Respiratory

Question 1

Bronchiolitis common pathogen

Answer 1

RSV 80%
Parainfluenza
Rhinovirus
Adenovirus
Influenza virus

Question 2

3 patterns of wheezing

Answer 2

Viral episodic-in response to infection
Multi-trigger- likely to develop into asthma
Asthma

Question 3

Causes of recurrent/persistent wheeze

Answer 3

Viral episodic wheeze
Multiple trigger wheeze
Asthma
Recurrent anaphylaxis (e.g. in food allergy) Chronic aspiration
Cystic fibrosis Bronchopulmonary dysplasia Bronchiolitis obliterans Tracheo-bronchomalacia

Question 4

Asthma treatment

Answer 4

SABA
ICS
>5 LABA. <5 LRTA
>5 increase ICS. <5 refer
Max ICS 1600 ug. 800 ug for under 5

Question 5

Criteria for hospital admission: asthma

Answer 5

If after high dose inhaled bronchodilator therapy:

Question 6

Different types of URTI

Answer 6

commoncold(coryza)
sore throat (pharyngitis,tonsillitis)
Acute otitis media
Sinusitis (relatively uncommon)

Question 7

Most common pathogen of coryza (common cold)

Answer 7

Rhinovirus
Coronavirus
Respiratory syncytial virus (RSV)

Question 8

Common pathogens for pharyngitis

Answer 8

Adenovirus
Enterovirus
Group A B-Haemolytic streptococcus

Question 9

Common pathogens Tonsillitis

Answer 9

Group A beta haemolytic streptococcus

Epstein-Barr virus (infectious mononucleosis)

Question 10

Treatment of bacterial tonsillitis

Answer 10

Penicillin V or erythromycin m

Question 11

Acute otitis media pathogens

Answer 11

RSV
Rhinovirus
Pneumococcus
Non typical H.Influenza

Question 12

Common indications for tonsillectomy

Answer 12

Recurrent severe tonsillitis 
Peritonsillar abscess (Quincy)
Obstructive sleep apnoea

Question 13

Croup pathogens

Answer 13

Parainfluenza
Rhinovirus
Influenza virus

Question 14

Croup peak incidence

Answer 14

6 months to 6 years

Peak at 2

Question 15

Features of croup

Answer 15

Coryza
Fever 
Hoarseness 
Barking cough
Harsh stridor
Symptoms often start and are worse at night

Question 16

Croup first line Tx

Answer 16

Oral steroids
Dexamethasone, prednisolone

Nebulises steroid- budenoside

In severe cases adrenaline with oxygen via face mask

Question 17

Acute epiglottis

Answer 17

Intense swelling of the epiglottis and surrounding tissues

Caused by Haemophilia influenza type b (HIb)

Question 18

Acute epiglottis presentation m

Answer 18

High fever in an ill looking child
Painful throat prevents child from speaking or swallowing
Saliva drools from mouth
Soft inspiratory stridor
Child sits immobile upwards with mouth open to breath

Question 19

Another name for pertussis

Answer 19

Whooping cough caused by Bordtella pertussis.

Question 20

Pertussis clinical features

Answer 20

Week of coryza 
Paroxysmal or spasmodic cough
Inspiratory whoop
Often worse at night may have cough
Goes red/blue in the face

Question 21

Cystic fibrosis

Answer 21

Autosomal recessive disease

Misfolded CFTR

Question 22

Clinical features of CF

Answer 22

Newborn
• Diagnosed through newborn screening
• Meconium ileus

Infancy
• Prolonged neonatal jaundice
• Growth faltering
• Recurrent chest infections
• Malabsorption, steatorrhoea

Young child
• Bronchiectasis
• Rectal prolapse
• Nasal polyp
• Sinusitis

Older child and adolescent
• Allergic bronchopulmonary aspergillosis
• Diabetes mellitus
• Cirrhosis and portal hypertension
• Distal intestinal obstruction (meconium ileus
equivalent)
• Pneumothorax or recurrent haemoptysis
• Sterility in males

Question 23

Pneumothorax

Answer 23

pneumothorax may occur spontaneously in up to 2% of deliveries. It is usually asymptomatic but may cause respiratory distress. Pneumothoraces also occur secondary to meconium aspiration, respiratory distress syndrome or as a complication of mechanical ventila- tion.

Question 24

Bacterial tracheitis

Answer 24

This rare but dangerous condition is similar to severe epiglottitis in that the child has a high fever, appears very ill, and has rapidly progressive airways obstruction with copious thick airway secretions. It is typically caused by infection with Staphylococcus aureus. Man- agement is by intravenous antibiotics and intubation and ventilation if required.

Question 25

Laryngomalacia

Answer 25

Most common cause of stridor in infancy. Due to congenital softening of the tissues of the larynx. Hence predisposed to collapse upon inspiration and partially block airway.

Question 26

Clinical features of bronchiolitis

Answer 26

``` dry wheezy cough • tachypnoea and tachycardia • subcostal and intercostal recession • hyperinflation of the chest • fine end-inspiratory crackles • high-pitched wheezes – expiratory > inspiratory. ```

Question 27

Laryngomalacia presentation

Answer 27

Feeding related vomiting choking etc Fine inspiratory crackles Weight loss and failure to thrive presents at birth or within 6 weeks peaks at 6-8 months. Often Dx at 4.

Question 28

Bronchiolitis Tx

Answer 28

Humidified air | May require fluids or CPAP

Question 29

Causes of anaphylaxis

Answer 29

``` Food allergy Drugs Insect stings Latex Exercise ```

Question 30

signs of anaphylaxis AABC skin

Answer 30

``` Acute Onset Airway: swelling hoarsness, stridor Breathing: Tachypnoea, wheeze, Sp02>92% Circulation: Clammy, Pale, hypotension, drowsy, coma Skin: Urticaria, angiodema ```

Question 31

Emergency treatment of anaphylactic shock

Answer 31

ABCDE If breathing difficult Sit up If hypotensive- supine and elevate legs If unconcious- recovery position and BALS. ``` Adrenaline- 1:1000 IM Additional treatment: Establish airway High-flow oxygen IV fluid (20 ml/kg crystalloids) Chlorpheniramine (IM or slow IV) Hydrocortisone (IM or slow IV) Consider salbutamol if wheeze ```

Question 32

CENTOR criteria

Answer 32

Tonsillar exudate Tender anterior cervical lymphadenopathy or lymphadenitis History of fever (over 38°C) Absence of cough

Question 33

What Centor score require Abx

Answer 33

3/4

Question 34

Tx for tonsillitis/pharyngitis who require Abx

Answer 34

Phenoxymethylpenicillin 1 to 11 months, 62.5 mg four times a day or 125 mg twice a day for 5 to 10 days 1 to 5 years, 125 mg four times a day or 250 mg twice a day for 5 to 10 days 6 to 11 years, 250 mg four times a day or 500 mg twice a day for 5 to 10 days

Question 35

Acute otitis media presentation

Answer 35

Most common 6-12 months Fever Bright red bulging with loss of light reflection May have perforation or pus visible

Question 36

Tx for acute otitis media

Answer 36

Paracetamol or ibuprofen for the pain | Can give prescription of amoxicillin and tell parents to only give if child unwell after 2-3 days

Question 37

Tx of otitis media with effusion

Answer 37

Grommets | If persists grommet insertion with adenoidectomy

Question 38

Allergic rhinitis Tx

Answer 38

Second-generation non-sedating antihistamines (used topically or systemically) • Topical corticosteroid nasal or eye preparations (the latter under specialist ophthalmology supervision) • Cromoglycate eye drops • Leukotriene receptor antagonists, e.g. montelukast • Nasal decongestants (use for no more than 7–10 days due to risk of rebound effect) • Allergen immunotherapy – sublingual or subcutaneous (limited by anaphylaxis risk) • Systemic corticosteroids should not be used due to the risk of adverse effects

Question 39

Acute sinusitis

Answer 39

Often paranasal sinus as frontal sinuses do not develop until late childhood. Treat with Abx and analgaesia. Ofte secondary to URTI

Question 40

Tx for epistaxis

Answer 40

Lean forward, pinch nose cartilage firmly for 10-15mins. If still bleeding: Nasal cautery Nasal Packaging If bleeding is posterior aspect of nose admit to hospital