Respiratory

Question 1

∆∆ stridor

Answer 1

Inhaled foreign body 
Anaphylaxis 
Croup 
Epiglottis 
Bacterial tracheitis 
Laryngomalacia

Question 2

difference between stridor and wheeze

Answer 2

stridor = upper airway obstruction - monophonic
High inspiratory noise
Wheeze = lower airway obstruction - polyphonic

Question 3

Asthma
Aetiology
Presentation
Investigations

Answer 3

Aetiology 
Fam Hx 
Atopy 
Hygiene hypothesis 
Viral illness 
Maternal smoking 

Presentation 
Diurnal cough - worse @ night 
Dyspnoea
Wheeze 
SOB 

O/E
harrison’s sulci
hyper inflated chest
Wheeze

Investigations 
FEV1/FVC - >70 
Reversibility - >12% 
FeNO >35ppb 
CXR - hyperinflation

Question 4

Asthma management

Answer 4

SABA
+ICS
+ LRTA
Swap LRTA for LABA

SABA + MART
SABA + MART higher dose ICS
SABA + other eg theophylline

Question 5

Asthma attack severity

Answer 5

Moderate
PEF >50%
Sats >92
Can speak in full sentences

Severe 
PEF 33-50%
Sats <92 
Struggles to speak in full sentences 
Use of accessory neck muscles 

Life threatening 
PEF <33% 
Sats <92
Symptoms 
1) Silent chest 
2) Reduced breathing effort 
3) ∆ consciousness 
4) Cyanosis

Question 6

Asthma attack management

Answer 6

OSHITME 
O2
Salbutamol - neb
Hydrocortisone IV 
Ipratroprium IV 
Theophylline IV
Magnesium sulphate IV 
Escalate care

Question 7

Cystic fibrosis 
Aetiopathophysiology 
Presentation 
Investigations 
Management

Answer 7

Aetiopath
Autosomal recessive - CFTR gene - ∆F508 mutation - –> defect in cAMP chloride channel –> decreased Chloride in lungs –> decreased water –> thicker secretions

Presentation
Neonate
- Prolonged jaundice
- Meconium ileus

Resp

• Recurrent infections
• Thick secretions
• Cough/ wheeze/ dyspnoea

GI

• Gall bladder insufficiency - decreased ADEK absorption
• Liver - cirrhosis + portal HTN
• Pancreatic insufficiency - malnutrition

UROGEN
- Subfertility

General

• FTT
• Clubbing

Investigations

• Heel prick test - immunoreactive trypsinogen
• Sweat test - decreased Cl
• raised faecal elastase
• CXR - hyperinflation, train track sign - bronchial wall thickening

Recurrent infection organisms

• Staph A
• Hib
• Pseudomonas
• Burkholderia

Management 
Resp 
Mucolytic - carbocystine 
Physio 2/3 x/day 
Vaccinations + prophylactic abx 
Remember they can have palivizumab for bronchiolitis 

GI

• 12-150% RDA
• ADEK
• Creol for pancreatic insufficiency

Lung transplant if Rx compliant and no burkholderia C

Isolation

Question 8

Recurrent infections in CF

Answer 8

Staph A
Pseudomonas
Hib
Burkholderia C

Question 9

Bronchiolitis

Aetiology
Presentation
Investigations
Management

Answer 9

Aetiology
RSV
HMV
parainfluenza

Presentation 
Coryzal symptoms 
Cough (sharp + dry)
Poor feeding 
Wheeze 
Respiratory distress symptoms 

Investigations
Nasal swab/ nasopharyngeal aspirate

Management

• Fluids/ supportive
• NG feed if poor feeding
• Humidified O2
• Neb salbutamol

Palivizumab for people at risk - given IM injection monthly -

• CF
• Congenital heart defects
• Immunocompromised
• premature

Question 10

When to admit in bronchiolitis

Answer 10

Resp distress 
Poor feeding 
Poor fluid intake 
Cyanosis 
Apnoea 
RR >70

Question 11

Croup

Aetiology
Presentation
Investigations
Management

Answer 11

More common in autumn

Aetiology

• Parainfluenza - main
• HMV
• RSV

Presentation (initial fever/ coryza symptoms)
Stridor
Barking cough
Symptoms worse @ night

Investigations
Do not examine throat

Management

• Fluids
• O2
• Dexamethasone oral
• Nebulised budesonide
• Neb adrenaline

Question 12

Epiglottitis

Aetiology
Presentation
Investigations
Management

Answer 12

Aetiology
Hib

Presentation 
Tripod sign 
Lack of cough 
Soft stridor 
Drooling 
Fever
Use of accessory muscles 

Investigations
Do not examine throat
Thumb sign on XR

Management

• INTUBATION
• IV cefuroxime
• Rifampicin to household contacts

Question 13

Whooping cough

Aetiology
Presentation
Investigations
Management

Answer 13

Aetiology
Bordatella pertussis

Presentation 
Catarrhal phase -->
Cough with inspiratory whooping sound 
Severe coughing bout can --> 
Vomit 
Conjunctival haemorrhage 
Apnoea 

Investigations
Nasal swab

Management
Azythromycin
School exclusion

Question 14

Rx for whooping cough

Answer 14

Azithromycin

Question 15

Rx for bronchiolitis

Answer 15

Fluids
Supportive

Humidified O2
Neb salbutamol (less used now)
Suction if excess secretions
NG feed if poor intake

Question 16

Rx for croup

Answer 16

Fluids + O2
Oral dex
Neb budesonide
Neb adrenaline

Question 17

Bacterial tracheitis

Aetiology
Presentation
Investigations
Management

Answer 17

Aetiology
Staph A

Presentation
Stridor
Cough
high fever

Investigations

Management

• IV cefuroxime + clindamycin
• Intubation

Question 18

Pneumonia causes

Answer 18

Neonates
GBS
Gram -ve enterococci
Listeria

Infant 
Strep P 
Hib 
RSV
Bordatella 

Adolescent
Strep P
Chlamydia P
Mycoplasma P

Question 19

What distinguishes pneumonia from other resp infections clinically

Answer 19

if HIGH FEVER - suspect pneumonia

Question 20

Pneumonia

Investigations
Management

Answer 20

Investigations

• Blood cultures
• Septic screen
• CXR
• Sputum sample

Management

• IV ben pen if severe
• Amox
• Co amox if not responding

Question 21

Otitis media

Aetiology
Presentation
Management
Complications

Answer 21

Aetiology
Strep pneumonia
Hib
RSV

Presentation 
Pulling ear/ hearing loss 
pain 
Fever 
Otorrhoea  

Management
amoxicillin

Complications
OME
CSOM + TM perforation
mastoiditis –> meningitis

Question 22

Heel prick test in CF looks at

Answer 22

immunoreactive trypsinogen

Question 23

croup cause

Answer 23

parainfluenza

Question 24

bronchiolitis cause

Answer 24

RSV

Question 25

Infections in CF

Answer 25

Staph A
Pseudomonas
Hib
Burk

Question 26

Epiglottitis cause

Answer 26

Hib