Respiratory distress

Question 1

A 3-month-old girl, Kelly, is admitted to hospital with respiratory distress and wheezing and on examination there is marked indrawing, hyperexpansion and wheezes and fine crackles in the chest. Her temperature is 38.5oC, respiratory rate 60/min, pulse 120/min. Pulse oximetry reading is 89%. A diagnosis of bronchiolitis has been made.

What is the appropriate initial management for Kelly?

Question 1Select one:

a.
Oxygen administration and nasogastric fluids

b.
Intravenous salbutamol and hydrocortisone

c.
Nasotracheal intubation and mechanical ventilation

d.
Nebulised adrenaline and oral dexamethasone

Answer 1

Oxygen administration and nasogastric fluids

Supportive only

Question 2

In a 3 month old child with bronchiolitis what instructions should be given for optimal nursing care?

Question 2Select one:

a.
Rotate sleep position regularly

b.
Minimise handling of the baby

c.
Give oral paracetamol 4 hourly

d.
Obtain capillary gases 4 hourly

Answer 2

Minimise handling of the baby

Supine,do not rotate. Blood gas only if deteriorating.Parace not routine

Question 3

WHICH ONE of the following viruses is NOT a recognised cause of bronchiolitis?

Question 3Select one:

a.
Parainfluenza type three

b.
Respiratory syncytial virus

c.
Human metapneumovirus

d.
Human cytomegalovirus

Answer 3

Human CMV

Question 4

A 5-month-old boy presents in winter with a 3-day history of coryza, cough, mild fever and poor oral intake. He has previously been well and was born at 39 weeks gestation. He has 3 older siblings at school and preschool. On examination he has a cough, a temperature of 38.6o C and has oxygen saturations of 92% in room air. His respiratory rate is 60 and there is intercostal and lower costal recession. On auscultation of his chest there is soft wheeze throughout the chest with showers of fine inspiratory crackles. From the options provided WHICH ONE is the MOST LIKELY cause for this child’s clinical presentation?

Question 4Select one:

a.
Pulmonary fibrosis

b.
Infantile asthma

c.
Left-to-right shunt

d.
RSV bronchiolitis

Answer 4

RSV bronchiolitis

Question 5

Aleisha is a 9 month old child with acute onset of wheezing and respiratory distress following a runny nose, and on auscultation she has wheezing but no crackles on auscultation. She has eczema and her mother has asthma. Oxygen saturation is 93%. Nasal aspirate is positive for rhinovirus. A chest x-ray shows right middle lobe collapse.

This is Aleisha’s 5th episode of wheezing since 6 months of age.

What is the likely diagnosis?

Question 5Select one:

a.
Preschool asthma

b.
RSV Bronchiolitis

c.
Inhaled foreign body

d.
Lobar pneumonia

Answer 5

Preschool asthma

>4 episodes, eczema and family hx. no crackles, likely not rsv

Question 6

An 18 month old boy presents to the emergency department with a barking cough and inspiratory stridor. Over the past 24 hours he has had coryza and a mild fever (37.8 degrees Celsius).

What is the most likely micro-organisms responsible for his condition?

Question 6Select one:

a.
Parainfluenza virus

b.
Influenza B virus

c.
Coxsackie B virus

d.
Human rhinovirus

Answer 6

Parainfluenza virus

Question 7

An 18 month old girl has a 2 day history of what the mother describes as a harsh loud cough and loud wheezing. On examination she is cooperative but in moderate respiratory distress. She has a temperature of 38.5o C, respiratory rate of 35 breaths/minute, a frequent barking cough, a loud musical inspiratory noise and marked inter and subcostal recession. From the following list WHICH ONE is the MOST LIKELY diagnosis?

Question 7Select one:

a.
Acute viral croup

b.
Acute epiglottitis

c.
RSV Bronchiolitis

d.
Viral pneumonia

Answer 7

Acute viral croup

Question 8

Jack is a 2 year old boy with acute viral croup accompanied by inspiratory stridor and respiratory distress. His oxygen saturation level is 92%. WHICH ONE of the following treatments is MOST APPROPRIATE for Jack.

Question 8Select one:

a.
Subcutaneous adrenaline 1:1000

b.
Nebulised salbutamol 5 mg

c.
Dexamethasone po 0.15 mg/kg

d.
Inhalation of cold diffused mist

Answer 8

Dexamethasone po 0.15 mg/kg

treatment of choice for croup, reduces stridor + breathlessness

Question 9

While you are working in your surgery, the 9 month old boy who was sitting playing with Lego on the floor of the waiting room suddenly gasps, becomes distressed, tries to cry and falls on his back, blue in the face. the FIRST THING you should do is:

Question 9Select one:

a.
Time the seizure and give rectal valium if it lasts >5 minutes

b.
Give five sharp back slaps followed by five chest compressions

c.
Place in recovery position and call an ambulance

d.
Give a subcutaneous injection of adrenaline

Answer 9

Give five sharp back slaps followed by five chest compressions

Foreign body concern (playing w small objects)