Respiratory disease

Question 1

What are the causes of glandular fever/infectious mononucleosis?

Answer 1

1) EBV (90% of cases)

2) CMV

Question 2

What is the HxPC in glandular fever?

Answer 2

1) Exudative pharyngitis
2) Generalised, tender, lymphadenopathy
3) Lethargy
4) Widespread erythematous macular rash
5) Hepatosplenomegaly

Question 3

What is the classic triad for Dx of glandular fever?

Answer 3

1) Lymphocytosis
2) >/=10% atypical lymphocytes on peripheral blood film
3) +ve serology for EBV

Question 4

What investigation may be used to Dx glandular fever?

Answer 4

The monospot test

Question 5

What are the GI complications of glandular fever?

Answer 5

1) hepatitis; 2) splenomegaly; 3) spleen rupture

Question 6

What are the CNS complications of glandular fever?

Answer 6

1) aseptic meningitis; 2) encephalitis; 3) GBS

Question 7

What are the other complications of glandular fever?

Answer 7

POST-VIRAL TENDERNESS; lymphoma; orchitis; myocarditis; pneumonia

Question 8

What is the causative organism in croup?

Answer 8

Parainfluenza viruses

Question 9

How is croup managed?

Answer 9

Admit (for moderate/severe) + single dose oral dexamethasone

Question 10

How is croup managed as an emergency?

Answer 10

High flow oxygen + nebulised adrenaline

Question 11

What is the HxPC of croup?

Answer 11

1. Stridor (laryngeal oedema + secretions)
2. Barking cough, worse at night
3. Pyrexia
4. Coryzal Sx

Question 12

What type of cough is seen in croup?

Answer 12

Barking cough, worse at night

Question 13

What is the dose of oral dexamethasone in croup?

Answer 13

0.15mg/kg

Question 14

What are the causes of stridor in children?

Answer 14

1. Croup
2. Laryngomalacia
3. Epiglossitis
4. Foreign body upper airway obstruction
5. Anaphylaxis
6. Measles
7. Diptheria
8. Severe LN swelling (as in mono)
9. Hypocalcaemia from decreased vit D
10. Retropharyngeal abscess

Question 15

What is the causative organism in whooping cough?

Answer 15

Bordetella pertussis

Question 16

How long might Sx last in whooping cough?

Answer 16

10-14 WEEKS

Question 17

What are the 3 phases of whooping cough?

Answer 17

1. CATARRHAL PHASE
2. PAROXYSMAL PHASE
3. CONVALESCENT PHASE

Question 18

What are the features of the catarrhal phase of whooping cough?

Answer 18

1 week of coryzal Sx

Question 19

What are the features of the paroxysmal phase of whooping cough?

Answer 19

Paroxysmal/spasmodic cough, followed by an inspiratory ‘whoop’
Lasts 3-6 weeks

Question 20

How is whooping cough Dx?

Answer 20

Blood film - marked lymphocytosis (>15x10^9)
Nasal swab, culture or PCR (PCR more sensitive)
CXR = patchy atelectasis (as with bronchiolitis)

Question 21

What are the complications of whooping cough?

Answer 21

1. Subconjunctival haemorrhage (from coughing)
2. Seizures (from anoxia from coughing)
3. Pneumonia
4. Bronchiectasis

Question 22

How is whooping cough managed?

Answer 22

Oral macrolide, e.g. erythromycin, but only decreases Sx if started in the catarrhal phase
Close contacts should receive erythromycin prophylaxis + unvaccinated children should be vaccinated

Question 23

How long should children stay off school with whooping cough?

Answer 23

May return to school 5 days after commencing antibiotics

Question 24

What are the causative organisms of bronchiolitis?

Answer 24

1. RSV
2. Mycoplasma
3. Adenovirus
4. May be secondary to bacterial infection

Question 25

What is the organism that most commonly causes bronchiolitis?

Answer 25

RSV - in 75-80%

Question 26

Who are at increased risk of developing bronchiolitis?

Answer 26

1. Premature infants 2. Infants with heart/lung abnormalities 3. Immunocompromised

Question 27

What may be given when a child is at increased risk of severe disease to prevent them getting bronchiolitis?

Answer 27

Palvizumab - a monoclonal Ab

Question 28

What are the CXR findings in bronchiolitis?

Answer 28

Hyperinflation + 'patchy' atelectasis + gas trapping

Question 29

How should bronchiolitis be investigated?

Answer 29

``` Temperature O2 sats RR HR Cap refill/hydration status Bloods (CXR) ```

Question 30

How should bronchiolitis be managed?

Answer 30

Humidified O2 if sats <92% Supported feeding/NG feeding necessary Suction for upper airway secretions

Question 31

What are the causative organisms of pneumonia in newborns?

Answer 31

1. Group B strep | 2. Gram -ve enterococci

Question 32

What are the causative organisms of pneumonia in children <5y/o?

Answer 32

``` 1. Viruses most common in <5y/o, usually, RSV Other causes = 2. Strep pneumoniae 3. H. influenzae 4. Bordetella pertussis 5. Chlamydia trachomatis 6. S. aureus ```

Question 33

What are the causative organisms of pneumonia in children >5y/o?

Answer 33

Bacterial most common: 1. Mycoplasma pneumoniae 2. Strep pneumoniae 3. Chlamydia pneumoniae

Question 34

What is the cause of epiglottitis?

Answer 34

Hib

Question 35

What features should lead you to suspect epiglottis?

Answer 35

1. Pyrexia, toxic-looking child 2. Child is drooling (because it is painful for them to swallow) 3. Inspiratory stridor 3. Tripod position (to optimise the airway)