Respiratory

Question 1

Viral infective agents

Answer 1

adenovirus 
influenza A,b
Para flu 1,3
RSV 
Rhinovirus

Question 2

Bacterial infective agents

Answer 2

H influenzae 
M Catarrhalis 
Mycoplasma
S aureus 
Strptococci

Question 3

Rhinitis epidemiology and the dilemma

Answer 3

very common in winter
5-10 per year
prodrome to other illness eg pneumonia, meningitis

Question 4

Otitis media appearance

Answer 4

erythema and bulging drum

Question 5

Otitis media infection

Answer 5

primary viral

secondary bacterial - pneumococcus/H flu

Question 6

otitis media treatment

Answer 6

analgesia

Question 7

tonsillitis/pharyngitis - how to determine if its bacterial or vial and how to treat

Answer 7

throat swab
nothing or 10 days penicillin
NOT AMOXICILLIN

Question 8

Presentation and treatment of croup

Answer 8

para flu 1 - common
well, coryza, stridor, hoarse voice and barking cough
oral dexamethasone

Question 9

Epiglottitis presentation and treatment

Answer 9

H influenzae type B
rare, toxic
stridor, drooling
intubation and antibiotics

Question 10

tracheitis presentation

Answer 10

croup which does not get better
fever, sick child
staph or strep

Question 11

treating tracheitis

Answer 11

augmentin

Question 12

Bronchitis presentation

Answer 12

common, endobronchial infection 
loose rattly cough with URTI
post tussive vomit - glut
chest free of wheeze and creps
child well

Question 13

causative organisms of bronchitis

Answer 13

haemophilus

pneumococcus

Question 14

Mechanism of bacterial bronchitis

Answer 14

disturbed mucociliary clearance
minor airway malacia
RSV/adenovirus
infection secondary

Question 15

Natural history of bacterial bronchitis

Answer 15

following URTI
last 4 weeks
first winter bad, second winter better, third winter fine

Question 16

Persistent bacterial bronchitis

Answer 16

wet cough, more than 1 month

Question 17

red flags with persistent bacterial bronchitis

Answer 17

age <6 months or over 4 years
static weight
associated SOB
disrupt child’s life

Question 18

bronchiolitis - clinical diagnosis

Answer 18

LRTI - 30-40% of infants
RSV, Para flu 3, HMPV
nasal stuffiness, tachypnoea, poor feeding 
crackles +/- wheeze
ONE OFF

Question 19

LRTI

Answer 19

48 hrs, fever, SOB, cough
wheeze - bacteria unlikely
reduced or bronchial breath sounds
viruses, pneumococcus

Question 20

Is it pneumonia or not?

Answer 20

signs are focal
creps
high fever

Question 21

managing community acquired pneumonia

Answer 21

oral amoxycillin
oral macrolide
IV if vomiting

Question 22

pertussis

Answer 22

common!
vaccine reduces risk and severity
coughing fits
vomiting and colour change

Question 23

Empyema

Answer 23

complication of pneumonia
pleural space infection
chest pain and unwell
antibiotics and drain

Question 24

Main line treatment for LRTI

Answer 24

oxygen, hydration, nutrition

Question 25

Asthma presentation

Answer 25

wheeze, cough, SOB

variable/reversible

Question 26

asthma triggers

Answer 26

URTI, exercise, cold air, allergen

Question 27

3 main key words for asthma

Answer 27

wheeze
variability
responds to treatment

Question 28

child and adult asthma differences

Answer 28

gender - boys and women

occupational asthma

Question 29

Multiple hits for asthma

Answer 29

genes 
inherently abnormal lungs
early onset atopy 
later exposure 
- rhinovirus 
- exercise 
- smoking

Question 30

What happens within the bronchus to cause asthma?

Answer 30

bronchoconstriction
airway wall thickening
luminal secretions

Question 31

cough with asthma

Answer 31

dry
nocturnal
exertional

Question 32

Asthma differential diagnosis

Answer 32

viral induced wheeze

GORD, CF, immune deficiency etc

Question 33

treatment of infrequent episodic wheeze with a cold

Answer 33

salbutamol

Question 34

age - likeliness of asthma

Answer 34

under 18 months - infection

over 5 - asthma

Question 35

Goals of asthma treatment

Answer 35

Minimal symptoms during day and night
minimal need for reliever meds
no exacerbations

Question 36

How to measure asthma control - SANE

Answer 36

SABA/week
Absence from school
Nocturnal symptoms/week
exertional symptoms/week

Question 37

Initial asthma treatment

Answer 37

ICS

Question 38

Classes of asthma medications

Answer 38

SABA
ICS
LABA
LRT
oral steroids
theophyllines

Question 39

first line preventer in under 5’s

Answer 39

LTRA

Question 40

Add on therapies

Answer 40

LABA

increase ICS?LTRA?

Question 41

Adverse effects of ICS

Answer 41

height suppression

oral candidiasis?

Question 42

2 things to remember about LABA

Answer 42

do not use without ICS

use as a fixed dose inhaler

Question 43

2 types of delivery systems for asthma meds

Answer 43

MDI/spacer

dry powder device

Question 44

spacers

Answer 44

shake inhaler, wash spacer

increases delivery by 100%

Question 45

nebulisers

Answer 45

not for day to day use

MDI with spacer is quieter, quicker, valve mechanism and portable

Question 46

Other management of asthma

Answer 46

stop smoke exposure

remove environmental triggers eg cat

Question 47

Acute asthma treatment

Answer 47

SABA via spacer + pred
SABA via neb +pred
Iv salbutamol, IV hydrocortisone

Question 48

How to choose treatment for acute asthma

Answer 48

RR, HR, work of breathing

O2 sats, confusion, ability to complete sentences

Question 49

chronic/acute steroids - inhaled or oral?

Answer 49

chronic - inhaled

acute - oral

Question 50

age cut off for difference in asthma treatment

Answer 50

5