Respiratory

Question 1

Features common cold

Answer 1

Clear or mucopurulent discharge with nasal blockage
Self limiting
No required treatment: OTC analgesic
Cough may persist for 4 weeks following cold

Question 2

Features Pharyngitis

Answer 2

Pharynx and soft palate are inflamed
Local lymph nodes enlarged and tender
Usually viral or group A haemolytic strep
Headache, apathy, abdominal pain, white tonsillar exudate, cranial lymphadenopathy

Question 3

Mx Pharyngitis

Answer 3

Penicillin V 10 day minimum required- prevent rheumatic fever
Amoxicillin is avoided in case of EBV infection and possibility of rash

Question 4

Features tonsillitis

Answer 4

Form of pharyngitis
Intense inflammation of the tonsils
Often purulent exudate
EBV or group A strep common

Question 5

Features acute otitis media

Answer 5

Most common 6-12 months
Children prone as estaashion tubes are short, horizontal and function poorly
Pain in ear and fever
Tympanic membrane bright red and bulging with loss of normal light reflection
Acute perforation of the ear drum with visible pus
Most cases resolve spontaneously

Question 6

Mx Acute otitis media

Answer 6

Amoxicillin once symptoms have persistent for 2-3 days

Regular analgesia for a week

Question 7

Cx Acute otitis media

Answer 7

Can develop mastoiditis and meningitis

Recurrent infection leads to effusion (glue ear) requiring Grommets- can be a cause of reduced hearing

Question 8

Features sinusitis

Answer 8

Infection of the paranasal sinuses
Frontal sinusitis is uncommon: only develop in late childhood
Maxillary sinus swelling may present with pain, swelling and tenderness

Question 9

dDx Stridor

Answer 9

Croup
Acute epiglottitis
Bacterial tracheitis
Foreign body
Laryngomalacia

Question 10

Features croup

Answer 10

6months-6years of age, occuring during the autumn
Characteristic seal like cough associated with tracheal edema
Inflammation of the vocal cords produces hoarseness
Onset or worsening at night

Question 11

Mx Croup

Answer 11

Low threshold for admission in under 12 months
Oral dexamethasone/prednisolone
Nebulised adrenaline

Question 12

Features Acute epiglottitis

Answer 12

Life threatening due to high risk of respiratory obstruction
Caused by Hib: Rare due to vaccine
Children aged 1-6 years
High fever, drooling (inability to swallow)
Do not perform any examination which will distress child and risk occlusion

Question 13

Mx Acute epiglottitis

Answer 13

Direct transfer to ICU
Early intubation first line- tracheostomy if unsuccessful
Cultures and IV antibiotic AFTER intubation
Prophylaxis for household contacts with rifampicin

Question 14

Feautures bacterial tracheitis

Answer 14

Rare but dangerous
High fever, very ill child, rapidly progressive airway obstruction
Copious thick secretions

Question 15

Features Layngomalacia

Answer 15

Usually presents at 4 weeks
Obstruction due to anatomic malformation
Resoles with age

Question 16

dDx Wheeze

Answer 16

Bronchiolitis
Viral episodic wheeze
Asthma

Question 17

Features bronchiolitis

Answer 17

Aged 1-9 months
Typically RSV
Coryzal symptoms with a dry cough and increasing breathlessness

Question 18

Indications for admission bronchiolitis

Answer 18

apnea, persistent saturations <90%, inadequate oral intake, severe respiratory distress

Question 19

Mx Bronchiolitis

Answer 19

Supportive therapy: humidified O2 via nasal cannulae

Most recover within 2 weeks

Question 20

Features viral episodic wheeze

Answer 20

Most preschool children with wheeze is due to viral illness
Always likely to narrow and construct in inflammation
Risks: maternal smoking, remturiy
More common in males
Typically self resolves by age 5

Question 21

Features asthma

Answer 21

Diagnosis in under 3 difficult
Symptoms worse at night and with specific triggers
Normal examination of the chest normally, with wheeze presenting in acute asthma
Hyperinflation of the chest in chronic asthma
Typically history of atopy

Question 22

Mx Asthma <5y

Answer 22

Short acting beta agonist
SABA + 8week trial of Paediatric moderate dose inhaled corticosteroid
-If symptoms doe not resolve consider alternative diagnosis
-If symptoms recur within 4 weeks when stopping ICR, restart low dose ICS as maintenance
-If symptoms recur beyond 4 weeks repeat 8 weeks trial
SABA + Low dose ICS + LTRA
Stop LTRA and refer

Question 23

Mx Asthman 5-16y

Answer 23

Short acting beta agonist
SABA + Paediatric low dose inhaled corticosteroid
SABA + Low dose ICS + LABA
SABA + switch ICS/LABA for low dose MART
SABA + moderate dose MART OR fixed dose moderated ICS and LABA
SABA + high dose ICS OR theophylline trial OR referral

Question 24

Steroid dosing in asthma

Answer 24

Low dose 200mcg budesonide
Moderate dose 200-400mcg budesonide
High dose 200-400mcg Budesonide

Question 25

Features of cough

Answer 25

Dry cough with expiratory wheeze suggests narrowing of smaller airways.
Barking cough suggest tracheal inflammation, narrowing or collapse.
Wet cough associated with mucous secretion and inflammation of lower airway

Question 26

Features whooping cough

Answer 26

Highly contagious
Paroxysmal cough with inspiratory whoop
Wrose at night
May induce vomiting after coughing
Child can go red or blue during paroxysmal phase with production of mucous
Vigorous cough can cause epistaxis and subconjunctival haemorrhage

Question 27

Dx whooping cough

Answer 27

Culture pernasal swab

Question 28

Mx whooping cough

Answer 28

Macrolide Abx
Isolation
Admission

Question 29

Features pneumonia

Answer 29

Virl in younger children, bacterial in older children
Fever, cough, rapid breathing preceded by URTI
Most children can be managed at home

Question 30

Cx pneumonia

Answer 30

Small effusions may occur- persistent fever >48 hours following antibiotics suggests effusion requiring drainage

Question 31

Mx Pneumonia

Answer 31

Antibiotics: newborns broad spectrum IV; older infants amoxicillin; children>5 amoxicillin/erythromycin

Question 32

Admission in pneumonia

Answer 32

oxygen sat <92%, recurrent apnoea, grunting, inability to maintain adequate feed/fluid

Question 33

Features chronic lung infection

Answer 33

Chronic wet cough associated with persistent bacterial bacterial bronchiolitis
Persistent inflammation of the lower airways
Bacterial growth from sputum or bronchial lavage

Question 34

Mx chronic lung infection

Answer 34

high dose co-amoxiclav

physiotherapy

Question 35

Features bronchiectasis

Answer 35

Permanent dilation of the bronchi
Generalised bronchiectasis associated with cystic fibrosis
Focal bronchiectasis associated with severe pneumonia, congenital lung abnormality, obstruction by foreign body

Question 36

Features Cystic fibrosis

Answer 36

meconium ileus, prolonged neonatal jaundice, growth faltering, recurrent chest infections, bronchiectasis, rectal prolapse, nasal polyps, sinusoids, allergic bronchopulmonary aspergillosis, diabetes mellitus, cirrhosis and portal hypertension, distal intestinal obstruction, pneumothorax, sterility in males

Question 37

Ix Cystic Fibrosis

Answer 37

Post natal screening on heel prick
Sweat test showed raised sodium chloride 60-125mmol/L
Regular FEV measurement and physiotherapy to remove secretions

Question 38

Mx Cystic fibrosis

Answer 38

Prophylactic flucloxacillin and rescue antibiotics for initial signs of infection
High calorie diet with overnight feeding and pancreatic supplementation

Question 39

Features primary ciliary dysplasia

Answer 39

Congenital abnormality of structure and function of ciliary lining
Recurrent respiratory tract infections, severe bronchiectasis, recurrent productive cough, purulent nasal discharge, chronic ear infection
Associated with dextrocardia and situs inversus