, too breathless to talk, use of accessory muscles, raised HR and RR

Life threatening:
PEF<33%, sats <92%, silent chest, cyanosis, altered consciousness