Respiratory Pathology

Question 1

A paradoxical coughing spasms which occur on expiration and then followed by a sharp intake of breath is a sign of what?

Answer 1

Pertussis - i.e. whooping cough

Question 2

How is whooping cough diagnosed?

Answer 2

Per-nasal swab

Question 3

What are some differentials of acute respiratory distress in infants?

Answer 3

RSV
Inhaled foreign body
Bronchiolitis
Whooping cough
Croup
Acute epiglottis

Question 4

What is the causative organism of acute epiglottitis?

Answer 4

Haemophilus influenza

Question 5

What are the main viral causes on pneumonia in children?

Answer 5

RSV
Influenza
Parainfluenza
Adenovirus
Coxsackie virus

Question 6

What are the main bacterial causes on pneumonia in children?

Answer 6

Haemophilus influenzae
Streptococcus pneumonia
Mycoplasma

Question 7

In neonates what bacterial infection is most likely to cause pneumonia and other significant complications?

Answer 7

Group B bet-haemolytic streptococcus

Question 8

In children with cystic fibrosis, what infectious agents are more likely to be the source of their pneumonia?

Answer 8

Pseudomonas Aeruginosa

Staphylococcus aureus

Question 9

An infant <2 years old comes in coughing and coryzal with difficulty feeding, respiratory distress and apnoea. There are wheezes and crackles heard on auscultation. What is the most likely diagnosis?

Answer 9

Bronchiolitis

Question 10

What is the pathology of bronchiolitis?

Answer 10

This is a LRTI caused by obstruction of the lower airways (small bronchioles) which is usually self limiting and lasts about 7-10 days
Main cause is RSV
Other causes include adenovirus, parainfluenza and influenza.

Question 11

What will be seen on a CXR of a child with bronchiolitis?

Answer 11

Hyperinflation with patchy consolidation

Question 12

What is common respiratory condition in children, caused by parainfluenza which presents with coryzal symptoms, barking cough and stridor?

Answer 12

Croup a.k.a. acute laryngotracheobronchitis

Question 13

How is croup managed?

Answer 13

Dexamethasone IV 0.15mg/kg

If in severe respiratory distress give adrenaline nebulised at 400 micrograms/kg

Question 14

Why must a patient be monitored after receiving steroids for respiratory distress?

Answer 14

Rebound symptoms can occur

Question 15

What illness can occur secondary to croup?

Answer 15

Bacterial tracheaitis

Question 16

How is bacterial tracheaitis managed?

Answer 16

3rd generation cephalosporins (broad spectrum cover)

Question 17

What are the most common causative organisms of bacterial tracheaitis

Answer 17

Staph Aureus
Moroxella
Catarrhalis
Strep Pneumonia
Haemophilus influenza

Question 18

Define stridor:

Answer 18

A high pitched noise heard on inspiration, caused by partial obstruction of the airway (upper airway)

Question 19

List some congenital causes of stridor:

Answer 19

Laryngomalacia
Web / stenosis
Double arch aorta a.k.a vascular ring

Question 20

This illness is an acute cause of stridor which can be fatal due to airway closure. It presents with an acutely unwell child, drooling, fever, distressed and irritable with signs of a sore throat. NO COUGH
What is the diagnosis?

Answer 20

Acute epiglottitis

Question 21

What might be seen on examination of acute epiglottitis?

Answer 21

Cherry red epiglottis

Question 22

What is the management for acute epiglottitis?

Answer 22

Keep the child upright
DO NOT examine throat or cause any kind of distress
Call for an ENT or anaesthetist to intubate as loss of airway is highly likely
Treat with dexamethasone and antibiotics

Question 23

What antibiotic therapy is used for haemophilus B?

Answer 23

Cefotaxime