Respiratory

Question 1

Usual cause of bronchiolitis?

Answer 1

Respiratory syncytial virus (RSV)

Question 2

Usual age for bronchiolitis?

Answer 2

Under 1 (most commonly under 6 months)

Question 3

Presentation of bronchiolitis?

Answer 3

Coryzal symtpoms
Dyspnoea
Tachypnoea
Poor feeding
Wheeze and crackles on auscultation

Question 4

Signs of respiratory distress?

Answer 4

Raised resp. rate
Accessory muscle involvement
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises

Question 5

Abnormal airway noises?

Answer 5

Grunting
Wheezing
Stridor

Question 6

Typical RSV course?

Answer 6

Coryzal symptoms
1-2 days chest symptoms
Day 3-4 usually worst
Lasts 7-10 days

Question 7

Management of bronchiolitis?

Answer 7

Supportive management

• intake
• nasal suctioning
• oxygen if needed

Question 8

Palivizumab?

Answer 8

Monoclonal antibody against RSV given to ex-premature or congenital heart disease

Question 9

Viral induced wheeze or asthma?

Answer 9

Viral induced wheeze more likely if:

• Presenting under 3
• No atopic history
• Only occurs during viral infections

Question 10

Presentation of viral induced wheeze?

Answer 10

Evidence of viral illness
SOB
Respiratory distress
Expiratory wheeze throughout the chest

Question 11

Focal wheeze in children?

Answer 11

Think inhaled foreign body

Question 12

Presentation in pneumonia?

Answer 12

Cough (wet and productive)
High fever
Increased resp. effort
Tachypnoea
Tachycardia
Lethargy
Delirium

Question 13

Signs in pneumonia?

Answer 13

Derangement in basic obs. could indicate sepsis
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever

Question 14

Characteristic chest signs in pneumonia?

Answer 14

Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

Question 15

Bacterial causes of pneumonia?

Answer 15

Strep. pneumoniae (most common)
Group A strep
Group B strep (pre vac)
Staph aureus
Haemophilus influenzae
Mycoplasma pneumonia

Question 16

Investigations in pneumonia?

Answer 16

Sputum cultures and throat swabs
Blood cultures if sepsis suspected
Blood gas

Question 17

Management of pneumonia?

Answer 17

Nothing if symptoms are mild

1st: oral amoxicillin
2nd: oral macrolide
3rd: IV if vomiting

Question 18

Causes of croup?

Answer 18

Parainfluenza virus (classic)
Adenovirus
RSV

Question 19

Croup typically affects ages?

Answer 19

6 months - 2 years

Question 20

Treatment for croup

Answer 20

Oral dexamethasone

Question 21

Presentation of croup?

Answer 21

Generally well
Barking cough
Stridor
Hoarse voice
Low grade fever

Question 22

Epiglottitis symptoms?

Answer 22

Sore throat and stridor
Drooling
Tripod position

Question 23

Investigations in epiglottitis?

Answer 23

Lateral x-ray of neck shows thumbprint sign (also to rule out foreign body)

Question 24

Treatment of epiglottitis?

Answer 24

Intubation if needed
IV ceftriaxone
Steroids (dexamethasone)

Question 25

When should you trial inhaled corticosteroids?

Answer 25

If quality of life affected by symptoms (no wheeze, no asthma)

Question 26

Asthma diagnosis?

Answer 26

Wheeze Variability Responds to treatment

Question 27

Presentation suggesting asthma?

Answer 27

``` Wheeze and dry cough SOB Diurnal variability Typical triggers Family history of atopy Other atopic conditions ```

Question 28

Presentation suggesting something other than asthma?

Answer 28

Wheeze only related to coughs and colds Isolated or productive cough Normal investigations Unilateral wheeze

Question 29

Typical asthma triggers?

Answer 29

``` Dust (HDM) Animals Cold Exercise Smoke Food allergens ```

Question 30

Asthma treatment?

Answer 30

Inhaled corticosteroids for 2 months, then inhaler holiday for 2 months

Question 31

Step 2 (regular preventer) asthma treatment needed if?

Answer 31

Using SABA more than two days a week | Symptomatic three or more days a week or waking in the night

Question 32

Step 2?

Answer 32

Low dose inhaled corticosteroids (or LTRA in under 5s)

Question 33

Step 3?

Answer 33

Add long acting beta agonist or leukotriene receptor antagonist (Montelukast)