Respiratory

Question 1

What are the DDx of acute stridor?

Answer 1

Infective: croup, acute epiglottitis, tracheitis, retropharyngeal abscess, (LN (TB or EBV), measles, diphtheria)
Non-infective: FB, allergy, smoke inhalation, (hypoCa, trauma to throat, vasculitis, thyroiditis)

Question 2

What to do first with a child presenting with SOB?

Answer 2

Assess child: need for resuscitation, reduced LOC, cyanosis, respiratory distress
Hx from parents: inspiratory or expiratory, recent coryzal sypmtoms

Question 3

How to diagnose acute epiglottitis?

Answer 3

Clinical dx

• Hyperacute onset
• High fever, toxic looking
• Painful throat: drooling, tripod position, x speak in full sentences
• Soft inspiratory stridor, minimal/no cough

Question 4

How to manage acute epiglottitis?

Answer 4

Immediate:

• Urgent admission, x do anything except pulse oximetry
• ABC: intubation under GA, O2, IVF

IV cefuroxime x 3-5d
Ix: CBC, LRFT, blood culture & sensitivity, ABG
Monitor vitals, SpO2, urine output
PPx: rifampicin for close contacts, Hib vaccine

Question 5

What is the cause of acute epiglottitis?

Answer 5

Hib, (staph, strep)

Question 6

How to diagnose croup?

Answer 6

Triad of stridor, hoarseness of voice, barking cough
Subacute onset
Lower fever, less toxic looking, preceding coryzal symptoms

Question 7

How to differentiate croup and epiglottitis by imaging?

Answer 7

Croup: frontal XR -> steeple sx
Epiglottitis: lateral XR -> thumbprint sx

Question 8

How to manage croup?

Answer 8

ABC
Ix: CBC, LRFT, NPA for PCR, immunofluorescence
Corticosteroids (oral prednisolone or IV/IM dexamethasone)
Severe: nebulized EP w/ O2 by facemask

Question 9

What are the DDx of chronic stridor?

Answer 9

Laryngomalacia

Structural problems e.g. laryngeal cleft, hemangioma

Question 10

How to Ix chronic stridor?

Answer 10

USG throat
CT/MRI thorax
Laryngoscopy

Question 11

How to manage laryngomalacia?

Answer 11

Mild to moderate: monitor wt gain (high calorie formula), tx reflux (acid suppression, swallowing therapy)
Severe: refer, tracheostomy, surgery (remove redundant supraglottic tissue)

Question 12

How to monitor laryngomalacia?

Answer 12

FTT b/c feeding difficulties & GERD

• Clinical: ht & wt
• Biochemical: electrolyte disturbance

Question 13

Tell me more about hemophilus influenzae

Answer 13

GN coccobacilli
6 encapsulated types: A-F
Causes epiglottitis, OM, pneumonia, sinusitis
Vaccine is available but x universal -> useful for preventing second episode

Question 14

What are the DDx of pleural effusion?

Answer 14

Transudative (low pr): heart (HF), liver (cirrhosis, hypoalbuminemia), renal (nephrotic, PD)
Exudative (high pr): mal, inf (TB, pneumonia), trauma, respi (pulmonary infarct, PE)

Question 15

How to Ix pleural effusion?

Answer 15

CBC, U&E, LRFT, CXR

Pleural fluid aspiration, culture, cytology

Question 16

What is Light’s criteria?

Answer 16

Differentiate transudative & exudative pleural effusion

• pleural to serum LDH >0.6
• pleural to serum pr >0.5
• pleural LDH: >2/3 ULN of serum

Question 17

How to manage pleural effusion?

Answer 17

Stabilize vitals, correct electrolyte disturbance
Therapeutic chest aspiration
Empirical ABX

Question 18

How to interpret culture results of pleural aspiration?

Answer 18

Positive: 35% prevalence in children
Negative: TB (difficult to grow), non-inf (AI, mal)

Question 19

What are the DDx of wheeze?

Answer 19

Respi: asthma, bronchiolitis, FB, aspiration, pneumonia
HF
GERD

Question 20

What are the DDx of prolonged cough?

Answer 20

Dry cough: asthma, GERD, HF, post nasal drip, post viral cough, habit cough
Wet cough: recurrent inf, post specific respi inf (pertussis, RSV, mycoplasma), bronchiectasis, TB, FB, immunodeficiency

Question 21

What is the cause of croup!

Answer 21

Parainfluenza