Paeds resp

Question 1

What is the stepwise management of an acute asthma presentation?

Answer 1

1. High flow oxygen
2. Nebulised salbutamol (2.5mg <5 yrs, 5mg >5yrs)
3. Nebulised ipratropium bromide (250 mcg)
4. Oral prednisolone (20mg <5 yrs, 40mg >5 yrs)
5. IV hydrocortisone (4 mg/kg)

Question 2

What is the stepwise management of a severe acute asthma presentation?

Answer 2

1. IV salbutamol bolous + MgSO4
2. IV salbutamol infusion or IV aminophyline
3. If still not improving add the other from step 2
4. Resp support

Question 3

What is the stepwise management of childhood asthma?

Answer 3

1. SABA (salbutamol)
2. • low dose ICS (beclomethasone)
3. • LTRA (montelukast)
4. • LABA (salmeterol) and stop LTRA (differs to adult management)
5. Switch LABA/ICS to MART with low dose ICS
6. MART with moderate dose ICS
7. Specialist management

Question 4

Asthma respiratory rate:
1. What RR would indicate severe asthma in 1-5 year old
2. What RR would indicate severe asthma in >5 year old

Answer 4

1. > 40
2. > 30

Question 5

Asthma heart rate:
1. What HR would indicate severe asthma in 1-5 year old
2. What HR would indicate severe asthma in >5 year old

Answer 5

1. > 140
2. > 125

Question 6

Asthma peak flow:
1. What peak flow indicates moderate asthma
2. What peak flow indicates severe asthma
3. What peak flow indicates life threatening asthma

Answer 6

1. PF >50% predicted
2. PF <50% predicted
3. PF <30% predicted

Question 7

What age group does bronchiolitis typically affect?

Answer 7

Children under 1

Question 8

What is the most common cause of bronchiolitis?

Answer 8

RSV

Question 9

What is the management of bronchiolitis?

Answer 9

• Supportive
• Ensuring adequate intake (oral/NG/IV)
• Nasal suctioning
• Supplementary oxygen (if sats <92%)
• Ventilatory support (if required)

Question 10

What babies are considered high risk for bronchiolitis?

Answer 10

Ex-premature and congenital heart disease

Question 11

What preventer is given to babies at high risk of bronchiolitis?

Answer 11

Palivizumab - a monoclonal antibody that targets RSV

Question 12

What 3 features distinguish viral induced wheeze from asthma?

Answer 12

• Presenting < 3 years old
• No atopic Hx
• Only occurs during viral infections

Question 13

What is the management of viral induced wheeze?

Answer 13

The same as acute asthma

Question 14

What’s the most common cause of 1) bacterial pneumonia and 2) viral pneumonia?

Answer 14

1) Strep pneumonia
2) RSV

Question 15

What is often first line treatment for bacterial pneumonia?

Answer 15

Amoxicillin

Question 16

When is IV antibiotic therapy indicated for pneumonia?

Answer 16

When there is sepsis or a problem with intestinal absorption

Question 17

The addition of what type of antibiotics would cover atypical pneumonia?

Answer 17

Macrolide (erythromycin)

Question 18

What age group is typically affected by croup?

Answer 18

Ages 6 months to 2 yrs

Question 19

Croup is an URTI that results in…

Answer 19

… oedema in the larynx

Question 20

What is the most common cause of croup?

Answer 20

Parainfluenza

Question 21

What is the stepwise management of croup?

Answer 21

1. Supportive (fluids and rest)
2. Oral dexamethasone (single dose 150mcg/kg)
3. Oxygen
4. Nebulised budesonide
5. Nebulised adrenaline
6. Intubation and ventilation

Question 22

What is epiglottis typical caused by?

Answer 22

Haemophilus influenza B

Question 23

What investigation can be carried out in epiglottis? What would it show?

Answer 23

• Lateral XR of neck
• ‘Thumb sign’

Question 24

What is the management of epiglottis?

Answer 24

1. Inform senior paediatrician and anaesthetist
2. Once airway secure - IV abx (ceftriaxone), steroids (dexamethasone)

Question 25

What is the inheritance pattern of CF?

Answer 25

Autosomal recessive

Question 26

What is normally the first sign of CF?

Answer 26

Meconium ileus

Question 27

When is CF first screened for?

Answer 27

Newborn blood spot testing

Question 28

What is the gold standard test for diagnosing CF?

Answer 28

Sweat test

Question 29

What is a diagnostic chloride concentration for CF (in sweat test)?

Answer 29

>60 mmol/L

Question 30

CF infections: 1. What are the 2 key microbial colonisers in CF 2. What prophylactic antibiotics do patients take and what for

Answer 30

1. Staph aureus and pseudomonas 2. Prophylactic flucloxacillin for staph aureus

Question 31

What is whooping cough caused by?

Answer 31

Bordetella pertussis

Question 32

How long does it take for the symptoms of whooping cough to resolve? What's it sometimes referred to?

Answer 32

- Within 8 wks - The '100 day cough' as can last several months

Question 33

When is a child admitted due to asthma exacerbation deemed stable enough to be discharged? What is the step down salbutamol regime?

Answer 33

When on 6 puffs of salbutamol 4 hourly Step down: - 6 puffs 4 hourly for 48 hrs - 4 puffs 6 hourly for 48 hrs - 2-4 puffs as required

Question 34

What dose of dexamethasone is given in croup? When can it be repeated?

Answer 34

150mcg/kg. Can be repeated after 12 hours