Paediatrics

Question 1

What is the other name for croup?

Answer 1

Laryngotracheobronchitis

Question 2

In what population is croup common in

Answer 2

6m-3.y.o., more common in males

Question 3

Give the four main symptoms of croup

Answer 3

Hoarse voice, barking cough, inspiratory stridor, increased RR

Question 4

Describe four signs of croup

Answer 4

Intercostal recession, tracheal tug, chest wall recession, hypoxia, tachycardia

Question 5

How do we treat croup?

Answer 5

Dexamethasone, nebulised adrenaline if moderate/severe

Question 6

Give four differentials of croup

Answer 6

Anaphylaxis, epiglottitis, bacterial tracheitis, inhaled foreign body, congenital abnormality

Question 7

What causes bronchiolitis?

Answer 7

Respiratory syncytial virus (RSV), usually

Question 8

Describe the signs of bronchiolitis

Answer 8

Tracheal tug, increased RR, inspiratory crepitations, wheeze, abdominal breathing, intercostal recession, apnoea, grunting, cyanosis

Question 9

Give risk factors for bronchiolitis

Answer 9

<6wks, premature, lower weight for gestation, immunodeficiency, congenital heart disease, neurological conditions

Question 10

Give differentials for bronchiolitis

Answer 10

Acute asthma, viral induced wheeze, pneumonia, CHF, pertussis

Question 11

What bacteria most commonly causes epiglottitis?

Answer 11

Haemophilus influenza type B

Question 12

How can you distinguish between epiglottitis and croup?

Answer 12

Epiglottitis can present in a similar way to croup, but with a more rapid onset.

Question 13

Describe the characteristic epiglottitis pt

Answer 13

Unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling

Question 14

What is the tripod position?

Answer 14

Sat forward with a hand on each knee

Question 15

Describe the investigations and findings for epiglottitis

Answer 15

Performing a lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”. This is a soft tissue shadow that looks like a thumb pressed into the trachea.

Question 16

A five year old comes in acutely unwell. You suspect epiglottitis. What Ix are you going to perform.

Answer 16

None. If the patient is acutely unwell and epiglottitis is suspected then investigations should not be performed (risk of stress causing airway closure).

Question 17

How is epiglottitis managed?

Answer 17

Don’t distress the pt. The most important thing is to alert the most senior paediatrician and anaesthetist available. They will secure the airway, and potentially give steroids and abx

Question 18

Give a common complication of epiglottitis.

Answer 18

Epiglottic abscess.

Question 19

Give a common cause of croup

Answer 19

Parainfluenza virus, RSV

Question 20

What dose of dexamethasone do we give to croup pts?

Answer 20

Usually a single dose of 150 mcg/kg, which can be repeated if required after 12 hours. Prednisolone is sometimes used as an alternative where dexamethasone in not available (e.g. by GPs).

Question 21

What are coryzal symptoms?

Answer 21

These are the typical symptoms of a viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.

Question 22

Give nine signs of respiratory distress.

Answer 22

Raised RR, use of accessory muscles, intercostal recessions, subcostal recessions, nasal flaring, head bobbing, tracheal tugging, cyanosis, abnormal airway noises

Question 23

What is wheezing?

Answer 23

A whistling sound caused by narrowed airways, typically heard during expiration

Question 24

What causes grunting?

Answer 24

Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure

Question 25

What is stridor?

Answer 25

Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup

Question 26

What is palivizumab?

Answer 26

A monoclonal antibody that targets the respiratory syncytial virus. A monthly injection is given as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ex-premature and those with congenital heart disease. Passive protection.

Question 27

What causes cystic fibrosis?

Answer 27

It is caused by a genetic mutation of the cystic fibrosis transmembrane conductance regulatory gene on chromosome 7.

Question 28

What are the main consequences of CF?

Answer 28

Thick pancreatic and biliary secretions, low volume thick airway secretions, congenital bilateral absence of the vas deferens

Question 29

Some cystic fibrosis pts suffer from thick pancreatic and biliary secretions. Why is this an issue?

Answer 29

It can cause blockage of the ducts, resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract

Question 30

Some cystic fibrosis pts suffer from low volume thick airway secretions. Why is this an issue?

Answer 30

It can reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections

Question 31

Explain why male cystic fibrosis sufferers may be infertile.

Answer 31

Patients generally have healthy sperm, but the sperm have no way of getting from the testes to the ejaculate due to lack the of the vas deferens, resulting in male infertility

Question 32

Two parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?

Answer 32

The child doesn’t have the condition, so the answer is two in three

Question 33

How do we screen for CF?

Answer 33

Newborn bloodspot test

Question 34

What is meconium ileus?

Answer 34

Often the first sign of cystic fibrosis. The first stool that a baby passes is called meconium. This is usually black and should be passed within 24 hours of birth. In about 20% of babies with CF, the meconium is thick and sticky, causing it to get stuck and obstruct the bowel. This is called meconium ileus, and is practically pathognomonic for cystic fibrosis. This presents as not passing meconium within 24 hours, abdominal distention and vomiting.

Question 35

If a pt isn’t diagnosed with CF as a baby, how may it present?

Answer 35

FTT, recurrent resp tract infections, pancreatitis

Question 36

Give symptoms of CF

Answer 36

Chronic cough, thick sputum production, recurrent resp tract infections, steatorrhoea, abdo pain and bloating, salty sweat, FTT

Question 37

Give signs of CF

Answer 37

Low weight/height on growth charts, nasal polyps, finger clubbing, crackles and wheezes on auscultation, abdominal distension

Question 38

How do we diagnose CF?

Answer 38

Sweat test is the gold standard. Genetic testing for CFTR gene can be performed during pregnancy by amniocentesis or chorionic villous sampling, or as a blood test after birth.

Question 39

What is the diagnostic chloride concentration in sweat for CF?

Answer 39

The diagnostic chloride concentration for cystic fibrosis is more than 60mmol/l.

Question 40

Describe two key colonisers of the respiratory tract for pts with CF.

Answer 40

The key colonisers to remember for your exams are staph aureus and pseudomonas.
Patients with cystic fibrosis take long term prophylactic flucloxacillin to prevent staph aureus infection. Pseudomonas should be remembered as a particularly troublesome coloniser that is hard to treat and worsens the prognosis of patients with cystic fibrosis.

Question 41

What is otitis media?

Answer 41

An infection in the middle ear. The middle ear is the space that sits between the tympanic membrane (ear drum) and the inner ear.

Question 42

How does otitis media occur?

Answer 42

The bacteria enter from the back of the throat through the eustachian tube. Bacterial infection of the inner ear is often preceded by a viral upper respiratory tract infection.

Question 43

How do we treat otitis media?

Answer 43

Try to avoid antibiotic use, it usually resolves on its own. Prescribe simple analgesia. If abx used, use amoxicillin first line or alternatives are erythromycin/clarithromycin.

Question 44

A young pt comes to see you with otitis media. Their parent is very worried about them, and wants you to prescribe abx. It is not clinically indicated to do so, as the child rates the pain a 4/10. What will you do?

Answer 44

Inform them that complications (usually mastoiditis) are rare. Consider giving a delayed prescription for three days time if symptoms do not improve. Advise them to get in touch if the symptoms worsen.

Question 45

Give complications of otitis media.

Answer 45

Otitis media with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)