Respiratory

Question 1

What is the first investigation in mgmt of likely laryngomalacia?

Answer 1

Flexible laryngoscopy

Question 2

What are the indications for investigation of likely laryngomalacia?

Answer 2

Stridor at rest
Late onset (> 4 months old)
Poor weight gain
Persistent or severe stridor 

Note: usually self resolves by 1 yr old

Question 3

In an acute severe asthma attack the peak flow is 33-50% of best/predicted T/F

Answer 3

T

Other features:

• Can’t complete sentences in one breath
• O2 < 92%
• HR > 140 or RR > 40 in 2-5 yrs; HR >125 or RR >30 in >5

Question 4

OSA is commonly associated with nocturnal enuresis T/F

Answer 4

T - thought to be due to changes in intra thoracic pressure leading to increased production of atrial natriuretic peptide –> increased frequency of urination

Note: also associated with poor growth and polycythaemia due to prolonged hypoxaemia

Question 5

What is the 1st line treatment in new diagnosis Crohns disease?

Answer 5

Elemental diet or steroid monotherapy

Would choose elemental therapy over steroids if the child is young so there is concern about growth or there have already been issues with growth

Question 6

Where is an azygous lobe seem on CXR?

Answer 6

Right upper lobe

Normal variant - seen in 0.5% chest xray

Question 7

According to the NICE guidelines for what persistent O2 saturation is oxygen supplementation rec for bronchiolitis?

Answer 7

Persistently less than 92%

Question 8

Defn of a + sweat test?

Answer 8

Chloride greater than or equal to 60mmol

Question 9

What % of infants born with mec ileus have CF?

Answer 9

> 95%

Note: 15% of new borns with CF will present with mec ileus

Question 10

A large bore chest tube is indicated in the drainage of an empyema T/F

Answer 10

F - want a thin bore, shown these patient are d/c from hospital earlier

Question 11

When a person is standing is the blood flow and ventilation higher or low at the apex compared to the bases?

Answer 11

Both are lower at the apex

Note: the V/Q ratio is higher at the apex though as the reduction in V is less than the reduction in Q

Question 12

Does congenital lobar emphysema commonly upper or lower lobes?

Answer 12

Commonly the upper lobes

Of note it can be found incidentally on chest xray and be asymptomatic

Question 13

Pulmonary stenosis is a common cause of pulmonary hypertension T/F

Answer 13

F - pulmonary stenosis protects against pulmonary hypertension

Question 14

Common causes of pulmonary hypertension

Answer 14

1. Chronic lung disease
2. Post tricuspid shunts - large VSD, atrioventricular septal defect, PDA
3. Cardiomyopathy
4. TGA
5. Familial/idiopathic (most common)

Question 15

What is the most common cause of pulmonary hypertension in paediatrics?

Answer 15

Idiopathic or familial disease (55%)

Followed by pulmonary htn secondary to congenital heart disease (35%) and resp disorders (15%).

Question 16

What is the most common secondary cause of pulmonary htn in children?

Answer 16

Congenital heart disease

Note: familial or idiopathic is the most common cause overall though

Question 17

Compare the clinical presentation of croup to epiglottitis

Answer 17

Croup - barking cough, hoarse voice, harsh stridor, non toxic appearing, no drooling

Epiglottitis - no cough, muffled voice, soft stridor, sudden onset, toxic

Question 18

What is the most common cause of epiglottitis?

Answer 18

H influenzae B

Note: bacterial tracheitis is also commonly caused by H flu or staph aureus

Question 19

Most common cause of croup?

Answer 19

Parainfluenza

Question 20

In Guilain-Barre syndrome what is the most sensitive measure of rest muscle weakness?

Answer 20

Vital capacity - used to monitor progression

Note: GBS leads to restrictive lung disease

Question 21

Pulmonary haemorrhage results in what type of resp failure?

Answer 21

Type 1 - due to V/Q mismatch and results in hypoxia without hypercarbia

Injury to lung parenchyma - other type 1 pulmonary oedema, resp distress syndrome

Question 22

Where is surfactant made?

Answer 22

Type 2 pneumocytes

Question 23

What is the function of type 1 pneumocytes?

Answer 23

Gas exchange

Question 24

Nebulised steroids have no role in the treatment of croup T/F

Answer 24

F - can be helpful in reducing upper airway swelling

Question 25

In croup inhaled humid air only helps with symptom relief T/F

Answer 25

T - no therapeutic effects, can relieve symptoms in some cases

Question 26

What children with asthma should be considered for monoclonal antibody treatment?

Answer 26

Children over the age of 6 with severe and persistent asthma

Question 27

What is the drug used for RSV prophylaxis called?

Answer 27

Palivizumab

Question 28

Tidal vol is the vol inspired with each breath at rest T/F

Answer 28

F - it is inspired AND expired

Note: functional residual capacity is what is left in the lungs after normal tidal expiration

Question 29

Total lung capacity is the total vol of air in the lungs following max inspiration T/F

Answer 29

T

Question 30

Total lung capacity is the max volume of air that can be expired after a max inspiration T/F

Answer 30

F - this is vital capacity

Question 31

Residual is a commonly measured PFT T/F

Answer 31

F - it cannot be measured via spirometry, it is the volume of air remaining in the lungs after max expiration