Respiratory

Question 1

What are the differentials for tonsilitis in children?

Answer 1

• Scarlet fever: Fever before the rash (Report)
• Quinsy : peri-tonsilar rash
• Kawasakis: 5 days fever with issues
• Rubella: Rash
• Infectious mononucleosis
• COVID

Question 2

What are the investigations of Tonsillitis:

Answer 2

1- Throat swab
2- Urinalysis for ASOT
3-Centor criteria: 1- Fever> 38, tonsillar exudate, anterior cervical adenopathy, No cough
4-

Question 3

What is the management of Tonsilitis?

Answer 3

1- Admit if clinically unwell eg dehydrated, difficult breathing,
2-Phenoxymethylpenicilin NEVER AMOXICILLIN
3- Stay hydrated, salt water gargles, paracetamol

4- Tonsillectomy if recurrent

Question 4

Complications of tonsilitis?

Answer 4

Acute gloumerulonephritis
Otitis media esp if scarlet fever
Toxic shock syndrome - IV clindamycin

Question 5

Common causative organisms and presentation of otitis media?

Answer 5

Bacterial: Hib, S.pneumo, S. pyogenes
Viral: RSV, Rhino, Adeno, Influenza

Common: 6-12 months as they have a short eustachian tubes

Present:

• Ear pain
• Fever
• Poor feeding
• Cough
• Discharge

Question 6

What Investigations do you carry out for Otitis Media and what do you see?

Answer 6

• Basic observations

- Otoscopic: Bright red, cloudy tympanic membrane, bulging, perforation

Question 7

What is the management of Otitis Media?

Answer 7

Admit if: Systemic infection, complication
38 degrees + in <3 months
3-6 months + temp > 39 degrees

Conservative: 3 days to 1 week and have para / ibu

Medical:

• Meds if > 3 days or child worsens
• Back-up prescription: given for the above
• Immediate= Amoxicillin (7 days)

Question 8

What are the complications of Otitis Media?

Answer 8

Glue Ear: effusion = hearing loss

IMMEDIATE CARE if : Cleft palate or Downs.

Can cause conductive hearing loss = grommet use

Question 9

What are the differentials of Stridor?

Answer 9

Croup
Epiglottis
Bacterial Trachietis

Question 10

What is the management of croup?

Answer 10

Always give Oral Dexamethasone PO (0.15mg/kg) ASAP

Conservative: Usually resolves in 48 hours , but A&E if childf turns blue, intercostal recessions etc

If moderate: PO dex , admit and neb adrenaline

Severe: IV dexamethasone and neb adrenaline with O2

Question 11

What is the management of acute epiglottitis?

Answer 11

Urgent hospital admission (Present with High fevers) -> ICU

1-Secure airways + O2 delivery
2- Blood culture + IV ABx

HiB? - Rifampicin Tx for household

Question 12

The main cause of wheeze?

Answer 12

Bronchiolitis (RSV)

Asthma

Question 13

What is the management of Bronchiolitis?

Answer 13

Red flags= urgent admission

Supportive treatment:
Humidified O2 and paracetamol

Infants recover within 2 weeks + remian hydrated

Prevention: High risk groups give PALIVIZUMAB

Question 14

What is Asthma and how is it split up?

Answer 14

Asthma - Chronic respiratory problem causing airway inflammation and hyper-responsiveness

Split into: Viral induced and multi-trigger wheeze

Question 15

What are the key features of an asthma Hx?

Answer 15

Diurnal variation, being worse at night and morning

Post-exercise
cough
check atopy

Question 16

How do you investigate Asthma?

Answer 16

<5 - Clinical
> 5 years - Bronchodilater reversibilty on PEF
-Spirometry ( FEV1/FVC)
-Skin prick test for atopy

Question 17

What is the stepwise management of patients under 5 years for Asthma?

Answer 17

1- SABA
2-SABA + moderate dose ICS
3- SABA + low-dose ICS+LTRA
4- Refer to asthma specialist + stop LTRA

Question 18

What is the stepwise management of asthma in 5+ years

Answer 18

1-SABA
2-SABA + low dose ICS
3-SABA+ low dose ICS+ LTRA
4- SABA+ low dose ICS+ LABA
5- SABA+MART 
6-SABA+MART (medium dose ICS)
7- Specialist care

Question 19

Acute Management of Asthma

Answer 19

ABCDE

1- Burst therapy - salbutamol (10 puffs- 1 every 60 seconds) 3 rounds - Neb if severe

2-neb ipratropium bromide (2x)

3-PO prednisolone - always
IV hydrocortisone if not

4- PICU, IV MgSO2

5- intubate