Respiratory

Question 1

What is the classical triad seen in asthma?

Answer 1

Cough, shortness of breath, wheeze

Symptoms tend to be worse at night and in early morning

Question 2

What test should be used to aid diagnosis of asthma in children?

Answer 2

Spirometry with improvement in FEV1 of 12% following bronchodilator (e.g. salbutamol) therapy

Question 3

What is the first step in asthma management in kids?

Answer 3

Salbutamol (Short acting b2 agonist) prn

Question 4

What is the second step in asthma management in kids 5 or over?

Answer 4

Add on very low dose inhaled corticosteroid (e.g. beclametasone)

Question 5

What is the second step in asthma management in kids under 5?

Answer 5

Add on a leukotriene receptor anatgonist (e.g. montelukast)

Question 6

What is the third step in asthma management in kids 5 or over?

Answer 6

In addition to the salbutamol and v. low dose ICS, add on Long Acting B2 agonist (e.g. Salmeterol)

Question 7

What is the third step in asthma management in kids under 5?

Answer 7

In addition to the salbutamol and montelukast, add on a very low dose inhaled corticosteroid (e.g. beclametasone)

Question 8

What is the fourth step in asthma management in children?

Answer 8

If no response to LABA, stop this and increase ICS dose
If some response to LABA but control still inadequate, continue but consider increasing dose of ICS and trialling a LRTA.

Question 9

What is the fifth step in asthma management in children?

Answer 9

Increase dose of ICS again

Question 10

What is the fifth step in asthma management in children?

Answer 10

Daily low dose steroid tablet

Question 11

When is asthma control deemed inadequate and therefore consideration given to moving up the asthma management ladder?

Answer 11

If requiring reliever inhaler more than twice a week.

Question 12

What should all children receive to aid delivery of inhaled drugs?

Answer 12

A spacer

Question 13

Which age group is most commonly affected by bronchiolitis and when is the peak incidence?

Answer 13

0-2 year olds.

Peak incidence: 3-6 months

Question 14

What organism is most commonly causative of bronchiolitis?

Answer 14

Respiratory syncytial virus (RSV) is the pathogen in ~80% of cases.

Question 15

How may bronchiolitis present?

Answer 15

Coryzal Sx preced a sharp, dry cough with SOB. Subcostal and intercostal recession. Feeding difficulty. High pitched wheeze. Hyperinflated chest. Fine end inspiratory crackles.

Question 16

What structures become inflamed in Croup?

Answer 16

Larynx, trachea, bronchi

Question 17

Which age group is most commonly affected by croup and when is the peak incidence?

Answer 17

6 months - 6 years.

Peak incidence: 1-3 years

Question 18

What organism is most commonly causative of croup?

Answer 18

Parainfluenza virus

Question 19

How may croup present?

Answer 19

Stridor, barking cough (worse at night), fever, coryzal symptoms. There may be intercostal and sternal recession

Question 20

How is croup managed?

Answer 20

Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity. In emergency situation, high flow O2 and nebulised adrenaline

Question 21

What organism most commonly causes epiglottitis?

Answer 21

Haemophilus influenza B (hence low incidence now due to vaccine)

Question 22

What symptoms may be seen in someone with epiglottitis?

Answer 22

Stridor, drooling, ‘hot potato voice’, sudden onset, very unwell child, fever.

Question 23

What scoring system helps determine severity and guides management of croup?

Answer 23

Westley Croup score
=< 3: ok, send home, parents to monitor progress
4-7: steroids and admit
>= 8: Resus

Question 24

What are the most common causative organisms of pneumonia in neonates?

Answer 24

Group B strep, E.coli, gram -ve bacilli, chlamydia trochamatis

Question 25

What are the most common causative organisms of pneumonia in pre-school children?

Answer 25

Viral: parainfluenza, influenza, RSV, adenovirus Bacterial: Strep. pneumonia (90%), H. influenza, bordatella pertussis.

Question 26

Sputum is often described as yellow-greeny in pneumonia, what might be the appearance of the sputum in pneumonia due to strep. pneumoniae?

Answer 26

Rusty

Question 27

What are common causative organisms of tonsillitis?

Answer 27

Group A beta-haemolytic streptococci | Epstein-Barr virus

Question 28

What forms the modified Centor criteria for bacterial tonsillitis?

Answer 28

1. Absence of cough 2. Fever > 38 degrees 3. Anterior cervical lymphadenopathy 4. Tonsillar exudates Score of 3 or more suggests Group A strep may be the cause and therefore antibiotics may be of benefit

Question 29

What is the first choice antibiotic in tonsillits?

Answer 29

Phenoxymethylpenicillin aka Penicillin V

Question 30

How common is cystic fibrosis?

Answer 30

Commonest life-limiting autosomal recessive condition in Caucasians. Incidence: 1 in 2500 1 in 25 are carriers

Question 31

What is the defective protein in Cystic Fibrosis and where is the gene for this protein located?

Answer 31

Cystic Fibrosis Transmembrane conductance Regulator (CFTR) - a chloride channel in cell membranes. The gene is located on chromosome 7.

Question 32

What is the most common mutation that leads to Cystic Fibrosis?

Answer 32

Delta F508

Question 33

What are the cardinal symptoms of CF?

Answer 33

Recurrent chest infections, loose, offensive stool and FTT

Question 34

How may someone present with CF?

Answer 34

Mostly picked up via Guthrie screen on day 5 of life - results ~3 weeks. 15-20% will get meconium ileus, presenting on day 1-2 of life with failure to pass meconium and billious vomiting - managed with gastrograffin enema or bowel surgery +/- stoma. Babies have to be above 3/4kg to have diagnostic sweat test.

Question 35

In CF patients, infection with what organism causes a doubling in the rate of lung function decline?

Answer 35

Pseudomonas aeringuosa

Question 36

Presence of which bacteria in the lungs of patients with CF prevents lung transplantation and how is it deteceted?

Answer 36

Non-tuberculosis mycobacterium | Alcohol and acid fast bacilli (AAFB) test

Question 37

What will be seen on CT chest of a CF patient if there is bronchiectasis?

Answer 37

Signet ring sign

Question 38

How is CF managed?

Answer 38

Chest physio. Prophylactic antibiotics. Mucolytics (inc. DNAase). Inhalers. Likely need long-term IV access (PICC line or Port-a-cath). Lung transplant. For the gut, high fat/high protein/high calorie diet. Creon (pancreatic enzyme replacement therapy). Vitamin replacements. Insulin often required as diabetes likely to develop.

Question 39

What is the name of the test that diagnoses Tuberculosis?

Answer 39

Mantoux test

Question 40

What is the management of tuberculosis?

Answer 40

Quadruple therapy with rifampicin, isoniazid, pyrazinamide, ethambutol. Reduced to just rifampicin and isoniazid after 2 months. Treatment often needed for 6 months, longer if disseminated disease.

Question 41

What is the causative organism of whooping cough?

Answer 41

Bordatella pertussis

Question 42

How may whooping cough present?

Answer 42

Typically, week long catarrhal phase then characteristic paroxysmal/spaspmodic coughing stage with inspiratory whoop noise. Coughing spasms worse at night and may culminate with vomiting. Paroxysmal phase lasts 3-6 weeks.

Question 43

How is whooping cough managed?

Answer 43

Although erythromycin eradicates the organism, it is only effective if started during the catarrhal phase. Immunisation reduces risk of the condition.