Respiratory Conditions

Question 1

What is a congenital diaphragmatic hernia?

Answer 1

Bowel protrudes through a hole in the diaphragm and ends up beside the lungs (usually the left lung) The loops of bowel are sitting in the hemithorax and cause lung and pulmonary vascultature underdevelopment.

Question 2

What causes bronchiolitis?

Answer 2

Respiratory synctycial virus

Question 3

Cold like illness in 1 9 month years old followed by a dry cough, increasing breathlessness, wheeze and feeding difficulties.

Answer 3

Bronchiolitis

Question 4

What causes whooping cough?

Answer 4

Caused by the gram negative bacterium bordatella pertussis

Question 5

What is the treatment for whooping cough?

Answer 5

Macrolides - erythromycin, clarithromycin, azithromycin

Question 6

2 – 3 days of cold like symptoms, coughing bouts, inspiratory whoop

Answer 6

Whooping cough

Question 7

Stridor, barking cough, hoarse voice mild fever and runny nose.

Answer 7

Croup

Question 8

What causes croup?

Answer 8

Parainfluenza virus

Question 9

What is the treatment for croup?

Answer 9

Oral prednisolone

Question 10

Difficulty swallowing, drooling, fever, stridor, cyanosis. Septic and very unwell with fever.

Answer 10

Epiglottitis

Question 11

What causes epiglottitis?

Answer 11

Haemophilus influenzae

Question 12

What investigation do you order if you suspect epiglottitis?

Answer 12

Lateral cervical X Ray

Question 13

What do you see on a lateral cervical X Ray for epiglottitis?

Answer 13

Thumbprint sign

Question 14

What is the treatment for epiglottitis?

Answer 14

Endotracheal intubation
IV ceftriaxone
Steroids

Question 15

Autosomal recessive inherited multisystem disease characterised by recurrent respiratory tract infections, pancreatic insufficiency, malabsoprtion and male infertility

Answer 15

Cystic fibrosis

Question 16

What causes cystic fibrosis?

Answer 16

Defective CFTR gene on chromosome 7q. This endcodes for a cAMP dependant chlorine channel which regulates sodium and chlorine concentrations in exocrine secretions mainly in the lungs and pancreas. This loss of function mutation causes viscous secretions.

Question 17

What is the most common mutation in CF?

Answer 17

F508

Question 18

What is the investigation for a child who has a high probability of having asthma in order to confirm the diagnosis?

Answer 18

Start 6 weeks of inhaled corticosteroids (if the response is good then a diagnosis of asthma can be made)

Question 19

Describe the management of asthma in children

Answer 19

Stage 1 : Inhaled beta agonists as required
Stage 2: Add in regular inhaled corticosteroids
Stage 3A: Regular inhaled steroids + LABA
Stage 3B: Add in leukotriene antagonists
Stage 4: High dose steroids

Question 20

How do leukotriene receptor antagonists work?

Answer 20

Oppose the action of leukotrienes which are inflammatory mediators produced by the immune systme and promote bronchoconstriction, inflammation and mucus secretion.

Question 21

What are examples of leukotriene receptor antagonists?

Answer 21

Montelukast

Question 22

What is transient tachypnoea of the newborn?

Answer 22

A respiratory problem that occurs just after birth - consists of a period of rapid breathing and is likely to be due to amniotic fluid remaining in the lungs following birth.

Question 23

How do you treat transient tachypnoea of the newborn?

Answer 23

Oxygen and antibiotics

Question 24

A newborn baby has a respiratory rate of 70. You do a chest X ray and see hyperinflation of the lungs, flattening of the diaphram and fluid in the horizontal fissure of the right lung.

Answer 24

Transient tacchypnoea of the newborn.

Question 25

Is transient tachypnoea of the newborn more common in babies born by vaginal delivery or C section?

Answer 25

C section

Question 26

What is the treatment for an acute asthma attack in a child?

Answer 26

Oxygen 
Nebulised salbutamol 
Oral prednisolone 
IV salbutamol 
IV aminophylline 
IV magnesium

Question 27

What are the most common causative organisms for pneumonia in neonates?

Answer 27

Group B Strep
E Coli
Klebsiella
Staph aureus

Question 28

What are the most common causative organisms for pneumonia in infants?

Answer 28

Strep pneumoniae

Chlamydia

Question 29

What are the most common causative organisms for pneumonia in school age children?

Answer 29

Strep pneumoniae
Staph aureus 
Group A Strep
Mycoplasma
Legionella

Question 30

What is the empirical treatment for community acquired pneumonia in children?

Answer 30

Non Severe: Amoxicillin for 7 days.Co Amoxiclav if less than 1. (Clarithromycin if allergic)
Severe: Co Amoxiclav IV. Add in clarithromycin if atypical pneumonia or pertussis.