Paediatrics - Respiratory

Question 1

What is bronchiolitis?

Answer 1

Inflammation of the small airways of the lungs (bronchioles)

Question 2

What is the most common cause of bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV)

Question 3

At what age is bronchiolitis most common?

Answer 3

Under 6 months (usually under 1 year old, although can occur in children up to 2 years - esp if ex-premature babies with chronic lung disease)

Question 4

How does bronchiolitis present/

Answer 4

Coryza precedes cough +/- fever
Tachypnoea / apnoea
Wheeze and crackles
Intercostal recession
Poor feeding

Question 5

Give 8 signs of respiratory distress

Answer 5

Raised RR
Use of accessory muscles
Intercostal + subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises

Question 6

Most infants with bronchiolitis can be managed at home. Give 3 reasons for admission.

Answer 6

Inadequate feeding (50-75% less than normal intake milk)
Moderate to severe respiratory distress (deep recessions, head bobbing, RR >70)
Hypoxia (sats <92%)
Apnoeas
Clinical dehydration
Age <3 months or pre-existing condition (prematurity, T21, CF)

Question 7

How is bronchiolitis managed?

Answer 7

1. Ensure adequate intake (PO / NG / IV)
2. Saline nasal drops + nasal suctioning
3. Supplementary O2 if <92%
4. Ventilatory support if required

Question 8

What can be given as prevention against bronchiolitis caused by RSV?

Answer 8

Palivizumab (monoclonal antibody) - can be given as monthly injection to high risk babies, e.g. ex-premature / congenital heart disease

Question 9

What is croup?

Answer 9

Acute URTI (laryngotracheobronchitis) causing oedema in the larynx

Question 10

What is the most common cause of croup?

Answer 10

Parainfluenza (but also influenza, adenovirus, RSV)

prior to vaccination, it used to be caused by diptheria and lead to epiglottitis - high mortality

Question 11

What ages are typically affected by croup?

Answer 11

6 months to 2 years (but can be older)

Question 12

How does croup present? (5)

Answer 12

Coryza (runny nose, sore throat)
Seal-like 'barking' cough - worse at night
Hoarse voice
Stridor
Low-grade fever

Question 13

When do hospital admissions due to croup peak?

Answer 13

Autumn (Sept-Dec)

Question 14

How long does croup last?

Answer 14

3-7 days (can be up to 2 weeks)

Question 15

Give 7 ddx for croup

Answer 15

Epiglottitis
Acute anaphylaxis
Diphtheria
Peritonsillar abscess
Retropharyngeal abscess
Angioneurotic oedema

Question 16

How is croup managed?

Answer 16

Most cases can be managed at home with fluids and rest
Oral dexamethasone (stat dose 15mg/kg) is effective - can be repeated after 12h
If mod-severe, may need admission for steroids, oxygen, nebs