Respiratory

Question 1

What is the admissions criteria for bronchiolitis?

Answer 1

<3 months
pre-existing conditions such as CF or DS
Oral intake <75% normal 
If RR >70
pO2 <92%
Signs of resp distress or apnoea

Question 2

What is the management of bronchiolitis?

Answer 2

Supportive with nasal suction.

If severe O2 and ventilatory support

Question 3

What are the main types of ventilatory support?

Answer 3

1. High flow humidified oxygen - Airvo (to give +ve expiratory pressure to maintain the airway and prevent collapse)
2. Continuous Positive Airway Pressure (CPAP)
3. Intubation and ventilation via endotracheal tube

Question 4

What is the key feature of T2 Respiratory Failure?

Answer 4

Increased CO2, decreased O2.

Question 5

What is the treatment for bronchiolitis?

Answer 5

Palivizumab

Question 6

What are the three features that differentiate Viral Induced Wheeze from Asthma?

Answer 6

< 3y/o
no atopic history
only occurs during viral infections

Question 7

What observations would be found in a viral induced wheeze?

Answer 7

Expiratory wheeze throughout chest (if focal, check for obstruction)

Question 8

What is the guideline for severe asthma?

Answer 8

Peak flow < 50% predicted
Sats <92%
Can’t complete a sentence
High HR + RR

Question 9

What is the guideline for life-threatening asthma?

Answer 9

Peak flow < 33% predicted
Sats < 92%
Hypotension
Silent chest
Cyanosis

Question 10

What is the treatment for an asthma attack?

Answer 10

O2 -> bronchodilators (neb salbutamol) -> ipratproprium -> MgSO4

10 puffs every 2 hours
If steroids, prednisolone 1mg/kg for 3 days

Question 11

What is the treatment for an emergency asthma attack?

Answer 11

3 B2B - 3 neb salbutamol + 3 neb ipratproprium bromide back to back
IV MgSO4
IV corticosteroid

Question 12

What is the main cause of epiglottitis?

Answer 12

Haem. Influ B

Question 13

What would be the radiological finding in epiglottitis?

Answer 13

Neck X-ray - thumb print

Question 14

What are the treatment options for epiglottitis?

Answer 14

Secure airway - anaesthetists
IV Abx - Ceftriaxone
Steroids - dexamethasone

Question 15

What are the signs of laryngomalacia?

Answer 15

Chronic stridor that worsens when feedings or lying down.

Question 16

What are the signs of Chronic Lung Disease of Prematurity? (CLDP)

Answer 16

< 28 weeks gestations
RDS - need O2 or vent+intub at birth
Chest X-Ray changes

Question 17

What can be done to minimise the risk of CLDP?

Answer 17

Give mother Betamethasone if signs of prematurity

Once born, CPAP baby
Caffeine to stimulate resp effort

Question 18

What investigations need carried out for CLDP?

Answer 18

Sleep study

Question 19

What gene mutation is tested for in CF?

Answer 19

CFTR gene

Question 20

What are the three causes of symptoms in CF?

Answer 20

• thick pancreatic and biliary secretions (block the ducts and prevent digestive enzymes from entering the GI tract, pancreatic lipase)
• thick airway secretions
• absence of Vans Deferens

Question 21

What is commonly the first sign of CF?

Answer 21

Meconium ileus

Question 22

What are non-respiratory signs of CF?

Answer 22

Distension of abdomen
Steatorrhoea
Failure to thrive
nasal polyps
finger clubbing

Question 23

What investigations can be done in CF?

Answer 23

Newborn spot test
Sweat test
Genetic testing

Question 24

What is used in the Sweat Test?

Answer 24

Pilocarpine - make an area of skin sweat using electrodes and measure [Cl]- in sweat collected, if >60 possible CF diagnosis.

Question 25

What bacteria are most commonly associated with infections in patients with CF?

Answer 25

Staph auerus + pseudomonas

Question 26

How are RTI treated in CF?

Answer 26

Staph aureus - flucloxacillin

Pseudo - nebulised tobramycin or ciprofloxacin

Question 27

What are other treatment options in CF?

Answer 27

CREON tablets - digest fats
physio
Nebulised DNAse - break down respiratory tract infections