Respiratory

Question 1

What can rhinitis be a prodrome to?

Answer 1

• Pneumonia
• Bronchiolitis
• Meningitis
• Septicaemia

Question 2

When does rhinitis usually occur?

Answer 2

Very common

5-10 per year but concentrated in the winter months

Question 3

How long does a runny nose usually last?

Answer 3

10-14 days

Question 4

How long can earache last?

Answer 4

Up to 8 days usually

Question 5

What is otitis media?

Answer 5

A common self-limiting infection of the ear

Question 6

How does otitis media present?

Answer 6

• Painful ear
• Erythema in ear
• Bulging drum (may spontaneously rupture)

Question 7

What organisms can cause otitis media?

Answer 7

• Primary viral infection
• Secondary infection with pneumococcus or haemophilus influenza

Question 8

How is otitis media managed?

Answer 8

• Analgesics
• Antibiotics have more side effects than benefits so are generally not used

Question 9

What antibiotic should not given in tonsillitis/pharyngitis?

Answer 9

Amoxicillin

Question 10

How long does a sore throat usually last?

Answer 10

About 2-7 days

Question 11

How is tonsillitis/pharyngitis treated?

Answer 11

Either nothing or 10 days of penicillin if known strep infection

Question 12

What organism is responsible for croup?

Answer 12

Para’flu I

Question 13

What organism is responsible for epiglottitis?

Answer 13

H. influenza type B

Question 14

How does croup present?

Answer 14

• Coryza
• Stridor
• Hoarse voice
• Barking cough

Question 15

How does epiglottis present?

Answer 15

Stridor and drooling

Question 16

How is croup treated?

Answer 16

Oral dexamethasone

Question 17

How is epiglottitis treated?

Answer 17

Intubation and IV antibiotics

Question 18

How long does croup usually last?

Answer 18

2-3 days

Question 19

What common agents are implicated in LRTI?

Answer 19

• Bacterial overgrowth
  
  • Strep pneumoniae
  • Haemophilus influenza
  • Moraxella catarrhalis
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
• Viral infection
  
  • RSV
  • Parainfluenza III
  • Influenza A and B
  • Adenovirus
  • Rhinovirus

Question 20

What are the principles of management for LRTI?

Answer 20

• Make a diagnosis
• Assess the patient (oxygenation, hydration, nutrition)
• Treat or wait for resolve

Question 21

What is the most common LRTI of childhood?

Answer 21

Bronchitis

Question 22

How does bronchitis present?

Answer 22

• Loose rattly cough
• Post-tussive vomit - “glut”
• Chest free of wheeze/creps
• Child very well, parent worried

Question 23

What organisms are associated with bronchitis?

Answer 23

• Haemophilus
• Pneumococcus

Question 24

What is the mechanism of bacterial bronchitis?

Answer 24

• Disturbed mucociliary clearance due to Minor airway malacia and RSV/adenovirus
• Lack of social inhibition!
• Bacterial overgrowth is secondary

Question 25

What is the cycle of bronchitis in the winter?

Answer 25

* Resp virus obtained * Clearance stops for \<4 weeks * Cough and rattle * Clearance almost recovered * Child picks up another virus

Question 26

What are the red flags of bronchitis?

Answer 26

* Age \<6 mo, \>4yr * Static weight * Disrupts child’s life * Associated SOB (when not coughing) * Acute admission * Other co-morbidities (neuro/gastro)

Question 27

How long does a cough usually last?

Answer 27

Can be 7-25+ days

Question 28

What are the 3 points in the management of persistent bacterial bronchitis?

Answer 28

* Make the diagnosis * Reassure * Do not treat

Question 29

What organisms can cause bronchiolitis?

Answer 29

* usually RSV * Paraflu III * HMPV (Human metapneumovirus)

Question 30

How does bronchiolitis present?

Answer 30

(LRTI) * Nasal stuffiness * Tachynpnoea * Poor feeding * Crackles +/- wheeze

Question 31

What is the incidence of bronchiolitis?

Answer 31

Affects 30-40% of all infants

Question 32

What is the expected course of bronchiolitis?

Answer 32

* Child is well days 1+2 of cough * Gets worse days 3-5 * Parent usually seeks medical attention about day 5 * Child stabilises days 6+7 * Recovery days 7-14

Question 33

When does RSV infection usually occur?

Answer 33

Christmas period

Question 34

When is it bronchiolitis?

Answer 34

* \<12 months old * One off * Follows the typical history

Question 35

How is bronchiolitis managed?

Answer 35

* Maximal observation * Minimal intervention

Question 36

How is bronchiolitis investigated?

Answer 36

* NPA (nasopharyngeal aspirate) * Oxygen saturation for severity

Question 37

What is there no routine need for in bronchiolitis?

Answer 37

* CXR * Bloods * Bacterial cultures

Question 38

What medications are proven to work in bronchiolitis?

Answer 38

NONE

Question 39

When should a LRTI be suspected?

Answer 39

* 48 hrs, fever (\>38.5oC), SOB, cough, grunting * Wheeze makes bacterial cause unlikely * Reduced or bronchial breath sounds

Question 40

When can you call a LRTI pneumonia?

Answer 40

* Signs are focal * Crepitation's * High fever

Question 41

What is the BTS guidelines for the management of community acquired pneumonia?

Answer 41

* Nothing is symptoms are mild * Oral Amoxycillin first line * Oral Macrolide second choice * Only for iv if vomiting

Question 42

How is pertussis characterised?

Answer 42

(Whooping cough) Coughing fits with vomiting and colour change

Question 43

Why does pertussis still occur despite vaccination?

Answer 43

Vaccination reduces risk and severity but does not eliminate the possibility

Question 44

When is LRTI/pneumonia treated?

Answer 44

History of 2 days fever, cough and focal signs (ie one side) then treat with oral amoxycillin

Question 45

What is treatment for acute respiratory infections aimed at?

Answer 45

Maintaining oxygenation, hydration and nutrition

Question 46

When is otitis media treated?

Answer 46

Oral amoxicillin if \<2 years with bilateral OM