Respiratory

Question 1

Protracted bacterial bronchitis

Answer 1

1. prolonged moist of productive cough >4 weeks

2. response to antibiotics

Question 2

most common pathogens for PTT

Answer 2

H. influenzae, S.pneumonia, M Cattarhalis

Question 3

of acute stridor ddx

Answer 3

1. laryngotracheobronchitis
2. bacterial tracheitis
3. epiglottitis (Hib)
4. peritonsillar abscess
5. retropharyngeal abscess
6. foreign body
7. anaphylaxis
8. tonsillar web (Ciptheria)

Question 4

of acute wheeze ddx

Answer 4

1. Asthma
2. viral wheeze
3. foreign body
4. persistent bacterial bronchitis
5. anaphylaxis

Question 5

treatment for PBB

Answer 5

2-6 week course amoxycillin/clavulanic acid 20mg/kg BD

Question 6

Wet/productive cough ddx

Answer 6

1. PBB
2. chronic suppurative lung disease -> bronchiectasis
3. acute viral (start wet but assoc with coryzal sx)

Question 7

Chronic dry cough ddx

Answer 7

1. asthma (interval symptoms)
2. psychogenic cough (distractable and goes away at night)
3. post infectious (well and no hx of cough previously) mycoplasma pneumoniae/bordatella pertussis/ chlamydia pneumoniae

Question 8

what is the mean cough duration in children?

Answer 8

Acute respiratory infection : 10 days, max 25 days
beyond a month is not normal with the exceptions being
mycoplasma pneumoniae/bordatella pertussis/ chlamydia pneumoniae

Question 9

in young children the average number of viruses (symptomatic and asymptomatic)

Answer 9

12-14 per year, evolves from wet to dry and slowly improves (waxing and waning symptoms) intercurrent viruses

Question 10

causes of VQ mismatch

Answer 10

Asthma - vasodilation + bronchoconstriction (increased flow and decreased ventilation)

Question 11

what is VQ mismatch

Answer 11

A V/Q mismatch happens when part of your lung receives oxygen without blood flow or blood flow without oxygen.

Question 12

SABA
LABA
LAMA
ICS
LRTA
Tiotropium
anti IgE
IL-5 inhib

Answer 12

1. SABA: Salbutamol
2. +2 ICS: Flixotide jr (50microg per dose)
3. LABA: Seretide/symbicort/efemeterol or increase dose of 2 (long lipophillic side that binds the continuous binding and unbinding to the beta 2 adrenoreceptor) *increases pro inflammatory
4. LAMA: long acting muscarinic cholinergic/ ipatropium
   LTRA: montelukast (singulair)
5. Anti-IL5 epilixumab
   IL-4R (dutilimumab)
6. Anti IgE - omilizumab (SC injection)
7. phenotyping: eosinophillic or IgE

kids over 12: PRN symbicort as reliever (ICS - formeterol)

Question 13

warning about montelukast?

Answer 13

suicidal thoughts

Question 14

what is disodium chromoglycate?

Answer 14

mast cell stabiliser

Question 15

what is the strongerst ICS?

Answer 15

fluticasone is double the strenth of budesenide

Question 16

how much does each deliver?

Answer 16

neb: 15%
pMDI with spacer: 44%
pMDI alone: 15%

Question 17

what is vocal cord dysfunction?

Answer 17

in exercise: exercise induced laryngeal obstruction

• paradoxical vocal cord movement (during inspiration vocal cords should open) can visualised the opposite happening)
• causes stridor and dyspnoea on brea thing in
  triggers: lung irritants/cold/virus/gord
  treatment: speech therapy and deep breathing