Respiratory Conditions

Question 1

What are some side effects of antibiotic treatment in children?

Answer 1

Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Multi resistance

Question 2

What are some features of Rhinitis?

Answer 2

Common cold, runny nose. 
5-10 per year is normal. 
Winter months
Self-limiting
14-21 day duration
Can be a prodrome to pneumonia, bronchiolitis, meningitis or septicaemia.

Question 3

What are the features of Otitis Media?

Answer 3

Red and inflamed tympanic membrane which is about to burst.
Fever, ear pain and discharge.
Primary viral infection
Secondary infection with pneumococcus/H’flu.
Antibiotics usually do NOT help.
Watch and wait as self limiting.

Question 4

What are the features of Tonsillitis/pharyngitis?

Answer 4

Sore throat, red swollen tonsils, pus-sy spots.
Common
Can be viral or bacterial
Throat swab - 2 days for results.
Either watch and wait or Penicillin.
Do not give Amoxicillin as gives rash if have EBV.

Question 5

What are some features of Croup?

Answer 5

Laryngotracheo bronchitis. 
Para'flu I
Child is well just sounds bad. 
Barking cough, stridor, hoarse voice, coryza (runny nose). 
Treat oral dexamethasone.

Question 6

What are the features of Epiglottitis?

Answer 6

Rare
H. Influenzae type B
Child is severely unwell - emergency. 
Worse sore throat ever, can't swallow so drooling, stridor, high pulse/temp and low BP. 
Treat with intubation and antibiotics.

Question 7

What are some common agents that cause lower respiratory. tract infections?

Answer 7

Bacterial overgrowth - strep pneumoniae, Haemophillus infulenzae, Moraxella catarrhalis, mycoplasma pneumoniae, chlamydia pneumoniae.

Viral infection - RSV, parainfluenza III, influenza A and B, adenovirus, rhinovirus.

Question 8

What are the principles of management for LRTIs?

Answer 8

Make diagnosis
Assess patient - oxygenation, hydration, nutrition.
Treat or don’t treat.

Question 9

What are the features of Bronchitis?

Answer 9

Common
Loose rattly cough
Post-tussive vomit (after coughing fit phlegm).
Chest free of wheeze/creps
Haemophillus or Pneumococcus - disturbed mucocilliary clearance. 
Mostly self-limiting
Child very well. 
Antibiotics won't help.

Question 10

What is the cycle of bronchitis in winter?

Answer 10

Resp virus
Mucocilliary clearance stops for <4 weeks. 
Cough and rattle
Clearance almost recovers
Cycle repeats.

Question 11

What are some red flags for Bronchitis in children?

Answer 11

Age <6months or >4years
No relapse remission
Static weight
Disrupts child's life
Associated SOB when not coughing. 
Acute admission
Other co-morbidities

Question 12

What are the features of Bronchiolitis?

Answer 12

LRTI of infants peak at around 3months.
Usually RSV but can be para’flu III, HMPV.
Nasal stuffiness, tachypnoea, poor feeding.
Crackles and/or wheeze.
7-14day duration.
Worse by day 4/5, stabilises after this.
Monitor oxygenation, hydration and nutrition.
August to December

Question 13

What are some features of LRTI?

Answer 13

48hrs, fever, SOB, cough and grunting. 
Wheeze makes bacterial cause unlikely. 
Reduced or bronchial breath sounds. 
Virus + commensal bacteria. 
Treat with nothing if mild, oral amoxycillin 1st line, macrolide 2nd and IV only if vomiting.

Question 14

What are some features of Pertussis?

Answer 14

Whooping cough
Common even if vaccinated against it.
Coughing fits >2weeks
Vomiting and colour change.

Question 15

What are the key features of Asthma?

Answer 15

Wheeze and cough
Variability - relapse and remission.
Responds to treatment - inhaled corticosteroids.
Airflow obstruction.

Question 16

What known genes are involved in asthma predisposition?

Answer 16

ADAM33
ORMDL3
10 other variants making modest contribution.
Interact with environment.

Question 17

What causes asthma?

Answer 17

Primary epithelial abnormality (skin/gut/airway) results in eczema, asthma etc.
Allergy then occurs which fuels the eczema, asthma etc.

Question 18

How does asthma affect spirometry?

Answer 18

Reduced spirometry.

Cannot diagnose asthma.

Question 19

What are the tests for asthma according to the NICE guidelines?

Answer 19

Spirometry
BDR - broncho-dilator reversibility
FeNO
Peak Flow

Question 20

What are the symptoms of asthma?

Answer 20

Cough - dry, nocturnal and exertional.
SOB at rest - cooking in of ribs with wheeze.
Parental history
Personal Hx of eczema, hay fever, food allergies.

Question 21

What is the 1st line treatment for asthma?

Answer 21

Inhaled corticosteroids for 2 months.

Brown inhaler.

Question 22

What are the goals of asthma treatment?

Answer 22

Minimal symptoms during day and night.
Minimal need for reliever
No attacks
No limitation of physical activity.

Question 23

What are some questions to aid assessment of asthma control?

Answer 23

SANE
How many times a week do you use Short acting beta agonist?
Absence from school/nursery?
Nocturnal symptoms/week?
Excertional symptoms/week?
Child asthma Control test out of 27 is also useful.

Question 24

What is step 2 of asthma treatment?

Answer 24

Add a regular preventer if need beta agonists >2 days a week or symptomatic 3x a week or waking 1 night a week.

Low dose ICS or LTRA in <5s.

Question 25

What is step 3 of asthma treatment?

Answer 25

Add on LABA or LTRA (montelukast).

In some cases increase ICS dose.

Depends on what works for child.

Question 26

What is the treatment for Mild acute episodes of asthma?

Answer 26

SABA via spacer

SABA via spacer + prednisolone.

Question 27

What is the treatment for moderate acute episodes of asthma?

Answer 27

SABA via neb + prednisolone.

SABA + ipra via neb + prednisolone.

Question 28

What is the treatment fo severe acute episodes of Asthma?

Answer 28

IV salbutamol, IV aminophylline, Iv magnesium (neb), IV hydrocortisone
Intubate and ventilate.