Respiratory

Question 1

Congenital laryngeal stridor; presentation and management.

Answer 1

Progressive stridor during crying/supine. Doesn’t interfere with feeding.

Mx with reassurance or ENT referral if necessary.

Question 2

Examples of URTI.

Answer 2

-common cold
-sore throat (include pharyngitis, tonsillitis)
- acute otitis media
-sinusitis (rare)

Question 3

Complications of URTI.

Answer 3

Difficulty feeding, acute exacerbations of asthma and febrile convulsions.

Question 4

Pharyngitis; aetio.

Answer 4

Viral usually = adenovirus, enterovirus, rhinovirus, EBV, corona

Older kids = Streptococcus pyogenes

Question 5

Tonsillitis; definition, aetio, management

Answer 5

-Inflammation of the tonsils with purulent exudate.
- Group A beta-hemo Streptococci and EBV
-Penicillin 6hr for 10d (macrolides is allergic), salt water gargling, paracetamol etc

*avoid amoxicillin; maculopapular rash if due to EBV

Question 6

Infectious mononucleosis; presentation, Ix.

Answer 6

• fever, malaise, generalised lymphadenopathy, sore throat, palatal petechia. Splenomegaly 50%, hepatomegaly 10%
  -Monospot test (Abs for EBV), FBC (atypical lymphos)

Question 7

Indications for tonsillectomy.

Answer 7

-recurrent tonsillitis (>3/yr)
-peritonsillar abscess (quinsy)
-obstructive sleep apnoea

Question 8

Indications for adenoidectomy.

Answer 8

-recurrent otitis media (>4/yr)with effusions and hearing loss.
-obstructive sleep apnoea

Question 9

Acute otitis media.

Answer 9

-6 to 12m commonly due to short and horizontal Eustachian tubes (m/o from throat)
-bulging and loss of light reflex on otoscopy
-Causes are RSV, rhinovirus, pneumococcus, H.influenza, Moraxella catarrhalis
-Mx is analgesia, Abx
-Complications = glue ear, chronic otitis media, meningitis and mastoiditis

Question 10

Viral croup; aetio, epi, CF.

Answer 10

-Parainfluenza and other viruses (RSV, metapneumovirus…)
-6m to 6yrs but peak at 2yrs
-Barking cough and harsh stridor preceded by cough and fever. Worse at night.

Question 11

Viral croup; management.

Answer 11

Admission of moderate/severe croup (+other cases)

1. One time PO dexamethasone 0.15mg/kg. Prednisolone if unavailable.
2. Other Mx= nebulised adrenaline, oxygen supplementation, Abx if underlying bacterial infection present.

Question 12

Pseudomembranous croup (Bacteral tracheitis)

Answer 12

-Similar to croup + high fever, progressive airway obstruction, toxic
- Aetio = S. aureus, S. pneumoniae, S. pyogenes, M. catarrhalis etc (follows viral infection)
-Males>females 5-7yrs.
-Mx = IV ABx and ventilation

Question 13

Acute epiglottis; aetio, epi and CF.

Answer 13

• Life threatening infection by H.influenza (immunisation available w/ Hib)
  -1-6yrs but can affect all ages
  -Very acute onset of high fever, drooling, soft insp. stridor, tripod position.

Question 14

Acute epiglottis; management.

Answer 14

-Do NOT examine throat and get senior paeds, ENT and anesthetist.
- Mask O2, admit to ICU until intubation (urgent tracheostomy if needed). Tube may be removed after 24hrs.
-Abx = IV cefotaxime 3-5d
-Prophylaxis with rifampicin in the household.

Question 15

Causes of acute stridor.

Answer 15

Croup (commonly)

Epiglottitis, bacterial tracheitis, foreign body, allergic laryngeal angioedema, smoke inhalation, trauma, hypocalcaemia, retropharyngeal abscess, measles, diphtheria …

Question 16

Mechanism of asthma.

Answer 16

Hyper-responsiveness of the airways to stimuli leading to reversible narrowing of the airways.

Bronchial inflammation leads to increased mucous production, infiltration of cells and bronchial smooth muscle constriction.

Question 17

DDX of severe asthma vs life threatening asthma

Answer 17

Severe = severe breathlessness, accessory muscles to breath, peak flow <50%, type 1 resp. failure with respiratory alkalosis on ABG.

Life-threatening = silent chest and cyanosis, poor respiratory effort, peak flow <33%, SatO2 ,92%, type 2 resp. failure with respiratory acidosis.

Question 18

Complications of asthma

Answer 18

Medical acute = respiratory distress, pneumothorax
Medical long term = growth failure, S/E of medications
Social = medication cost, psychological…

Question 19

S/E of common asthma drugs; salbutamol, aminophylline, MgSO4

Answer 19

Salbutamol = tremors, hypokalaemia
Aminophylline = seizures, SVT, tachycardia
MgSO4= hypotension, urinary retention, respiratory depression, neurological depression

Question 20

Dosages of drugs in emergency Mx of asthma.

Answer 20

Salbutamol = 2.5mg/kg if <2yrs or 5mg/kg
Prednisolone = 1-2mg/kg PO
IV hydrocortisone = 4mg/kg
IV MgSO4= 50mg/kg
Aminophylline= 10mg/kg bolus followed by 5mg/kg infusion

Question 21

Inhalers types (2)

Answer 21

Blue inhalers = relievers - salbutamol and ipatropium bromide

Purple inhalers = Flusal (Salmeterol + fluticazone)

Question 22

Bronchiolitis; epi, aetio and pathophysiology.

Answer 22

Common serious infection up to 1yr. Rare later but can occur until 2yrs.

Aetio= RSV (80%), others (metapneumovirus, parainfluenza, rhinovirus, M. pneumoniae etc)

Patho= bronchiolar obstruction with oedema, mucous and cellular debris

Question 23

Bronchiolitis; CF

Answer 23

Precedes with coryzal symptoms
Sharp dry cough
Tachypnoea
Subcostal and intercostal recessions
Hyperinflation of the chest
Fine-end inspiratory crackles
High pitched ex. wheeze
Cyanosis/pallour
Apnoea

Question 24

Risk factors for bronchiolitis

Answer 24

Prematurity that leads to bronchopulmonary dysplasia
Underlying lung diseases such CF
Congenital heart disease
Preterm

Question 25

X-ray changes in bronchiolitis

Answer 25

Hyper-luscent blackish lung fields
Horizontal ribs
Flat diaphragm
Hyperinflated chest

Question 26

Indications for hospital admission in bronchiolitis

Answer 26

Apnoea
Persistent SatO2 <90%
inadequate oral fluid intake
severe respiratory distress

Question 27

Management of bronchiolitis

Answer 27

Supportive;
-humidified O2, fluids, monitoring, ABx, hypertonic saline nebulisation, IVIG

Prevention = palivizumab monthly injections for babies at risk

Question 28

BCG vacine facts

Answer 28

Given on the left deltoid before the child is discharged from hospital. the scar should be present by 6m; if not revaccination up to 5 years.

Prematurity and low birth weight are NOT CI for vaccination.