Respiratory

Question 1

What is the reliever for asthma in kids

Answer 1

SABA

Question 2

Croup management

Answer 2

Mild
- dexamethasone 0.15mg/kg PO or prednisolone 1mg/kg PO with repeat dose next evening
- discharge home once strider-free at rest, at least 30 mins post steroid
Mod
- same as above, consider adrenaline if persistent or worsening symptoms
Severe
- nebulised adrenaline (0.5ml/kg of 1:1000 to max 5ml undiluted) AND dexa 0.6mg/kg max 12mg IM/IV/oral
- O2 if SpO2 low
- if strider-free at rest after 4 hours can discharge
- if minimal response, repeat dose and escalate to ICU

Question 3

Management of acute exacerbation of asthma

Answer 3

Assess severity 
Check vitals, O2 if SpO2 <90% 
Mild 
- Salbutamol MDI spacer 
- if good response, discharge with PRN B2 agonist, provide asthma action plan
- if poor response treat as moderate 
- consider oral prednisolone 
Moderate 
- O2 if needed 
- Salbutamol MDI 
- Ipratropium bromide MDI 
- Consider oral prednisone
Severe 
- Involve senior staff 
- High-flow O2 
- Salbutamol (may need nevulised if given O2) 
- Ipratropium 
- Oral prednisolone 2mg/kg initially, only continue with 1mg/kg OD for further 1-2 days of regular need for salbutamol 
- if vomiting, give IV methylpred 1mg/kg 6hrly 
- if poor response: 
  MgSO4 50% or IV aminophylline loading dose 10mg/kg, continue with infusion 6hrly 
- consider adrenaline 
- if deteriorate treat as critical 
Critical 
- involve senior staff and transfer 
- O2 humidified 
- nebulised salbutamol and ipratropium 
- IV Methylpred 
- IV aminophylline 
- Consider IV salbutamol, adrenaline 
- ICU admission if needed respiratory support

Question 4

Tests for bronchiolotiis

Answer 4

Usually unnecessary

Nasopharyngeal swab for PCR, vitals, ABG if severe
CXR: hyper inflated lungs and focal atelectasis

Question 5

Management of bronchiolitis

Answer 5

Monitor vitals
- maintain SpO2 >90%, if needed give humidified O2 via nasal prongs, if severe CPAP
Hydration: IV fluid 2/3rd of maintenance
Feeding via NG tube if required
No B2 agonists, steroids, adrenaline, saline, antibiotics
Prevention: Palivizumab

Question 6

Tests for pneumonia

Answer 6

Mostly if severe/complicated: FBC, ESR, CRP, UEC, blood culture, nasal swab

CXR: Only for those who need admission or severe pneumonia

Question 7

Management of pneumonia

Answer 7

Usually treatable at home with amoxicillin 30mg/kg PO TDS for 3-5 days
If severe: ceftriaxone 50mg/kg IV OD + flucloxacillin 50mg/kg IV 6hrly
If deteriorating despite oral antibiotics, change to IV benpen or broaden antibiotics

Question 8

Indications for admission for pneumonia

Answer 8

<3 months, fever >38.5, refusal to feed, fast breathing, systemic features, failure of previous antibiotics, recurrent pneumonia, severe underlying disorder, hypoxia

Question 9

Tests for cystic fibrosis

Answer 9

Newborn screening: Guthrie (IRT)
Sweat test: elevated chlorine concentration
Genetic testing
CXR: ring shadows, marked peribronchial shadowing, bronchial wall thickening

Question 10

Management of cystic fibrosis

Answer 10

Multidisciplinary: paeds, physio, dietician, specialist nurse, GP, teachers
Review at least annually by specialist
Regular nutritional assessment: high calorie diet, fat soluble with supplements
Chest physio to clear sputum at least twice a day
Physical exercise
Prophylactic antibiotics (flucloxacillin) with rescue antibiotics: persistent symptoms require immediate intense IV therapy for 14 days
Nebulised DNAse/hypertonic saline
Bilateral sequential lung transplant is only option for end-stage

Question 11

Clinical Features of Cystic Fibrosis

Answer 11

Infant: meconium ileus, prolonged jaundice, FTT, recurrent chest infections, malabsorption, steatorrhoea
Child: Bronchiectasis, nasal polyps, sinusitis, rectal prolapse
Older child/adolescent: ABPA, DM, cirrhosis, portal HTN, distal intestinal obstruction, pneumothorax/recurrent hemoptysis, sterility in males

Question 12

Commonest cause of pneumonia in newborns, infants, children >5, school age

Answer 12

Newborn: Group B strep, Gram-ve
Infants: RSV, S pneumoniae, H influenzae, C trachomatis, B pertussis
Children >5: S pneumoniae, H influenzae, S aureus, M catarrhalis, P aeruginosa
School age: M pneumoniae, C pneumoniae

Question 13

OSA assessment and management

Answer 13

Overnight pulse oximetry
Polysomnography
EEG, electrooculogram, submental EMG

Adenotonsillectomy
CPAP/BiPAP

Question 14

TB management paediatrics

Answer 14

Other management same as in GP 
Pharmaco: 
- 2 months on RIP 
- 4 months on RI 
Test all household members

Question 15

How to test for TB in kids

Answer 15

If below 8 years old, cannot get sputum sample so have to do gastric washings on 3 consecutive mornings (NG tube) and do AFB culture

Mantoux test

• if no BCG given, positive if >10 mm
• if BCG given, positive if >15 mm
• positive result enough to initiate mx

if appropriate test urine, LN excision, CSF, X-ray/CT, IgRA