Paeds Resp

Question 1

Three cardinal symptoms of asthma

Answer 1

Productive cough
SOB
High pitched expiratory wheeze

Question 2

Spirometry criteria for asthma

Answer 2

FEV1/FVC <70 % indicates OBSTRUCTIVE

12% ANd 200 ml improvement in FEV1 after SABA confirms asthma

Question 3

What part of the spirometry result indicates severity ?

Answer 3

FEV1 indicates severity with >80% mild, <60% severe

Question 4

Stepwise management plan for asthma

Answer 4

SABA - reliever 
Low dose ICS- preventer
Low dose ICS + LABA 
High dose ICS + LABA 
Others: IgE antagonists, OCS

Question 5

Management for acute attack asthma

Answer 5

Oxygen if says less than 92
SABA - MDI/ spacer/ nebuliser 
6-12 puffs with 4 breaths between each 
Prednisolone oral 
Ipratropium 
Mgso4 or aminophylline 

OSPIMqq

Question 6

Common agents of pneumonia in children + treatment
<5yo
8-14
Older

Answer 6

<5yo- viral RSV - IV CTX
8-14 - mycoplasma - amoxicillin
Older- strep pneumo - roxithromycin

Question 7

3 month old infant presents to Ed with sob, high pitched exploratory wheeze and fever. Laboured breathing with chest wall retraction
- widespread crackles, apnoea occasional, low O2, CRP low, RR 70

Answer 7

Bronchiolitis

Question 8

What is the peak incidence for bronchiolitis and it’s agent?

Answer 8

Peaks in 2-6 months. Affects 1/30 infants in first year of life.
Symptoms peak at D3, improves D5, recovers D7-10

REspiratory syncytial virus

Question 9

How do you diagnose and manage Bronchiolitis ?

Answer 9

Clinical diagnosis. A NPA ELiSA antigen can be performed. CXR rule out pneumonia. May see hyperinflation and peri hilar fullness

O2 monitoring

Question 10

Barking cough, inspiration strider and fever in a 2 year old child 
What is it? 
Definition? 
Aetiology? 
Management?

Answer 10

Croup- inflammation of trachea leading to sub glottis narrowing.

Peaks at 3m-3y
Symptoms worsen at night and peaks at night 2-3.

Parainfluenza or influenza

Mx with upright, cool air, ice cream.
O2 if necessary
Oral pred/ dexamethasone
Nebulised adrenaline

Question 11

Epiglottitis presentation: four Ds

Answer 11

Drooling
Dysphagia
Dysphonia
Dyspepsia

High fever, tripod position.
Major risk factor : unvaccinated child.
Hib- haemophillus influenza b

Question 12

Causative agent and management of Epiglottitis and investigation

Answer 12

Hib

XR- thumb print sign
CRP

ABC intubation (call paed reg, NEVER do yourself)
CTX + dexa

Question 13

Whooping cough

Answer 13

Bordatella pertussis

1-2w of rhino sinusitis
2-3m coughing spasms, post tussive vomiting

Not protected until 3rd vaccination at 6 months. Reportable illness. Treat or vaccinate all contacts

Question 14

How to assess level of control of asthma ?

Answer 14

1. Daytime symptoms
2. Night time symptoms
3. Activity limitations
4. Need for reliever

Question 15

Name three congenital laryngeal malformations - and how do you distinguish them?

Answer 15

Intermittent Inspiration stridor, worse on feeding supine: laryngomalacia
Biphasic stridor hx of neonatal intubation: sub glottic stenosis
Hoarse voice on cooing: vocal cord paralysis

Question 16

Drooling, dysphonia, distress, dysphasia , fever

Answer 16

Epiglottitis

Question 17

Barking cough + inspiratory stridor, fever

Answer 17

Croup

Question 18

SOB, laboured breathing, chest wall retraction in a 2mo

Answer 18

Bronchiolitis