Paeds Resp

Question 1

Asthma
- Definition

Answer 1

Asthma Definition

1. Chronic inflammatory airways
2. Reversible and paroxysmal constriction
3. Occlusion by exudate

Question 2

Additional breath sounds

Answer 2

Breath sounds

1. Wheeze
   - Expiratory
   - Musical
   - Polyphonic
2. Stridor cf. croup
   - Inspiratory (biphasic, exp.)
   - Chronic in palsies
3. Stertor
   - Tonsils/adenoids
4. Grunting
5. Whoop
   - Uninterrupted involuntary expirations
   then
   - inspiratory whoop (swollen glottis)

Question 3

Wheeze
- Causes

Answer 3

Causes of wheeze

1. Asthma
2. Viral
3. Bronchiolitis
4. Foreign body
5. Airway Malacia
6. CF
7. Tumour
8. Vascular ring

Question 4

Diagnosis of asthma
- Organisation guidelines
- Techniques

Answer 4

Diagnosis of asthma

1. BTS, NICE, GINA
2. Spirometry
   - Plethysmography
3. FeNO Test
   - Fractional exhaled NO
   - 10s exhalation
   - 40ppb of NO indicates inflammation
4. Diurnal monitoring

Question 5

Distressed child
- Signs

Answer 5

Recognising distressed child

1. Clingy
2. Irritable
3. Acclimatised
   - Happy

Question 6

Respiratory history
- Exercise clues

Answer 6

Resp history clues

• Able to finish a match?

Question 7

Resp history
- Environmental clues

Answer 7

Resp history - environmental

1. Smoking
2. Pollen
3. Mould
4. Pigeons (Hypersensitivity pneumonitis/ bird fancier’s lung)

Question 8

Paeds LRTI

1. Prognosis
2. Ix

Answer 8

Paeds LRTI

1. Prognosis
   - 13% of child deaths
2. Ix
   - Consider CXR

Question 9

Paeds Pneumonia
- Pathogens

Answer 9

Paeds Pneumonia

CAP

1. RSV
   - First 6mo
2. Strep pn.
   - First 2yrs

Question 10

Paeds pneumonia
- Tx

Answer 10

Paeds CAP

1. PO ABx
   - Amoxicillin
2. IV ABx
   - Co-amoxiclav

Question 11

Paeds pneumonia
- Complications

Answer 11

Paeds pneumonia complications

1. Parapneumonic effusion
2. Empyema
   - ABx
   - Chest drain
   - Fibrinolytic (urokinase)

Surgery
- VATS
- Video-assisted thoracoscopic surgery

Question 12

Chronic Wet Cough
DDx

Answer 12

Chronic Wet Coughs

1. PBB
   -Protracted bacterial bronchitis
2. Rhinitis/post-nasal drip
3. GORD
4. CF
5. Asthma

Question 13

PBB
- Mx

Answer 13

Protracted bacterial bronchitis

1. R/O FB, chest pain, SoB
2. 2/52 Co-amoxiclav

Question 14

Paeds rhinitis
Mx

Answer 14

Paeds rhinitis

1. Antihistamine
2. Steroid

Question 15

Bronchiectasis

• CT Parameters

Answer 15

Bronchiectasis HRCT

1. Child
   - Bronchi >0.8 size of vessels
2. Adult
   - Bronchi >1.0 size of vessels
   (Signet Ring Sign)
   - Thickened walls (tram track sign)

Question 16

Cystic Fibrosis
- Prevalence
- Genetics

Answer 16

Cystic fibrosis

1. Prevalence
   - 1/25 carriers
   - 1/2500 AD
2. Genetics
   - Chromosome 7

Question 17

CF
- Pathophysiology

Answer 17

CF

1. Chromosome 7 abnormality
2. Decreased Cl- movement
3. Increased Na+ Reabsorption
4. Increased H2O Reabsorption
   - Thickened secretions

Question 18

Kartagener’s

1. Prevalence
2. Triad

Answer 18

Kartagener’s
- 1/40,000

• Triad
  1. 1º CD
  2. Bronchiectasis
  3. Situs invertus

Question 19

Tracheobroncomalacia

• Prevalence
• Causes

Answer 19

Tracheo-broncho-malacia

• Prevalence
  c1/10 airway problems
• Causes

1. Congenital
   - Ehlers Danlos/Marfan
   - Bronchopulmonary dysplasia
   - Fistula
   - Double aortic arch
2. Compression
   - Vascular rings
   - Goitre
   - GORD
3. Acquired
   - Asthma
   - COPD
   - Tracheostomy

Question 20

RDS
- Types of retraction

Answer 20

RDS Retraction

1. Suprasternal
2. Clavicular
3. Substernal
4. Intercostal
5. Subcostal

Question 21

Croup
- Epidemiology
- Presentaiton

Answer 21

Croup (laryngotracheobronchitis)

• Epidemiology
  1. Parainfluenza virus I/III
  2. 6mo - 3 years
• Peak at 2yo
  3. Sept - Dec peak
• Presentation
  1. Barky cough
  2. Stridor
  3. Hoarseness
  4. Respiratory effort
  5. Worse at night

Question 22

Croup
- Mx

Answer 22

Croup Mx

1. Dexamethasone PO(/IM)
   - 0.15mg/kg (- 0.6mg/kg)
2. Nebulised adrenaline
   - stridor at rest
3. Supplemental oxygen
   - agitation/lethargy