Respiratory System 2

Question 1

What is the other name for croup?

Answer 1

Acute laryngotracheobronchitis

Question 2

Define croup?

Answer 2

Mucosal inflammation with increased secretions - affecting the airways with oedema of the subglottic area - potentially life-threatening!

Question 3

What is the main causative agent of croup?

Answer 3

Parainfluenza virus - 95%

Question 4

What is the age range of children affected by croup - and what is the peak onset?

Answer 4

6months - 6 years

Peak = 2 years

Question 5

Describe the classical presentation of croup?

Answer 5

Onset is insidious (over a few days with slow progression) initially coryza followed by stridor, wheeze and a classical ‘barking’ cough

Question 6

What causative agent commonly causes epiglottis?

Answer 6

Haemophilias influenza B

Associated with septicaemia

Question 7

What age bracket does epiglottitis often affect?

Answer 7

1 - 6 years

Question 8

Describe 5 signs and 3 symptoms associated with epiglotitis?

Answer 8

Soft stridor
Drooling slaiva
Inability to drink
Toxic appearance
Child often leans forward
NO cough
High grade fever
Sore throat

Question 9

What should be avoided in children with suspected epiglotitis?

Answer 9

Attempts to lie the child flat

O/E of the throat

Question 10

What is the typical finding on laryngoscopy of a child presenting with epiglotitis?

Answer 10

‘Cherry’ red swollen epiglotis

Question 11

Define asthma?

Answer 11

Chronic inflammatory disorder of the airway with reversible airway obstruction and typical symptoms (diurnal variation)

Question 12

Describe four symptoms associated with asthma?

Answer 12

Cough - recurrent and dry - worse at night/exercise
Wheeze - expiratory
SOB - triggers and exercise limitation
Chest tightness

Question 13

Name six common triggers for asthma?

Answer 13

Smoking
Exercise
Pollen/dust
Beta blockers
Aspirin

Question 14

On Hx and O/E of a child with asthma - what five relevant likelihoods are there?

Answer 14

Family and personal Hx of atopy
Widespread wheeze on auscultation 
Acid reflux - 60%
Unexplained peripheral blood eosinophillia 
Symptoms improve with treatment

Question 15

O/E of a child with asthma - what three findings may be apparent with uncontrolled asthma?

Answer 15

Silent chest - SEVERE
Harrison’s sulcus
Barrel chest

Question 16

What two things might CXR of a child with asthma show?

Answer 16

Air trapping (hyper-inflation)
Collapse (mucous plugging)

Question 17

Describe the management of a child under the age of five with asthma?

Answer 17

1. Short acting B2 agonist
2. Inhaled corticosteroid
3. Monteleukast
4. Refer

Question 18

Describe the management of a child over the age of five with asthma?

Answer 18

1. Short acting B2 agonist
2. Inhaled corticosteroid
3. Long acting B2 agonist (+Monteleukast/theophyline)
4. Increase inhaled corticosteroid dose
5. Oral steroids/ Refer

Question 19

In an acute asthma attack - define what constitutes a ‘mild’ attack?

Answer 19

Peak flow = 50% or higher than normal

Breathlessness without distress

Question 20

In an acute asthma attack - define four factors that constitute a ‘severe’ attack?

Answer 20

Peak flow = Less than 50% normal
Too breathless to talk/feed
RR higher than 50
HR higher than 130

Question 21

Describe five factors that constitute a ‘life threatening’ asthma attack?

Answer 21

1. Peak flow below 33%
2. Silent chest
3. Cyanosis
4. Fatigue/confusion
5. Decreased BP