Paeds respiratory

Question 1

gene and chromosome cystic fibrosis

Answer 1

CFTR - codes a cAMP-regulated chloride channel

F508 on the long arm of chromosome 7

Question 2

Organisms which may colonise CF patients?

Answer 2

Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus

Question 3

Diagnostic test cystic fibrosis

Answer 3

sweat test - high sweat chloride
normal value < 40 mEq/l,
CF indicated by > 60 mEq/l

Question 4

Cystic fibrosis drug

Answer 4

Lumacaftor/Ivacaftor (Orkambi)

Fluclox to prevent s.aureus

Question 5

Investigation bronchiolitis

Answer 5

immunoflurescence of nasal secretions may show RSV

Question 6

A 3-year-old boy is brought into the emergency department with cough and noisy breathing following a 3-day history of coryzal symptoms. On examination, he is afebrile but has harsh vibrating noise on inspiration, intercostal recession and a cough. He is systemically well

Answer 6

croup

Question 7

A 5 month old baby, fever 38.2, coroyzal, struggling to feed< 75% of normal, RR of 70,

Answer 7

bronchiolitis

Question 8

Pathogen croup

Answer 8

Parainfluenza virus

Question 9

Pathogen bronchiolitis

Answer 9

RSV

Question 10

Pathogen pneumonia

Answer 10

Streptococcus pneumoniae

Question 11

Pathogen whooping cough

Answer 11

Bordetella pertussis

Question 12

Investigation pneumonia

Answer 12

CXR

Question 13

Management pneumonia in children

Answer 13

Amoxicillin

Macrolides may be added if there is no response to first line therapy

Question 14

Mangement pneumonia ?chlamydia or ?mycoplasma

Answer 14

Macrolides eg erythromycin

Question 15

Management pneumonia associated with influenza

Answer 15

co-amoxiclav

Question 16

Presentation bronciolitis

Answer 16

coryzal
mild fever
feeding difficulties
wet cough
wheeze
breathlessness

Question 17

when should children be admitted immediately with bronchiolitis 999

Answer 17

apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

Question 18

when should you consider hospital admission with bronchiolitis

Answer 18

a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration.

Question 19

Management bronchiolitis

Answer 19

humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%

nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth

suction is sometimes used for excessive upper airway secretions

Question 20

Prevention of bronchiolitis

Answer 20

Palivizumab is a monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease eg premature.

Question 21

what time of year is croup most common

Answer 21

autumn

Question 22

peak incidence croup

Answer 22

6mo-3years

Question 23

features croup

Answer 23

stridor
barking cough (worse at night)
fever
coryzal symptoms

Question 24

Indications for admission croup

Answer 24

< 6 mo age
known upper airway abnormality eg laryngomalacia, downs

anyone with mod/severe:
- frequent barking cough
- stridor
- wall recession

severe = distress

Question 25

Xray sign croup

Answer 25

a posterior-anterior view will show subglottic narrowing, commonly called the 'steeple sign'

Question 26

Xray sign epiglottitis

Answer 26

a lateral view in acute epiglottitis will show swelling of the epiglottis - the 'thumb sign'

Question 27

Management croup - routine and emergency

Answer 27

- oral dex (0.15mg/kg) to everyone emergency: - high flow O2 - nebulised adrenaline 3. neb budesonide 4. ENT

Question 28

features epiglottitis

Answer 28

rapid onset high temperature, generally unwell stridor drooling of saliva 'tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

Question 29

diagnosis epiglottitis

Answer 29

direct visualisation (only by senior/airway trained staff)

Question 30

Management epiglottitis

Answer 30

- ENT and anesthetics - endotracheal intubation - O2 - IV abx

Question 31

Pathogen epiglottitis

Answer 31

HiB

Question 32

Which of EV wheeze and MT wheeze are associated with asthma

Answer 32

Episodic viral wheeze is not associated with an increased risk of asthma in later life although a proportion of children with multiple trigger wheeze will develop asthma

Question 33

Management multiple trigger wheeze

Answer 33

1. If > 4 significant episodes per year consider a 3 month trial of inhaled corticosteroid 2. LRTA

Question 34

When should whooping cough be suspected

Answer 34

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features: Paroxysmal cough. Inspiratory whoop. Post-tussive vomiting. Undiagnosed apnoeic attacks in young infants.

Question 35

Investigations whooping cough

Answer 35

nasopharyngeal swab PCR anti-pertussis toxin immunoglobulin G (oral if <5, blood if >5)

Question 36

Management whooping cough

Answer 36

Macrolide antibiotics such as azithromycin, erythromycin and clarithromycin can be beneficial in the early stages (within the first 21 days) or vulnerable patients. Co-trimoxazole is an alternative to macrolides.

Question 37

when are pregnant women offered whooping cough vaccine

Answer 37

16-32 weeks

Question 38

school exclusion whooping cough

Answer 38

48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Question 39

complications whooping cough

Answer 39

subconjunctival haemorrhage pneumonia bronchiectasis seizures

Question 40

inheritance primary ciliary dyskinesia

Answer 40

autosomal recessive

Question 41

risk factor primary ciliary dyskinesia

Answer 41

consanguinity

Question 42

Kartagner’s triad

Answer 42

the three key features of PCD: Paranasal sinusitis Bronchiectasis Situs Inversus

Question 43

Diagnostic investigation PCD

Answer 43

nasal brushing or bronchoscopy (sample)

Question 44

risk factors laryngomalacia

Answer 44

Invasive ventilation Prematurity