Respiratory

Question 1

Management of asthma in children aged 5 to 11?

Answer 1

First step - Twice daily ICS and SABA.
Second step - New guidelines say low dose MART + SABA as needed. Old guidelines say add LTRA.
Third step - New guidelines say moderate dose MART + SABA. Old guidelines say switch to low dose ICS/LABA combination inhaler, if still not working then moderate ICS

Question 2

Management of asthma in children under age 5

Answer 2

8-12 week trial of twice daily paeds low dose ICS and SABA as required.

Question 3

What is primary ciliary dyskinesia

Answer 3

Also known as Kartagener’s syndrome.
Autosomal recessive condition affecting cillia, mostly around respiratory tract but can also affect cilia in fallopian tube.

Question 4

Presentation, investigations and management of primary ciliary dyskinesia?

Answer 4

Presentation: Triad of paranasal sinusitits, bronchiectasis and situs inversus (all internal organs mirrored)
Ix: Bronchoscopy or nasal brushing to examine ciliated epithelium.
Rx: Similar to CF/bronchiectasis with daily physio, high calorie diet and antibiotics

Question 5

What is laryngomalacia, its presentation and management?

Answer 5

Supragottic larynx is softer and has less tone than normal causing it to flop over the airway. Results in intermittent inspiratory stridor which is more prominent when feeding, upset, lying on back.
Usually child grows out of condition but sometimes tacheostomy may be required.

Question 6

Features of chronic lung disease of prematuritiy?

Answer 6

Bronchopulmonary dysplasia - occurs in babies born before 28 wks gestation.
Presents with low O2 sats, increased work of breathing, poor feeding/weight gain, crackles/wheeze.
Prevention - antenatal steroids, using CPAP instead of intubation in neonate, using caffine in neonate to stimulate resp effort and not over oxygenating.
Formal sleep study may be needed to assess sleep overnight.

Question 7

Causes of clubbing in children?

Answer 7

Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculosis
Inflammatory bowel disease
Liver cirrhosis

Question 8

What organisms are commonly found in patients with cystic fibrosis?

Answer 8

Straph aureus - patients take long term prophylactic fluclox.
Pseudomonas aeruginosa - very problematic and often needs nebulised antibiotics eg, tobramycin.
Haemophilus influenza.
E.coli,
Burkhodheria cepacia