Resp

Question 1

Common cause of Bronchioloitis

Answer 1

RSV

Question 2

What age does Bronchiolitis mainly occur

Answer 2

under 1yr, mainly under 6months

Question 3

Typical pattern of bronciolitis

Answer 3

symptoms worsen days 1-5
day 5-7 no change
7-10 recovery period

Question 4

treatment of bronchiolitis

Answer 4

usually no need

Question 5

presentation of bronchiolitis

Answer 5

Coryzal symptoms: running or snotty nose, sneezing, mucus in throat and watery eyes.
    Signs of respiratory distress
    Dyspnoea 
    Tachypnoea 
    Poor feeding
    Mild fever (under 39ºC)
    Apnoeas are episodes where the child stops breathing
    Wheeze and crackles on auscultation

Question 6

Signs of respiratory distress

Answer 6

Raised respiratory rate
    Use of accessory muscles of breathing
    Intercostal and subcostal recessions
    Nasal flaring
    Head bobbing
    Tracheal tugging
    Cyanosis (due to low oxygen saturation)
    Abnormal airway noises

Question 7

common causes of croup

Answer 7

Parainfluenza (main one)
Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)

Question 8

presentation of croup

Answer 8

Increased work of breathing
    “Barking” cough, occurring in clusters of coughing episodes
    Hoarse voice
    Stridor
    Low grade fever

Question 9

treatment of croup

Answer 9

Oral dexamethasone

Question 10

unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling what is the likely diagnosis

Answer 10

Epiglottitis

Question 11

Common cause of Epiglottitis

Answer 11

haemophilus influenza type B

Question 12

Presentation of epiglottitis

Answer 12

Patient presenting with a sore throat and stridor
    Drooling
    Tripod position, sat forward with a hand on each knee
    High fever
    Difficulty or painful swallowing
    Muffled voice
    Scared and quiet child
    Septic and unwell appearance

Question 13

Lx for epiglotittis

Answer 13

if patient is acutely unwell go straight to treatment

lateral x ray of neck can show thumb sign

Question 14

Treatment for epiglitittis

Answer 14

secure airway
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)

Question 15

Lx for whooping cough (pertussis)

Answer 15

A nasopharyngeal or nasal swab with PCR testing or bacterial culture
Anti-pertussis toxin immunoglobulin G if cough has been present for more than 2 weeks

Question 16

Treatment of whooping cough

Answer 16

Macrolides (azithromycin, erythromycin and clarithromycin) are beneficial in the early stages

Question 17

What is the inheritiance pattern of CF

Answer 17

Autosomal recessive

Question 18

Both 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 18

2/3

Question 19

what is the screening for CF

Answer 19

newborn blood spot test

Question 20

signs and symptoms of CF

Answer 20

failure to pass first poo within 24 hrs (usually first indicator of CF)

recurrent lower resp tract infections

failure to thrive

pancreatitis

Chronic cough
Thick sputum production
Recurrent respiratory tract infections
Loose, greasy stools (steatorrhoea) due to a lack of fat digesting lipase enzymes
Abdominal pain and bloating
salty skin

Nasal polyps
Finger clubbing
Crackles and wheezes on auscultation

Question 21

Lx for CF

Answer 21

Sweat test (gold standard)
genetic testing for CFTR gene

Question 22

2 main common colonises of patients with CF

Answer 22

Staph A

Pseudomonas

Question 23

Management of CF

Answer 23

Chest physiotherapy several times a day is essential to clear mucus and reduce the risk of infection and colonisation
Exercise improves respiratory function and reserve, and helps clear sputum
High calorie diet is required for malabsorption, increased respiratory effort, coughing, infections and physiotherapy
CREON tablets to digest fats in patients with pancreatic insufficiency (these replace the missing lipase enzymes)
Prophylactic flucloxacillin tablets to reduce the risk of bacterial infections (particularly staph aureus)
Treat chest infections when they occur
Bronchodilators such as salbutamol inhalers can help treat bronchoconstriction
Nebulised DNase (dornase alfa) is an enzyme that can break down DNA material in respiratory secretions, making secretions less viscous and easier to clear
Nebulised hypertonic saline
Vaccinations including pneumococcal, influenza and varicella

Question 24

what are typical features of viral induced wheeze (as opposed to asthma)

Answer 24

Presenting before 3 years of age
No atopic history
Only occurs during viral infections

Question 25

what is the management of chronic asthma in under 5yrs?

Answer 25

1. SABA as required
2. Add inhaled steroid
3. Add LABA
4. increased inhaled steroid

refer for step 4

Question 26

what is the management of asthma in 5-12yrs?

Answer 26

1. SABA as required
2. Add inhaled corticosteroid
3. Add LABA (do not use with ICS)
4. increase inhaled steroid
5. use daily steroid table

steps 4 and 5 should be done by specialist?