Respiratory

Question 1

What virus usually causes bronchiolitis?

Answer 1

RSV (Respiratory Syncytial Virus)

Question 2

What age group is largely affected by bronchiolitis?

Answer 2

Children under 1

Most common under 6 months

Rare in children over 2

Question 3

What can be heard on auscultation of the lungs of a patient with bronchiolitis?

Answer 3

Bilateral wheeze and crackles

Question 4

What are the signs and symptoms of bronchiolitis?

Answer 4

• Coryzal symptoms
• Respiratory distress
• Dyspnoea
• Tachypnoea
• Poor feeding
• Fever
• Apnoeas
• Wheeze/crackles on auscultation

Question 5

What are the features of respiratory distress in children?

Answer 5

• Increased RR
• Accessory muscle use
• Flared nostrils
• Subcostal recession
• Intercostal recession
• Head bobbing
• Tracheal tugging
• Cyanosis
• Abnormal airway noises (such as stridor, wheezing or grunting)

Question 6

What are the main reasons to admit a child with bronchiolitis?

Answer 6

• Age less than 3 months
• Pre existing conditions such as prematurity, Downs Syndrome or CF
• less than 50-75% of normal milk intake
• Clinical dehydration
• RR greater than 70
• Sats less than 92%
• Moderate to severe respiratory distress
• Apnoeas

Question 7

What is the management of bronchiolitis in an inpatient?

Answer 7

Supportive:

• Ensure adequate intake (either oral, NG or IV)
• Saline nasal drops or nasal suctioning
• Supplementary oxygen
• Ventilatory support (high flow humidified O2, CPAP or intubation)

Question 8

What medication is used to prevent RSV induced bronchiolitis?

Answer 8

Palivizumab

• a monoclonal antibody that targets the RSV virus
• Given as a monthly injection for high risk patients such as prematurity or CF

Question 9

What is croup?

Answer 9

An URTI that typically affects children aged 6 months to 2 years

It results in oedema in the larynx which creates the characteristic barking cough, hoarse voice and stridor

Question 10

What usually causes croup?

Answer 10

Parainfluenza virus

Question 11

What are the signs and symptoms of croup?

Answer 11

• Increased respiratory effort
• Barking cough
• Hoarse voice
• Stridor
• Low grade fever

Question 12

What is the management of croup?

Answer 12

Majority resolve at home with basic supportive treatment, but if severe:

• Oral dexamethasone
• Usually given as a single dose of 150 mcg/kg, which can be repeated after 12 hours
• Prednisolone is another alternative

In severe croup, the treatment pathway is:

• Oral dex
• O2
• Budesonide nebs
• Adrenaline nebs
• Intubation/ventilation

Question 13

What is meant by a diagnosis of viral induced wheeze?

Answer 13

Due to small, narrow airways, respiratory tract infections can cause an acute wheeze similar in nature to asthma

This can lead to respiratory distress and increases the risk of later developing asthma

Question 14

How is viral induced wheeze differentiated from asthma?

Answer 14

Viral induced wheeze typically presents:

• Before age of 3
• Without history of atopy
• Only occurs during viral infections

Question 15

What are the signs and symptoms of a viral induced wheeze?

Answer 15

• Shortness of breath
• Signs of respiratory distress
• Expiratory wheeze bilaterally

Question 16

What is the management of viral induced wheeze?

Answer 16

Similar to acute asthma episodes:

• B2 agonists
• Ipratropium
• O2

Question 17

What are the features of moderate acute asthma?

Answer 17

• Peak expiratory flow rate at 50% to 75% of predicted
• Worsening SoB
• Increased RR
• Bilateral expiratory wheeze

Question 18

What are the features of severe acute asthma?

Answer 18

• Peak expiratory flow less than 50% of predicted
• RR greater than 25
• HR greater than 110
• Unable to complete full sentences

Question 19

What are the features of life threatening acute asthma?

Answer 19

• Peak expiratory flow less than 33%
• O2 sats less than 92%
• Exhaustion
• Loss of wheeze (airways so tight there is no air entry); also known as ‘silent chest’
• Haemodynamically instable/Shock