Respiratory

Question 1

Asthma pathology

Answer 1

IgE ab to allergens

Question 2

S+S asthma

Answer 2

Cough, SOB, wheeze Worse at night + early in morning

Question 3

Management of acute asthma attack

Answer 3

Salbutamol inhaler or nebs, high flow O2 if sats <92%

Steroids early - Oral prednisolone or IV hydrocortisone if severe

• add iprotropium if not responding or nebulised MgSO4

If not improving: IV salbutamol and/ or aminophylline

Critical care review if not improving

Question 4

Pathogen causing bronchiolitis + RF

Answer 4

Respiratory syncytial virus (RSV)

RF: passive smoking

Question 5

S+S bronchiolitis

Answer 5

Coryzal symptoms, dry cough, SOB, decreased feeding Wheeze (high pitched, expiratory) Hyperinflation of chest Widespread crackles

Often following a viral URTI

Question 6

Pathology + epidemiology of croup

Answer 6

Laryngotracheobronchitis that causes mucosal infalmmation + increases secretions Oedema of subglottic area Usually caused by parainfluenza virus

Most common between 6 months - 3 years

Question 7

S+S croup

Answer 7

Barking cough Harsh inspiratory stridor Hoarseness, symptoms of URTIWorse at night

Takes hours - days to come on

Question 8

Management of croup

Answer 8

Oral dexamethasone or oral prednisolone (takes longer to work)

Budesonide nebs

If severe = adrenaline nebs

Lasts 3-7 days

Question 9

Pathology of epiglottitis

Answer 9

Intense swelling of epiglottis Caused by haemophilus influenza B

Question 10

S+S epiglottitis

Answer 10

High fever, toxic looking child Painful throat Saliva drooling down chin Soft stridor Cough is absent

Question 11

Management of epiglottitis

Answer 11

Intubation IV cefuroxime Rifampicin to rest of house

Question 12

Causes of pneumonia in children

Answer 12

Newborn: group B strep Infants: RSV, strep pneumonia, haemophilus influenza Children: mycoplasma pneumoniae, strep pneumonia, chlamydia pneumonia

Question 13

S+S pneumonia

Answer 13

Fever, difficulty breathing Cough Poor feeding Chest/ abdo pain = pleural irritation Transient pleural rub Tachypnoea

Question 14

Management of pneumonia

Answer 14

Supportive Co-amoxiclav for newborns + severely ill Oral amoxicillin or erythromycin for older children

Question 15

Causes of tonsillitis

Answer 15

Group A beta haemolytic strep EBV, RSV, rhino + adenovirus

Question 16

Complications of tonsillitis

Answer 16

Quinsy - peritonsillar abscess Cervical abscess Acute nephritis (2-3 weeks later) Rheumatic fever (1-2 weeks later)

Question 17

Management of tonsillitis

Answer 17

Penicillin V or erythromycin

Question 18

Genetics of cystic fibrosis + epidemiology

Answer 18

Defective CFTR protein - its a cyclic AMP dependent chloride channel - controls chloride transport Gene located on chromosome 7 Most common defect is on delta F508

Autosomal recessive

Affects 1 in 2500 newborns

Question 19

Pathology of CF

Answer 19

Impaired ciliary function Thick meconium produced Mucus secretions in pancreatic ducts Abnormal function of sweat glands

Question 20

S+S of CF

Answer 20

Perinatal presentation: screening, meconium ileus, prolonged jaundice, haemorrhagic disease

Infancy + children presentation: Recurrent chest infections, poor growth, malabsorption, loose offensive stools, acute pancreatitis, rectal prolapse, diarrhoea, nasal polyps

Infection with staph aureus, haemophilus influenza + pseudomonas aeruginosa Hyperinflation of the chest Pancreatic insufficiency - leads to malabsorption + steatorrhoea

Signs: bilateral changes, clubbing, cough, purulent sputum, wheeze, obstructive FEV1

Question 21

What is the investigation for CF?

Answer 21

Guithre test - screening of newborn Diagnosed with sweat test >60mmol Cl+

CT head + thorax, genetic testing after diagnosis

Question 22

Management of meconium ileus in CF

Answer 22

Gastrografin enema but may need surgery

Question 23

Respiratory management of CF

Answer 23

Physio twice a day Continuous abx (flucloxacillin + azithromycin) Nebulised saline, regular sputum samples

Question 24

Nutritional management of CF

Answer 24

Oral enteric coated pancreatic replacement therapy (Creon)

High calorie diet Overnight feeding via gastrostomy

Vitamin supplements (K, A, D, E)

Question 25

Complications of CF

Answer 25

DM Liver disease Bowel obstruction Chest infections Infertility due to absence of vas deferens in males Survival 40-50 years

Question 26

Screening for CF

Answer 26

Screen for immunoreactive trypsinogen in heel-prick test in newborns

Question 27

Bacterial + viral causes of otitis media

Answer 27

RSV, rhinovirus Pneumococcus, H influenza, moraxella catarrhalis

Question 28

Complications of glue ear

Answer 28

Mastoiditis Meningitis Sinus thrombosis Cerebral abscess

Question 29

Management of otitis media

Answer 29

Symptomatic Amoxicillin if needed Grommet insertion if persistent

Question 30

Causes of stridor

Answer 30

Croup, foreign body, epiglottitis Abscess, anaphylaxis

Question 31

S+S TB

Answer 31

Prolonged fever Malaise, anorexia Weight loss Tuberculous meningitis Cervical adenopathy

Question 32

Management of TB

Answer 32

Rifampicin, isoniazid, pyrazinamide, ethambutol

Question 33

Incubation period for whooping cough + causative organism

Answer 33

Bordetella pertussis 7-14 days

Question 34

S+S whooping cough

Answer 34

Coryzal symptoms initially Paroxysmal/ spasmodic cough then inspiratory whoop Worse at night, may culminate in vomiting During cough, child goes red/ blue in the face Lasts 3-6 weeks, up to 12 weeks

Question 35

Management of whooping cough

Answer 35

Erythromycin only works if given if catarrhal phase

Question 36

Complications of whooping cough

Answer 36

Pneumonia Lobal collapse Convulsions due to hypoxia Haemorrhage (nose, eyes, brain)

Question 37

Investigations + management of bronchiolitis

Answer 37

Nasal viral swab Most managed at home but hospital admission if: \<50% feeding, lethargy, significant tachypnoea, grunting, cyanosis, sats \<94% Supportive management: O2 + NG feeds

Question 38

When is bronchiolitis most common, and how many kids get it?

Answer 38

Most common between 2-6 months 80% kids have it by age 2

Question 39

Ways to give oxygen to babies?

Answer 39

High flow O2 therapy (humidified + warmed, nasal cannula) - can give up to 40L a min Oxygen box over head

Question 40

Prognosis for bronchiolitis

Answer 40

Usually lasts 7-10 days, mortality is higher with underlying heart + lung disease Immunoprophylaxis is available for high risk groups: congenital cardiac or lung disease (ex-prems) + congenital immunodeficiencies. Injections over winter period, once a month for 4/5 months

Question 41

What score is used to assess croup, and when should a child be hospitalised?

Answer 41

Westley score for croup: assesses chest wall retractions, stridor, cyanosis, consciousness, air entry Aged \<6 months Poor oral intake Severe obstruction Immunocompromised

Question 42

Differentials for CF (when a child is FTT, RTI, wheezy)?

Answer 42

Immunodeficiencies + PCD

Question 43

When is a port-a-cath used?

Answer 43

CF

Question 44

When do peak flows become useful?

Answer 44

Over 5-7 to get a good reading

Question 45

Management of asthma in \>5 y/o

Answer 45

Low dose ICS + LABA. If not working, remove + increase ICS. If working but not well, increase ICS and + LTRA + theophylline REFER + daily oral prednisolone

Question 46

Management of asthma in \<5 y/o

Answer 46

SABA + ICS/ LTRA (tablet) REFER

Question 47

Criteria for acute severe asthma

Answer 47

Sp02 \<92% PEF 33-50% Can't complete sentences in 1 breath HR \>125 in kids \>5 years; \>140 in kids 1–5 years RR \>30 in kids aged \>5 years; \>40 in kids aged 1–5 years

Question 48

Criteria for acute life-threatening asthma

Answer 48

SpO2 \<92% PEF \<33% Silent chest, cyanosis, poor resp effort, hypotension, exhaustion, confusion

Question 49

SE of inhaled steroids

Answer 49

Stunted growth + oral thrush

Question 50

How much O2 can be delivered in a non- rebreathe mask?

Answer 50

80%

Question 51

S+S of inhaled foreign body + most common location

Answer 51

Right main bronchus Wheeze, cough, stridor, absent/ decreased resp sounds

Question 52

Management of tension pneumothorax

Answer 52

Thoracocentesis

Question 53

Typically what is the age range for croup + bronchiolitis?

Answer 53

Bronchiolitis = 2-6 mths Croup = 6 mths - 3 years

Question 54

Describe PCD

Answer 54

Primary ciliary dyskinesia 50% also have situs inversus Hearing problems