respiratory problems in childhood

Question 1

How are children different to adults?

Answer 1

Sedentary lifestyle difference
Airways different shapes
Physiological maturity
e.g. β2 receptors
Reserves different
Chest wall compliance – resp distress different
Immunisation difference

larynx is more cylindrical in adults and more funnel shaped in infants–> important in BLS

Question 2

what is a wheeze

Answer 2

noise in expiration

Question 3

what is a wheeze associated with?

Answer 3

small airway pathology

Question 4

what is stridor?

Answer 4

noise on inspiration

Question 5

what is stridor associated with?

Answer 5

large/upper airway pathology e.g. obstruction

Question 6

what is grunting?

Answer 6

breathing against a partially closed glottis

Question 7

management of RDS

Answer 7

Manage with artificial surfactant via ETT and respiratory support
Antenatal steroids to accelerate maturation

Question 8

what is meconium

Answer 8

baby’s first bowel movement

Question 9

consequences of meconium aspiration

Answer 9

Causes chemical pneumonitis
Can lead to secondary bacterial infection
Further complications include PPHN and pneumothorax

Question 10

symptoms of bronchiolitis

Answer 10

Age <1year
Coryzal illness
Bronchiolitic cough
Bilateral wheeze and crackles
<1y

Question 11

most common cause of bronchiolitis

Answer 11

RSV

Question 12

mx of bronchiolitis

Answer 12

Respiratory
Nutrition
Secondary infections
Nebs ineffective- b2 receptors haven’t developed yet

Question 13

symptoms of a viral induced wheeze

Answer 13

wheeze
no chronic element
no interval symptoms 
secondary to bronchospasm
>1y

Question 14

mx of viral induced wheeze

Answer 14

Responds to bronchodilators

Steroids not indicated unless history of atopy

Question 15

what is croup?

Answer 15

Viral infection of upper airways

Question 16

signs and symptoms of croup

Answer 16

Inflammation -> stridor

Question 17

most common cause of croup

Answer 17

parainfluenza virus

Question 18

how do we measure severity of croup?

Answer 18

Wesley Croup score

Question 19

mx of croup

Answer 19

First line management steroids (dexamethasone)
May require adrenaline nebs or respiratory support (rare)
Epiglottitis (emergency, very rare due to immunisations)

Question 20

what is the OMG sign for epiglottitis

Answer 20

OMG this child looks unwell

Question 21

signs of whooping cough

Answer 21

High WCC +++ (lymphocytes)

cough

Question 22

mx of whooping cough

Answer 22

Treat with a macrolide
Azithromycin
Clarithromycin
(Consult local micro guidelines – differs)

Question 23

pathophys of CF

Answer 23

Sodium-chloride channel abnormality

ΔF508 gene

Question 24

systems affected in CF

Answer 24

respi
GI
repro