Respiratory

Question 0

If a child is using his inhaler more than 2 times a week would you move them on to the next step of asthma management?

Answer 0

Yes

Inhaled beclometasone 200-400 micrograms OD.

Question 1

Why should long term use of LARGE dose steroids be avoided in children?
What can it cause?

Answer 1

Can induce adrenal suppression

Can reduce growth in large doses.

Question 2

What is the third stage of chronic asthma treatment?

Answer 2

Add on long acting B2 agonist eg salmeterol or formoterol

Question 3

What is the starting dose of inhaled steroids in step 2 of chronic asthma?

Answer 3

100-400 micrograms beclometasone Twice daily

Usually start at 200.

Question 4

Name 3 symptoms that asthma may present with..

Answer 4

Wheeze
Cough (dry)
Difficulty breathing +/- chest tightness

Question 5

What time of the day may asthmatic symptoms be worse?

Answer 5

Night time or early morning

Question 6

What can trigger asthma?

Answer 6

Exercise
Pets
Cold
Emotions

Question 7

What is it important to ask in the social Hx in asthma?

Answer 7

Smoking
Pets
Housing conditions (could be mouldy and damp)

Question 8

Is stridor inspiratory or expiratory?

Answer 8

Inspiratory

Question 9

What are the 4 main differentials of stridor?

Answer 9

Croup
Inhaled foreign body
Laryngomalacia
Epiglottitis

Question 10

What age is it appropriate to diagnose asthma?

What is more common in younger children?

Answer 10

3-4 years

Viral induced wheeze

Question 11

What virus causes bronchiolitis?

What other ones cause it?

Answer 11

RSV - respiratory syncytial virus

hMPV- human metapneovirus
Adenovirus
Parainfluenza

Question 12

At what age is bronchiolitis most common?

Answer 12

2-6 months old

It is only seen in under 1’s

Question 13

What are the symptoms of bronchiolitis?

Answer 13

Rhinorrhoea
Cough
Fever

Also:wheeze, vomiting, irritability, poor feeding, cyanosis.

Question 14

What is laryngomalacia?

Answer 14

Collapse of upper larynx during inspiration as it has immature cartilage

Question 15

What signs might you see in bronchiolitis?

Answer 15

Increased resp effort
Widespread inspiratory crackles
Liver and spleen may be palpable

Question 16

How long does bronchiolitis last for?

Answer 16

7-10 days

Question 17

What is the treatment for bronchiolitis?

Answer 17

Supportive care if serious.
Eg, oxygen, fluids or NG feed

Passive immunity to immunocompromised

Question 18

What is the main cause of croup?

What are the other causes?

Answer 18

Parainfluenza virus (type 1)

Respiratory syncytial virus
Adenovirus
Rhinovirus

Question 19

What is croup?

Answer 19

Upper airway inflammation caused by a viral infection

Question 20

What is the most common age group for croup to present in?

Answer 20

6 months to 3 years

Question 21

You have a 2 year old child with a barking cough, what do you think that have?

Answer 21

Croup

Question 22

What are non specific symptoms of URTI?

Answer 22

Rhinorrhoea
Fever
Cough
Sore throat

Question 23

How long does croup last for?

Answer 23

3-7 days

Question 24

What might a chest X-ray show in bronchiolitis?

Answer 24

Hyperinflation of the lungs die to small airways obstruction and air trapping

Question 25

What can you give to prevent bronchiolitis? | Who would you give this to?

Answer 25

Monoclonal antibody to RSV | Premature babies to as it is expensive

Question 26

Why might the liver be displaced downwards in bronchiolitis?

Answer 26

Because the hyper inflated chest pushes it down

Question 27

What virus causes croup?

Answer 27

Parainfluenza virus

Question 28

What organism causes epiglotitis?

Answer 28

Haemophilia influenza B

Question 29

When does bronchiolitis peak at it's worse?

Answer 29

3-4 days

Question 30

What age group is bronchiolitis associated with a more serious morbidity?

Answer 30

Less than 3 months

Question 31

What is Palivisumab?

Answer 31

A treatment for the prevention of bronchiolitis - antibody to give passive immunity

Question 32

How often is Palivisumab given?

Answer 32

Once a month over the winter months

Question 33

Who is Palivisumab given to?

Answer 33

Young children with Chronic lung disease Or Significant cardiac abnormality

Question 34

In asthma if no evidence of airway obstruction is found you might consider testing atopy status - how is this done?

Answer 34

Skin tests Blood eosinophilia raised specific IGE to cat dog/ mite

Question 35

What happens in a 'test of airway reversibility'?

Answer 35

Used when asthma diagnosis is unsure Do spirometery before and after using a bronchodilator

Question 36

What is a test of airway responsiveness?

Answer 36

Stimulate airway with exercise or methacholine For when diagnosis of asthma is unclear Good at ruling out asthma but not ruling in

Question 37

At what age should a child be able to do a peak flow/spirometery?

Answer 37

5 years old

Question 38

What is the max dose of inhaled steroids under 5's should get on the asthma steps?

Answer 38

400 micrograms per day

Question 39

What next dose should the 5-12 year olds get of inhaled steroids?

Answer 39

800 micrograms per day

Question 40

What is fluticasone?

Answer 40

Corticosteroid used in asthma

Question 41

What are he drug management steps in asthma under 5's?

Answer 41

1. Salbutamol 2. Corticosteroid 3. Montelukast (can be also be given at step 2 instead) 4. Refer to consultant

Question 42

What is the steps for managing asthma over 5's?

Answer 42

``` Salbutamol Corticosteroid Long acting B2 agonist (salmeterol) (Or try monteleukast/ sr theophylline) 4. Increase corticosteroid 5. Add daily steroid tablet ```

Question 43

What is xanthine?

Answer 43

Oral bronchodilator can be used in step 4 management of asthma in over 5's

Question 44

What is seretide?

Answer 44

Fluticasone plus salmeterol

Question 45

How long to steroid inhalers take to work after being started?

Answer 45

3-7 days

Question 46

Name some inhaled steroids..

Answer 46

Beclometasone Budesonide Fluticasone Mometasone

Question 47

Name 2 short acting B2 agonists..

Answer 47

Salbutamol | Terbultaline

Question 48

Name two long acting B2 agonists?

Answer 48

Formeterol | Salmeterol

Question 49

How much salbutamol is in one puff?

Answer 49

100 micrograms

Question 50

How much salbutamol should be taken in any day?

Answer 50

1-2 puffs up to QDS 800 micrograms Although 10 puffs if asthma attack

Question 51

What is the most common gene mutation to cause CF?

Answer 51

Delta F508

Question 52

How common is CF?

Answer 52

1:2500 newborns

Question 53

What is the carrier rate of CF in the Caucasian population?

Answer 53

1:25

Question 54

What is the gold standard test to diagnose CF?

Answer 54

Sweat test

Question 55

How much sweat do you need in a sample for a sweat test? | How much sodium chloride is diagnostic of CF?

Answer 55

100 mg of sweat | Over 60mmol/ L

Question 56

How can CF present in children who have been missed on the Guthrie card?

Answer 56

``` FFT Recurrent LRTI Diarrhoea Nasal polyps Rectal prolapse In neonates: Meconium illeus Prolonged jaundice ```

Question 57

What are the fat soluble vitamins?

Answer 57

ADEK

Question 58

What treatment can be given in whooping cough?

Answer 58

None to actually treat but erythromycin to make them less contagious

Question 59

When using aminophyline what measurements do you need to have in place?

Answer 59

Cardiac monitoring | Regular sampling because of narrow therapeutic window

Question 60

What is the peak flow in life threatening asthma?

Answer 60

Less than 33%

Question 61

What is the peak flow in severe asthma?

Answer 61

33-50%

Question 62

What is the peak flow in moderate asthma?

Answer 62

50-75%