Respiratory

Question 1

What are the signs of resp distress in infants?

Answer 1

Head bobbing 
Nasal flaring 
Poor feeding 
Tracheal tug
Abdmoninal breathing
Recession

Question 2

What are the sounds of resp distress in children?

Answer 2

Wheeze 
Strider
Stertor 
"Ruttles" noisy breathing
Grunting 
(Silent chest!)

Question 3

Normal Resp rates in children?

Answer 3

<1 years 30-40
1-2 years 25-35
2-5 years 25-30
5-12 years 20-25
>12 years 15-20

Question 4

What causes bronchiolitis?

Answer 4

RSV

Rx- nasal saline, o2, fluid, atrovent/ adrenaline, vent support

Question 5

What are the causes of stridor?

Answer 5

Acute -
Croup (parainfluenza)
Epiglottitis (serious)
Foreign body

Chronic-
Laryngomalacia (common cause of inspiratory stridor- worse when crying or feeding. Self limiting and improves with age)
Vocal cord dysfunction (weak cry, biphasic stridor, worse if bilateral)

Question 6

What are the wheeze phenotypes and what age group do they effect?

Answer 6

Transient early wheeze - 0-3
Non-atopic wheeze - 3-6
IgE associated wheeze >3

Question 7

What’s the most common pathogen in acute epiglottis??

Answer 7

Haemophilus influenza type B

Drooling is a key feature

Question 8

Child with cough and right upper love collapse?

Answer 8

Strep pneumonia

Question 9

After anaphylaxis to a&e, What would you discharge a child with?

Answer 9

Epipen / subcut adrenaline

Question 10

What is laryngomalacia?

Answer 10

Softened larynx/epiglottis - occurs about 6m after birth, causes chronic strider when child is excited or crying.

See a “omega” shape on laryngoscopy.

Self corrects as muscles strengthen, but could have surgery to the “aryepiglottic folds”

Question 11

What are the proteins found of the influzena virus surface?

Answer 11

Haemagglutinin and neuramidase

Question 12

Most common cause of common cold?

Answer 12

Rhinoviruses

Question 13

Most common cause of sore throat?

Answer 13

Group A B-haemolytic strep

Question 14

What is seen on examination in otitis media?

Answer 14

Loss of light reflex, bulging eardrum, ?perforation w/ purulent discharge

Question 15

What causes croup?

Answer 15

Parainfluenza virus

Question 16

What causes bronchiolitis?

Answer 16

RSV

Question 17

How do you manage croup?

Answer 17

Oral dexamethosone (regardless of severity)

Severe: high flow o2 and nebuliser adrenaline

Question 18

How does diphtheria present?

Answer 18

Affect mucous membranes of nose and throat. Get a thick grey material depositing on back of throat.
Sore throat, fever, LNs and resp distress.

Question 19

How to manage expected epiglottis?

Answer 19

Do not lay down, or examine throats with spatula (causes total airway obstruction!)

Need anaesthetist to secure an airway (then bloods etc can be taken) and Iv ABX (cephalosporin eg cefuroxime.)

Question 20

For LRTIs what features in investigations suggest a bacterial cause?

Answer 20

Lobar consolidation
Pleural effusion
Polymorphonuclear leucocytosis

Question 21

Causes of pneumonia in neonates <1m?

Answer 21

Group b strep.
E. Coli.
Chlamydia
Listeria

Question 22

Risk factors for asthma?

Answer 22

Family history/ atopy
Male sex
Parental smoking