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Question 1

What are the main pathological features in childhood asthma?

Answer 1

Inflamed airways
Hypersensitivity
Airway remodelling

Question 2

Which cells mediate the inflammation in asthma?

Answer 2

Eosinophils and CD4+

Question 3

What is the classic presentation of asthma?

Answer 3

Wheeze, cough, chest tightness, dyspnoea

Question 4

What are common asthma triggers?

Answer 4

Cold
Exercise
Allergens
Stress

Question 5

What will PEFR investigation show for asthma?

Answer 5

Low for age/height

Better at rest and with a bronchodilator

Question 6

What will spirometry show for asthma?

Answer 6

15% improvement in FEV1 following inhalation of bronchodilator

Question 7

How is asthma managed chronically?

Answer 7

Stepwise ladder

SABA&raquo_space; +ICS&raquo_space; + LABA&raquo_space; + LTR antagonist&raquo_space; + oral steroids

Question 8

Which inhaler devices should be used in asthma 0-2 years?

Answer 8

Spacer + mask

Question 9

Which inhaler devices should be used in asthma 2-7 years?

Answer 9

MDI + spacer

Question 10

Outline acute management of asthma:

Answer 10

Oxygen
Salbutamol nebulised
Ipratropium nebulised
IV hydrocortisone
MgSO4

Question 11

What is the most common cause of bronchiolitis?

Answer 11

RSV

Question 12

Give risk factors for bronchiolitis:

Answer 12

Prem; chronic resp conditions; CHD

Question 13

Which age group get brnociolitis?

Answer 13

Under 18m

Question 14

How does bronchiolitis present?

Answer 14

Wheeze, dry cough, fever, nasal flaring, increased WOB, difficulty feeding

Question 15

What is found on examination of bronchiolitis?

Answer 15

Fine insp crackles

Exp wheeze

Question 16

How is bronchiolitis invesigated?

Answer 16

Tends to not be unless severe

If severe: nasopharyngea laspirate, blood gas, CXR

Question 17

How is bronchiolitis managed?

Answer 17

Mild: advice and safety net
Mod: admit or humidified oxygen and bronchodilation
Sev: HDU for ventilation and IV fluids

Question 18

How long does bronchiolitis generally take to clear?

Answer 18

2 weeks

Question 19

How does bronchitis present?

Answer 19

Productive cough and fever

Question 20

How is bronchitis managed?

Answer 20

Generally self-limiting

Supportive measures

Question 21

What mainly causes croup?

Answer 21

Parainfluenza virus

Question 22

What is croup?

Answer 22

Laryngotracheobronchitis

Question 23

How does croup present?

Answer 23

Barking cough
Harsh rasp stridor
Resp distress
Apyrexial

Question 24

How is croup treated?

Answer 24

Oral or nebulised steroids if severe enough

Nebulised adrenaline if o2 <94%

Question 25

True or false: | CF is an autosomal dominant condition

Answer 25

False | its AR

Question 26

Where is the mutation in CF?

Answer 26

CFTR gene on the long arm of chromosome 7

Question 27

What does the mutation in CF cause?

Answer 27

Abnormal Cl- channels, abnormal ion transport leading to abnormally thick mucus

Question 28

How does CF present in infants?

Answer 28

``` Malabsorption Large stools Failure to thrive Meconium ileus Prolonged jaundice ```

Question 29

How does CF manifest in young kids?

Answer 29

Rectal prolapse | Nasal polyps

Question 30

How does CF manifest in older kids?

Answer 30

``` Aspergillus infection DM Cirrhosis Portal hypertension Obstruction Pneumothroax ```

Question 31

How is CF investigated?

Answer 31

``` Sweat test (increased Cl in sweat) Guthrie test (raised immunoreactive trypsin) ```

Question 32

How is CF managed?

Answer 32

MDT | Mucolytics, nebulisers, abx and diet

Question 33

What commonly causes epiglottiis?

Answer 33

H influenzae

Question 34

What should YOU do to manage epiglottitis?

Answer 34

Nothing do not touch this child you can make things much worse Call ENT who may involve anaesthetics

Question 35

How does epiglottitis present?

Answer 35

Unwell child, drooling, fever, soft stridor Reluctant to speak No cough

Question 36

How is pneumonia managed in kids?

Answer 36

Same realy Oral abx and safety net if mild O2 and IV abs if moderate

Question 37

What organism causing whooping cough?

Answer 37

Bordetella pertussis

Question 38

How does whooping cough present?

Answer 38

Catarrhal phase: coryzal symptoms Paroxysmal: cough following by inspiratory whoop, apnoea, worse at night Epistaxis and subconjunctival haemorrhages can occur Note that coughing may cause vomiting

Question 39

How is whooping cough investigated?

Answer 39

Nasal swab

Question 40

How is whooping cough maanged?

Answer 40

Marcolide abx | Clarithromycin