Respiratory

Question 1

What is croup and what is it caused by?

Answer 1

URTI usually in 6-24month children leading to laryngeal oedema.

Predominantly caused by PARAINFLUENZA virus, but could be by:

• influenza virus
• adenovirus
• diptheria (less common due to vaccination)

Question 2

How does croup present?

When would you admit?

Answer 2

Barking cough (comes in episodes - worse at night)
Increased breathing effort
Hoarse voice
Stridor
Low grade fever

Admit if:
< 6 months
Abnormal airway e.g. laryngomalacia, Down’s
Diagnosis is uncertain
Signs of respiratory distress

Question 3

Diagnosis and management of croup

Answer 3

Clinical diagnosis

Usually supportive (fluids, rest, upright when coughing)

Oral dexamethasone (0.15mg/kg - can be repeated after 12h)

If more severe:
- oxygen
- nebulised budenoside/adrenaline
- intubation + ventilation

Question 4

What is epiglottitis?

Answer 4

Inflammation of epiglottis due to infection with Haemophilus influenza type B

Is life-threatening as can lead to complete airway obstruction.

Rare in children now due to vaccination

Question 5

How would epiglottitis present?

Answer 5

RAPID ONSET

Sore throat/painful swallow
Stridor
Drooling
Tripod position (hands on knees, sat forward)
High fever, unwell appearance
Quiet child

Question 6

Investigations and management of epiglottitis?

Potential complication?

Answer 6

Lateral X-Ray of neck - ‘thumb’ sign (swollen epiglottis) - not always needed

Do not examine child - distress can worsen airway obstruction

Immediate senior help (ENT, paediatrician, anaesthetist) - will visualise and intubate if necessary (can use tracheostomy)

IV ceftriaxone

Complication = epiglottic abscess

Question 7

What is whooping cough?
How can it be prevented?

Answer 7

URTI caused by Bordetella pertussis (gram neg)

Whooping = forceful inhalation of air after coughing

Vaccination of child + pregnant mother (16-32 weeks)

Question 8

How does whooping cough present and how is it diagnosed?

Answer 8

Catarrhal phase = coryzal symptoms for 1-2 weeks

Paroxysmal phase:
- Increased cough severity - sudden + recurring attacks at night/after feeding
- Large inspiratory whoop after coughing
- Can go apnoeic and faint
- Lasts 2-8 weeks

Diagnosis:
- nasal swab + PCR
(always suspect in any cough > 2 weeks)

Question 9

Management of whooping cough and complications

Answer 9

Management:
- Notify public health
- Admit if < 6 months
- Oral macrolide within 21 days (erythro-, azithro-, clarithro-)
- Prophylactic Abx to close contacts
- School exclusion (until 48h after commencing abx)

Complications:
- bronchiectasis
- subconjuctival haemorrhages
- seizures