Respiratory Cases

Question 1

What is the threshold for a chronic cough?

Answer 1

Children: >4 weeks
Adults: >8 weeks

Question 2

Why don’t young children cough out mucous?

Answer 2

They swallow it

Question 3

What causes coughing after eating in children?

Answer 3

Airway fistula

Laryngeal dysfunction

Question 4

What types of cough go away during the sleep?

Answer 4

Psychogenic

Question 5

What pathology causes cough that is worse in the morning?

Answer 5

Bronchiectasis

Question 6

What does being born premie predispose you too?

Answer 6

Bronchopulmonary dysplasia

Asthma like illness later in childhood

Question 7

Where is the pathology in stridor?

Answer 7

Extra-thoracic aspect of the tract

Question 8

Where is the pathology in wheeze?

Answer 8

Intra-thoracic

Question 9

What is the highest risk family history factor for asthma?

Answer 9

Asthma in mother

Question 10

What classically causes chronic cough with fevers?

Answer 10

TB

Question 11

What age groups inhale foreign bodies?

Answer 11

Toddlers

Or younger if has siblings

Question 12

What does Harrison’s sulci reflect?

Answer 12

Chronic increased work of breathing due to obstruction

Question 13

What is the most common cause of chronic wet cough?

Answer 13

Protracted bacterial bronchitis

Question 14

Which organisms cause protracted bacterial bronchitis?

Answer 14

Untypible haemophilus influenzae
Strep pneumonia
Moraxella catarrhalis

Question 15

What is the pathophysiology of PBB?

Answer 15

Viral illness causing damaged to mucociliary elevator

Biofilm formation

Question 16

How is PBB treated?

Answer 16

4-6 weeks of abx - augmentin, bactrim

Question 17

How long do URTI coughs take to resolve?

Answer 17

1-2 weeks

Question 18

How sensitive is CXR for detecting bronchiectasis?

Answer 18

Low in non-severe disease

Question 19

What are the CXR features of bronchiectasis?

Answer 19

Tram tracking
Ring shadows
Hyperinflation
Patchy atelectasis

Question 20

How do you investigate chronic lung disease?

Answer 20

Chest xray
FBE
Immunoglobulins 
Functional antibody response 
CF - sweat test

Question 21

How do you interpret the sweat test result?

Answer 21

Greater 60 mmol/L of chloride is diagnostic

Less than 40mmol/L is normal

Question 22

What is the definition of bronchiectasis?

Answer 22

Airway diameter greater than its accompanying artery

Radiological diagnosis

Question 23

What are the causes of bronchiectasis in children?

Answer 23

CF
Primary ciliary dyskinesia
Immunodeficiency
Previous severe pneumonia - focal 
Foreign body - focal 
TB

Question 24

What are the clinical features of primary ciliary dyskinesia?

Answer 24

• Sinusitis
  
  • Otitis media
  • Chronic suppurative lung disease
  • Rhinitis
  • Male infertility
  • Dextrocardia

Question 25

What is primary ciliary dyskinesia?

Answer 25

- Is a rare, ciliopathic, autosomal recessive genetic disorder that causes defects in the action of cilia lining the respiratory tract (lower and upper, sinuses, Eustachian tube, middle ear) and fallopian tube, as well as in the flagella of sperm cells.

Question 26

How is PCD diagnosed?

Answer 26

``` Nasal NO Ciliary beat frequency Ciliary beat pattern Cilial ultrastructure Cell culture with regrowth of ciliary epithelium ```

Question 27

How is PCD treated?

Answer 27

``` Airway clearance Abx Routine vaccination Hearing aids Grommets Functional endoscopic sinus surgery ```