Respiratory

Question 1

What are the signs of increased respiratory effort in children?

Answer 1

Childs position and use of accessory muscles
Recession - IC and SC
Nasal Flaring and Grunting 
Head bobbing
Increased RR

Question 2

Describe some of the signs of respiratory inadequacy in children

Answer 2

Increased HR
Change in skin colour
Decreased mental state

Question 3

Describe normal respiratory rates in children of different ages.

Answer 3

Infant 30-40
1-5 years - 25-30
5-12 years - 20-25
>12 years - 15-20

Question 4

Describe some of the core clinical features of cystic fibrosis

Answer 4

Persistant, loose cough, productive of purulent sputum with chronic chest infections
Failure to thrive - due to pancreatic ducts being blocked leading to pancreatic enzyme deficiency and malabsorption

Question 5

How do the majority children with CF present in this country?

Answer 5

Majority are picked up as newborns from the heel-prick Guthrie test screen

Question 6

Describe how newborns with CF may present with meconium ileus.

Answer 6

10-20% present with meconium ileus - causing intestinal obstruction - vomiting, abdo distension and failure to pass meconium within first few days of life. Most require surgery.

Question 7

Describe the two patterns of wheeze seen in young children.

Answer 7

TRANSIENT - episodic wheeze associated with common cold, usually resolves by age 5
PERSISTANT AND RECURRENT - Frequent wheeze, triggered by many stimuli, lasts beyond pre-school years. If evidence of allergy = atopic asthma.

Question 8

What are the core features of Asthma?

Answer 8

Wheeze, cough, beathlessness, tight chest.
Diurnal Variation (worse at night and early morning), e.g. nocturnal cough
Symptoms have triggers e.g. dogs, cigarrette smoke, pollen, dust
Interval symptoms - symptoms between acute exacerbations
Personal or family Hx of Atopy
Positive response to asthma therapy (reversible)

Question 9

What clinical signs would indicate a child was in a severe acute asthma attack?

Answer 9

SpO2

Question 10

What signs indicate a child is becoming exhausted - LIFE THREATENING?

Answer 10

Hypotension
Confusion/Coma
Silent Chest
Cyanosis
Decreased Respiratory Effort

Question 11

How might a child with a pneumonia present?

Answer 11

Fever & Difficulty Breathing
+/- cough, lethargy, poor feeding
Localised chest, neck or abdo pain is a sign of pleural irritation and suggests bacterial infection
Usually preceded by an URTI

Question 12

What are the common organisms causing pneumonia in the different age groups?

Answer 12

Newborn - organisms from mums genital tract, particularly GBS
Infants and Pre-School - viruses e.g. RSV Bacterial e.g. Strep Pneumoniae and Hib
>5 yrs - Strep pneumoniae, mycoplasma pneumoniae

Question 13

What might be the clinical signs on examination in a child with pneumonia?

Answer 13

Increased RR, increased rep effort. Fever. Decreased O2 sats. May be end inspiratory crackles over affected area - however classic signs of consolidation are often absent in young children

Question 14

What is Croup? And what is another name for it?

Answer 14

Viral URTI

Layngotracheobronchitis

Question 15

What is the peak incidence of croup?

Answer 15

Can occur from 6 months to 6 years of age, but peak incidence is in the second year of life

Question 16

What pathogen causes Croup?

Answer 16

Viral - usually parainfluenza virus

Question 17

What are the core clinical features of Croup?

Answer 17

Barking cough, harsh stridor, hoarse voice.

Usually preceded by fever and coryzal symptoms

Question 18

Describe the pathophysiology of Croup?

Answer 18

Symptoms are caused by mucosal inflammation and increased secretions affecting the airway.
Can get oedema of the sub-glottic area which is potentially dangerous as it may result in critical narrowing of the trachea.

Question 19

Briefly outline the management of Croup

Answer 19

Mild - managed at home
Moderate - Severe - inpatient, inhaled or oral steroids, nebulised adrenaline, very few need intubation due to inhaled steroid use.

Question 20

What is Bronchiolitis?

Answer 20

It is a viral LRTI

Question 21

What age is the peak incidence of Bronchiolitis?

Answer 21

90% are aged 1-9 months

rarely affects infants > 1 year

Question 22

What is the commonest viral pathogen causing Bronchiolitis? What other viruses can be responsible?

Answer 22

RSV in 80% of cases.

Others include- human metapneumovirus, parainfluenza, rhinovirus, adenovirus, influenza

Question 23

What are the clinical features of bronchiolitis?

Answer 23

Coryzal Symptoms followed by dry cough and increasing breathlessness
Feeding difficulty due to dyspnoea
Recurrent apnoea is a serious complication

Question 24

What would you hear on the chest of an infant with bronchiolitis?

Answer 24

Widespread fine inspiratory crepitations

Question 25

What is the management of bronchiolitis?

Answer 25

SUPPORTIVE Have a low threshold for admitting infants, for supportive oxygen, feeding and fluids. Infection control methods are vital as it is highly infectious.

Question 26

What is the prognosis of Bronchiolitis?

Answer 26

Most infants recover from the acute infection in 2 week As many as half will have recurrent episodes of cough and wheeze Rarely usually following adenovirus infection the illness may result in permanent damage to the airways - bronchiolitis obliterans.

Question 27

What can be given to high risk infants to prevent them from developing bronchiolitis?

Answer 27

Monthly IM injection of monoclonal antibody palivizumab.

Question 28

What is the biggest cause of anaphylaxis in children?

Answer 28

Food allergy (85%)

Question 29

Describe some of the presenting features of anaphylaxis

Answer 29

Itching, Sweating D&V, erythema, urticaria, oedema of larynx, lids, tongue, lips Leading to wheeze, laryngeal obstruction, cyanosis Leading to tachycardia and hypotension

Question 30

What type of hypersensitivity reaction is anaphylaxis?

Answer 30

``` Type 1 (IgE mediated) IgE binds to mast cells causing systemic release of histamine ```

Question 31

What three drugs are given to treat anaphylaxis?

Answer 31

ADRENALINE | + antihistamines and steroids

Question 32

What symptoms might a child show if they were in heart failure?

Answer 32

``` BABIES Breathlessness - particularly on feeding(does baby change colour during feeds) Poor feeding,weight faltering CHILDREN Breathlessnes on exertion - decreased activity levels or lying down Cold peripheries Cyanosis of facial oedema Recurrent chest infections ```

Question 33

How might we classify the causes of heart failure in children?

Answer 33

CONGENITAL i.e. something structurally wrong with the heart, presents before 6 months of age ACQUIRED Can be from any acquired cause of heart dysfunction or structural abnormality, can present at any age

Question 34

What investigations are done in a baby who has suspected bronchiolitis?

Answer 34

Nasopharyngeal Aspirate for Virology CXR not routinely indicated Measure O2 sats, can do blood gas if severe