Respiratory

Question 1

What treatment do URTI’s in children need?

Answer 1

Usually nothing

URTI’s are self-limiting

Question 2

How is croup treated?

Answer 2

Oral dexamethasone

Question 3

How is epiglottitis treated?

Answer 3

Intubation and antibiotics

Question 4

What are the common bacterias involved in LRTI’s in children?

Answer 4

Strep pneumoniae

Haemophilius Influenzae

Mycoplasma pneumoniae

Question 5

What are the common viral infections in LRTI’s in children?

Answer 5

Respiratory syncytial virus

Parainfluenza III

Influenza A & B

Adenovirus

Rhinovirus

Question 6

What are the symptoms of bronchitis?

Answer 6

Loose rattly cough

Post-tussive vomit - ‘glut’

No wheeze or creps heard in chest

Question 7

What is the most likely organism causing bronchitis?

Answer 7

Haemophilus

Pneumococcus

Question 8

What are the red flags to look for in bronchitis?

Answer 8

1 - < 6 months or > 4 years old

2 - Static weight

3 - SOB

4 - Other co-morbidities

Question 9

What is the treatment of bronchitis?

Answer 9

None

Question 10

What is the most likely organism to be found in bronchiolitis?

Answer 10

RSV

Paraflu III

Question 11

What are the symptoms of bronchiolitis?

Answer 11

1 - Nasal stuffiness

2 - Tachypnoea

3 - Poor feeding

4 - Crackles (possible wheeze)

Question 12

After how many days of a cough should parents seek medical attention?

Answer 12

5 days

Question 13

When is RSV most likely to occur?

Answer 13

Christmas

Question 14

In what age group does bronchiolitis occur?

Answer 14

< 12 months old

Question 15

Does bronchiolitis occur multiple times in the same patient?

Answer 15

No

It’s one off

Question 16

How is bronchiolitis managed?

Answer 16

Observation

No treatments

Question 17

What are the signs of a LRTI in children?

Answer 17

Lasts 48hrs

Fever

SOB

COUGH

Grunting

Question 18

What type of breath sounds are heard in LRTI’s?

Answer 18

Bronchial or reduced breath sounds

Question 19

What causes LRTI’s?

Answer 19

Virus + bacteria

Question 20

What are the treatments of the LRTI/pneumonia if the symptoms are severe?

Answer 20

1st - Amoxycilin

2nd - Macrolide

Question 21

What are the symptoms of pertussis?

Answer 21

1 - Coughing fits

2 - Vomiting and colour change

Question 22

How should a child with an LRTI initially be treated?

Answer 22

1 - Oxygenation

2 - Hydration

3 - Nutrition

Question 23

What are the classical signs of asthma?

Answer 23

Wheeze

SOB

Cough

Question 24

What can trigger asthma?

Answer 24

URTI

Exercise

Allergen

Cold weather

Question 25

What signs would indicate asthma over other respiratory disorders?

Answer 25

Wheeze variability responds to treatment

Question 26

What are the multiple hits that are thought to cause asthma?

Answer 26

Genes Abnormal lungs Early onset atopy Environmental exposures (exercise, smoking)

Question 27

How is childhood asthma diagnosed?

Answer 27

History of: Wheeze SOB at rest Cough

Question 28

What are the features of the cough associated with asthma?

Answer 28

Dry Nocturnal Exertional

Question 29

What are likely features of a history in a patient with atopy?

Answer 29

Eczema Hayfever Food allergies

Question 30

What is the most effective way to diagnose a suspected childhood asthma?

Answer 30

Inhaled cortico steroid for 2 months then review

Question 31

If when the child starts their asthma treatment they also go away on holiday and the asthma symptoms stop, does this mean that the asthma treatment has worked?

Answer 31

No - often going away from their normal environment can improve asthma symptoms

Question 32

What questions can be asked to assess how well a childs asthma is being controlled?

Answer 32

SANE 1 - SABA/week 2 - Absences from school/nursery 3 - Nocturnal symptoms/week 4 - Exertional symptoms/weel

Question 33

If a child who is older than 5 does not respond to Low dose ICS treatment, what is the next treatment option?

Answer 33

Add inhaled LABA

Question 34

If a child who is younger than 5 does not respond to Low dose ICS treatment, what is the next treatment option?

Answer 34

LTRA

Question 35

If LTRA's and LABA's do not work on top of very low ICS doses, what can be tried next?

Answer 35

Increase the ICS dose

Question 36

After starting a child on a very low dose ICS (step 1), what criteria are used to indicate the treatment is not working?

Answer 36

- Symptomatic 3 times a week or more - Waking 1 night a week

Question 37

Can LABA's be used on their own without ICS's?

Answer 37

No

Question 38

Apart from medication what other treatment options can be used for asthma in children?

Answer 38

Remove smoke exposure Remove environmental triggers (e.g. cat, dog)

Question 39

In what instances are inhaled steroids or oral steroids used?

Answer 39

Inhaled steroids - chronic asthma/maintenance Oral steroids - acute treatment of asthma

Question 40

What is the most effective way to deliver ICS in a child \< 8 years old?

Answer 40

Metered dose inhaler plus spacer