Respiratory Childhood Diseases.

Question 1

What increases the incidence of pneumothorax in children?

Answer 1

IPPV, CPAP and ventilation.

RDS

Question 2

What can cause chronic lung disease in children?

Answer 2

General follows RDS

Barotrauma, volume trauma, high inspired oxygen.

Question 3

How do we examine older children for respiratory conditions?

Answer 3

Weight, height and length all plotted. Look for clubbing, chest shape and do auscultation.

Question 4

What kind of genetic abnormality is cystic fibrosis and what number of people are carriers of the disease?

Answer 4

Autosomal recessive mutation in the CFTR gene.

Carried by roughly 1 in 25 people.

Question 5

What is the differential diagnosis of CF?

Answer 5

Immune deficiency
Ciliary dyskinesia
Asthma
Kartageners syndrome - rare involves immobile cilia.

Question 6

What clinical signs and symptoms point to a child having asthma?

Answer 6

Wheeze, cough, chest tightness, difficulty breathing. Atopy. Response to drugs.

Question 7

What are the stages of treatment for childhood asthma?

Answer 7

1 - inhaled shirt acting beta agonists.
2 - regular inhaled steroids.
3a - regular inhaled steroids plus LABA
3b - stage 3a plus leukotrine antagonists.

Question 8

What can passive smoking cause in children?

Answer 8

Reduces birthweight.
Increased likelihood of asthma attack.
Glue ear
Cleft lip

Question 9

What are the signs of acute asthma?

Answer 9

Cough and wheeze worsening over hours or days.

Question 10

What causes bronchiolitis?

Answer 10

Viral infection commonly caused by RSV but also HMPV and adenovirus.

Question 11

What children normally get bronchiolitis?

Answer 11

Under 18 months.
More severe in younger babies, ex Prem and
family smokers.

Question 12

What are the complications of bronchiolitis?

Answer 12

Respiratory and cardiac failure.

Question 13

What organisms cause pneumonia in neonates?

Answer 13

GBS, e.coli, klebsiella and staph aureus.

Question 14

What organisms cause pneumonia in infants?

Answer 14

Strep pneumoniae and chlamydia.

Question 15

What organisms cause pneumonia in school age children?

Answer 15

Strep pneumoniae, staph aureus, GR A strep, bordetella, mycoplasma and legionella.

Question 16

What is croup? What are the symptoms and treatments?

Answer 16

Viral laryngealtracheobronchiolitis.
Stridor and a barking cough.
Given oral steroids to reduce inflammation or humidification in mild cases.

Question 17

What is the presentation of measles?

Answer 17

Pyrexia, runny nose, red eyes, malaise and a dry cough.

Get kopliks spots and a maculopoular rash which begins behind the ears and descends over 3 days.

Question 18

What are the complications of measles?

Answer 18

Bacterial bronchopneumonia, bacterial otitis media and encephalitis.

Question 19

What jab prevents TB?

Answer 19

BCG

Question 20

What jab prevents measles?

Answer 20

MMR.

Question 21

What is the vermillion border?

Answer 21

The junction between the lip and the skin.

Question 22

What do kopliks spots look like?

Answer 22

Coarse grains of sea salt on the inside of the mouth.

Question 23

What is a macropopular rash?

Answer 23

Smooth red raised areas.

Question 24

What 3 types of encephalitis can we get following measles?

Answer 24

At the time, post infectious and subacute sclerosing panencephalitis (occurs 7 years later and can be fatal).

Question 25

When are complications from measles more common?

Answer 25

In the immunocompromised and the malnourished.

Question 26

What do children with bronchiolitis present with?

Answer 26

Fever, corzya, irritating cough, wheeze and Tachypnoea.

poor feeding and apnoea in small babies.

Question 27

What do severe cases of bronchiolitis present with?

Answer 27

Grunting, decreased PaO2 and intercostal or sternal indrawing.

Question 28

How do we confirm bronchiolitis?

Answer 28

PCR from throat or nasal swab.

Question 29

What is the therapy for bronchiolitis?

Answer 29

Supportive measures.

Question 30

When does bronchiolitis happen and how common is it?

Answer 30

Every winter and it is very common.

Question 31

What other virus is second to RSV in causing bronchiolitis and what are the symptoms?

Answer 31

Metapneumovirus.
Similar symptoms to RSV in both children and adults.
Range of severity goes from mild to requiring ventilation.

Question 32

How do we generally test for a viral infection?

Answer 32

PCR from throat or nasal swabs.

Bronchial lavage or endotracheal aspirate.

Question 33

What STI can cause infantile pneumonia and how do we test for it?

Answer 33

Chlamydia trachomatis.

Diagnosed by PCR of mothers urine or throat and nasal swabs of child.

Question 34

What does acute epiglottisis cause and what can this lead to?

Answer 34

Causes severe croup in children.

can progress to obstruction and death.

Question 35

What do children suffering from acute epiglottisis look like?
What do they usually have a history of?

Answer 35

Very unwell.

have a history of RTI illness and infections.

Question 36

Why must we be careful when examining children with acute epiglotitis?

Answer 36

When depressing the tongue, the epiglottis thinks we are swallowing and flips down. As it is enlarged it may get stuck and cause obstruction.

Question 37

What causes respiratory distress syndrome of the newborn?

How do we treat it?

Answer 37

Surfactant deficiency due to preterm birth.
Surfactant isn’t made until 32 weeks.
Results in impaired gas exchange and actelectasis.
Production stimulated by steroids.

Question 38

What is a respiratory complication in the new baby in around 1% of vaginal births?

Answer 38

Pneumothorax.

slightly higher incidence in C sections.