Respiratory

Question 1

How many peak flow measurements should be taken?

Answer 1

three, take average reading

Question 2

What are peak flow results dependent on?

Answer 2

height

Question 3

Child is snoring at night. What study can be conducted?

Answer 3

home oximetry study

Question 4

Name an important aspect of a history of someone with wheeze and cough?

Answer 4

sleep quality

Question 5

What specific question should be asked about wheeze?

Answer 5

where can you hear the wheeze? in chest then likely asthma, if in mouth then something else

Question 6

six month baby, five day hx of cough and coryzal symptoms. Wheeze and crackles. Nappies are normal. What is the most appropriate initial management?

Answer 6

reassure and discharge home with worsening advice. Self-limiting + encouraging observations (feeding, normal nappy)

Question 7

At what age can you diagnose a child with asthma?

Answer 7

Not until >5 due to compliance with peak flow and spirometry

Question 8

What diagnosis is wheeze + cough associated with in children <2 years old?

Answer 8

bronciolitis

Question 9

What diagnosis is wheeze + cough associated with in older children >2?

Answer 9

viral induced wheeze

Question 10

What is the difference between bronchiolitis and viral induced wheeze?

Answer 10

While bronchiolitis is wet lungs, viral wheeze is bronchospasm. Plus difference in age of child

Question 11

Why doesn’t bronchiolitis respond to salbutamol?

Answer 11

babies don’t develop B2 receptors until a later stage

Question 12

4 year old, barking cough and stridor, given adrenaline. Temp is still 38.2. What is the diagnosis and next step in management?

Answer 12

Croup, oral steroids.

Question 13

Should you examine the throat of a child with croup?

Answer 13

Never examine throat of patient with child, or blood tests, don’t do anything the child will be distressed by, crying will make it worse, therefore clinical diagnosis.

Question 14

2 hours after c section, term baby develops tachyopnoea. Mother had uncomplicated pregnancy, no infection, amniotic fluid clear. What is the likely diagnosis?

Answer 14

transient tachyopnoea of the newborn
TTN

Question 15

Why does transient tachyopnoea of the newborn (TTN) happen?

Answer 15

TTN due to residual fluid in lungs. C section without mechanical push leaves residual fluid, this resolves within hours.

Question 16

What is the difference between TTN and respiratory distress?

Answer 16

Respiratory distress in preterm neonates due to poor development of lungs and is more serious and requires medical input. TTN is transient and resolves spontaneously.

Question 17

Questions to ask in history about a cough

Answer 17

duration, worse during day or night, exercise, triggers, wheeze/bark

Question 18

What are the components of the 6-in-1 vaccine?

Answer 18

diptheria, tetanus, pertussis, polio, Hib disease

Question 19

Harrison sulcus is a sign of which condition?

Answer 19

Chronic asthma
=indentation of chest around 6th rib

Question 20

Nasal polyps is a sign in which respiratory condition?

Answer 20

cystic fibrosis

Question 21

Name three factors which influence lung function

Answer 21

Height
Sex
Age
Ethnicity

Question 22

What is the main virus that causes bronchiolitis?

Answer 22

RSV

Question 23

Three signs of respiratory distress?

Answer 23

raised RR
accessory muscles
nasal flaring
head bobbing
cyanosis
abnormal airway noises

Question 24

List three abnormal airway noises

Answer 24

wheezing
grunting
stridor

Question 25

What is the time course of RSV infection?

Answer 25

Coryzal symptoms Chest symptoms day 1-2 Worst on day 3/4 Symptoms last 7-10 days in total and most recover fully within 2-3 weeks

Question 26

Name a drug given in the prevention of bronchiolitis?

Answer 26

Palivizumab

Question 27

Why is it important to feel for liver edge in respiratory exam in child?

Answer 27

may be pushed down by hyper expanded lungs

Question 28

Three differentials for acute cough

Answer 28

URTI Croup Bronchiolitis Pneumonia Pertussis Inhaled foreign body

Question 29

Two differentials for chronic cough in child

Answer 29

asthma infection- TB GORD Cystic fibrosis Kartagener syndrome

Question 30

Two differentials for acute stridor

Answer 30

Inhaled foreign body Croup Epiglottitis

Question 31

Which organism typically causes croup

Answer 31

parainfluenza

Question 32

How is cough described in croup?

Answer 32

barking

Question 33

Briefly describe the pathophysiology of cystic fibrosis

Answer 33

disorder of exocrine gland function wherein mutations in CFTR causes thickened secretions which accumulate in the lunga

Question 34

Which organs are affected in cystic fibrosis?

Answer 34

pancreas lungs reproductive tract

Question 35

Three features of cystic fibrosis?

Answer 35

respiratory poor growth pancreatic insufficiency anaemia of chronic disease

Question 36

What screening is involved in cystic fibrosis?

Answer 36

Neonatal blood spoot- immunoreactive trypsin levels (newborn screening) sweat test genetic test

Question 37

What is the mode of inheritance of cystic fibrosis?

Answer 37

autosomal recessive

Question 38

both parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?

Answer 38

We know the child doesn’t have the condition, so the answer is two in three.

Question 39

What is the first sign of cystic fibrosis in newborn?

Answer 39

meconium ileus

Question 40

Three signs of cystic fibrosis?

Answer 40

low weight growth charts nasal polyps finger clubbing abdominal distention crackles and wheeze

Question 41

Name two common colonisers in cystic fibrosis

Answer 41

staph aureus pseudomonas

Question 42

Three causes of finger clubbing in children?

Answer 42

cyanotic heart disease cystic fibrosis TB IBD Liver cirrhosis Infective endocarditis

Question 43

List three differences between the presentation of a pneumonia and URTI

Answer 43

URTI- runny nose, sore throat, sneeze, ear pain. Clear sounds upon auscultation!!! Pneumonia- Cyanosis, tachyopnoea, abnormal breath sounds, general body malaise

Question 44

Cystic fibrosis can cause which condition in children?

Answer 44

Diabetes! Cystic fibrosis presents in childhood with respiratory symptoms, but as the disease progresses, further features begin to develop. If the pancreas becomes affected, then diabetes mellitus can develop. It can take time for the pancreas to be affected enough to cause diabetes, which is why children with cystic fibrosis may develop diabetes later in life.

Question 45

State two severity markers for croup deterioration?

Answer 45

Sternal/intercostal recession, asynchronous chest wall and abdominal movement. Fatigue, pallor or cyanosis, decreased level of consciousness or tachycardia. The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires. A respiratory rate of over 70 breaths/minute is also indicative of severe respiratory distress.

Question 46

After dexamethasone, which treatment should you offer if child continues to deteriorate with croup?

Answer 46

nebulised adrenaline