Respiratory

Question 1

What is acute bronchitis?

Answer 1

Acute chest infection - result of inflammation of trachea and major bronchi resulting in sputum production

Question 2

Presentation of acute bronchitis?

Answer 2

Cough,
Sore throat,
Rhinorrhoea,
Wheeze.
Low-grade fever,
wheeze - otherwise normal chest examination

Question 3

How can you differentiate acute bronchitis from pneumonia?

Answer 3

Sputum, wheeze and breathlessness may be absent in acute bronchitis but common in pneumonia.
There are no other focal chest signs in acute bronchitis

Question 4

Investigations for acute bronchitis?

Answer 4

Clinical diagnosis but CRP testing is available to guide antibiotic therapy.

Question 5

Management for acute bronchitis?

Answer 5

Analgesia,
Good fluid intake.
Abx if systemically unwell, pre-existing co-morbidities or CRP > 100. If CRP 20-100 then offer delayed prescription.
Doxycycline first line.

Question 6

Important history points for allergic disorder?

Answer 6

Timing after exposure to allergen.
Previous and subsequent exposure and reaction to allergen.
Symptoms of rash, swelling, breathing difficulty, wheeze and cough.

Question 7

What are different investigations for allergic disorders?

Answer 7

Skin prick testing (sensitisation not allergy)
RAST testing (shows sensitisation not allergy)
Food challenge testing - GOLD STANDARD.

Question 8

What is the management of allergic disorder?

Answer 8

Lifestyle - Avoidance of allergen, Regular hoovering and changing sheets (dust mites), Staying indoors when pollen count high.
Following exposure - antihistamines, steroids or IM adrenalin.

Question 9

What is the management for anaphylaxis?

Answer 9

< 6 months - 100 to 150 mcg.
6 mth - 6 yr - 150mcg.
6-12 years - 300mcg
Adult/ > 12 yr - 500mcg.
Dose can be repeated every 5 mins.

Question 10

Describe features of refractory anaphylaxis

Answer 10

Defined - resp/CV problems despite 2 doses of IM adrenaline.
Give IV fluids for shock and expert help for IV adrealine infusion

Question 11

What is the management following anaphylaxis?

Answer 11

• Non sedating oral antihistamines eg, chlorphenamine.
• Serum tryptase levels taken.
• referal to allergy clinic.
• Risk stratified approach to discharge.

Question 12

What is the risk stratified approach to anaphylaxis discharge?

Answer 12

Discharge after 2hr - good response to adrenaline, complete resolution, supervision following discharge, education on auto-injection.
6hr discharge - 2 doses of IM adrenaline needed or previous biphasic response.
12hr discharge - >2 doses of adrenaline needed, severe asthma, presents late at night, rural area.