3008 Respiratory

Question 1

Name 3 anatomical differences in a paediatric airway that complicate airway management.

Answer 1

Larger tongue, floppy epiglottis, higher anterior larynx with a sharp curve.

Question 2

Why is a smaller airway diameter a problem in children?

Answer 2

Small changes cause significant resistance; more likely to cause turbulent flow (wheeze/stridor).

Question 3

Until what age does airway smooth muscle continue to develop, and what is the clinical implication?

Answer 3

Until age 7; salbutamol may be less effective in younger children.

Question 4

What are key signs of increased work of breathing in a child?

Answer 4

Nasal flaring, grunting, chest recession, use of accessory muscles, tracheal tug.

Question 5

What is the main difference between stridor and wheeze?

Answer 5

Stridor = inspiratory, upper airway; Wheeze = expiratory, lower airway.

Question 6

Give an example of a condition causing a ventilation vs. an oxygenation problem.

Answer 6

Ventilation: Asthma, Croup; Oxygenation: Pneumonia, Anaemia.

Question 7

How does croup present and how is it treated?

Answer 7

Barking cough, stridor at night; treat with oral prednisolone and nebulised adrenaline.

Question 8

What symptoms suggest epiglottitis over croup?

Answer 8

Sick child, drooling, head/neck extension, no cough.

Question 9

How does a foreign body obstruction present?

Answer 9

Sudden onset choking, coughing, localised wheeze, possible pneumonia later.

Question 10

What is the clinical course of bronchiolitis?

Answer 10

Worsens over 3–5 days, then gradually improves.

Question 11

How is bronchiolitis managed in children?

Answer 11

Supportive care, oxygen if needed, feeding support, CPAP if severe.

Question 12

Name the 3 components of asthma pathophysiology.

Answer 12

Bronchospasm, airway oedema, mucous plugging.

Question 13

How is mild/moderate asthma treated prehospital?

Answer 13

Oxygen if SpO₂ <92%, salbutamol puffer, ipratropium (if needed), oral steroids.

Question 14

What are signs of severe asthma?

Answer 14

Silent chest, RR > 60, SpO₂ < 90%, inability to speak full sentences, altered consciousness.

Question 15

List three advanced treatments for severe asthma.

Answer 15

Nebulised salbutamol/ipratropium, IV steroids (hydrocortisone), IV MgSO₄.

Question 16

How can anaphylaxis affect the respiratory system?

Answer 16

Causes airway oedema, bronchospasm, possible respiratory collapse.

Question 17

First-line treatment for anaphylaxis in children?

Answer 17

IM adrenaline (0.01 mL/kg of 1:1000), consider nebulised adrenaline or salbutamol.

Question 18

Why are infants at higher risk of respiratory fatigue?

Answer 18

High oxygen consumption, compliant chest wall, and immature respiratory muscles.

Question 19

How does oxygen consumption in children compare to adults?

Answer 19

Children have a higher basal metabolic rate, so they consume more oxygen per kg.

Question 20

Why are neonates under 6 weeks at higher risk for apnoea?

Answer 20

Immature central respiratory control, especially in premature infants.

Question 21

What should you observe first in a paediatric respiratory exam?

Answer 21

General appearance, interaction, posture, colour, and work of breathing.

Question 22

What vital signs indicate organ compromise in a sick child?

Answer 22

Altered GCS, poor cap refill, hypotension, bradycardia or tachycardia, low SpO₂.

Question 23

What do wheezes and crackles suggest on chest auscultation?

Answer 23

Wheeze = airway obstruction; Crackles = fluid or inflammation in alveoli.

Question 24

How is bacterial tracheitis different from croup?

Answer 24

Tracheitis causes fever, painful breathing, and a sick-looking child—less responsive to croup treatments.

Question 25

How can you differentiate croup from epiglottitis?

Answer 25

Croup = barking cough, responsive to steroids; Epiglottitis = drooling, no cough, toxic appearance.

Question 26

What are red flags for foreign body aspiration in children?

Answer 26

Sudden cough or wheeze, localised decreased air entry, history of choking, not febrile.

Question 27

Why do we use inspiratory and expiratory X-rays for suspected airway foreign bodies?

Answer 27

To detect air trapping and hyperinflation, especially during expiration.

Question 28

What should you avoid when managing a choking child?

Answer 28

Blind finger sweeps—can cause trauma, bleeding, or push object further in.

Question 29

Name 4 body systems affected by anaphylaxis.

Answer 29

Respiratory, cardiovascular, skin (rash), and gastrointestinal.

Question 30

What factors predict severe bronchiolitis?

Answer 30

Prematurity, chronic lung disease, early severe symptoms, apnoea history.

Question 31

When should feeding be a concern in bronchiolitis?

Answer 31

If intake drops below 50% of normal—risk of dehydration and fatigue.

Question 32

How can you differentiate asthma from bronchiolitis?

Answer 32

Asthma = older child, responsive to salbutamol; Bronchiolitis = <2 years, progressive, not salbutamol-responsive.

Question 33

What is the role of IV magnesium sulfate in asthma?

Answer 33

Smooth muscle relaxant used for severe or refractory asthma.

Question 34

Is adrenaline preferred over salbutamol for asthma?

Answer 34

False – Salbutamol is preferred; adrenaline has more side effects and no proven benefit.

Question 35

What are signs of salbutamol (Ventolin) toxicity?

Answer 35

Agitation, tachycardia, muscle tremor, lactic acidosis.

Question 36

Why is giving 10mg salbutamol nebs or adrenaline not recommended in children?

Answer 36

Can cause toxicity, increased oxygen demand, and acidosis.

Question 37

A 4-year-old is febrile, drooling, sitting upright, and has inspiratory stridor. What’s your top differential and priority action?

Answer 37

Suspect epiglottitis. Do not examine the airway. Provide oxygen, keep child calm, prepare for emergency airway support and urgent transport.

Question 38

A 10-month-old has progressive wheezing, mild fever, and poor feeding over 2 days. Diagnosis and management?

Answer 38

Likely bronchiolitis. Supportive care, monitor oxygen sats, encourage feeding, admit if sats <92% or apnoeas occur.

Question 39

A 2-year-old suddenly starts coughing and has localized wheeze after playing. Diagnosis and action?

Answer 39

Suspect foreign body aspiration. Supportive care, oxygen, urgent hospital transfer for bronchoscopy if needed.

Question 40

Child presents with a barking cough, mild stridor, and low-grade fever. What’s the likely diagnosis and treatment?

Answer 40

Croup. Treat with oral prednisolone (1 mg/kg) and nebulised adrenaline if stridor at rest or significant distress.

Question 41

What does a silent chest in a child with asthma suggest, and what should you do?

Answer 41

Sign of severe airway obstruction. Start nebulised salbutamol and ipratropium, give oxygen, consider IV steroids and prepare for advanced airway management.

Question 42

Which patients are at highest risk of apnoeas with bronchiolitis?

Answer 42

Infants <3 months, especially premature babies.

Question 43

Why do infants with bronchiolitis need continuous monitoring even if initially stable?

Answer 43

Because symptoms peak at day 3–5, and desaturations/apnoeas can occur unpredictably, especially during sleep or feeding.

Question 44

What dose of salbutamol and ipratropium would you give a 5-year-old with asthma using a spacer?

Answer 44

6 puffs salbutamol, 4 puffs ipratropium via spacer.

Question 45

When is nebulised adrenaline indicated in croup?

Answer 45

Moderate to severe croup: stridor at rest, significant work of breathing, or signs of hypoxia.

Question 46

Why do you reassess after each neb dose in asthma?

Answer 46

To determine response and avoid overtreatment/toxicity (e.g., lactic acidosis, tachycardia, agitation).

Question 47

What history flags a child as high-risk in an asthma presentation?

Answer 47

Previous ICU admission, intubation, or frequent hospitalisations for asthma.

Question 48

A child has increased work of breathing but no wheeze or stridor. What could this suggest?

Answer 48

Very severe asthma (silent chest), foreign body, or fatigue/apnoea in bronchiolitis.

Question 49

What is a key clinical clue to oxygenation rather than ventilation failure?

Answer 49

Effortless tachypnoea (e.g., in carbon monoxide poisoning or anaemia).

Question 50

In which phase of breathing do you expect wheeze vs. stridor?

Answer 50

Wheeze = expiratory, stridor = inspiratory (can become biphasic in severe obstruction).