Respiratory Conditions

Question 1

Which gene is defective in cystic fibrosis?

Answer 1

The cystic fibrosis transmembrane regulator gene on chromosome 7

Question 2

How common is cystic fibrosis in Caucasians?

Answer 2

1 in 2500 live births, carrier rate 1 in 25

Question 3

True / False - Testing for cystic fibrosis is routinely done as part of the newborn heel-prick test?

Answer 3

True

Question 4

Which age group is most commonly affected by bronchiolitis?

Answer 4

0-12 months. It is rare after 3 year.

Question 5

Which organism causes over 50% of cases of bronchiolitis?

Answer 5

Respiratory syncytial virus

Question 6

What is the treatment for bronchiolitis?

Answer 6

Supportive - keep hydrated and maintain saturations with humidified oxygen. CPAP or ventilation only required in a very small number of severe cases.

Question 7

What are the classical symptoms of croup?

and age group?

Answer 7

Barking cough
Stridor
URI (LOW - grade fever)
worse at night
3 months - 6 years

Question 8

Which virus causes croup?

Answer 8

Parainfluenza virus

Question 9

True / False: A throat examination should be performed on a child with epiglottis to check for exudates on the tonsils

Answer 9

FALSE - It’s important not to distress a child with epiglottisitis as this can make it much worse so NEVER look in their throat

Question 10

What is the management of croup?
all croup?
mild and moderate?

Answer 10

All croup - Corticosteriods (one dose IV or PO)
(dexamethasone)
Mild = no stridor at rest –> outpatient
Moderate = stridor at rest –> hospital
- Humidified oxygen
- Nebulised budesonide
- Nebulised adrenaline may be required
- Intubation in extremis (about 2% of children)

Question 11

Which organism causes acute epiglottitis?

Answer 11

Haemophilus influenza B

streptococci, pneumonic

Question 12

True / False: Whooping cough (pertussis) is highly infectious

Answer 12

True

Question 13

What age group are affected by croup?

Answer 13

3 months to 6 years

Question 14

Which organisms are responsible for causing pneumonia throughout childhood?

Answer 14

Neonate = Group B streptococcus
Infancy = Viral infection especially RSV
Childhood = Strep. pneumoniae, mycoplasma pnemonia, haemophilus influenza

Question 15

When should a patient with chronic asthma be advised to check their peak flow?

Answer 15

At least morning and evening, and preferably again during the day as well

Question 16

In asthmatics, are peak flow values generally lower in the morning or in the evening?

Answer 16

Morning

Question 17

Give an example of a long-acting beta-2 agonist added in at Step 3 of asthma management in children

Answer 17

Salmeterol

Question 18

What might be heard on auscultation of the chest in bronchiolitis?

Answer 18

Fine end-inspiratory crackles

Expiratory wheeze

Question 19

Which infants are particularly at risk of severe bronchiolitis?

Answer 19

Premature
Chronic lung disease
Passive smokers

Question 20

True / False: Steroids are not indicated in bronchiolitis, but bronchodilators are

Answer 20

FALSE - Neither of these have been shown to improve outcomes in bronchiolitis so NEITHER are indicated

Question 21

What is the underlying pathology in bronchiolitis?

Answer 21

Inflammation of the small airways (bronchioles)

Question 22

What is the underlying pathology in croup?

Answer 22

Inflammation of the upper airway and increased secretions causing upper airway obstruction

Question 23

What causes the stridor in croup?

Answer 23

Subglottis edema causing tracheal narrowing

Question 24

True / Flase: Epiglottitis is common in the UK

Answer 24

False - Children are vaccinated against HiB so it’s uncommon

Question 25

What are some clinical features of epiglottis?

Answer 25

Very acute onset
HIGH Fever, toxic looking child - they look unwell!
Child is open mouthed to help open the away
Drooling
Intensely painful throat - child cannot speak or swallow
Inspiratory stridor, respiratory distress
NO cough

Question 26

What is the management of epiglottis?

Answer 26

• Sit child upright, do not examine throat, do not distress
• Alert senior paediatrician, ENT surgeon, anaesthetist
• ITU admission and intubation
• Antibiotics: Ceftriaxone or cefataxime…usually a 3-5 day course
• Extubation usually after 24 hours

Question 27

Give some key clinical features of cystic fibrosis in neonates and children

Answer 27

Faltering growth
Meconium ileus
Recurrent infections
Bronchiectasis
Clubbing
Diabetes mellitus
Steatorrhoea

Question 28

What is the goal standard test for diagnosis of cystic fibrosis?

Answer 28

Sweat test looking for raised chloride ion levels

pilocarpine iontophoresis sweat test

Question 29

What is a key infective organism which affects patients with cystic fibrosis?

Answer 29

Pseudomonas

Question 30

What is the causative organism in whooping cough?

Answer 30

Bordetella pertussis

Question 31

Can the pertussis vaccination be given to pregnant women?

Answer 31

Yes - It is an inactivated vaccine

Question 32

What is the incubation period of pertussis?

Answer 32

10-14 days

Question 33

What are the clinical features of whooping cough?

Answer 33

Coryza
‘Whooping’ cough (caused by inspiration against closed glottis) worse at night
Vomiting after coughs
Epistaxis and subconjunctival haemorrhage may result from vigorous coughing
Apnoeas in neonates

Question 34

What investigations might be carried out in pertussis?

Answer 34

Pernasal swab

Lymphocytosis on WCC

Question 35

What are the key differences in features between epiglottitis and croup?

Answer 35

Croup: Harsh loud cough, hoarse voice, child will appear more ‘well’
Epiglottitis: NO cough, muffled voice, toxic looking child

Question 36

S&S of bronchiolitis?

Answer 36

URI symptoms
moderate fever
tachypnea, wheezing, restlessness, retracting
hyperinflated lungs on CXR - not needed