Respiratory

Question 1

Differential diagnosis of stridor

Answer 1

Differential diagnosis of stridor:
•	Croup
•	Bacterial tracheitis
•	Epiglottitis
•	Foreign body aspiration
•	Subglottic stenosis (congenital or iatrogenic)
•	Laryngomalacia/trachiomalacia (collapse of airway cartilage on inspiration)
•	Vocal chord palsy

Question 2

Causes of croup

Answer 2

Paraninfluenza virus, metapneumovirus, RSV, andn influenzae

Question 3

Differential for croup

Answer 3

Epiglottitis, Bronchiolitis, Foreign body, bacterial tracheitis, Pertussis

Question 4

Treatment of Croup:

Answer 4

Oral Prednisolone 1mg/kg or Dexamethason. If it doesn’t improve add nebulised adrenaline

Question 5

Organism causing bacterial tracheitis:

Answer 5

Staph Aureus

Question 6

Difference in presentation and management of Croup and bacterial Tracheitis:

Answer 6

Presentation: BT - the child has a high fever, toxic and has a rapidly progressive airways obstruction with copious thick airway secretions.

Management: Antibiotics, Intubation and ventilation if required

Question 7

Cause of epiglottitis

Answer 7

H. influenzae

Question 8

Clinical features of Epiglottitis:

Answer 8

High fever, toxic child, 4D’s: drooling, dysphagia, dysphonia and distress

Question 9

Management of Epiglottitis:

Answer 9

Don’t distress the child and call ambulance.

Child should be inubated (possible tracheostomy), once airway is secure - BC and start on cefuroxime

Question 10

Prophylactic management of epiglottitis?

Answer 10

• Other children in the house could be treated with prophylaxis Rifampicin.

Question 11

Treatment of GAS pharyngitis and Tonsillitis?

Answer 11

Phenoxymethylpenicilin with panadol

Question 12

Treatment of Peritonsillar abscess:

Answer 12

IV Benzylpenicillin and IV Metronidazole

Question 13

Ipslateral ear pain, Dysphagia/odonophagia, Drooling, trismus and high fever

Answer 13

Peritonsillar Abscess

Question 14

Sore throat, no coryzal symptoms, sudden onset, Abdominal pain/vomitting,

Answer 14

GAS pharyngitis

Question 15

Dysphagia/odonophagia, Drooling, Neck rigidity and tenderness, high fever

Answer 15

Retropharyngeal abscess

Question 16

What age group affected by retropharyngeal abscess

Answer 16

2-4 years

Question 17

Age group affected by Epiglottitis

Answer 17

1-6yr unvaccinated

Question 18

Age group affected by Croup?

Answer 18

6mo-3yr

Question 19

Signs of increased work of breathing

Answer 19

Nasal flaring
Paradoxical breathing
Abdominal breathing
Tachypnea
Pursued lips
Sternal recession
Tracheal tug
Head bobbing
Grunting

Question 20

What is subglottic stenosis

Answer 20

Narrowing of the upper trachea immediately below the glottis

Question 21

Cause of Subglottic stenosis?

Answer 21

Often from trauma of premature infants who require intubation

Question 22

When and how does subglottic stenosis present?

Answer 22

During times of infection - if severe can have an expiraory component with stridor and sternal recessions.
Generally Improve on their own

Question 23

What is the most common cause of PERSISTENT stridor

Answer 23

laryngomalacia. Will last 2-3 years but should improve on it’s own

Question 24

What is laryngomalacia?

Answer 24

Subglottic tissue appears as if they are too large and hence narrows the glottis aperture during inspiration

Question 25

Cog wheel stridor, Worse when lying supine or crying, persistent occurring in a 2-3 year old since birth

Answer 25

Laryngomalacia

Question 26

Cough, fever in an infant for about 2 weeks?

Answer 26

Bronchitis

Question 27

What is the catarrhal (prodromal) phase of whooping cough?

Answer 27

Phase 1: 1 week of coryzal symptoms

Question 28

What is the paroxysmal phase of whooping cough?

Answer 28

Phase 2: There is a paroxysmal cough for 3 to 6 wks with spasmodic coughing (sticato – not wet) causing vomiting, cyanosis, epistasis and subconjunctival haemorrhage. With a whoop to get some air

Question 29

What is the covalescent phase of whooping cough?

Answer 29

Resolution of symptoms - may take months

Question 30

Complications of whooping cough

Answer 30

Pneumonia, Febrile convulsions, encephalopath

Question 31

Investigations for whooping cough

Answer 31

NPA swab, marked lymphocytosis on blood film and Serology (IgA Pertussis)

Question 32

Management of whooping cough?

Answer 32

• Report
• Neonates - azithromycin oral daily for 5 days
• Children who cannot swallow tablets Clarithromycin liquid 7.5mg/kg/dose (max 500mg) oral BD 7/52
• Children who can swallow azithromycin (for children = 6months old); 10mg/kg (max 500mg) on day 1, then 5mg/kg (max 250mg) daily for 4 days

Question 33

What is the infectious period of whooping cough?

Question 34

Who gets prophylactic treatment of whooping cough?

Answer 34

Confirmed contact

AND first contact was within 14 days (or within 21 days for infant

Question 35

Age group affected by Bronchiolitis?

Answer 35

1-9mo. rare after 1yr

Question 36

Causes of Bronchiolitis?

Answer 36

RSV, Parainfluenzae, adenovirus, mycoplasma, metapneumovirus. Combination in 10-30%

Question 37

Presentation of Bronchiolitis:

Answer 37

Coryzal symptoms first 2 days. Day 3 worst.
Increased WOB, Hyperinflation of the chest, Fine inspiratory crackles, Apnea and cyanosis, High-pitched wheeze - expiratory more than inspiratory

Question 38

Management of bronchiolitis:

Answer 38

O2 (HFNP or LFNP), NG tube? Admission? supportive therapy? ventilation?

Question 39

Monoclonal antibody to RSV?

Answer 39

A monoclonal antibody to RSV reduces the number of hospital admissions in high-risk preterms

Question 40

Causes of childhood wheeze?

Answer 40

Transient early wheezing
Atopic asthma (IgE mediated)
Non-Atopic asthma (exercise and cold)
Inhaled foreign body
Cystic fibrosis
Recurrent anaphylaxis in a child with food allergies
Congenital abnormality of lung - CLD
Bronchiolitis