Respiratory

Question 1

Antibiotics side effects

Answer 1

Diarrhoea
Oral thrush 
Nappy rash 
Allergic reaction 
Multiresistance

Question 2

What is rhinitis

Answer 2

irritation and inflammation of the mucous membrane inside the nose

Self limiting

Question 3

What can rhinitis lead to?

Answer 3

Pneumonia
Bronchiolitis
Meningitis
Septicaemia

Question 4

Otitis Media

Answer 4

Ear infection
Self limiting
Primary viral infection 
Secondary infection with pneumococcus 
Erythema 
Bulging drum

Question 5

Treatment for otitis media

Answer 5

Analgesia

Antibiotics (may work >24 hours)

Question 6

Investigation for tonsillitis/ pharyngitis

Answer 6

Throat swab

To determine if viral or bacterial

Question 7

Treatment for tonsillitis/ pharyngitis

Answer 7

Amoxicillin if bacterial !

Question 8

Croup cause and presentation

Larygnotracheobronchitis

Answer 8

Cause- para flu 1
Lasts about 3 days

Presentation:
Child seems well,
Coryza ++
Stridor
Hoarse voice
“Barking” cough

Question 9

Treatment for croup

Answer 9

Oral dexamethasone
Can give prednisolone

Severe nebulised adrenaline

Question 10

Cause of epiglottitis

And presentation?

Answer 10

Cause- haemophillius influenzae type B

Presentation- very unwell, stridor, drooling, severe sore throat

Question 11

Eiglottitis treatment

Answer 11

Intubation and antibiotics

Question 12

Common bacterial agents in children LRTI

Answer 12

Strep pneumoniae, 
Haemophilus influenzae,
Moraxella catarrhalis,
Mycoplasma pneumoniae, 
Chlamydia pneumoniae

Question 13

Common viral infections in children causative agent

Answer 13

RSV
Parainfluenza III
Influenza A and B
Adenovirus 
Rhinovirus

Question 14

Bronchitis presentation

Answer 14

Loose rattly cough,
Post-tussive vomit- “glut”

No wheeze or creps

Question 15

Common causative agent in bronchitis

Answer 15

Haemophilus/ pneumococcus

Question 16

Treatment for bronchitis

Answer 16

Self limiting

Question 17

What is happening to cause bacterial bronchitis

Answer 17

There is disturbed mucociliary clearance so clearance stops for about 4 weeks
Resulting in cough and rattle

Question 18

Red flags in LRTI (7)

Answer 18

Age <6months
Age >4 years
No relapse-remission
Static weight
Disrupts child’s life
Associated SOB (when coughing)
Acute admission 
Other co-morbidities

Question 19

Presentation of bronchiolitis

Answer 19

Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze

Question 20

Common causative agent of bronchiolitis?

Answer 20

RSV
Paraflu III
HMPV

Question 21

Prognosis of bronchiolitis

Answer 21

Day 2-5 gradual gets worse
Day 5-7 remains stable
Day 7-14 gradual recovery

Question 22

Common age to be affected by bronchiolitis

Answer 22

3 months
Born in August-December

Overall typically less that 12 months

Question 23

Management of bronchiolitis

Answer 23

Maximal observation

Minimal intervention

Question 24

Investigations in bronchiolitis

Answer 24

Oxygen saturations

Nasopharyngeal aspirate

Question 25

General lower respiratory tract infection signs

Answer 25

``` 48 hours Fever, SOB, Cough, Grunting, Reduced or bronchial breath sounds ```

Question 26

If a wheeze is present is the infection likely caused by a virus or bacteria

Answer 26

Virus

Question 27

When would you call a LRTI pneumonia

Answer 27

If signs are focal, Crepitations, High fever

Question 28

Treatment for community acquired pneumonia

Answer 28

Nothing if symptoms are mild Oral amoxycillin first line Oral macrolide second choice IV if vomiting

Question 29

Pertussis presentation

Answer 29

Coughing fits Vomiting Colour change of child (red)

Question 30

First line in all URTI and LRTI treatment

Answer 30

Oxygenation, Hydration, Nutrition

Question 31

When would you treat otitis media with antibiotics and which one if so?

Answer 31

If aged under 2 and has bilateral OM Oral amoyxcillin

Question 32

What key words are associated with asthma definitions

Answer 32

Wheeze Variability Responds to treatment

Question 33

What causes asthma

Answer 33

``` Host response to environment Infection Physiology abnormal before symptoms Genes- ADAM33 ORMDL3 Primary epithelial abnormality ```

Question 34

What are the 5 ways asthma pathways to asthma

Answer 34

``` 1- infant onset 2- childhood onset 3- adult onset 4- exertional asthma 5- occupational asthma ```

Question 35

Investigations for asthma (but not diagnostic)

Answer 35

Peak flow Spirometry Exhaled nitric oxide Response to corticosteroids

Question 36

Symptoms/signs of asthma

Answer 36

Wheeze, SOB at rest (“sooking” in of ribs) Dry cough (nocturnal and exertional) Responds to treatment

Question 37

Risk factors for asthma

Answer 37

Eczema Hayfever Food allergies

Question 38

What age range is resp symptoms more likely to be asthma

Answer 38

Over 5 more likely asthma | Under 18 months most likely infection

Question 39

Differential diagnosis for asthma under 5 years

Answer 39

``` Congenital CF PCD Bronchitis Foreign body ``` Primary ciliary dyskinesia

Question 40

Differential diagnosis for asthma over 5 years

Answer 40

Dysfunctional breathing Vocal cord dysfunction Habitual cough Pertussis

Question 41

Goals of asthma treatment

Answer 41

“minimal” symptoms during day and night minimal need for reliever medication no attacks (exacerbations) no limitation of physical activity

Question 42

How to measure asthma control

Answer 42

``` SANE Short acting beta agonist/ week Absence school/nursery Nocturnal symptoms/ week Excertional symptoms/ week ```

Question 43

Initial treatment of asthma

Answer 43

Low dose Inhaled corticosteroid Review after 2 months

Question 44

Classes of medications used in asthma

Answer 44

``` Short acting beta agonists Inhaled corticosteroids Long acting beta agonists Leukotriene receptor antagonists Theophyllines Oral steroids ```

Question 45

How does treatment for asthma in children differ from adults

Answer 45

``` Max dose ICS 800micrograms for <12 years No oral B2 tablet LTRA first line preventer in <5y No LAMAs Only 2 biologicals ```

Question 46

Step 2 of treatment of asthma | And when to go onto stage 2

Answer 46

Regular preventer- low dose ICS (or LTRA in <5y) when? -diagnostic test -B2 agonist >2 days a week Symptomatic 3 times a week or more or waking one night a week

Question 47

Adverse effects of ICS

Answer 47

``` Height suppression Oral candidiasis Adrenocortical suppression Hypertension Cataracts ```

Question 48

Step 3 of treatment of asthma

Answer 48

add on LABA or LTRA (leukotriene receptor anatagonist (montelukast) was

Question 49

Step 4 of asthma treatment

Answer 49

Refer to specialist Increase ICE Add 4th drug eg theophylline

Question 50

Other non-medical management for asthma

Answer 50

Stop tobacco smoke exposure | Remove environmental triggers

Question 51

How to treat someone with acute asthma

Answer 51

Mild: SABA via spacer Or SABA via spacer and prednisolone Moderate: SABA via nebuliser + prednisolone SABA + ipratropium via nebuliser + prednisolone ``` Severe: IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate ```