Respiratory

Question 1

CXR showing thickening around bronchi , flattened heme-diaphragms and incomplete inflation?

Answer 1

Asthma

Question 2

What colour spacers are used at different ages?

Answer 2

Neonate - orange, child - yellow, 5+ - blue

Question 3

What would be the next step in Mx of 7y/o child currently taking salbutamol inhaler PRN and 200mcg/day beclomethasone

Answer 3

Introduce LABA. If only partial response, keep LABA & increase beclomethasone to 400mcg/day.

Question 4

What are the steps in managing asthma in children <5y?

Answer 4

SABA –> ICS 200-400mcg/day –> leukotriene antagonist –> refer to paeds

Question 5

At what age would you have expected children airways to have grown enough to stop wheezing?

Answer 5

5y. If still wheezy –> likely asthma Dx

Question 6

What are the features of viral-induced wheeze?

Answer 6

typically <5y, episodic with no interval Sx, absence of atopy.

Question 7

What might cause displacement of liver downwards?

Answer 7

Hyperinflation of chest - bronchiolitis

Question 8

At what age range are you most likely to get croup? When is most common age?

Answer 8

6m-6y. Peak at 2y

Question 9

Sx of croup?

Answer 9

Preceding coryza & fever. Barking cough, harsh stridor, worse at night

Question 10

Causative organism of epiglottitis?

Answer 10

H influenza type B. Decreased in incidence due to Hib vaccine

Question 11

Mx of epiglottitis?

Answer 11

Call anaesthetist –> intubate with nasotracheal tube. IV cefotaxime 3-5days

Question 12

When might you give rifampicin to family members of unwell child?

Answer 12

If child had epiglottitis. Rifampicin = prophylactic

Question 13

How is croup Mx in hospitals?

Answer 13

Nebulised adrenaline - transient relief Sx. Oral prednisolone - 3d, or oral dex - stat dose.

Question 14

Most common mutation causing CF? what type of mutation is this?

Answer 14

Delta F508 = missense

Question 15

Sx of meconium ileum in CF?

Answer 15

Abdo distension, intestinal obstruction, vomiting

Question 16

Possible presenting Sx of CF?

Answer 16

FTT, malabsorption, steatorrhea, prolonged neonatal jaundice, recurrent chest infections

Question 17

Examination of child shows chest hyperinflation, coarse insp crackles and exp wheeze. Possible Dx of child?

Answer 17

CF - recurrent infections, bronchiectasis & air trapping

Question 18

How is CF normally Dx?

Answer 18

Raised immunoreactive trypsin on Guthrie, positive sweat test

Question 19

Nutritional Mx of CF?

Answer 19

Creon & high calorie diet

Question 20

Dx criteria for bronchiectasis?

Answer 20

coryza prodrome + persistent cough + raised RR or chest recession + wheeze/crackles

Question 21

What increases risk of bronchiolitis?

Answer 21

Prematurity, heart murmur, CF

Question 22

4m old baby comes in with feeding difficulty, raised RR and cold/cough Sx. What is most appropriate investigations and Mx plan?

Answer 22

Bronchiolitis.
Investigations - PCR of nasopharyngeal secretions.
Mx - suportive - O2, fluids if need, bronchodilators for wheeze.

Question 23

Dx of child with fine-end insp crackles & high pitched wheeze and hyper inflated chest?

Answer 23

Bronchiolitis.

Question 24

How can you prevent bronchiolitis in high-risk children?

Answer 24

Prophylactic monoclonal Ab to RSV. Monthly IM injections

Question 25

RR above what level indicates severe illness in infants and in children?

Answer 25

> 70 in infants, >50 in children

Question 26

Auscultation of end inspiratory coarse crackles might be indicative of…?

Answer 26

pneumonia

Question 27

Opacification of R middle lobe on CXR might suggest what?

Answer 27

Pneumonia caused by strep pneumoniae. Classic lobar appearance

Question 28

Tx of pneumonia in <5y?

Answer 28

Amoxicillin

Question 29

What is the Centor criteria used for? What are the domains?

Answer 29

Dx of tonsillitis.

1. No cough
2. tonsillar exudate
3. Hx fever >38
4. cervical lymphadenopathy

Question 30

Tx bacterial tonsillitis?

Answer 30

Penicillin or erythromycin (avoid amoxicillin)

Question 31

8m old child with bulging, red tympanic membrane with loss normal light reflection?

Answer 31

Acute otitis media

Question 32

What is glue ear? What age is it common?

Answer 32

Secretory otitis media, age 2-7y

Question 33

Dull and retracted tympanic membrane with visible fluid level?

Answer 33

Secretory otitis media (glue ear)

Question 34

Cause of monophonic wheeze in child?

Answer 34

Bronchial obstruction - foreign body

Question 35

Tx of TB?

Answer 35

Isonazid + rifampicin + pyrazinamide

Question 36

Tx whooping cough?

Answer 36

erythromycin