Respiratory System

Question 1

With regards to ‘signs’ of respiratory distress, which three components can they be broken down into?

Answer 1

Effort
Efficacy
Effect

Question 2

Name five signs related to ‘Effort’ within respiratory distress?

Answer 2

Child's positioning
Use of accessory muscles - (intercostal and subcostal recession)
Nasal flaring
Grunting
Increased respiratory rate

Question 3

Name four signs related to ‘Efficacy’ within respiratory distress?

Answer 3

Chest expansion
O2 sats
Air entry
Auscultation

Question 4

Name four signs related to ‘Effect’ within respiratory distress?

Answer 4

Heart rate
Skin colour (initially pale - late stage = cyanosed)
Confusion
Decreased AVPU

Question 5

What is the typical range of respiratory rate for an infant 0-2 months?

Answer 5

40 - 60

Question 6

What is the typical range of respiratory rate for an infant 2 months - 1 year?

Answer 6

30 -50

Question 7

What is the typical range of respiratory rate for a pre school child?

Answer 7

20-40

Question 8

What is the typical range of respiratory rate for an adult?

Answer 8

12 - 20

Question 9

Name five signs of severe respiratory distress in an infant?

Answer 9

Drowsiness/unresponsiveness
Agitation
Increased respiratory effort (marked use of accessory muscles)
Cyanosis
Auscultation = SILENT chest

Question 10

A 9 month old baby presents with a four day history of a dry cough with poor feeding, wheeze and breathlessness after initially having a runny nose. What is the most likely diagnosis?

Answer 10

Bronchiolitis

Question 11

What is the most common causative agent for bronchiolitis?

Answer 11

RSV - 80% (endemic in winter months)

Question 12

On examination of a baby with bronchiolitis, what are the most common findings?

Answer 12

Widespread wheeze
FINE inspiratory crackles
Tachypnoea
Intercostal and subcostal recession

Question 13

In bronchiolitis, what finding may be more apparent to baby’s under 4 months old?

Answer 13

Apnoea (temporary cessation of breathing - particularly in sleep)

Question 14

How is bronchiolitis managed?

Answer 14

Supportive treatment - feed little and often

Question 15

Name three indications for hospital admittance?

Answer 15

1. Poor feeding
2. Apnoea and signs of increased respiratory distress
3. Decreased O2 saturation

Question 16

Name the most likely causative agent of pneumonia in newborns?

Answer 16

Group B strep

Question 17

Name the three most likely causative agents of pneumonia in infants and toddlers?

Answer 17

RSV (C)
Strep. pneumoniae (C)
Haemophilus influenza
(staph aureus - rare but serious)

Question 18

Name the four most likely causative agents of pneumonia in children 5+?

Answer 18

Strep. pneumoniae
Haemophilus influenza
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 19

Which two agents are more commonly seen in children with underlying respiratory conditions (i.e. CF)?

Answer 19

Pseudomonas aeruginosa

Staph aureus

Question 20

Name a sign that may possibly indicate a bacterial pneumonia over a viral?

Answer 20

Localised chest pain = pleuritic irritation = more likely bacterial cause

Question 21

Describe three signs consistent with consolidation in children with pneumonia?

Answer 21

Dullness to percussion
Increased vocal resonance
COURSE crackles on auscultation

Question 22

Name four steps in the management of pneumonia?

Answer 22

O2
Analgesia
Fluids
Amoxicillin - 1st line